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final-review-advanced-medical-surgical-nursing-adv-med-surg
Chapter 11:
Delirium: disturbance in level of awareness and change in cognition. Develops rapidly, abruptly and over
a short period of time. S/S: shifting attention, extreme distractibility, disorganized thinking, speech that is
rambling, irrelevant, disorientation to time and place. Vital signs unstable. Is reversible if underlying
cause is treated.
- Autonomic symptoms, tachycardia, sweating, flushed face, dilated pupils and elevated BP
- Staff to remain with patient at all times to monitor behavior and reorientation. Room with low
stimulus level. Low dose antipsychotic agents to relieve agitation and aggression.
Benzodiazepines are commonly used when etiology is substance withdrawal.
Dementia: multiple cognitive deficits that impair memory and can affect language. Donepezil is used to
improve cognition in patients diagnosed with mild to moderate dementia associated with AD. Vital signs
stable. Memory loss is an example. Gradual onset and progressive and irreversible.
Alzheimer dementia: Primary NCD. Non-reversible dementia. Risk factors: exposure to metal waste, head
injury/trauma and history of herpes infection. Onset is slow and insidious, generally progressive and
deteriorating. Memory loss and changes in personality.
- Offer snacks and finger food, provide frequent walks to prevent wandering. Keep a structured
environment and introduce change gradually. Avoid overstimulation, noise and clutter to a
minimum. Single day calender, reorientation and maintain toileting schedule. Remove scatter
rugs. Install door locks at home, good lighting.
- 7 stages,
Stage 1: no symptoms
Stage 2: forgetfulness, no memory problems
Stage 3: mild cognitive deficits, mild memory loss, noticeable to family members.
Stage 4: personality changes, obvious memory loss (confabulation can occur)
Stage 5: assistance with ADL is necessary
Stage 6: incontinence and wander, safety risk
Stage 7: impaired swallowing, no ability to speak ataxia.
- Confabulation, during the fourth stage a patient can present this behavior, memory loss in which
the patient fills in memory gaps with information about events that have not occurred.
- Meds: Donepezil: prevent breakdown of acetocolyne: administer daily at bedtime.
memantine/rivastigmine and cholinesterase are used in AD. Observe for frequent stools and upset
stomach. Monitor for dizziness or headache and use caution with patients with asthma or COPD.
Chapter 14:
Stages of shock:
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final-review-advanced-medical-surgical-nursing-adv-med-surg
1st: Compensatory: increased HR. SNS causes vasoconstriction. Maintains BP, CO. Body shunts
blood from skin, kidneys, GI tract, resulting in cool, clammy skin, hypoactive bowel sounds,
decreased urine output. Tissue perfusion is inadequate. Metabolic acidosis/anaerobic metabolism
= LACTIC ACID (LIVER). RR decreased (respiratory alkalosis), confusion may occur.
REVERSIBLE. Normal serum lactate <4 mmol. Vasoconstriction = Kidneys activate Renin-
angiotensin system. (RAS)
2nd Progressive: BP can no longer compensate, BP and MAP decreased. Organs suffer from
hypoperfusion leading to decreased cellular/cerebral perfusion. Lungs being to fail, hypoxemia,
CO2 increases, alveoli collapses and pulmonary edema occurs. MAP falls below 70. Acute renal
failure can begin, DIC can occur as a cause or complication of shock.
3rd Irreversible/Refactory: Organ damage so severe that the patient does not respond to treatment,
cannot survive. BP remains low. Renal, liver function fail. Metabolic acidosis worsens. MOD
(multiple organ dysfunction syndrome)- judgement that shock is irreversible only made in
retrospect.
Management: Fluid replacement: crystalloid, colloid solutions (Lactated ringers and Normal
Saline). Vasoactive meds (norepinephrine, dopamine, phenylephrine, vasopressin) : used when
fluid therapy alone does not maintain BP. ) and nutritional support. Modified trendelenburg
position. Continuous monitoring of VS every 15 minutes.
Classifications of shock:
Hypovolemic: Decreased intravascular volume due to fluid loss. (Blood loss and dehydration)- 2
large bore IV’s for fluid/blood replacement. Intraosseous cannulation as last resort
Cardiogenic: Impairment or failure of myocardium. (MI, HF, hypoglycemia, PE, hypocalcemia,
dysrhythmias.) – Oxygen, REST, EKG continuous, hemodynamic monitoring, BNP, fluid
therapy/avoid overload. MEDS: dobutamine, nitroglycerin, digoxin, dopamine, vasoactive agents.
Circulatory/Distributive shock: decreased venous return, CO and tissue perfusion. (vasodilation)
Septic: Overwhelming infection causing relative hypovolemia. (GNR, GPC bacteremia.) S/S low
BP, tachycardia, hyperthermia, tachypnea.
Neurogenic: Loss of sympathetic tone causing relative hypovolemia. – Vasodilation- Causes:
spinal cord injury, spinal anesthesia, CNS depressants, hypoglycemia. S/S- dry, warm skin. Low
bp, bradycardia, hypotension. Airway, stabilize spinal cord, position properly, Atropine 0.5mg
IV for bradycardia. IV steroids, HOB 30 degrees, keep MAP greater than 70. (decrease LOC, CO,
UO)
Anaphylactic: severe allergic reaction producing overwhelming systemic vasodilation, relative
hypovolemia. IV Epi, benadryl, give epi IM. O2, bronchodilators. Mechanical ventilation.
Chapter 16: End of life
Palliative care – Psychosocial, comfort, spiritual care.
Hospice: Home or designated facility, death accepted, bereavement care for family for one year.
Accepted death. Will no live longer than 6 months.
Signs and symptoms of impending death: Refusal of foods, fluids. UO decreases. Weakness, sleep,
confusion, impaired vision, secretions in throat, incontinence, decreased temperature control.
- symptom management: Pain, no needles, Pain patches or oral meds. (Least invasive) dyspnea,
N/V, weakness, anxiety, delirium, depression.
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final-review-advanced-medical-surgical-nursing-adv-med-surg
Chapter 21: Respiratory care modalities:
- Chest tubes (indications for, removal of and complications) : Keep chamber upright and below
the chest tube insertion site at all times. Chest tubes are inserted into the pleural space to drain
fluid, blood or air and facilitate lung expansion. If the tubing seperates- instruct the client to
exhale as much as possible and to cough to remove as much air as possible. If compromised
immerse the end of the chest tube in sterile water to provide a temporary water seal. If chest tube
is accidently removed, dress the area with dry sterile gauze.
o Tracheostomy (indications for suctioning),
o
o Ventilator Associated Pneumonia
o Oxygen administration and pulse oximetry
Chapter 23: Chest and lower respiratory tract disorders
- Hypoxia: decrease in tissue oxygenation, Findings: tachypnea, tachycardia, pale skin, elevated
BP.
- Pulmonary edema- accumulation of fluid in the alveoli and interstitial spaces of the lung that can
result from severe heart failure. – Remain physically active but consult first. Consume low
sodium diet and some require fluid restrictions. No tobacco use.
S/S: Anxiety, persistent cough with pink frothy sputum, tachypnea, crackles, cyanosis
(late stage)
- Pulmonary embolism: life threatening blockage (DVT main cause)
Findings: anxiety (impending doom) hypotension, pleural friction rub, petechiae,
tachycardia, distended neck veins, diaphoresis.
Lab tests- d.dimer less than 0.4, If it is elevated, indicates presence of blood clot. ABG.
Meds: thrombolytic (break up clots) heparin, warfarin. (stop new clots from forming)
Place in high fowlers, administer oxygen. Compare BP in both arms. PACO2 levels are
low (Range, 35-45) Patient teaching- frequent blood draws to monitor bleeding. 2-3 INR
levels. Maintain consistent intake of vitamin K if on warfarin.
ARDS,o
acute respiratory failure,
o
- Pneumothorax: Presence of air or gas in the pleural space that causes collapse lung.
S/S: hyperresonance on percussion due to trapped air.
- Tension pneumothorax- Air enters the pleural space during inspiration and is not able to exit
upon expiration.
S/S: tracheal deviation to unaffected side. Pleuritic pain. Tachypnea, tachycardia,
hypoxia, cyanosis, use of accessory muscles.
- Hemothorax- Accumulation of blood in the pleural space.
S/S: Dull percussion.
- DX: Thoracentesis is used to confirm. (Surgical perforation of the chest wall and pleural pace
with a large bore needle.
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final-review-advanced-medical-surgical-nursing-adv-med-surg
Chapter 11:
Delirium: disturbance in level of awareness and change in cognition. Develops rapidly, abruptly and over
a short period of time. S/S: shifting attention, extreme distractibility, disorganized thinking, speech that is
rambling, irrelevant, disorientation to time and place. Vital signs unstable. Is reversible if underlying
cause is treated.
- Autonomic symptoms, tachycardia, sweating, flushed face, dilated pupils and elevated BP
- Staff to remain with patient at all times to monitor behavior and reorientation. Room with low
stimulus level. Low dose antipsychotic agents to relieve agitation and aggression.
Benzodiazepines are commonly used when etiology is substance withdrawal.
Dementia: multiple cognitive deficits that impair memory and can affect language. Donepezil is used to
improve cognition in patients diagnosed with mild to moderate dementia associated with AD. Vital signs
stable. Memory loss is an example. Gradual onset and progressive and irreversible.
Alzheimer dementia: Primary NCD. Non-reversible dementia. Risk factors: exposure to metal waste, head
injury/trauma and history of herpes infection. Onset is slow and insidious, generally progressive and
deteriorating. Memory loss and changes in personality.
- Offer snacks and finger food, provide frequent walks to prevent wandering. Keep a structured
environment and introduce change gradually. Avoid overstimulation, noise and clutter to a
minimum. Single day calender, reorientation and maintain toileting schedule. Remove scatter
rugs. Install door locks at home, good lighting.
- 7 stages,
Stage 1: no symptoms
Stage 2: forgetfulness, no memory problems
Stage 3: mild cognitive deficits, mild memory loss, noticeable to family members.
Stage 4: personality changes, obvious memory loss (confabulation can occur)
Stage 5: assistance with ADL is necessary
Stage 6: incontinence and wander, safety risk
Stage 7: impaired swallowing, no ability to speak ataxia.
- Confabulation, during the fourth stage a patient can present this behavior, memory loss in which
the patient fills in memory gaps with information about events that have not occurred.
- Meds: Donepezil: prevent breakdown of acetocolyne: administer daily at bedtime.
memantine/rivastigmine and cholinesterase are used in AD. Observe for frequent stools and upset
stomach. Monitor for dizziness or headache and use caution with patients with asthma or COPD.
Chapter 14:
Stages of shock:
Page 1 2026
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final-review-advanced-medical-surgical-nursing-adv-med-surg
1st: Compensatory: increased HR. SNS causes vasoconstriction. Maintains BP, CO. Body shunts
blood from skin, kidneys, GI tract, resulting in cool, clammy skin, hypoactive bowel sounds,
decreased urine output. Tissue perfusion is inadequate. Metabolic acidosis/anaerobic metabolism
= LACTIC ACID (LIVER). RR decreased (respiratory alkalosis), confusion may occur.
REVERSIBLE. Normal serum lactate <4 mmol. Vasoconstriction = Kidneys activate Renin-
angiotensin system. (RAS)
2nd Progressive: BP can no longer compensate, BP and MAP decreased. Organs suffer from
hypoperfusion leading to decreased cellular/cerebral perfusion. Lungs being to fail, hypoxemia,
CO2 increases, alveoli collapses and pulmonary edema occurs. MAP falls below 70. Acute renal
failure can begin, DIC can occur as a cause or complication of shock.
3rd Irreversible/Refactory: Organ damage so severe that the patient does not respond to treatment,
cannot survive. BP remains low. Renal, liver function fail. Metabolic acidosis worsens. MOD
(multiple organ dysfunction syndrome)- judgement that shock is irreversible only made in
retrospect.
Management: Fluid replacement: crystalloid, colloid solutions (Lactated ringers and Normal
Saline). Vasoactive meds (norepinephrine, dopamine, phenylephrine, vasopressin) : used when
fluid therapy alone does not maintain BP. ) and nutritional support. Modified trendelenburg
position. Continuous monitoring of VS every 15 minutes.
Classifications of shock:
Hypovolemic: Decreased intravascular volume due to fluid loss. (Blood loss and dehydration)- 2
large bore IV’s for fluid/blood replacement. Intraosseous cannulation as last resort
Cardiogenic: Impairment or failure of myocardium. (MI, HF, hypoglycemia, PE, hypocalcemia,
dysrhythmias.) – Oxygen, REST, EKG continuous, hemodynamic monitoring, BNP, fluid
therapy/avoid overload. MEDS: dobutamine, nitroglycerin, digoxin, dopamine, vasoactive agents.
Circulatory/Distributive shock: decreased venous return, CO and tissue perfusion. (vasodilation)
Septic: Overwhelming infection causing relative hypovolemia. (GNR, GPC bacteremia.) S/S low
BP, tachycardia, hyperthermia, tachypnea.
Neurogenic: Loss of sympathetic tone causing relative hypovolemia. – Vasodilation- Causes:
spinal cord injury, spinal anesthesia, CNS depressants, hypoglycemia. S/S- dry, warm skin. Low
bp, bradycardia, hypotension. Airway, stabilize spinal cord, position properly, Atropine 0.5mg
IV for bradycardia. IV steroids, HOB 30 degrees, keep MAP greater than 70. (decrease LOC, CO,
UO)
Anaphylactic: severe allergic reaction producing overwhelming systemic vasodilation, relative
hypovolemia. IV Epi, benadryl, give epi IM. O2, bronchodilators. Mechanical ventilation.
Chapter 16: End of life
Palliative care – Psychosocial, comfort, spiritual care.
Hospice: Home or designated facility, death accepted, bereavement care for family for one year.
Accepted death. Will no live longer than 6 months.
Signs and symptoms of impending death: Refusal of foods, fluids. UO decreases. Weakness, sleep,
confusion, impaired vision, secretions in throat, incontinence, decreased temperature control.
- symptom management: Pain, no needles, Pain patches or oral meds. (Least invasive) dyspnea,
N/V, weakness, anxiety, delirium, depression.
Page 2 2026
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https://www.stuvia.com/user/amelyn
final-review-advanced-medical-surgical-nursing-adv-med-surg
Chapter 21: Respiratory care modalities:
- Chest tubes (indications for, removal of and complications) : Keep chamber upright and below
the chest tube insertion site at all times. Chest tubes are inserted into the pleural space to drain
fluid, blood or air and facilitate lung expansion. If the tubing seperates- instruct the client to
exhale as much as possible and to cough to remove as much air as possible. If compromised
immerse the end of the chest tube in sterile water to provide a temporary water seal. If chest tube
is accidently removed, dress the area with dry sterile gauze.
o Tracheostomy (indications for suctioning),
o
o Ventilator Associated Pneumonia
o Oxygen administration and pulse oximetry
Chapter 23: Chest and lower respiratory tract disorders
- Hypoxia: decrease in tissue oxygenation, Findings: tachypnea, tachycardia, pale skin, elevated
BP.
- Pulmonary edema- accumulation of fluid in the alveoli and interstitial spaces of the lung that can
result from severe heart failure. – Remain physically active but consult first. Consume low
sodium diet and some require fluid restrictions. No tobacco use.
S/S: Anxiety, persistent cough with pink frothy sputum, tachypnea, crackles, cyanosis
(late stage)
- Pulmonary embolism: life threatening blockage (DVT main cause)
Findings: anxiety (impending doom) hypotension, pleural friction rub, petechiae,
tachycardia, distended neck veins, diaphoresis.
Lab tests- d.dimer less than 0.4, If it is elevated, indicates presence of blood clot. ABG.
Meds: thrombolytic (break up clots) heparin, warfarin. (stop new clots from forming)
Place in high fowlers, administer oxygen. Compare BP in both arms. PACO2 levels are
low (Range, 35-45) Patient teaching- frequent blood draws to monitor bleeding. 2-3 INR
levels. Maintain consistent intake of vitamin K if on warfarin.
ARDS,o
acute respiratory failure,
o
- Pneumothorax: Presence of air or gas in the pleural space that causes collapse lung.
S/S: hyperresonance on percussion due to trapped air.
- Tension pneumothorax- Air enters the pleural space during inspiration and is not able to exit
upon expiration.
S/S: tracheal deviation to unaffected side. Pleuritic pain. Tachypnea, tachycardia,
hypoxia, cyanosis, use of accessory muscles.
- Hemothorax- Accumulation of blood in the pleural space.
S/S: Dull percussion.
- DX: Thoracentesis is used to confirm. (Surgical perforation of the chest wall and pleural pace
with a large bore needle.
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