INTERMEDIATE MED SURG FINAL (100 QUESTIONS)
1. Kidney assessment, costovertebral angle
a. Costovertebral angle: landmark for locating kidneys. Formed by the rib cage and vertebral column
b. Left kidney rarely palpable, right kidney lower pole is palpable
c. Percussion: Tenderness and pain in the flank area (CVA) may indicate kidney infection or polycystic kidney
disease
d. Auscultation : Bell is used to auscultate over CVA and upper abdominal quadrants. Auscultate the
abdominal aorta and renal arteries for a bruit. If present, it may indicate impaired blood flow to the kidney
2. Multiple sclerosis interventions
a.
b. Other therapies:
i. Spasticity: dorsal-column electrical stimulation, neurectomy, rhizotomy
ii. Tremors: thalamotomy or deep brain stimulation
iii. Neurologic dysfunction: physical and speech therapies
iv. Exercise decreases spasticity, increases coordination, and retrains unaffected muscles to substitute
for impaired ones
, v. Water exercise is important, patient is able to have more control over the body
c. During an acute exacerbation patient may be immobile and on bedrest
i. Interventions include respiratory and urinary tract infection prevention
ii. Pressure ulcer prevention
d. Tell pt. to avoid fatigue, extremes of heat and cold, and exposure to infection
e. Encourage early and vigorous treatment of infection
f. Teach pt. to achieve good balance of exercise and rest
g. Minimize caffeine, and eat nutritious meals (high in fiber may help with constipation)
h. Bladder control is a major problem: Anticholinergics may help with spasticity, may need to teach patient
self-catheterization
Some Goals
Maintain or improve muscle strength and mobility
Use assistive devices for ambulation
Maintain urinary continence
3. Addison’s disease, assessment
Addisons: hypofunction of adrenal cortex. Glucocorticoids, mineralocorticoids and androgens are reduced.
Manifestations
Weakness anf fatigue
Weight loss
Anorexia
Increased ACTH causes bronze-colored skin hyperpigmentation (at pressure points such as joints and palmar
creases)
Orthostatic hypotension
Salt craving
Nausea and vomiting
Diarrhea
-Serum cortisol levels; decreased in adrenal unsufficiency
-Blood glucose levels; decreased
-serum sodium levels; decreased
-Serum potassium levels; increased
-BUN levels; increased
Assessment
Health History
Weight loss
Skin color changes
Nausea and vomiting
Anorexia
Abdominal pain
Weakness
Amenorrhea
Confusion
Intolerance of stress
Physical Assessment
Height and weight
Monitor vital signs (hypotension may occur due to crisis)
Skin color
Hair quality
Muscle size and strength
,4. ESRD, manifestations and specific assessments, GFR 15 or less
a. Retained substances such as urea, creatinine, phenols, hormones, electrolytes, and water
b. Uremia -> symptoms may develop in other body systems -> usually occurs with GFR <10 mL/min
c. Problems with fluid elimination and require diuretic therapy
d. As GFR decreases, the BUN and creatinine levels increase
i. Elevations in BUN causes nausea, vomiting, lethargy, fatigue, and headaches
e. Altered lipid metabolism leading to dyslipidemia
f. Early: Nausea apathy, weakness, fatigue
g. Vomiting, weakness, confusion, restless leg syndrome, paresthesia, sensory loss, irritability, kussmaul
pattern, skin becomes pale and dry with yellowish hue
h.
History Assessment
Polycystic kidney disease
Diabetes
Hypertension
Systemic lupus erythematosus
Severe infections
Assess current use of drugs:
o Decongestants and antihistamines cause vasoconstriction and increase BP
o Antacids: high levels of salt can cause hypertension
o NSAIDS
o Analgesics
o Antibiotics
-Assess dietary habits
-Measure height and weight, evaluate any recent weight changes
- Assess support systems
, Physical
Daily weight (fluid volume status indicator)
Intake and output
Assess for edema, dysrhythmias, tingling, muscle tetany
Assess for s/s of infection
Monitor vital signs (BP AND HR)
Cardio: dysrhythmias, hypertension
Resp: SOB, kussmaul breathing leads to increased CO2 levels
GI: n/v, anorexia, odor in breath
Neurologic: Seizures may occur due to increasing BUN and hypertension, restless leg syndrome
Musculo: thin fragile bones
Skin: skin changes (yellow, bluish color), dry itchy skin
Reproductive: decreased libido
5. Chemotherapy: therapeutic communications regarding taking meds, teaching
o Remind anxiety is common due to dependency, ability to pay, side effects, and poor outcomes
o Remind for repetitive office visits and lab testing
o Tell patietns they will be followed and support is ongoing
o Provide info and support that can help minimize negative impact
o Patient teaching, symptom management, and interventiosn to help patients self-manage (adjusting treatment
schedules to permit patients to work, making referrals to support groups)
o Arrange patients to meet with those who completed therapy
o Regular supportive telephone contacts between office visits and assist with planning for transportation,
nutrition, and emotional support available with Cancer society and Cancer lifeline
Neutropenia
o Avoid crowds
o Take temp daily
o Avoid fresh fruits and veggies, undercooked meat, fish , and eggs
o Avod yard work
o Avoid fluids at room temp for longer than 1 hour
o Wash everything in hot water
o Wash toothbrush daily
o Don’t share toiletry
Alopecia
o Suggest use of a wig
o Protect scalp using creams and head coverings
Thrombocytopenia
o Use electric razor and soft toothbrush
o Don’t blow nose vigorously
o No NSAIDs
6. CHF, in regards to digoxin toxicity
Digoxin (Lanoxin): Increases force of cardiac contraction, decreases Hr, and allows complete emptying of ventricles,
reducing volume in ventricles during diastole
Use in CHF: increases CO, reduces HR, decreases O2 demand, increases renal blood flow (reduces sodium
reabsorption allowing excretion of edema fluid
1. Kidney assessment, costovertebral angle
a. Costovertebral angle: landmark for locating kidneys. Formed by the rib cage and vertebral column
b. Left kidney rarely palpable, right kidney lower pole is palpable
c. Percussion: Tenderness and pain in the flank area (CVA) may indicate kidney infection or polycystic kidney
disease
d. Auscultation : Bell is used to auscultate over CVA and upper abdominal quadrants. Auscultate the
abdominal aorta and renal arteries for a bruit. If present, it may indicate impaired blood flow to the kidney
2. Multiple sclerosis interventions
a.
b. Other therapies:
i. Spasticity: dorsal-column electrical stimulation, neurectomy, rhizotomy
ii. Tremors: thalamotomy or deep brain stimulation
iii. Neurologic dysfunction: physical and speech therapies
iv. Exercise decreases spasticity, increases coordination, and retrains unaffected muscles to substitute
for impaired ones
, v. Water exercise is important, patient is able to have more control over the body
c. During an acute exacerbation patient may be immobile and on bedrest
i. Interventions include respiratory and urinary tract infection prevention
ii. Pressure ulcer prevention
d. Tell pt. to avoid fatigue, extremes of heat and cold, and exposure to infection
e. Encourage early and vigorous treatment of infection
f. Teach pt. to achieve good balance of exercise and rest
g. Minimize caffeine, and eat nutritious meals (high in fiber may help with constipation)
h. Bladder control is a major problem: Anticholinergics may help with spasticity, may need to teach patient
self-catheterization
Some Goals
Maintain or improve muscle strength and mobility
Use assistive devices for ambulation
Maintain urinary continence
3. Addison’s disease, assessment
Addisons: hypofunction of adrenal cortex. Glucocorticoids, mineralocorticoids and androgens are reduced.
Manifestations
Weakness anf fatigue
Weight loss
Anorexia
Increased ACTH causes bronze-colored skin hyperpigmentation (at pressure points such as joints and palmar
creases)
Orthostatic hypotension
Salt craving
Nausea and vomiting
Diarrhea
-Serum cortisol levels; decreased in adrenal unsufficiency
-Blood glucose levels; decreased
-serum sodium levels; decreased
-Serum potassium levels; increased
-BUN levels; increased
Assessment
Health History
Weight loss
Skin color changes
Nausea and vomiting
Anorexia
Abdominal pain
Weakness
Amenorrhea
Confusion
Intolerance of stress
Physical Assessment
Height and weight
Monitor vital signs (hypotension may occur due to crisis)
Skin color
Hair quality
Muscle size and strength
,4. ESRD, manifestations and specific assessments, GFR 15 or less
a. Retained substances such as urea, creatinine, phenols, hormones, electrolytes, and water
b. Uremia -> symptoms may develop in other body systems -> usually occurs with GFR <10 mL/min
c. Problems with fluid elimination and require diuretic therapy
d. As GFR decreases, the BUN and creatinine levels increase
i. Elevations in BUN causes nausea, vomiting, lethargy, fatigue, and headaches
e. Altered lipid metabolism leading to dyslipidemia
f. Early: Nausea apathy, weakness, fatigue
g. Vomiting, weakness, confusion, restless leg syndrome, paresthesia, sensory loss, irritability, kussmaul
pattern, skin becomes pale and dry with yellowish hue
h.
History Assessment
Polycystic kidney disease
Diabetes
Hypertension
Systemic lupus erythematosus
Severe infections
Assess current use of drugs:
o Decongestants and antihistamines cause vasoconstriction and increase BP
o Antacids: high levels of salt can cause hypertension
o NSAIDS
o Analgesics
o Antibiotics
-Assess dietary habits
-Measure height and weight, evaluate any recent weight changes
- Assess support systems
, Physical
Daily weight (fluid volume status indicator)
Intake and output
Assess for edema, dysrhythmias, tingling, muscle tetany
Assess for s/s of infection
Monitor vital signs (BP AND HR)
Cardio: dysrhythmias, hypertension
Resp: SOB, kussmaul breathing leads to increased CO2 levels
GI: n/v, anorexia, odor in breath
Neurologic: Seizures may occur due to increasing BUN and hypertension, restless leg syndrome
Musculo: thin fragile bones
Skin: skin changes (yellow, bluish color), dry itchy skin
Reproductive: decreased libido
5. Chemotherapy: therapeutic communications regarding taking meds, teaching
o Remind anxiety is common due to dependency, ability to pay, side effects, and poor outcomes
o Remind for repetitive office visits and lab testing
o Tell patietns they will be followed and support is ongoing
o Provide info and support that can help minimize negative impact
o Patient teaching, symptom management, and interventiosn to help patients self-manage (adjusting treatment
schedules to permit patients to work, making referrals to support groups)
o Arrange patients to meet with those who completed therapy
o Regular supportive telephone contacts between office visits and assist with planning for transportation,
nutrition, and emotional support available with Cancer society and Cancer lifeline
Neutropenia
o Avoid crowds
o Take temp daily
o Avoid fresh fruits and veggies, undercooked meat, fish , and eggs
o Avod yard work
o Avoid fluids at room temp for longer than 1 hour
o Wash everything in hot water
o Wash toothbrush daily
o Don’t share toiletry
Alopecia
o Suggest use of a wig
o Protect scalp using creams and head coverings
Thrombocytopenia
o Use electric razor and soft toothbrush
o Don’t blow nose vigorously
o No NSAIDs
6. CHF, in regards to digoxin toxicity
Digoxin (Lanoxin): Increases force of cardiac contraction, decreases Hr, and allows complete emptying of ventricles,
reducing volume in ventricles during diastole
Use in CHF: increases CO, reduces HR, decreases O2 demand, increases renal blood flow (reduces sodium
reabsorption allowing excretion of edema fluid
