Med Surg 1 HESI Final Exam Blueprint Answers Grade A 2023

Preop assess- checklist ● Consent is obtained- how do you know they understand. If they do not understand it is the surgeon’s job to go over surgery. ● Go over patient history ● Allergies and effects of any previous surgery medications. ● Testing, labs, medications and confirmed ● Go over expectation of pre and post-op Post op vital sign- drug use ● Any regional anesthesia will be weaning off, pain meds may be administered ● Frequent monitoring and safety ● Baseline vitals documented in order to assess if patient is declining after surgery. Post op priority ● Pain control ● Assessment of the surgical site and drainage tubes ● Monitoring the rate and patency of IV fluids and IV access ● Assessing the patient's level of sensation, circulation. ● Safety ● Signs of infection or decline in bassline vitals Post op vital signs- reason ● Ensure patient is not decline ● Monitor for post-op infection or complications ● Signs of bleeding or aspiration Pain scale- med selection ● Preventive approach, rather than an "as needed" (PRN) approach, is more effective in relieving pain ● Opioid analgesic agents are commonly prescribed for pain and immediate postoperative restlessness. ● PCA permits patients to administer their own pain medication when needed ● Epidural Infusions and Intrapleural Anesthesia: allows more effective coughing and deep breathing in conditions such as cholecystectomy, renal surgery, and rib fractures, in which pain in the thoracic region would interfere with these exercises ● Catheter is attached to a pump that delivers a continuous amount of local anesthetic at a specific amount determined and prescribed by the primary provider Malignant hyperthermia- postop ● The patient is still at risk in the postoperative period ● Severe muscle rigidity or spasms. Rapid, shallow breathing and problems with low oxygen and high carbon dioxide Pain outcomes- POC ● The nurse assesses the patient's pain level using a verbal or visual analog scale and assesses the characteristics of the pain. ● The goal is pain prevention rather than sporadic pain control. ● Patients recover more quickly when adequate pain relief measures are used ● PCA permits patients to administer their own pain medication when needed. 1 Shock- hypovolemic ● Monitor fluid and electrolyte imbalance ● Patient is NPO after surgery which will decrease fluid volume Pneumonia- CAP ● In older people that live in close quarters. ● Prevention is through vaccination 23. ● Occurs in patients who have not been hospitalized or resided in a long-term care facility within 14 days of the onset of symptoms. ● Can be treated at home or in hospital Pneumonia- airway ● Pneumonia arises from normal flora present in patients whose resistance has been altered or from aspiration of flora present in the oropharynx ● Atelectasis - alveoli unable to expand due to fluid COPD- oxygen level ● Patient will have a low level for baseline 88% ● Pulse oximetry values to assess the patient's need for oxygen and administers supplemental oxygen as prescribed HF & COPD ● Pulmonary vascular changes result in pulmonary and HTN ● Over time, pulmonary hypertension may occur as a result of chronic hypoxemia COPD & infections - 1st sign ● Infection may be accompanied by subtle changes ● Report any signs of infection!!!! ● Fever ● Change in sputum color, character, consistency, or amount. ● Any worsening of symptoms (increased tightness of the chest, increased dyspnea, fatigue) Crohn's disease ● Chronic inflammation of the GI tract wall that extends through all layers ● Bowel wall thickens and becomes fibrotic, and the intestinal lumen narrows (cobblestone) ● Diarrhea ● Crampy abdominal pain (especially after meals) ● Malnourishment ● Secondary anemia Crohn's disease- menu ● Avoid consumption of nuts, corn, chocolate, diary, nuts, seeds, spicy foods, onions, and citrus fruits Bariatric Surgery- Post op checklist ● Watch for dumping syndrome and vitamin/mineral imbalances ● Ulcers can be possible ● Bleeding ● Nutritional education and portion size 2 ● Medical management, including the use of dietary supplements ● Follow-up appointments Constipation- action ● Defined as less than 3 bowel movements per week ● High fiber/residue diet ● Establishing healthy bowel habits ● Digital dislodgement and enema administration ● Avoiding holding in stool when urge is present ● May consider bulk-forming OTC's ● Fissures likely require stool softener like Docusate Bowel obstruction- action ● Decompression of the bowel through an NG tube is necessary for all patients with small bowel obstruction. ● Bowel is completely obstructed then Appendicitis- pre-op preparation ● To correct or prevent fluid and electrolyte imbalance, dehydration, and sepsis, antibiotics and IV fluids are given until surgery ● Analgesic agents for pain ● NPO ● If pain stops entirely then emergency situation Septic shock- peritonitis ● Fever (100-101) ● increased pulse rate ● With progression patients may become hypotensive ● Hardening of the abdomen ● Absent bowel sounds ● Caused by leakage of contents from abdominal organs into the abdominal cavity Diverticulosis- S&S ● Diverticulum becomes inflamed, causing perforation and potential complications, such as obstruction, abscess, fistula (abnormal tract) formation, peritonitis, and hemorrhage ● Diverticula form when the mucosal and submucosal layers of the colon herniate through the muscular wall ● Bowel irregularity with intervals of alternating constipation and diarrhea, with nausea, anorexia, and bloating or abdominal distention Colitis ● Typically starts in the rectum and moves inward ● Bloody diarrhea ● Mucus or pus may also be present in stool ● Left lower quadrant abdominal pain HTN- blurred vision ● Hemorrhages, exudates (fluid accumulation), arteriolar narrowing, and cotton-wool spots (small 3 infarctions) occur. ● Examined and laboratory studies are performed to assess possible target organ damage ● Retinopathy