Medical Surgical Questions With Answers.

Medical Surgical Questions With Answers. MAP: 65 for adequate blood flow to major organs (MAP= 2x diastolic + Systolic/3) Preload: Amount of blood into heart at end of diastole Afterload: Resistance met when blood pushes out of left ventricle SA Node: located in right atrium, natural pacemaker of the heart (60-100bpm) AV Node: delay impulse to allow atrial contraction and ventricle filling, then conducts impulse to the ventricles (40-60bpm) Purkinje Fibers: ventricular pacemaker (20-40bpm) Labs: PT (9-12) INR (0.9-1.2) PTT (55-75) ABG (pH: 7.35-7.45, CO₂: 45-35, HCO₃: 22-26) CBC (blood) BMP (electrolytes) Diagnostic Tests: CXR, EKG, Stress test, Echo, TEE, MRI Heart Cath: Pre- consent, prep area, NPO 6hrs, mark pulses, BUN/Cr, Fluids and mucomyst to facilitate excretion/protection; Hold GLUCOPHAGE 24-48 hrs pre/post; ALLERGY: shellfish/dye Post- BEDREST, vitals, monitor site/pulse, ↑fluids (↓dye), Pain, Hematoma, ↓Vitals, color, arrhythmia, Retroperitoneal Bleed Nursing- no lifting 5lbs., remove dressing in shower, don’t resume normal activities until Dr. release, medication education Hemodynamic Monitoring: Measures vascular capacity, blood volume, pump effectiveness, tissue perfusion Risks: thrombosis, hematoma, bleeding, pneumothorax, dysrhythmias, pericardial tamponade A-Lines: into artery, DO NOT PUSH MEDS, monitor BP and ABG Central Lines: give meds, draw blood, monitor CVP (Dry 2 ←→6 Wet) CABG Unstable angina, AMI, failure of percutaneous interventions Pre- CBC, CXR, Coags, UA, coronary angiogram, blood type, teaching Post- ↓CO (bleeding, fluid loss, meds, ↓temp, surgery, dysrhythmias, ↑afterload) *chest tube drainage: 70mL = report *cardiac tamponade: muffled heart sounds, ↑HR, ↓BP, ↓urine, ↓chest tube output, ↓peripheral pulses, tx- pericardiocentesis, cause Heart Failure Causes: HTN, CAD, substance abuse, valvular disease, DM, smoking, lung disease, MI Dx: ↑BNP (untreated) Tx: diuretics, ACE, ARB, nitrates, Beta blockers, inotropic agents, diet, fluid management, weight Complications: pulmonary edema (dyspnea, cyanosis, gurgles, pink/frothy sputum, ↓O₂), shock Nursing: weight, diet, meds, activity, risks *Digoxin Toxicity: anorexia, fatigue, blurred vision, mental status change Myocardial Infarction Blood supply to the heart is reduced or stopped; “TIME IS MUSCLE” LAB values Hgb Women: 12-16% Men: 13.5-18% Hct Women: 38-47% Men: 40-54% RBC (million) Women: 4-5 Men: 4.5-6 WBC Plt 150,000-400,000 PT 10-15 sec INR 1-1.2 sec Intervention within 4-6hr of symptom onset Sx: angina (pressure, squeezing, fullness, pain, radiating), N/V, SOA, cold sweat, lightheaded Dx: EKG, Cardiac enzymes Tx: Morphine, Oxygen, Nitro, Aspirin *TPA: clot buster, within 6hr of onset, certain requirements *CATH LAB for stent placement Nursing: no lifting, drinking, stairs, resume activities slowly, Plavix/aspirin, SX of bleeding Aneurysm Aortic Aneurysm: dilation or thinning of wall, flank/abd/back pain, bruit, surgery (7cm) AAA- loss of pulses; TAA- SOA, hoarseness, difficulty swallowing Aortic Dissection: tear of layer of vessel, sudden/sharp/shifting pain, surgery ABGs Metabolic Acidosis: ↓pH, diarrhea, dehydration, DKA, ↓BP, ↑K, kussmaul respirations Causes: renal failure, DKA, diarrhea Tx: NaHCO₃ (give bicarb), tx underlying cause Metabolic Alkalosis: ↑pH, vomiting, GI suction, diuretics, confusion, ↓K, ↓RR, ↑HR Causes: vomiting, NG suction, ↓K, antacid abuse Tx: K replacement, PPI, antiemetics (retain acids) Respiratory Acidosis: anesthesia, overdose, COPD, pneumonia, ↓BP, ↑K, ↓RR, ↓LOC Causes: CNS depression, OD, pneumothorax, RI, HF, PE, airway obstruction, emphysema Tx: ↑ventilation and underlying cause Respiratory Alkalosis: hyperventilation, mechanical ventilation, ↑HR, ↓BP, ↓K, ↓LOC Causes: vomiting, NG suction, ↓K, antacid abuse Tx: K replacement, PPI, antiemetics (retain acids) Pulmonary (19) Respiratory Failure: Patient Hx: smoking, drug use, allergies, travel, area of residence, nutrition status, cough, sputum, chest pain, dyspnea, orthopnea, PND (waking up with SOA) Sx of respiratory failure: clubbing, wt loss, uneven muscles, skin/mucous membrane changes, general appearance, endurance, sleep in chair Sx of hypoxemia: (1st) neuro Dx: ABG, CBC (↓Hgb=↓O₂), BMP, sputum, CXR (PA- front view, LA- side view), CT, ventilation and perfusion scan, pulse ox Pulmonary Function TestingNoninvasive: evaluate lung volume/capacity, flow rates, diffusion capacity, gas exchange, airway resistance, distribution of ventilation [exercise testing, skin testing, done pre-surgery to assess for vent capability] Invasive: [Bronchoscopy] conscious sedation, numb throat, consent, monitor for gag reflex, breath sounds, complications- bleeding, infection, pneumothorax [Thoracentesis] aspiration of fluid/air from pleural space, hunched over table, IV access, do not allow pt to cough, observe for shock, post CXR, watch site, prone [Lung Biopsy] obtain tissue, assess breath sounds Q4 for 24 hr., report reduced/absent breath sounds immediately, monitor for hemoptysis Pulmonary Embolism: Prevention: TEDs, compression devices, position changes, Tx dysrhythmias, anticoagulant therapy, NO pillows under knees; no central lines or dialysis Sx: chest pain (worse on inspiration), sudden SOA, crackles, wheezes, ↑RR, ↑HR, cough, hemoptysis, ↓O₂, anxiety, sense of impending doom, ↑D-Dimer {Sx same as MI} Dx: clinical sx, ↑D-Dimer, CXR (nonspecific), V/Q scan (high probability of PE), CT scan w/contrast, pulmonary angiogram, EKG (rule out MI) Tx: O₂, thrombolytic, IV heparin (5days til PO therapy is effective), Lovenox, embolectomy, inferior vena cava filter/umbrella (heart cath) ARDS: Cause: aspiration, pneumonia, trauma, toxic inhalation, TB, sepsis, burns, overdose, CABG Sx: Hypoxemia w/ 100% O₂, pulmonary edema, SOA, ↑RR, respiratory alkalosis (can’t blow off CO₂, ↑Temp, ↑HR, white out CXR, produces systemic inflammatory response Tx: Intubation, sedation or paralytic (Norcuron), positioning, PEEP (lungs stay inflated to prevent alveoli collapse, ↓CO, ↓venous return, ↑intrathoracic pressure) Complications: Multiple-organ dysfunction syndrome, renal failure, disseminated intravascular coagulation, long-term pulmonary effects associated w/ ↑O₂ therapy Atelectasis: fluid in alveoli COPD: emphysema and chronic bronchitis Sx: chronic dyspnea, productive cough, hypoxemia, crackles, wheezes, rapid/shallow breathing, use of accessory muscles, barrel chest, irregular breathing, think extremities and enlarged neck muscle, dependent edema (right sided heart failure), clubbing fingers/toes, pallor/cyanosis of extremities, ↓O₂ sat Tx: High fowlers, coughing, suctioning, deep breathing, IS, O₂ (no more than 4L; ↓drive to breathe), nutrition, ↑ fluids to 2-3L/day; diaphragmatic breathing, pursed-lip breathing, incentive spirometer, bronchodilators, anti-inflammatory, mucolytics Lung Cancer: Sx: chronic cough, hemoptysis, SOA, wheezing, dull/aching chest pain, hoarseness, dysphagia, wt loss, anorexia, fatigue, weakness, bone pain, clubbing fingers/toes Tx: chemo, targeted radiation, surgery Lung Abscess: liquified necrosis, antibiotics, drainage, frequent mouth care Pulmonary Emphysema: pus in pleural space, empty empyema and re-expand lung, tx infection Pneumothorax: air in pleural space, ↑intrathoracic pressure Types: Spontaneous pneumo- rupture of pulmonary bleb Open pneumo- opening the chest wall Tension pneumo- blunt chest trauma (vent with PEEP) Tx: dressing over open chest wound, O₂, fowler’s position, chest tube placement, chest tube drainage monitor for subcutaneous emphysema, tension pneumo Pneumonia: inflammatory response to inhaled particles Sx: confusion, ↑RR Tx: supportive, antibiotics Asthma: pharmacological management and exercise