FINAL REVIEW: MEDSURG 2

Medsur
2
na
Review
Cardio
-
Nitroglycerin
-
angina
pectoris
-
Place
a
new
patch
each
morning
-
Remove
the
patch
for
10-12
hours
daily
-
Apply
the
patch
to
a
hairless
area
Risk
for
DVT
-
Encourage
fluid
intake
-
Dehydrated
-
slow
blood
flow,
high
risk
for
stagnant
and
clot
formation
and
build
up
for
clot
-
Elastic
compression
stocking
-
Frequent
leg
exercise
-
Measure
thigh
bc
of
unilateral
DVT,
one
leg
is
ok
and
the
other
is
swollen
Prevention
of
DVT:
-
Immobility
-
Dehydration
-
Oral
contraceptives
Cardiac
Catherization:
-
Check
pedal
pulses
every
15
mins
-
Have
the
client
remain
in
bed
up
to
6hr
-
Check
peripheral
pulses
in
the
affected
extremity
-
Keep
the
client’s
hip
and
leg
extended
Digoxin:
HF,
hypertension,
MI
Digoxin
toxicity
●
Furosemide
causes
digoxin
toxicity
●
Monitor
digoxin
levels
when
giving
furosemide
○
Digoxin
level
0.08-2
●
Even
if
lab
value
is
normal
but
they're
seeing
having
vision
problems
●
Monitor
P
waves
on
EKG
●
s/s
of
digoxin
toxicity ○
Nausea
and
vomiting ○
Vision
changes ○
Monitor
P
wave ●
what
medical
condition?
Congestive
heart
failure
Digoxin
toxicity
-
Monitor
apical
heart
rate
for
1
minute -
Review
rhythm
strip
for
prolonged
P-R
intervals -
Heart
Rate -
Digoxin
level
COUMADINE
=
WARFARIN
:
blood
thinner
●
Interferes
with
coagulation
factors
by
antagonizing
phytonadione
(
vitamin
K
).
Treats and
prevents
blood
clots ○
Labs:
■
INR
:
2-3
seconds ■
PT
:
10-12
seconds ■
Withold
if
numbers
are
higher
Antidote
for
coumadin
/
warfarin
=
phytonadione
/
vitamin
K
●
Vitamin
K
decreases
the
newborn's
risk
of
hemorrhagic
disorders
HEART
FAILURE
Left-sided
HF:
-
Administer
supplemental
oxygen -
Elevate
HOB -
Monitor
weight -
Monitor
Urine
output -
Orthopnea -
Tachycardia -
Dyspnea -
Pink-frothy
sputum
Fluid
overload:
LUNGS
-
Low
urine
specific
gravity
<1.005
-
Bounding
pulse
-
Crackles
in
the
lungs
***
Always
look
at
the
lungs
first
with
fluid
overload
-
Edema
-
We
need
to
look
at
airway
first
-
Monitor
weight
daily
-
Low
sodium
Right-sided
HF:
-
JVD
-
Nocturnal
polyuria
-
Ascites
Hem
-
Iron-rich
foods:
****
for
iron
deficiency
anemia -
Cooked
oatmeal
-
Pernicious
anemia: -
Results
from
the
body's
inability
to
absorb
vitamin
B12
due
to
the
deficiency of
intrinsic
factor
produced
by
gastric
mucosa
which
is
necessary
for
the absorption
of
b12. -
Vitamin
b12
is
necessary
for
production
of
RBC -
Causes:
-
gastrectomy,
removal
of
stomach
part
of
the
intrinsic
factor
that
will be
removed
as
well -
Q:
What's
the
test
to
identify
pernicious
anemia? -
Schilling
test
:
24
hour
urine
sample -
CBC -
Q:
How
do
you
get
the
specimen
for
pernicious
anemia? -
In
urine
throughout
a
24
hour
period
Sickle
cell
anemia
-
Promote
hydration
with
IV
and
oral
fluids ●
Q:
What's
the
major
discomfort
if
it
is
in
crisis? ○
Episode
of
acute
“sickling”
of
RBC
clumping ○
Abdominal
and
long
bone,
joint
pain ○
Causes
stress
and
can
lead
to
multisystem
failure ●
Q:
How
do
you
prevent
the
crisis
of
sickle
cell
anemia? ○
Hydration ○
Oxygenation ○
Pain
relief ○
Sickle
cell
anemia
is
a
genetic
disorder ●
Meds:
iron
ferrous
sulfate ●
Cyanocobalamin
(vitamin
B12)
Aplastic
anemia
●
Rare,
bone
marrow
doesn’t
produce
RBC’s
for
the
body
to
function ○
Femur,
sternum,
and
ileum
crest -
Urinar
/
Rena
/
electrolyte
UTI:
anything
below
urinary
tract
-
How
do
u
know
someone
has
a
UTI?
-
Foul
urine
-
Cloudy
urine
-
WBC’s
in
urine
-
Electrolytes
-
Most
important:
potassium
-
Potassium
is
key.
-
Too
little
can
kill