Med Surg 1 HESI Final Exam Blueprint Answers Grade A 2025

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. lOMoAR cPSD| 2 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 lOMoAR cPSD| 3 ● 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 lOMoAR cPSD| 4 infarctions) occur. ● Examined and laboratory studies are performed to assess possible target organ damage ● Retinopathy HTN- Diabetes- blurred vision ● Diabetic retinopathy ● Microvascular damage Antihypertensive- POC ● Hyperkalemia ● Nausea ● Constipation ● Palpitation ● Swollen feet or legs, cold hands or feet, cramps ● Persistent dry cough ● Skin rash ● Frequent urination ● Decreased sexual desires HTN meds- actions ● Reduce blood pressure. ● Angiotensin-Converting Enzyme Inhibitors ● Angiotensin II Receptor Blockers ● Calcium Channel Blockers ● Direct Renin Inhibitors ● Antiadrenergics ● Diuretics HCTZ- valsartan combo ● Valsartan (ARB) works by relaxing blood vessels so that blood can flow easier ● Hydrochlorothiazide is a water pill (diuretic) that causes patient to pee more which helps body get rid of extra salt and water. HF- fluid retention ● Right side failure ● Increased venous pressure leads to jugular venous distention JVD ● Increased capillary hydrostatic pressure throughout the venous system ● Edema of the lower extremities ● Hepatomegaly ● Ascites ● Weight gain due to retention of fluid. HF- fluid volume ● Pulmonary congestion when left ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic circulation ● Causing high blood pressure ● Fluid that accumulates in the dependent extremities during the day may be reabsorbed into the circulating blood volume when the patient lies down. lOMoAR cPSD| 5 Heart disease- diuretic ● Patients receiving potassium-sparing must be carefully monitored for hyperkalemia ● Using the smallest dose of diuretic necessary to control fluid volume ● Can also lead to orthostatic hypotension and kidney injury ● Loop diuretics, such as furosemide (Lasix) ● Loop, thiazide, and aldosterone blocking ● Aldosterone antagonists such as spironolactone (K sparing) Fe Supplement administration ● Oral iron that is poorly absorbed or poorly tolerated, or iron supplementation is needed in large amounts. alternative will be giving through IV administration several doses are required to replenish the patient's iron stores ● Can stain teeth Diverticulitis- WBC ● The inflammation of the weakened colonic wall of the diverticulum can cause it to perforate, giving rise to irritability and spasticity of the colon ● Acute onset of mild to severe pain in the left lower quadrant ● Abscess develops, the associated findings are tenderness, a palpable mass, fever, and leukocytosis ● Will need a CBC Pernicious anemia ● Deficiency of vitamin B12 absence of intrinsic factor ● Run in families ● Higher incidence of gastric cancer ● Develop a smooth, sore, red tongue and mild diarrhea ● Replacement is by monthly intramuscular injections of vitamin B12 done when defect in absorption or the absence of intrinsic factor Blood admin- negative response ● Febrile- Chills, Fever, Headache, flushing, Tachycardia ● Allergic-hives, pruritus, SOB, bronchospasm ● Hemolytic- low back pain, Hypotension, tachycardia, fever & chills, chest pain, quick onset, blood in urine ● High number of pregnancy, blood transfusions, incorrect blood typing SBAR- initiate process ● Confirm order and signed documents ● Confirm blood type match ● Take primary vitals ● Inform patient of signs of reaction ● Use proper needle and blood tubing ● Which for signs of fluid volume overload ● Monitor for the first 15 mins then every 30 mins after ● Notation of how patient handles transfusion Urine retention- incontinence-male lOMoAR cPSD| 6 ● Benign Prostatic Hyperplasia(BPH) ● obstruct the bladder neck or urethra, causing incomplete emptying of the bladder and urinary retention ● untreated obstruction can cause UTI ● S&S ○ Urinary frequency ○ Urgency ○ Nocturia ○ Hesitancy BPH- pathology ● Testicular androgens ● Dihydrotestosterone = metabolite of testosterone critical mediator of prostatic growth ● BPH generally occurs when men have elevated estrogen levels and when prostate tissue becomes more sensitive to estrogens and less responsive to DHT. TURP- discharge plan ● Catheter is removed usually when the urine appears clear ● Monitored for major complications such as hemorrhage, infection, VTE, catheter problems, and sexual dysfunction. ● Drink plenty of water to help flush fluids through the bladder Tamsulosin- BPH ● Relax the smooth muscle of the bladder neck and prostate. ● Improves urine flow and relieves symptoms of BPH ● Side effects ○ Dizziness ○ Headache ○ Asthenia/fatigue ○ Postural hypotension ○ Rhinitis ○ Sexual dysfunction Sildenafil- adverse effects ● Headache ● Facial flushing ● Dyspepsia ● Nasal congestion ● Dizziness ● Severe ○ Nonarteritic ischemic optic neuropathy (obstruction of blood flow to the optic nerve) ○ Sudden permanent hearing loss accompanied by dizziness and tinnitus ○ Priapism (prolonged erection of the penis) Stress Incontinence ● Involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position ● Women ○ Affects women who have had vaginal deliveries (decreasing ligament and pelvic floor support of lOMoAR cPSD| 7 the urethra and decreasing or absent estrogen levels within the urethral walls and bladder base) ● Men ○ After a radical prostatectomy for prostate cancer because of the loss of urethral compression that the prostate had supplied before the surgery, and possibly bladder wall irritability Urolithiasis (Kidney stones) ● Relieve pain ● Decrease swelling to allow stone to pass ● Eradicate the stone ● Determine the stone type ● Prevent nephron destruction ● Control infection ● Increase fluid ● Diet change ● Relieve any obstruction that may be present. Alzheimer's- ADL ● Goals ○ Physical safety ○ Promoting independence in self-care activities (instruct rather than do it for them) ○ Reducing anxiety and agitation ○ Improving communication ○ Providing for socialization and intimacy ○ Promoting adequate nutrition ○ Promoting balanced activity and res ○ Supporting and educating family caregivers Dementia- AD nighttime ● Nightlights are helpful, particularly if the patient has increased confusion ● Driving is prohibited ● Doors leading from the house must be secured ● Watch for increased risk for falls Donepezil Aricept- effects ● Centrally acting reversible cholinesterase inhibitor ● Increases acetylcholine in the brain by inhibiting its metabolism elevated acetylcholine levels in the cortex ● Lows the neuronal degradation that occurs in Alzheimer's disease. Rivastigmine Exelon- early Alzheimer's ● Enhance acetylcholine uptake in the brain, thus maintaining memory skills for a period of time ● Cognitive ability may improve within 6 to 12 months of therapy ● Indicated for severe AD; it is recommended that treatment continue as long as possible Parkinson's disease- freezing ● Transient inability to perform active movement and is thought to be an extreme form of bradykinesia Parkinson- ambulation lOMoAR cPSD| 8 ● Patient tends to shuffle and exhibits a decreased arm swing as well ● Loss of postural reflexes, the patient stands with the head bent forward and walks with a propulsive gait ● Shuffling gait ● Increased risk for falls Parkinson's ● Neuro-degenerative disease that is characterized by low dopamine levels in the brain ● More excitatory neurotransmitters than inhibitory neurotransmitters, leading to an imbalance that affects voluntary movement Parkinson's flat affect ● Hypomimia-affects the facial muscle movement given the patient a permanent unemotionless facial appearance ● loss of facial expression Parkinson's swallowing ● Drooling (accumulation of saliva) ● Poor head control ● Coughing ● risk for aspiration ● Swallowing difficulties due to muscle weakness ● dysphagia ● throat clearing during or after eating/drinking ● Feeling as food is stuck in the throat Seizure- home care ● Patient who has an aura may have time to seek a safe, private place ● Look at your watch at the start of the seizure, to time its length ● Don't put anything in their mouth ● Place them on their side, to help keep their airway clear Depakote D/C ● Do not stop the medication abruptly ● Consult doctor before you discontinue ● If you stop abruptly seizures will return Dilantin- pregnancy ● Risk of birth defects is a significant adverse effect ● Category D Gingival hyperplasia- dilantin ● An overgrowth of gum tissue, is also common, especially in children ● Can be associated with long-term use of phenytoin ● Periodic physical and dental examinations and laboratory tests are performed for patients Hypothyroid- labs ● Free T4 levels decreased ● High levels of TSH lOMoAR cPSD| 9 Hypothyroid- drug treatment ● Synthetic levothyroxine ● Dosage is based on the patient's serum TSH concentration Hypothyroid- weight loss ● Levothyroxine is not for treatment of obesity or for weight loss ● Adverse effects of levothyroxine is weight loss ● Myxedema, the nurse assesses for decreased edema and loss of weight Exophthalmos- patho ● Abnormal protrusion of one or both eyeballs ● Increase in orbital volume from the extraocular muscles and fat ● Graves = hyperthyroidism Thyroidectomy- postop ● Watch for bleeding, breathing, pain, oxygen, positioning ● watch for signs of hypothyroidism ● Thyroid carcinoma treatment is surgical removal Goiter- TSH ● Low levels of TSH trigger an increase in the pituitary gland this over production causing the thyroid to hypertrophy ● Do not palpate the goiter as it can further the production of thyroid ● Treatment of goiter with Potassium Iodide to protect the thyroid Thyroidectomy- hypocalcemia ● Major post-operative complication of total thyroidectomy ● Will need to take calcium supplements due to low levels of calcium Foot care ● Cardiac; peripheral vascular; foot complications ● Foot examination (lesions, signs of infection, pulses) Type I DM- teach ● Self-monitoring of blood glucose ● How to use monitoring equipment DM- Insulin Nausea, Vomiting ● Never eliminate insulin doses when nausea and vomiting occur ● Patient should take the usual insulin dose (or previously prescribed special sick day doses) and then attempt to consume frequent small portions of carbohydrates ● Blood glucose and urine ketones must be assessed every 3 to 4 hours ● Ketosis and acidosis of DKA lead to gastrointestinal DM- upper respiratory infection ● More likely to have lung conditions such as COPD and pulmonary fibrosis ● High risk for pneumonia and constant issues with congestion lOMoAR cPSD| 10 Insulin- meal time ● Rapid : 10 to 15 before meals ● Short: 3-60 mins before meals DM- safety ● Always double check insulin with the order given ● Monitor blood sugar before administration DM- illness ● Insulin temporarily during illness if was only taking oral medications ● Due to illness insulin may be required or dosage may even increase Rheumatoid arthritis- elevated RF ● Nodules occur only in people who have rheumatoid factor Rheumatoid arthritis ● Systemic, autoimmune inflammation ● Symmetric swelling in the small joints (hand, feet, wrist) ● NSAIDs ● Steroids ● DMARDs SLE- exacerbation ● Sun and ultraviolet light exposure can increase disease activity SLE- hematuria ● Lupus nephritis ● Kidney damage will have blood in urine Bariatric Surgery- Osteoporosis ● Increased risk for osteoporosis as the duodenum is bypassed, which is the primary site for absorption of calcium ● Malabsorption disorders Ulcerative Colitis ● chronic ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum that is characterized by unpredictable periods of remission and exacerbation with bouts of abdominal cramps and bloody or purulent diarrhea. The inflammatory changes typically begin in the rectum and progress proximally through the colon Crohn's Disease ● characterized by periods of remission and exacerbation. It is a subacute and chronic inflammation of the GI tract wall that extends through all layers (i.e., transmural lesion). Although its characteristic histopathologic changes can occur anywhere in the GI tract, it most commonly occurs in the distal ileum and the ascending colon. The onset of symptoms is usually insidious in Crohn's disease, with prominent right lower quadrant abdominal pain and diarrhea unrelieved by defecation