Med Surg 1 – Final Exam Study Guide & Key Concepts

Med surg 1 Final

1. Appendicitis and what will get you worried
 If pt is having pain and suddenly the pain goes away it is not good, it now
becomes medical emergency and surgery is required!!


2. Hemodialysis what are s/s Disequilibrium syndrome
Dialysis Disequilibrium Syndrome

 Fluid shift in brain
 Early: nausea, disorientation, restlessness
 Late: confusion



3. Aki? If they develop hyperkalemia what's the tx for it
 Sodium polystyrene sulfonate (Kayexalate)

4. Max dose of acetaminophen (APAP)
 4 g or 4,000mg

5. Ketorolac
 No with NSAIDS & Max 5 days usage (EX: if start on tues stop on Sunday)


6. Opioid toxicity tirade
 Pinpoint pupils, ALOC, Resp depression


7. s/s PAD, vs venous insufficency PVD and differences (both could have ulcers and sore
but where?) one feels warm or feels cold SATA for s/s
 PVD vs PAD SATA question

PAD - Peripheral Arterial Disease (HANG LEGS)

 Cold toes
 No pulses
 Hairless shiny skin
 Dependent rubor
 Sores on toes

PVD - Peripheral VENOUS Disease (ELEVATE LEGS)

,  Red/ brown color
 Pitting edema
 Ulcers on medial malleolus
 Chronic dermatitis
 Varicose veins



8. What is rovsing sign Kehr's sign
 rovsing's sign
o push/palpate on left lower quad ( makes right quad hurt)
 Kehr’s sign
Left should pain (ruptured spleen)



9. s/s hypothyroidism
 Lethargy, cold intolerance, late s/s- wt gain, subnormal temperature,
bradycardia


10. Know Levothyroxine
 A/e: s/s of hyperthyroidism
 Admin in morning before food
 Don't stop abruptly, Hold HR > 110

11. s/s hyperthyroidism
 Wt loss, finger clubbing, tremors, intolerance to heat, bulging eyes,
tachycardia, high systolic BP

12. Tx hyperthyroidism and safety considerations
 Medical therapy
o PO PIlls PTU and Methimazole (can cause agranulocytosis of pancytopenia)
o Radioactive Iodine therapy
 Sub total thyroidectomy- use lugols solution while waiting for sx
o Have trach tray and calcium
o Stridor is bad and could be swelling and tetany
o Support neck while coughing
o Lugol's can stain teeth and take after meals
 Equipment for Sub- thyroidectomy:
 O2 set up with humidification, Suction tubing, trach tray, IVP Ca

, 13. Iodine 131 therapy radioactive so know precaution in hospital or home
o Delayed response 2-3 months
o Remember time, Distance and Shielding


14. S/S of Hypocalcemia
 Chvostek's & Trousseaus, Circumoral tingling, fractures, bleeding, arrythmias


15. S/S SIADH (Too much ADH) (SATA)
 Pt wet but the bag is dry (30 ml/hr is normal urine output)
 S/S: H/A, weakness, anorexia, muscle cramps, wt gain without edema (Na is not
retained)
 Testing: urine( concentrated) and blood tests (Diluted)

16. S/S Diabetes insipidus (Low ADH) (SATA)
 Dry but foley is wet (urinate a lot)
 S/S: Polyuria, Sunken eyes, Tachycardia, OH, Tenting, Dry mucous membrane, Weak
thready pulse, Aloc/ SZ
 Testing: Urine testing (more dilute urine) & blood draw (concentrated)

17. CI of Vasopressin
 CI: CAD/ MI/ Angina , monitor ECG

18. s/s insulin
 Lipodystrophy (Rotate sites to prevent) , Hypoglycemia, hypokalemia (heart
palpitation, weakness, fatigue, tingling)

19. Type 1 diabetes & 2 if you need to explain to pt
 DM I (Autoimmune)
o Caused by genetic factors
 DM II
o mainly lifestyle or maybe ethnicity


20. Metabolic syndrome what were the 4 things that contribute
 Abdominal obesity, insulin resistance, elevated lipids & triglycerides, HTN