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Bullets in Medical Surgical Nursing

Bullets in Medical Surgical Nursing

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Published by: api-3822508 on Oct 18, 2008
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BULLETS(Authored from previous board exam questions)
Chest X ray
 
painless procedure
Bronchoscopy
o
AtSO4
Anticholinergic
mimics SNR
Decreases saliva
dry mouth
o
NPO 6 to 8 hours
o
Local anesthesia
check gag reflex before feeding
ABG
o
Hyperventilation
decreased CO2
increased blood pH
respiratory alkalosis
o
Hypoventilation
increased CO2
decreased blood pH
respiratory acidosis
o
Diarrhea
decreased HCO3
decreased blood pH
metabolic acidosis
o
Vomiting gastric content
decreased HCL
increased blood pH
metabolic alkalosis
o
Vomiting blood
decreased O2
anaerobic metabolism
formation of lactic acid
decreased blood pH
metabolic acidosis
o
Blood pH
normal 7.35 to 7.45
If increased
alkalosis; If decreased
acidosis
o
Partial CO2
normal 35 to 45
If increased Respiratory Acidosis; if decreased RespiratoryAlkalosis
o
Partial HCO3
normal 22 to 26
If increased Metabolic alkalosis; If decreased metabolicacidosis
Cancer of the larynx
 
CS, alcohol and over usage of voice (choir member)
o
A - nterior neck mass
o
B – urning sensation with hot beverages / Bad breath
o
C - hange in the voice (hoarseness)
o
D – ysphagia/dyspnea
Chronic Obstructive Pulmonary Disease
o
Chronic Bronchitis
Blue bloater 
Excessive mucus production
o
Asthma
Periods of bronchospasm and bronchoconstriction
o
Emphysema
Disequilibrium of elastase and antielastase
Pink puffer 
o
Manifestations
A
 – LTERATION IN
LOC
decreased O2
Thoracic anatomy
over distention of alveoli
TD = APD
barrel chest
Skin
o
Temperature
cool clammy skin
o
Color 
pale to cyanotic
ABG
Respiratory acidosis
Increased CO2
B
 – reathing
difficulty, purse lip
expiration
>
inhalation
removal of excess CO2(diet low CHO)
C
– ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2 therapy, decreased O2demand by rest and SFF)
clubbing of the fingers and decreased TP to the kidneyscausing polycythemia
D
– ecreased Metabolism
Anorexia
weight loss (high calorie diet)
fatigue
weakness
Bronchodilators
o
Theophylline and aminophylline
Primary effect
stimulates beta 2 receptors
smooth muscle relaxation
bronchodilation
Side effect
stimulates beta 1 receptors
increases cardiac rate
need not to notifythe physician
 
Adverse effect
hypotension
monitor BP
sign of toxicity
Evaluation
check breath sounds
Acute Respiratory Distress Syndrome
o
Causes
A
– spiration
R
 – espiratory trauma (embolism)
fracture
embolism
ARDS
D
– rug toxicity (ASA)
S
 – epsis and shock
Vomiting, bleeding, dehydration
hypovolemia
shock
ARDS
o
Syndrome
Severe hypoxia
Bilateral infiltrates
Dyspnea
Pulmonary embolism
o
Restlessness
earliest sign
Water Seal System
o
Drainage Bottle
marked the level every shift
o
Water seal bottle
Presence of fluctuation
normal
Absence of fluctuation
lungs are fully expanded
 
assess first
patient
(X ray
confirm)
OR presence of obstruction
Intermittent bubbling
normal
Absent
obstruction
Continuous
leakage
o
Suction Control
continuous bubbling
normal
Risk factors for cardiovascular disorders
o
R
– ace
non modifiable
o
I
– ncreased blood pressure
modifiable
o
S
– tress
SNR
increased BP and CR, vasoconstriction
modifiable
o
K
– nowing sedentary life style
modifiable
o
F
– at foods
atherosclerosis
modifiable
o
A
– lcohol (modifiable) / Age
above 40 (non modifiable)
o
C
– igarette smoking
vasoconstriction (nicotine)
modifiable / Contraceptive pills
clottingof blood
thrombus formation
o
T
– ype A behavior (modifiable)
competitiveness, perfectionist
high stress level
o
O
 – besity
o
R
– esult of DM
lipolysis
increased fatty acids
atherosclerosis
o
S
 – ex
gender 
males > female (before menopausal because estrogen decreases PVR)after menopausal female eversible}[inverted T wave]
Injury [elevated ST segment]
> male
Decreased TP in heart
 
Ischemia (Angina)
{r 
necrosis (MI)
{irreversible}[pathologic Qwave/permanent in the ECG]
Eating a heavy meal, strenuous exercise, sex, exposure to cold
Decreased blood flow (heart)
decreased TP (heart)
decreased O2 (heart)
anaerobic respiration
production of lactic acid
PAIN
 
management decreased O2 demand by rest and SFF
 
Angina
o
Pain relieved by rest and NTG
o
NTG
Vasodilation
orthostatic hypotension
move gradually
Monitor BP
Store in a dark and amber container 
 
Effective
tingling sensation
no need to notify physician
Maximum of 3 tablets with 5 minute interval
MI
o
Pain relieved by Morphine SO4
Narcotic analgesic
Can cause respiratory depression
monitor RR and O2 saturation
Antidote
narcan
Cardioversion
 
synchronous
Defibrillation
 
unsynchronous
Buerger’s disease
 
CS
vasoconstriction
stop CS
common in men
Raynaud’
s
stress and cold
vasoconstriction
common in female
Congestive heart failure
o
Left sided
pulmonary
Dyspnea
Crackles
Polycythemia
due to decrease O2 to the kidneys
Clubbing of the fingers
due to prolonged hyxia
Orthopnea
o
Right sided
systemic
Hepatomegaly
Distended neck veins
Edema
Portal hypertension
Ascites
weight gain
Varicose veins
o
Digoxin
Cardiac glycoside
Positive inotrophic effect
increased strength of myocardial contraction
Negative chronotrophic effect
decreased cardiac rate
monitor CR
never give if CR below 60 bpm
Adverse effect
V
– omitting
A
– norexia
N
– ausea
D
– iarrhea
A
– bdominal pain
REMEMBER
: earliest
GI; late
halo vision
Antidote
Digibind
Decreased RBC
Activity in tolerance, Fatigue, provide rest, Anemia
Decreased Platelets
Prone to bleeding, avoid parenteral injection, appl pressure on injectionsite, high risk for injury
Decreased WBC
prone to infection, reverse isolation
Increased WBC
presence of infection
First Day/Newly diagnosed
Knowledge deficit
Diuretic
o
D
– iet
high K diet except aldactone
o
I
 – input and Output
expected increased output
o
U
– ndesirable effect electrolyte imbalance (K)

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