Supplemental BULLETS

MEDICAL – SURGICAL
NURSING

CAUSE OF FEVER IN A PATIENT WHO HAS HAD SURGERY WITHIN THE PAST 48 HOURS –
ATELECTASIS
WHAT IS THE CAUSE OF FEVER IN A PATIENT WHO IS 5-6 DAYS POST OPERATIVE?- WOUND
INFECTION
COMMON ELECTROLYTE DISTURBANCE IN PATIENTS WITH ACUTE PANCREATITIS –
HYPOCALCEMIA AND HYPOMAGNESEMIA
GREY-TURNERS SIGN: FLANK ECCHYMOSIS INDICATIVE OF PANCREATIC DISEASE
CULLEN SIGN:PERIUMBILICAL ECCHYMOSIS INDICATIVE OF PANCREATIC DISEASE
BODY SURFACE AREA/RULE OF NINES %-FACE 9, ARMS 9 EACH,
FRONT 18%, BACK 18%, LEGS 18% EACH
PREVENTIVE MEASURES-TREATMENT OF HEMORRHOIDS- HIGH FIBER DIET, SITZ BATH
AND GOOD HYGIENE
SPINAL SHOCK-SUDDEN AREFLEXIA, HYPOTENSION WITH PARADOXICAL BRADYCARDIA

Life threatening injury associated with pelvic fractures – severe hemorrhage

(retroperitoneal)
Compartment Syndrome- increased pressure within closed tissue spaces, which
compromises blood flow to muscle and nerve tissue. Contributing causes include external
compression(by burn eschar,circumferential casts,dressings or pneumatic pressure
garments ) and volume increase within the compartment(due to hemorrhage into the
compartment, IV infiltration , or edema with post-ischemic swelling that is secondary to
injury)
Early signs and symptoms of compartment syndrome-tenderness and pain out of
proportion to the injury, pain that accompanies active and passive motion and paresthesia.
Late signs of compartment syndrome- compartment is tense, indurated and
erythematous, there is pallor and pulselessness and capillary refill is slow.

Acute tinnitus toxicity to-aspirin

Unilateral tinnitus- trauma, Otitis and Menieres
Valsalva maneuvers holding the breath, stimulation of the gag
reflex,ipecac,squating,pressure on the eyeball or immersing face in
ice
Adverse effects of lidocaine- drowsiness, nausea,
vertigo,confusion, ataxia, tinnitus, muscle twitching

Sudden non-traumatic cardiac arrest-ventricular fibrillation(80-90%). Early

defibrillation is the key
CPR, one rescuer- 2 breaths , 15 compressions
CPR, two rescuers- 1 breath 5 compressions
Which hypertensive medications should not be given to diabetics? –
diuretics and B-blockers which increase insulin resistance-ACE drug of
choice for these patients
Choking but able to speak- encourage to breathe deeply-don’t interrupt
spontaneous breathing but if with severe respiratory difficulty with
weakening cough and inability to talk – Heimlich Maneuver

Obese and pregnant chest thrust above navel

Most common postoperative resp. complication-atelectasis
COPD –high FiO2 – suppression of the hypoxic ventilatory drive
Common presentation of cyctic fibrosis in newborns – GI Obstruction
Chronic hoarseness more than 4-6 weeks – laryngeal carcinoma
Major cause of pulmonary embolism – DVT
Elect. Imbalance in cirrhosis- hypo NA, hypoK,hypoMg

Colon Ca screening; annual digital exam –over 40 ; occult blood –annual

over 50 ; sigmoidoscopy – Q3-5 years – 50y.o.
Common cause of bacterial diarrhea – E. Coli
Diarrhea due to toxin – within 12 hours
Travellers diarrhea – 3-7 days after travel
Chronic diarrhea – above 200g lbm/day for 3 wks.
Crampy abdl. Pain,mucus filled stool..relief after defecation – Irritable
Bowel Syndrome
Obese – 20% above the weight recommended for height
Hyperglycemia leads to hyponatremia

Hyponatermia- NAV , lethargy , seizures and coma

Hyper natremia – confusion, muscle irritability resp. paralysis , seizures
and coma
Hypokalemia- flattened T waves , depressed ST segments, prominent P
waves
Hyperkalemia – tall/peaked T-waves, diminished P – waves
Hyperkalemia – acidosis
Hypocalcemia – alkalosis
Hyperkalemia – common cause – CRF
Hypercalcemia – common cause – malignancy, hyperparathyroidism and
thiazides
S and Sx of hypercalcemia: stones,bones abd.groans and psychic overtones
(calculi,osteolysis, PUD and pancreatitis and psych. D.O.)

Hypercalcemia – interfere with ADH – DHN – 5 – 10 L for 24 hours of

NSS.
Adrenal Insufficiency-fatigue,weakness,weight loss,hyperpigmentation,
NAVDA, orthostatic hypotension
Adrenal insufficiency – hyperK, hypoNa and hypoglycemia
Myxedema coma- hypothermia and coma
ALS- progressive loss of the anterior motor neurons.no sensory
abnormalities just muscular atrophy and gradual weakness
GCS – eye opening, verbal ability and motor activity

Korsakoff’s Psychosis- inability to process new information-to

form new memories-reversible condition sec. to chronic
alcoholism-induced by thiamine def.
Werniche,s encephalopathy – irrev. Brain tissues break
down,inflame and bleed. Dec. muscle coordination,opthalmoplegia
and confusion.induce by thiam.def.
MG- exogenous anticholinesterase-relieve Sx
Resting tremor- parkinsons
APAP(acetaminophen poisoning – liver damage

Most common oppurtunistic infection in AIDS-PCP-non-

productive cough and dyspnea
Common food allergies-milk,eggs and nuts
Drug allergies-Penicillins
Acute Rheumatic Fever- Migratory polyartritis, Carditis, Chorea,
erythema marginatum and subQ nodules
Acute Rheumatic Fever – Penicillin or Erythromycin. High dose
aspirin therapy and Tx with carditis with prednisone.

False –positive hematuria – food coloring, phenothiazines, dilantin ,

menstruation and myoglobin
AGN – Oliguria,HPN, pulmonary edema and urnie sediments with
RBC,WBC,CHON and casts
Urinary retention- post void volume greater than 60 cc.
Oliguria less than 500cc/day,anuria less than 100 cc/day
Risk factor for pyelonephritis – UTI’s,DM, anatomic abn. And
immunocompromised pnt,indigents
What is the common cause of CRF - NIDDM

Heatstroke-cool sponging, ice packs to groin and axilla, fanning

and iced gastric gavage. Antipyretics not useful
Scabies- small vesicles and papules – web space itching
Hypothermia – core temp.below 35’C
Fresh Frozen Plasma: rapid repletion of coagulation factors and
control of hemorrhage.Disadvantages:volume overload,possible
viral transmission
Clinical complication of DIC - Bleeding and Thrombosis

Diagnostic studies for DIC- PT-prolonged and PC – low

Sickle Cell Crisis – vaso-occlusive(thrombotic),Hematologic(sequestration
and aplastic) and infectious
Mainstay therapy in Sickle Cell Crisis
hydration , analgesia, Oxygen(if hypoxic) and cardiac monitoring
Factors indicating need for Blood Typing and crossmatching in ER
Evidence of shock and potential for surgery
Gross bleeding more than 100ml
Hgb less than 10 and Hct less than 30
Rash – clearly demarcated, erythematous covered with silvery
scales w/c re3moved by scraping w/ pitting in the nail beds---Tx-
hydration and mid potency steroids.
Band like distribution painful vesiculo-papular rash with crops of
blisters- Shingles or herpes zoster Dx ----Tx acyclovir and
analgesics
Aminoglycoside and cephalosporins in elderly and / with
dehydration – ARF
Sundown syndrome – hallucinations and delusions
Common cause of cataract – senility

Alzheimers Dx – progressive memory loss.followed by

disoriientation,personality changes,language diff. and etc.
Dementia-irreversible changes/deficits in memory , spatial
concepts, personality, cogniton , motor and sensory skills ,
judgement or behavior…no change in consciousness
Delirium – a reversible organic mental syndrome reflecting
deficits in attention, organized thinking, orientation , memory and
perception. Confused,anxious,excited and have hallucinations.a
change in consciousness observed( acute state of confusion)

Pressure Ulcer-Sepsis….Vit.C…Saline…repositionQ2H
UTI …most common – E. Coli
Tricyclic Anti-depressants ----Orthostatic hypotension
Common cause of AD in the elderly – family history
Mammography-n Q 1-2 years after 40 , QY over 50
Barium C/I for complete bowel Obstruction or intestinal perforation
MRI – C/I- pacemakers, metal objects/implants and claustrophobic
URI, GI illness,(fever of 38’C), use of antibiotics and recent exposure are
not reasons for vaccination delay
Mantoux - > 5mm for HIV , >10 mm for pnt with risk factors, >15 mm for
pnt. no risk factors
AIDS-- most common nalignancy-Kaposis Sarcoma---most common
infection – PCP
Influenza vaccine – C/I- hypersensitivity to eggs
Fluid resuscitation for burns – 2-4 ml/kg/%BSA /day. ½ is given during the
first 8 hours
Spinal shock – flaccid paralysis, sensory loss , areflexia, loss of autonomic
function. Bradycardic, hypotensive,hypothermic( vasodilated)
Paralytic ileus-common cause – surgery
Incubation of hepa A– 30 days ; Hepa B – 90 days

Principal signs of adrenal crisis- abdominal pain,

hypotension and shock-withdrawal of steroids ….
Tx – steroids , And D5 .9 NSS infusion
SIADH- low serum NA, high urine NA
Hypercalcemia – hypokalemia
Strabismus – lack of paralllelism
Salicylate overdose – respiratory alkalosis and metabolic acidosis
Meniere’s disease – Vertigo, hearing loss and Tinnitus

Highest cause of injuries in the elderly – falls

Treatment for coumadin overdose – FFP , vit K IM
Common transfusion Rxn.- Febrile
Salmonella – 3 days diarrhea , abrupt onset , slimy green
malodorous stools w/ blood patient is febrile
Hyperkalemia treatment – Potassium
Kayexalate exchanges Na for K+. Results in HyperNa and CHF
Digoxin – cardiac effects – potentiated by hypokalemia and
hypercalcemia