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Blueprint Med_SurgII Final Exam

Parkinsons disease
o S/S tremors at rest, rigidity, bradykinesia, stooped posture, masklike facies, short shuffling steps,
hips and knees slightly flexed, arms flexed at elbows and wrists
o What is said to occur - a progressive degenerative disorder that results in an eventual loss of
coordination and control over involuntary motor movement
o What sort of nursing considerations should we be alert to as far as ADLS Spinal cord Injury (SCI)
o complications
Autonomic dysreflexia - Exaggerated response of autonomic nervous system to noxious
(painful) stimuli
S/S - severe HTN which mad led to SZ or a stoke(increase in BP can stimulate vagus
nerve causing bradycardia, dilation only above the level of injury nasal
congestion, facial flushing, profuse sweating and pounding HA
Causes - noxious (painful) stimuli, fever, kinked, f/c tubing, constipation
Treatment - prevention of triggers
o Triggers include- distended bladder, constipation, renal calculi, ejaculation,
or uterine contractions, but also may be caused by pressure sores, skin rash,
enemas, or even sudden position changes
CVA - Obstruction of blood vessel by atherosclerotic plaque, blood clot, or a combination of the two, or by other
debris released into vessel that impedes blood flow to an area of the brain
o S/S sudden numbness or weakness of the face, arm, or leg, especially on one side of the body,
Sudden confusion trouble speaking or understanding, sudden trouble seeing in one or both eyes,
sudden trouble walking, dizziness loss of balance or coordination, sudden severe HA with no know
cause
o Early interventions - control Bp, overdose with anticoagulants, atherosclerosis, diet and lifestyle
changes
o nursing considerations and the immediate care of these patients
o treatment o who is at higher risk African Americans
o care of the patient in the acute and rehabilitation phase care of the patient and possible complications
Acute 4 major areas to focus Htn, O2, hyperglycemia and hyperthermia; fluids, meds,
sx
Rehab allow pt to participate in there care, personal devices, environmental adaptions,
ADL, nutrition (thickener), gait belts
Recognition of increasing intracranial pressure
o S/S
Early - decreasing LOC : become lethargic, talkative or quiet, or restless and irritable. May
have trouble remembering things, experience a change in personality, or complain of nausea
and vomiting. Symptoms may progress to confusion or diminished responsiveness
Late - increased systolic blood pressure, widened pulse pressure, and slowed heart rate.
Irregular respiratory patterns may develop, and the patient's temperature may rise
o Assessment of these patients LOC ,pupillary characteristics, motor functions, sensory function, v/s
o nursing considerations TIA
o S/S dizziness, momentary confusion, loss of speech, loss of balance, tinnitus, visual disturbances,
ptosis, dysarthria, dysphagia, drooping mouth, weakness and tingling or numbness on one side of
the body
o Causes blood vessels may be occluded by spasms, fragments of plaque or blood clots

Treatment depends on cause: warfarin, ASA, Aggrenox, Plavix(clopidogrel), carotid endarterectomy,


TPA
o who is at risk pts with HTN, cardiac disease, DM, atherosclerosis, African Americans
o patient teaching reducing risk factors(wgt, control bp), take your meds,
Expressive aphasia difficulty speaking or writing
o who does it affect pts with CVA in broca area
o how does it affect our patients/care of these clients will need to teach pt and use nonverbal means of
communication, speech therapy exercises
Know the different levels of spinal cord injuries and what vital functions would it affect (ex: Injury at C4, injury
at L6 etc.) care of patients with SCI and how does it affect at different ages
o C1 to C4 - motor and sensory function from neck down, respiratory function, bowel and bladder
control
o C5 motor and sensory function below shoulders, intercostal function in ventilation and bowel and
bladder control
o C6 Motor and sensory function below shoulders but increased degree of sensation in arm and
thumb, Intercostal function in ventilation and bowel and bladder control
o C7 Motor control of portion of upper ext. sensation below clavicle, intercoastal function and
bowel and bladder control
o C8 - motor control of portions of upper extremities, sensations below chest, intercostal function
and bowel and bladder control
o T1 to T6 trunk muscles below midchest, sensations from midchest, some intercostal function and
bowel and bladder control
o T6 to T12 motor control below waist, sensation below waist and bowel and bladder control
o L1 to L3 motor and sensory function to lower extremities, sensation to lower abdomen, bowel and
bladder function
o L3 to L4 Motor and sensory function to distal portions of lower extremities and bowel and
bladder control
o L4 to S5 Variable motor and sensory function to knee, ankle and foot, sensation to perineum and
variable bowel and bladder control
Myasthenia Gravis - a chronic, progressive disease in which the amount of acetylcholine available at the
neuromuscular junction is reduced
o S/S - Weakness of voluntary muscles, particularly those of chewing, swallowing, and speaking,
Ptosis and diplopia, patient becomes unable to perform any activity that demands sustained
muscular contractions, such as brushing the hair, walking upstairs, or holding the hands over the
head.
o Treatment anticholinersterase drugs, Corticosteriod agents, cytotoxic therapies, thymectomy,
plasmapheresis
o Complications - If respiratory muscles involved, death from respiratory insufficiency or arrest
possible
o nursing considerations
crisis S/S - Difficulty breathing or speaking, retractions, Weak cough with increased
secretions (mucus or saliva) or an inability to clear secretions, Weak tongue, trouble
swallowing or chewing, and weight loss
Know how to delegate certain situations to your UAP (unlicensed assistive personnel)
Concussions head trauma in which no visible injury exists to the skill or brain
o S/S LOC lasting less than 5 min and may have HA, amnesia about the even N/V
o causes - most common mva, assaults, and falls, with drug and alcohol accidents
o patient/family teaching positioning pt to prevent hip and neck flexion, elevate HOB, spacing
activities, monitor urine output
Precautions/Nursing considerations with patients who are post CVA
Meningitis - inflammation of the coverings of the brain and spinal cord caused by either viral or bacterial
organisms
o S/S - Headache, nuchal rigidity (stiffness of the back of the neck), irritability, diminished level of
consciousness, photophobia (sensitivity to light), hypersensitivity, and seizure activity
o

Tx - Bacterial infections usually respond to antimicrobial therapy, but no specific drugs effective
against most viral infections and Anticonvulsants used to control seizure activity if necessary
o Precautions isolation precautions
o Testing LP
o patient teaching - immunizations
o nursing priorities - WASH HANDS
ch 36/37/35
congestive heart failure
o Care of the patient- Eliminate unnecessary activities, Help the patient change positons every 2 hrs,
Give a partial bed bath
o S/S SOB, fatigue, weakness, swelling, dysthymias, persistent cough wheezing, ascites, sudden wgt
gain, lack of appetite, chest pain, decreased alertness
o patient teaching Antihypertensive medications know the different classifications that are used:
o ACE inhibitors captopril(Capoten), liniopril (Zestril, Prinivil), enalopril (Vasotec)
Uses -prevents conversion of angiotensin, potent vasoconstrictor
Nursing considerations monitor pt blood cell counts, report changes in urine output
Contraindications renal problems
Pt teaching o Calcium channel blockers diltiazem(Cardizem), isradipine(DynaCirc), nicardipine(Cardene,
nifedipine(Procardia), amlodipine (Norvasc), verapamil (Calan), Caduet
Uses decreases the force of cardiac contraction and dilates the peripheral blood vessels
Nursing considerations monitor pts pulse, elevate legs to reduce edema
Contraindications monitor hypotension, bradycardia and edema
Pt teaching o Beta-blockers
Uses decreases cardiac stimulation
nursing considerations monitor for bradycardia, hypotension, hypoglycemia
contraindications asthma, COPD pts, heart block, or CHF
Pt teaching o Diuretics)
Thiazide agents(chlorothiazide(Diuril), HCTZ) decrease the reabsorption of sodium and water
Potassium sparing( spironolactone(Aldactone) do not promote secretion of potassium into urine
Non-potassium sparing( furosemide (Lasix) allows water and salt to be excreted thru urine
Uses reduces fluid volume, may cause vasodilation, sodium loss
Nursing considerations pts fluid balance, hydration, urine output, mental status and
muscle tone,
Contraindications Pt teaching myocardial infarction
o S/S
Pain
Heavy or constrictive pain located below or behind sternum
May radiate to the arms, back, neck, or jaw
Patient becomes diaphoretic and lightheaded and may experience nausea, vomiting, and
dyspnea
The skin is frequently cold and clammy
Patient experiences great anxiety; feeling of impending doom
o Causes - Begins with occlusion of coronary artery
Period of 4 to 6 hrs. process of ischemia, injury, infarction develops
Ischemia lasting 20 minutes or more is sufficient to produce irreversible damage
o Treatment
o

Drugs - SL Nitro, o2(4-6L), Beta-adrenergic blockers, Fibrinolytic therapy is recommended


for patients with total occlusion.MONA!!
Percutaneous coronary intervention (PCI) - Intracoronary stents, Coronary atherectomy,
Laser angioplasty, Radiation therapy
CABG
o labs and tests - Cardiac markers
Troponin, myoglobin, and cardiac enzymes
o patient teaching
Patients with coronary artery disease
o Causes - Arteriosclerosis, Atherosclerosis, Progression of lesions
o Complications MI, Stroke
o nursing considerations o patient care of a patient/patient teaching - STOP smoking, control Bp, Check cholesterol, keep DM
under control, exercise, eat healthy foods, maintain healthy wgt, and manage stress
Valvular disease
o what illnesses included and why?
o Treatment
o nursing considerations
o patient teaching
Mitral valve prolapse
o Causes - one or both leaflets enlarges and protrudes into the LA during systole
o who is most at risk for this
o treatment - management of stress and beta blockers (syncope, palpitations and severe chest pain)
o S/S chest pain, palpitations, dizziness, and syncope
o patient teaching - stress-reduction tech
o nursing consideration
DVT presence of a thrombus in a vein as a result of stasis, deep veins rather than in the superficial vessels
o S/S edematous, warm and tender at the area of compromise, + homans signs
o whos at risk (know how to recognize patients who are at risk for DVT) those prescribed BR, sx
under general anesthesia for people older than 40, leg trauma resulting in immobilization from
casts or traction, previous venous insufficiency, obesity, use of oral contraceptives, malignancy
o Treatment goal is to prevent thrombus extension and PE, reduce the risk of further thrombus
formation and reduce discomfort: anticoagulant or thrombolytic therapy
o patient teaching protect leg from pressure and trauma, elevate your legs when sitting to improve
circulation, do not massage or rub affected areas, gradually increase you activity, slow or stop if you
have pain, avoid prolonged standing and crossing your legs, notify your physician if you have chest
pain or SOB
o nursing considerations Peripheral Vascular Disease peripheral arterial occlusive disease, pathological changes in the arteries
o Causes plaque formation that arise where the arteries branch, veer, arch or narrow
o S/S intermittent claudication (classic sign), aching, cramping, tiredness, and weakness in the legs that
occur with walking and is relieved by rest, absence of peripheral pulses below the occlusive area, rest
pain, complaints of tingling or numbness in the toes is common, cold and numb ext, muscle atropy may
be evident, pale, thicken nails, shiny scaly skin, Sq tissue loss, hairlessness on the affected ext. ulcers with
pale gray or yellowish hue
o Treatment lifestyle changes including smoking cessation, exercise and wgt management, smoking
cessation, exercise programs, stenting, endartectomy, percutaneous transluminal angioplasty, ASA,
vasodilation agents
o nursing considerations DO NOT elevate ext, resting ext in dependent position, administer analgesics as
prescribed along with comfort measures, keep ulcerated area clean
o patient teaching and patient self-care at home gradually increase exercise, during activity stop if pt has
chest pain, prevent tissue trauma to legs, wear properly fitted shoes, keep toenails neatly trimmed,
Know what nursing diagnosis and interventions most common with PVD
o activity intolerance activity schedule, gradually increase exercise

chronic pain resting ext in dependent position administer analgesic agents as prescribed
impaired skin integrity prevent tissue damage, properly fitted shoes, cut toenails straight across
disturbed body image encourage the pt to express any feelings that results from problems
ineffective peripheral tissue perfusion vasodilator agents and other drugs that improve blood flow as
ordered
o ineffective self-health management adaption to lifestyle changes in essential to good management of
PAD
o risk for infection after sx risk for infection of the surgical incision and the grafts
o decreased cardiac output monitor DW, and inspect dressing for bleeding, decreased urine output,
hypotension
o ineffective peripheral tissue perfusion monitor pulses, warmth and color of the operative extremity and
promptly
o acute pain analgesic agents, positioning and relaxation tech
o impaired physical mobility assess muscle strength and tolerance of activity
Hypertension define it
o Causes - Requires the LV to work harder to overcome increased peripheral resistance. The
increased workload may cause the LV to hypertrophy (enlarge) & may eventually fail
o complications - MI, kidney damage, CVA, TIA, retinal hemorrhages may lead to blindness, and
death
o S/S occipital HA that are more severe on arising, light-headedness and epistaxis
o modifiable and non-modifiable risks o diet
o know your different levels ex: essential
Know your lab value normal of all your electrolytes o
o
o
o

o Sodium(Na) - Major role in regulating body fluid volumes, muscular activity, nerve impulse conduction, and
acid-base balance

Hyper S/S - thirst, flushed skin, dry mm, low urine output, restlessness increased HR convulsions and
postural hypotension

Hypo S/S -

headache, muscle weakness, fatigue, apathy, confusion, abd cramps and orthostatic

hypotension

Values - 136-145mEq/L
Complications o Potassium(K) - Important in maintaining fluid osmolality and volume within the cell, Essential for normal
membrane excitabilitya critical factor in transmitting nerve impulses, Needed for protein synthesis, for the
synthesis and breakdown of glycogen, and to maintain plasma acid-base balance

Hyper S/S explosive diarrhea and vomiting, muscle cramps, weakness and paresthesia, irritability,
anxiety, abd cramps and decreased urine output

Hypo S/S anorexia, abd distention, vomiting, diarrhea, muscle cramps, dysrhythmias, postural
hypotension, dyspnea, shallow resp, confusion, depression, polyuria, nocturia

Values 3.5-5.1 mEq/L


Complications
o Chloride(Cl) - Functions are to regulate osmotic pressure
between fluid compartments and assist in regulating acid-base balance

Values 98 - 107 mEq/L.


Complications o Calcium(Ca) - Promotes transmission of nerve impulses; helps regulate muscle contraction and relaxation,
Usually combined with phosphorus to form the mineral salts of the bones and teeth

Hyper S/S nausea, vomiting, dyspepsia and anorexia, lethargy, psychosis, cerebellar ataxia and
possibly coma or death

Hypo S/S fatigue, depression, memory loss, hallucinations and possible seizures or tetany; Early
signs: finger numbness, tingling, burning of extremities and paresthias.

Values 8.5 to 10.8


Complications
o Magnesium(Mg) - Plays a role in the metabolism of carbohydrates and proteins, the storage and use of
intracellular energy, and neural transmission, Important in heart, nerve, and muscle function

Hyper S/S = bradycardia, flushing, sweating, N/V, low Ca, flaccid paralysis, EKG changes over 15
= respiratory distress and asystole.

Hypo S/S weakness, muscle fasciculation with tremor, tetany, increased reflexes, personality changes,
convulsions, psychosis, come and cardiac arrhythmia. weight loss, reduced appetite, nausea, vomiting, fatty
stool, bloating, muscle pain, irritability, disorientation, confusion, tremor, seizures( severe deficiency),
vertigo, nystagmus, impaired balance.

Values 1.5 to 2.2


Complications

o
Inderal (propanalol)
o Uses o Contraindications
o patient teaching
o nursing considerations
Hypertensive emergency - life threatening medical emergency
o S/S - Severe headache, blurred vision, nausea, restlessness, and confusion along with very highBP
o Causes make be because pt stop taking his HTN meds, malignant HTN, HTN encephalopathy,
eclampsia, pheochromocytome or CVA
o Treatment rapidly reduce the pressure to non-life threatening level then bring it slowly within normal
range
o Complications cardiac and renal damage, death, CVA, renal failure or cardiac failure
Ch 46
Diabetes type 1 Absence of endogenous insulin
o Causes - autoimmune process, possibly triggered by a viral infection, destroys beta cells, the
development of insulin antibodies, and the production of islet cell antibodies (ICAs)
o s/s - Urinating often, Feeling very thirsty, Feeling very hungry - even though you are eating,
Extreme fatigue, Blurry vision, Cuts/bruises that are slow to heal, Weight loss - even though you are
eating more
o tx - Affected people require exogenous insulin for the rest of their lives
o specific differences - Formerly called juvenile-onset diabetes because it most commonly occurs in
juveniles and young adults
o pt teaching
Diabetes type 2..Inadequate endogenous insulin and bodys inability to properly use insulin
o Causes - Beta cells respond inadequately to hyperglycemia; results in chronically elevated blood
glucose, Continuous high glucose level in the blood desensitizes the beta cells; they become less
responsive to the elevated glucose
o s/s dm 2 have s/s that are mild and may go unnoticedtypical s/s - Urinating often, Feeling
very thirsty, Feeling very hungry - even though you are eating, Extreme fatigue, Blurry vision,
Cuts/bruises that are slow to heal, Tingling, pain, or numbness in the hands/feet
o tx - Controlled by diet and exercise; may require oral hypoglycemic agents or exogenous insulin
o specific differences -More common in adults; increasing in children
o pt teaching Know how to recognize long and short term goals for patients in general (specific when given detailed history)
HHNS - Hyperglycemic Hyperosmolar Nonketotic Syndrome
Patient goes into a coma from extremely high glucose levels (>600 mg/dl)

Causes - Pancreas produces just enough insulin to prevent breakdown of fatty acids & the formation of
ketones but not enough insulin to prevent hyperglycemia
S/S - diuresis, dehydration and hypernatremia, polydipsia, polyuria
assessment of client treatment - iv insulin drip
expected labs - fasting serum blood glucose, random glucose levels, 2 hr postprandial glucose levels
Know the different insulins and their peaks/nursing considerations/diets/interventions and patient teaching
Insulin drips
o when
o why
o how
o nursing considerations
DKA (diabetic ketoacidosis)
o Causes - Life-threatening emergency caused by a relative or absolute deficiency of insulin
o whos is at risk o S/S - As condition progresses, classic symptoms of polydipsia, polyuria, and polyphagia develop
If untreated, patient becomes dehydrated, weak, and lethargic with abdominal pain, nausea,
vomiting, fruity breath, increased respiratory rate, tachycardia, blurred vision, and
hypothermia
Late signs - Air hunger (Kussmaul respirations), coma, and shockdeath can results
without prompt medical care
o early recognition - Anorexia, headache, and fatigue
o Tx - aimed to correct 3 main problems.dehydration, electrolyte imbalance and acidosis
o Complications - coma from extremely high glucose levels (> 600 mg/dl) but no evidence of ketones
o nursing considerations when caring for these clients
Important teaching for diabetics on self- care/diet etc.
o Foot care
Wash & carefully dry the feet every day
Protect from extreme temperatures
Buy shoes that are comfortable & supportive
Keep skin soft & smooth
Wear shoes at all times
o Diet Immediate care of hypoglycemia

Ch 32
Anemia different types/causes in each and patient teaching/treatments/self- care and monitoring while at home
o Pernicious Anemia
Causes lack of intrinsic factor
S/S fatigue, pallor, weakness, a sore tongue, numbness of hands or feet
Tx
Pt teaching/self-care
o Iron Deficiency
Causes From a diet too low in iron or from the body not absorbing enough iron from the
gastrointestinal tract
S/S fatigue,
Tx ferrous sulfate and iron dextran
Pt teaching/self-care - Encourage foods high in iron; liver, oysters,red meats, fish, dried
fruits, legumes, dark green veggies, whole grain cereals/bread
o Aplastic Anemia

Causes Certain drugs (e.g., streptomycin and chloramphenicol) and exposure to toxic
chemicals/radiation cause bone marrow failure
S/S
Tx Transfusion: replace red blood cells and platelets
Antibiotics to prevent or treat infections; corticosteroids also may be given
If bone marrow does not recover, a transplant may be considered if donor can be
found
Pt teaching/self-care -

Hemophilia A
o Causes- certain infections, drug reactions, and certain cancers
o S/S - pallor, extreme fatigue, tachycardia, shortness of breath, and hypotension
Patients may appear jaundiced
High bilirubin levels from all the red blood cells lysed (broken down
o Treatment - identifying and treating the cause
Blood transfusions may be needed to replace red blood cells
Corticosteroids may be administered to the patient
o nursing considerations with care of these cients
Sickle-cell anemia o Causes - Disk-shaped red blood cells become sickle shaped, Misshapen cells more fragile than
normal red blood cells; as a result, the sickled cells easily rupture as they pass through small
capillaries, resulting in a chronic anemia
o who is at risk - almost exclusively in African Americans
o treatment - treatment is symptomatic
Intravenous fluids and pain medication
Red blood cell transfusions correct the anemia and help the body oxygenate tissues
Oxygen therapy
Hydroxyurea
o patient teaching
o prevention of crisis -treating Dehydration and infection, preventing overexertion, cold weather
changes, excessive alcohol consumption, smoking
o why does a crisis occur - Dehydration, infection, overexertion, cold weather changes, excessive
alcohol consumption, smoking
ch 44-45
Patients with adrenal gland problems,
o what is the disease
o S/S
o Labs
o treatment
o what occurs during the illness
Addisons disease adrenal insufficiency
o Interventions o what is it idiopathic atrophy, autoimmune disease , AIDS, TB, hemorrhage rt anticoagulant therapy,
metastatic cancer, adrenalectomy
o what is occurring destructive disease process affecting the adrenal glands that causes deficiencies of
cortisol and aldosterone
DI (diabetes insipidus)
o Causes Neurogenic hypothalamic tumors, head trauma, infection, surgical procedures or metastatic
tumors originating in the lung or breast
Nephrogenic inherited defect; renal tubules of the kidney do not respond to ADH, resulting in
inadequate water reabsorption by the kidneys
o S/S massive diuresis, dehydration, thirst, hypotension, tachycardia, dizziness, decreased skin turgor,
weakness, and fainting episodes

o Complications cardiac arrest and death if left untreated


o Labs urine osmolality, serum K+, Na, mag, phos
SAIDH - water imbalance related to an increase in ADH synthesis
o Causes brain trauma, surgery, tumors, and infection
o S/S dilutional hyponatremia and water retention, weakness, muscle cramps or twitching, anorexia,
nausea, diarrhea, irritability, HA, wgt gain without edema
o Complications sz, coma, LOC deteriorates
o nursing considerations muscle strength, urine specific gravity, mental status
Myxedema coma
o causes - longstanding untreated hypothyroidism secondary insult to hypothermia, infection or another
systemic condition
o S/S AMS, hypoglycemia, hypotension, hyponatremia, bradycardia, hypoventilation, hypothermia,
periorbital edema
o nursing considerations o care of clients Hyperthyroidism
o Causes abnormally increase synthesis and secretion of thyroid hormones
o S/S increased metabolic rate; wgt loss and nervousness, restlessness, irritable behavior, sleep
disturbances, emotional lability, personality changes, hair loss and fatigue, changes in menstrual and
bowel patterns may occur
o Complications thyrotocosis
o Labs TSH, T4
o The disease autoimmune disorder
Thyroid storm how to recognize - excessive stimulation cause by elevated thyroid hormone levels that produce
dangerous tachy and hyperthermia
Hypothyroidism
o Causes atrophy of thyroid gland(graves disease or thyroiditis), tx for hyperthyroidism, dietary iodine
deficiency, high intake of goitrogens, and defects in the thyroid hormone synthesis
o S/S metabolic rate slows, wgt gain, lethargy, forgetfulness and irritability, frequent HA, constipation,
menstrual disorders, numbness and tingling in the arms and legs and intolerance to cold, bradycardia and
dyspnea
o nursing considerations o nursing intervention o diagnosis free T4 and TSH