WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 6: MEDICAL AND SURGICAL HEALTH NURSING (A) PERIOPERATIVE NURSING A a B. Major Types of Pathologic Process Requiring Surgical itervention (OPET) Obstruction — impairment to the flow of vital Mulls (blood uringese bile) Perforation ~ rupture ofan organ. Erosion - wearingoff of asurface or membrane. ‘Tumors abnormal new growths. ‘Classification of Surgical Procedure Diagnostic - to establish the presence ofa lsease condition. ( egbionsy) Exploratory ~to determine the extent of disease condition (2g ap) Curative to teat the disease condition “Ablative- removal ofan organ * Constructive - repair of congenitally defective organ, * Reconstructive repair of Jamage organ Palliative ~ to roliove distressing sign and symptoms, not necessarily to cure the disease ‘According to URGENCY Classification Indication for | Examples Surg Emergent - patient weavers requires immediate Withoutdelay | bleeding tention life threatening gunshor/ stab condition wound + Fractured lL Urgent Imperative | Wihin2tw30 |- kidney f patient requires prompt hous | urctoral stones Required ~ patient Planwithina | ~ cataract reeds to have surgery. Feyrweeks or | ~thyrold d/o onthe lective - patient should | gfallre t have | ~repairotsear have surgery. Ssungery oot | - vaginal repair catastrophic Optional patents ‘Porsonal | ~cosmotic decision. proferoncds | surgery inform Consent Purposes. + To enailthar the client widerstand the milife of the feeatment incllding, the potential complications and ‘isfiguiesnent © To indicate, that the eligml® decision was pressure + Toprotec the dient against unauthorized procedure + To protec the surgeon and hospital against legal action by a nade without client who alms that an authorized procedure was performed, Essential Elements of Informed Consent the agnosis and explanation ofthe condition. Ya fair explanation of the procedure to be done and used and the consequences. | description of alternative treatment or procedure 4 description ofthe benefits tobe expected ‘material rights if any. the prognosis, ifthe recommended care, procedure is refused, Requistes fr Validity of informed Consent = Waitten permission is bestand legally accepted, Signature Is obtained with iene’s ‘understanding of whatto occur ‘adult sign their own operative permit ‘obained before sedation For minors, parents or someone standing In thelr behalf, ives the consent. Nowe: for 0 married emonejpated minor parental cansent isnot needed anymore, spouses accepted For mentally dl and unconscious patient, consent must be taken from the parents or egal guardian Ifthe patient is unable to write, an °X" is accepted if there isa witness o his marie Secured without pressureaii@hreat A witness Is desrablé = nse, physician or authortzad persons, When an emerged situation exists, no consent is necessary because inaction at such time may cause greater injury. (permission vid faleptone/cephone dsaegpted but must be Signed within 24s) complete D. Preoperative Meds. 54's Amsioliies(Trangulizers & Sedtives) ‘Bitzopam (Valium) @Lorazapam (Advan) *Diphenhydramine ‘Analgesics. * Nalluphine ( Nubain) Anticholinergics * Atropine Sulfate ‘Ant Uleor (Proton Pump Inhibitors) omeprazole (asec) *Famotdine Antibiaties E Preoperative Teachings Incentive Spiromeny > Duaptragmatc Breathing Footaid Les exer ould be done merninyaftemoon before the day of F. The Surgical Team Surgeon + Performance of the operative procedure according to the needsof the patients ‘The primary decision maker regarding surgical technique to use duringthe procedure Assistant Surgeon Assists with retracting, hemostasis, suturing and any other tasks requested. by the surgeon to faclitate speed while maintaining quality during the procedure. Anesthesiologist Selects the anesthesix administers it, intubates the cient if hecessary, manages technical problems related to. the administration of anesthetic agent, and supervises the cients Condition throughout thesurgical procedure Scrub Nurse “Assists with che preparation ofthe roam. Scrubs, gowns and gloves solf and other members of the Surgical team. Prepares the instrument table and organizes sterile equipment for funcionaluse, ‘Assists wath the drapping procedure Passes instruments to the surgeon and assistants. by anticipating theirneed Counts sponges, needles and instruments Keepstrack of rrigations used for calculations of blood bss POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE "Patterned on the previous board exams from December 2006 ~ July 2012... the purpose of this note the possible topics that might be part ofthe upcoming Dec 2012 PNLE (0 GUIDE students onWHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 6: MEDICAL AND SURGICAL HEALTH NURSING (A) reulaing Nurse Thronibophiebiiis |» Fariyanbaaton 2 fesponelble and accountable for all activites ocurrng during ant embele stocking 4 surgial procedure incuding the management of personel Encouragelog exrece tquipment supplies and the environment during & surgical Hydrate adequately procedure {Avid any restricting devices + hse allgupmen is orkng pope. that spared crcueton * Guarantessteniy of instruments and supple. orp mec * Monitor roman te members fr rena he see erat techie Iitiste anticoagulant therapy Nandles specimens. i radiology and pathology 5 Iain to facitate 6. Principles ofSungialAsepss Ptiary Cateeizaionas > senile obec cematns ene ony when touched By another La feted Gy tne may be placed ona tee ld nsontinence > Ontystenle cect may be pice ona ee Ls 7 Malitajetorsaetettapesttircranaxpanas [Emenee Vii telow a person’ wait contaminated Sus > When a sterile surace comes In contact with awe, catheterization 3 contaminated surface, the sterile object or field becomes tae iat contaminated by caplary actin Good perineal geno > ud ows inte retin of gravity | ease vresriNaL vs > The edges ofa stenie eld oF contner are consiered to be Nausea and > W tad ao contaminated (1 och) Vouiting reums «+ Prgreswe diet (clear lqud HPACU/RR Care then fall ds, so then regular det) Maintaining Patent Airway «fl emetic ordered 4% Aesecing Sats of Creulaory System Wecupe BeMET inserdonas newded % ‘Maintaining Adequate Resprtory Function SP ictabreath ie aking a % —dssessing Thermoregulatory Satis Tage swallow of water % ‘Maintaining Adequate Fluid Volume 4 Breath inand owton paper % Mininisng Complications of Skin nnpairment be % Maintaining Saeny Al emates ordered % Promting Comfort testinal * NGTinserdonas nevded Obstruction Administered VE as ordere A seceti at are DiS A frees ACURA, (Suasiday postop) |S Preparer paul surgery © Acivity.Ablo to obey commas Cpeonies: x faa yaaa + Respiratory. Easy nals breathing 2 Encourage early ambutaon { Gireuation BP eithin 20mg level samaanar ae =_facouraee con ambubiten 5 Clore Ph stin nd cis ante na ‘Wound tafection | + Keep wand sean and dry exidin inicio’ 2 Sarplalasptictrchnique |. Postoperative Complcata rben clanging dressing — Rg REN a + Auibiouethenpy ‘Wound Deniseence =aRATOR + Apty abdominal binders * hcouragebigh protein diet Preumania > Deepen erie beret + coughingextcise + Keepinbedrest Early rmbulation __ Wound visceraton | ¢.Semi-fowiers bendknees to ‘Atelectasis jeep breathing exercise Falevetenson onthe Couphigs exerese 2eominal muscle 2 givanbulaion + Sainangon conghing Pulmonary + ning Cover exposed organ with Embottsm + Ambulat sterile, molstsaline dressing Anti embolic stockings assure, kaop him/her que compression devises and relied Prevent massaging the lower Prepare foreurgery and rept extremes, iwraind GIRCULATION. Hypovolemia © Fluid ani bood replacement Hemorrhage + Fld and bled replacement * Vitkand hemostat gation ofbleders Pressure dressing POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE "Patterned on the previous board exams from December 2006 ~ july 2012... he purpose of this note is to GUIDE students on the possible topics that might be part ofthe upcoming Dec 2012 PNLEWHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 6: MEDICAL AND SURGICAL HEALTH NURSING (A) ‘A. Benign VS Malignant Neoplasm Characteristic | Henign Neoplasm _| Malignant Neoplasm ‘Speed Growth | Grows slowly Usually grows rapidly Usually continues | Tends ta grow relentlessly to grow throughout | throughout le Me unles surgically remo. Mode of Grows by enbrgjng | Growsby inflating Growth and expanding | surroundingtissues ‘Always romains | May remain localized (in localizod;never | situ) bu usually infiltrates ingltrates other tissues surrounding Capsule ‘Almostalways | Never contained withing contained wrhina | capsute AAbrows capsule | Absence of capsule allows Capsule neoplastic calls to invade sxivantageous surrounding issues because Surgical removal of tumor ssicapsulated aatrclt tumor an be removed surgically ceil Usually wel Tsay poorly characteristics | differentiated differentiated Recurrence | Unusual when | Common following rsem) surgically removed | heeause tumor eels spread Into surrounding tisses Metastasis | Never ocaur Very coruin Effect of Not harmful to host | Always harm ROR, Neoplasm unless located in| Cases digurement, area where it disrupted angan function, fompressestissue | nutritional mbelances fr obstructe vital | May resub in erations organs sepsis, perforations, Prognosis Very good Depends on cell pea ‘Tumor gendfally | spood of agnosie removed supgiealy | Poor prognosis ells are poorly diferentiatedaind ‘evidence of mtastaie spread exits ‘Goo prognosis indicated ir tells sti resemble normal celleandithere sno vide nee of metastasis 8. Recommendations ofthe Amtican Cancer SoCiety for Early Cancer Detection |For detection dfbiiast cancer 7 Beginning a 2M, rout Women ages 20-38 sul have breast examination by healthcare provider every years Women age 40 and older should have a yearly mammogram and breast selfzxamifation by a healdicare provider efor oly breast set 2. For detection of colon and rectal cancer ‘All pesoas age 5O and cde shel havea yearly fecal oceult| ied tt Digital rectal examination and flexible sigmoidoscopy should be done very 5 years ¥ Colonoscopy withbarium enema should be done every 10 years 3.ordetection of uterine cancor + Yeatlypapanieluo (Pap) smear fr sexually active females and any femme over age 18 ¥-Atimenopause, high-risk women should have an endometrial tissue sample 50, have a yearly digi well ex + Atage’0, havea yearly prostatespecific antigen (PSA) test . American Cancer Society's seven warning signs of cancer {uses acronym CAUTION US}: 4 Changein bowel or biadderhabits 2.A.sore that does not heal 3. Unusual bloeding orishas |. Thickening or lugip in breast or elsewhere 5. Indigestions ordifculyin swallowing. 6 Obvious changein wart or mole 7. Nagging cougharhoarseness, 8, Unosfained Anemia 9. adden loss of weit _ fiternal Radiation Therapy (Brachytheraphy) Sourceé of tnternal Radiation 7 Tnphini nt affected Hesue or body eaity ingesting a sohtion ¥Injeted as soliton ito the bloodstream or body cavity Inte rough a cater into the tor Side Effects Fatigue Anorexia + mminosuppression +Other side eects similar to extemal mdiaion lient Education “Asoidelose conse with othersunil ueasment is completed Maltin daily activities unss eonuaindicated, allowing or exra 1s periods as uceded ¥ J Mainsin balanced diet © Mainain did intake ensure adequate hydration (2-3 ltersay) Wimp istempory, maintain bedrest to avoid dslalng the implant Eereted by ids may be diostive;deuble-ush tikes afer Raison therapy nay lead ta bone arrow suppression ‘Nursing Management 7 Exposure octal anunts of radiation is posible dving close contnet with persons receiving ileal radiation: wersand the principles of protection tron tu shielding > Tle! oxnimize tine spent in close proximity tothe radon source: a common standard st ii cent ie ‘0.8 minutes total per 8-hour shift > Distances mintan the msximim distance 6 fet possible from the radation some > Shielding? vse lead silds ant ther precautions to race ‘exposure to ration Pace cca in private room © Insirut visiors to maintain at leas distance of feet fom the tiem und lit visitors wo 10-30 minutes Ensure proper handing and disposal of body Quis. asuring be somtiners ae maka sppropri ¥ Ensure proper handing of bed Enens and clothing Inthe even: of adisbdged inplant, we long-handled forceps and posure to adton ie, disatce, place dhe implant into a kad container: never dveely ouch the nplant ¥Dootaliow pregnant Woman w come into any conse with ‘aiation POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE "Patterned on the previous board exams from December 2006 ~ july 2012... he purpose of this note is to GUIDE students on the possible topics that might be part ofthe upcoming Dec 2012 PNLEWHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 6: MEDICAL AND SURGICAL HEALTH NURSING (A) g working rouinely neu radiation sources, wear «monitoring device to mesure espouire FBlucate cient in all sety measures External Radiation Therapy (Teletheraphy) “The raison oncolog ‘Treatment is usual week, for 27 wee “The dient does not pore arisk for radiation exposure to other people rks speci cations fer radiation jpemsnent ype of ink given 15-30 minutes per day,5 day per Side Effects * Tissue damige o wet wea (erythema, doughins, hemochage) * Ulcoratons of oral mucous membranes * GrFeffocs such as nausea, vomiting and diarrhea + Immunosuppression dient Education ‘Wash te marked area ofthe skin with plain water only and pat skin diy: do na use soaps, deodocans, lotions, perfurnes, powders ‘er medications on the ste during the duraia af the weatment, do tot wash ff the reine site masks Avoid rubbing, seratching or scrubbing the treatment site; do rotapply extreme temperatures (Heat or Coll) co the treatment ste; shaving, use only an electric razor Wear sot loose-fiting over the treatment area Protoct skin rom sun exposure during the treatment and for at least 1 year after the treatment is completed: when g ‘outdoors, use sun-blocking agents with sun protector factor (PF) of at least 15 Maintain proper rest, dt, and uid intake as essential 0 Promoting health and repair of normal tissues Nursing Management "Monior for ave side effects of radiation ¥ —-Moniuefor significam decreases in white blood call Counts ‘and platelet counts ¥ Gient reaching (reterto Iatefeections for management. Immunosuppression, thrambocytopenia CARDIOVASCULAR NURSING A. Heart Circulation 1B Heart Sound > Tricuspid valve (ub) -RT Sth intercostal, medial > Mil valve (ub) - LT Sth ntoreosta lateral Aortic scmilunar valve (dub) -RT 2nd intercostal > Pulmonary somilunar valve (dub) ~ LT 2nd intercostals St - due w closure ofthe AV(mitral/trteuspid) valvos $2 - duc wo the closure of th som lunar (pulmonic/ aortic valves 3 Ventricular Diastolic Gallop Mechanism: vibration resting from resitance to rapid ventricular illing secondary t poor compliance 4 Ateal Diastlle Gallop, Mechanism: vibration reiting fom resistance to late ventricula fling during atrial systole ‘Heart Murmurs Incompetent / Seti Valve Pericardial Friction ib 1 Ieisanextra heaftstund originatingfOM Une aricar dial sac Mechanism: On ginates fromthe perieardiatsacasit moves Timing with each Reartbeat cca! Cardiac Action Potential Depolarization /Gontraction/Systole-eletrtal acivation of acall caused by the influx of sodium into the cell while potassium exits the call Repolarization/Resting/Diastole - rusting state caused by re-antry of potassium ince hilesodium ests roturn of the cell to the 2 call CARDIAC Proteins and enzymes CK-MB (creatine kinase) > Most cardiacspediie enzymes > Accurate indicator of myocardial dammage > Hlevatesin MI within 4 hours, peaks in 1hoursand then declines til 3 days > Normal value is 0-7 UfLor males 50-325 mu/ml Female 50-250 mu/ml . LaetieDehydrogenase (LDN) > Most sensitive indicator of myocardial damage > levatesin Min 24 hears, peaks in 48-72 hours Return to normalin 10-14 days > Normally LDH is greater than LDI2 © Troponin tandT 7 Troponin Lis usually itized for ML > levates within 3-4 hous, peaks in 4-26 hours and persist fr 7 days to 3 weeks! » Normal value for Troponin! is lss than 0.6 ng/ml, > REMEMBER w AVOID IM injections before obtaining blood sample! » Early and Late diagnosis can be made! a. Serum Lipids ‘> Lipid profile measures the serum cholesterol, Uriglcerides and lipoprotein levels > Cholestrol=200me/dl 5 Triglycerides: 40-150 mg/dL LDH: 130 mg/dl HDL: 30-70- mg/dL. [NPO postimidnight (usually 12 hours) POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE "Patterned on the previous board exams from December 2006 ~ july 2012... he purpose of this note is to GUIDE students on the possible topics that might be part ofthe upcoming Dec 2012 PNLEWHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 6: MEDICAL AND SURGICAL HEALTH NURSING (A) E-cardiac Catheterization ( Coronary Angiography / Arteriography) Insertion oa catheter into the heart andsurrounding vessels Js an invasive procedure during which physician inoets dye into coronary arteries and immediately takes series ofx-ray films to assess the structures of the arteries Protest Ensure Consent assess for allergy w seafood and lodine,NPO, document weight and height baseline VS, blood twstsand document the peripheral pulsis Intra-test: inform patient ofa ucery feeling as the catheter asses through the heart; inform the patient thatafeeling of ‘warmth and metalic taste may occur when dye ts ‘administered Post-test: Monitor VSanceardiae rhythm Monitor peripheral pulses color and warmth and sensation of the extremity distalto insertion site Maintain sandbag tothe insertion site required to maintain presaure Monitor for bleeding and hematoma formation (VP (Central Venous Pressure) 1 Reflects the pressure ofthe blood the right atrium. 1 Engorgement is estimated by the venous column that can be observed as rises from an imagined ang atthe point of ‘manubrium (angle of Louis} > With normal physiologic condition, the jugular venous column ses no higher than 2-3em above the clavicle with theclem in siting postion at45 degree angle > NORMAL CVP is 2:f.om 20 or 2:6mm ig > ToMeasure: “Patient shoul! be faith ze point of monom dena te same ve of the RA wih coresponds othe nidanary lin ofthe patent wrappronss cx below he sternum Flucwatios follow patients fespstry funecom and Will {al om inspintion dnd r+ an expton due to changes i ‘nrputmonay press, Reading: should be obtained at We righes_ point of faction G. Coruilary AHBHal Diseases "ANGINA Coronary artery Bypass Pecroris — [iyevine'sSien: |) | surgery itil sign that [% Greater nd ieser sEs0f shovisthe hand sapheneus veins ore ‘Angina lute chest | commonly used for Peetoris ‘bypass srl procedures WBxcenive Pereutaneuos physieal ‘Transluminal Coronary cxction | aimiocatedat sub | Angloplasty (FTCA) VExpoaireto | Sterna usually | > Mechanical ciation o cost Fadiates from neck, | the comnary ese wall fnvionment | back, arms, ‘by compresing the vixteme ~ | shoulder sndjaw aeromtous plague, costional | muscles spae ‘Nursing Management: wtxcessve | pyspnea inake ot | Tachyeardia (N76 Tablet(sublingual) foods or | palpitations lve doses incerva of 3 treoy meal | iaphorests Sminutes Myocardial Infarction on) Death off smyocadal calgfrom inadequate ‘oxygenation, ofteneaused, by sudden complete blockage ofa coronary arery. Characterized by localized formation of necrsis, essue desertion) ‘with ang by sear formation fibrosis ECG: may revels ‘STsegment depression ‘Taveinversion Chest pain Usually radiates fromneck, back, shoulder arms jaw & abdominal muscles (abdominal ‘schema: severe ‘ushing Norusually relieved by rest or Dypttroglyeerine Nie Dyspnea Increase in blood pressure & pulse Hyperthermia: elevated rem Skin: coo}, clammy, ashen Mild restiessness R apprehension 7 Keep the drag ina dry place avoid moisture And exposure w sunlight Y Change stock every 6 months ¥ Offersips of water before gvingsublingual nitrates, NTGNttrolor ‘Transdermal patch “Aoi placing neae hairy areas asitmay decresse dug absorption ¥ Awoid rotating transdermal patches, Nursing Management Goal: Decrease myocardisl ‘oxygen demand ¥ Adminiscr maeoic analgesic as oer: Mowphine ¥ Admiaister oxygen low Mow2-31 /min ~ finforce CBR in sem fowlers postion without bathroom prvilog ¥ Instruct cient wo avoid forms of valsalva ¥ Monitor urinary ouput {report output of less ‘than 30mal / hs indicates decrease cardiac output ¥ Resumption of ADL particularly sexual Intercourse is 4-6 weeks ‘post cardiac rehab, past AMG & instruct to ¥ Instruct cient w assume ‘anon weight bearing position ¥ Glient ean resume sexual Intercourse fean elim loruse the staircase “The Most ritical Period 6-8 hours because majority fof death oceurs due to rthythmia leadingto premature ventricular contractions (PVC) *Lidocaime: DOC for arshythmia F. Congestive Heart Fllure Inability of the heart to pump blood towards systemic ireulation 1 Lefsided heart failure Pon Mitral valve stenosis Pulmonary Symptons Right sided heart failure Fe Tricuspid valve stenosis Venous congestion symproms POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE "Patterned on the previous board exams from December 2006 ~ July 2012... the purpose of this note the possible topics that might be part ofthe upcoming Dec 2012 PNLE (0 GUIDE students onWHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 6: MEDICAL AND SURGICAL HEALTH NURSING (A) NURSING MANAGEMENT Goal increase myocardial contraction ‘Administer medicuions es ondered + Cardiae glycosides 7 Digoxin “Antidote: Digibind + Loop diuratis + Bronchodiators + Narcotleanalgisies ¥ Morphine sulfate + Vasouliators *Antearshythmic agents Administer O2 ination at 3-4 Linge Restrict Naand Mids Monitor sriclly VS and [0 and Brew SoundsWWeigh pe daily and assess frp edema and asominal git daly and waify MD Provide maiculus skin eae Provide wdctary intake whichis low in strated fats and alfine RESPIRATORY NURSING ‘A. Diagnostic Evaluation 4. Sldn Test: Mantoux Test or Tuberculin Skin Test This is used to determineifa person hasbeen infected oF has been exposed to the TBbacilus This uilzes the PPD (Purified Protein Derivatives). The PDs injected tmtradermally usually the Inner aspect of the lower forearmabout 4 inches below the elbow. The tests read-48 to 72 hours after injection, (2) Mantous Tests induration of 10 mm or more ut for HIV postive clients, induration of about $m i considered positive 2. Pulse oximeter ‘Non-invasive method of continuously monitoFing he omygen saturation of hemoglobin probe or sensor is attached tothe ngertp. forthead, tatlabe or bridge ofthe nose Normal5p0Z =95% - 100% <859%- tissues are not éeiving enough 02 3. Chest X-ray “This & a NON-nvasive pocedfejnvolving the use of ars with minimal radiation “The nurse instructs the patient to praice the on cue to hold bis breath and to dadesp breathing Instruct the cient remove metals fromthe chest Ruleout pregnancy ist, tart romehograhy ‘radiopaque mediuits instilled directly into the trachea and thebbronchi andthe Outline o the ere bronchial tre for solectedareas may be visualized through x-ray. Iroveals anomalies of the bronchial ree a Important in taeda nosis of bronchiectasis. ‘Nursing Interven tonBBBEORE Bronchogram ‘Secure written eomsent (Choc for allergesto seafoods or iodine or anesthesia NPO or 6to8 hours Pre-op meds; atropine $0. and valium, topical anesthesia sprayed followed by local anesthetic Injected into lirynx. Thenurse must have oxygen and ant spasmodic agents rendy. Pores _Mursing Interventions AETER Bronchogram Side-lying postion YNPOuntit cough and gag reflexes retumed Instruct the chentto cough and deep breathe cent 5. Bronchoscopy 1» This is the direct inspection and observation ofthe layms, trachea and bronchi through a flexbleor gid bronchoscope > Passage ofa ighted bronchoscope ino the bronchial ree for direct visualization ofthe trachea and the tracheobronchial tre, Diagnosticuses: 1 Toexamine Wseues or collect secretions Y —Todetermine locaton or pathologte process and collect specimen for bop ¥Toevaluatebleedingsites ¥ —Todetermine fatumorean be resected surgically ‘Therapeutic uses To Remove foreign objects from tracheobronchial tree ¥ ToEsselesions 7 Toremove tacious secretf@ abathating the ‘wacheobranchial ee 1 i arain abscess A) Tolteat postoperative atelectasis Nursing Interventions BEFORE Branchostopy Inloel consent pert needed Espn proce oth ln wat expect to help tim cope wilh the unk % Atropine to diminish secretion) isadministered one Io hearst procedure ¥Aboubad minutes before bronchoscopy, Valiam i sen to-date ptien and aay anxiety Topical anesiesias spayed followed by local thei net note larynx Instrct of NPO for 6-8 hours Remove dentures prostheses and contact lenses “The paca is placed supine with hyper extended neck during te pacedue 546 Nursing Interventions AFTER Bronchoscopy Put the puient on Side ying position ‘Tell paiem tat te throst my fel sore with (Check for de turn of cough and gag reflex. Check vasovagl response, ‘Walch fr cyan, ypotersin, tachycardia, aeryth dyspnea. These ‘Symptons indicate perforation of bronchial tree Refer te patient immedi! Ka ces ADAM 6. Sputum Examination (> Indicated for microscopic examination of the sputum: Gross appearance, Sputum C&S, AFI staining, and for (Cytologic eamination/ Papanicolaou examination + Nursing Interventions: 7 Early morning sputum specimen isto be collected (suctioning or expectoration} ¥ Rinse mouth with plain water Y Usesterile container POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE "Patterned on the previous board exams from December 2006 ~ July 2012... the purpose of this note (0 GUIDE students on the possible topics that might be part ofthe upcoming Dec 2012 PNLEWHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 6: MEDICAL AND SURGICAL HEALTH NURSING (A) ¥ Sputum specimen for Sis collected before % —Auscultate lungs toasses for pneumothorax thefirst dose af antimicrobial therapy % Monitor oxygen saturation (5203 levels For AFB staining colet sputum specimen for ¥ Balrest Uitee consecutive moruings. Y Check for expectoration ofblood 6. Pulmonary Function Test/ Studies €.chronte Obstructive Pulmonary Diseases e Non-nvashotest Measurement of lung volume, venation and difusing Ghronienronchitie | Smowng | 7 Comer FNS spac 5 ‘due loaters) ar cough a Inflammation ofthe | pollution | ¥ Dyspnea on exenion bronchi due to with prolonged Lung Volumes and Capacities hypertrophy or expiry gu yperplaia of goblet Anorexia i aes tical reducing els eters body a ee leading to mare Saaie salle airways ¥ Cyanenis 0 % Seared clevtboochi 1 ro ancaT a a TTS Reversibealay matory ¥ Despnea son hing eonton ehised hy % Wheeeitg dn expiration ypennstiviyee ¥ Tecyearia Fem slrgens leading palit nd narrowing of smaller Siggorsis vn neways Bil apprcensin, 4 felons Y Cyanons ‘Bronchiedasis Recurrent | 7 Consbient pdaaine aati, the bronchus duct P| Congenital | ¥ Dyspnea ‘ventilation, and ack-base status > Anteral punctureis performed onarsas whore good pulses are palpable (radial, brachial, or femoral) Radlalartery destruction of muscular "disease | ¥ Presence of cyanosis and elastic ussue ofthe | Prosence | 7 Rak and erackes necomn den” |% ames Tea indore a 2 ESET ramen —_ =———= crore go _ ete Wo, cat ‘i an a wn x ae Fee NN tryst 7 tae y ecco, 2 oe ey back Bronchodilators Nursing Interventions after Thoracentesis Corticosteroids (5-10 minutes after bronchodilators) % Monitor va sig trequenty Position the pationton the affected side, as ordered, forat least hour seal the puncture site ¥Turnontheunaftected side to prevent leakage of Aud in the thoracic exviy Cheek the puncture site for Mud leakage Foe ts Nebr and sustion Provide comforhe an hurl environment ‘Avoidanes of smoking and llersens emt os needed POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE "Patterned on the previous board exams from December 2006 ~ july 2012... he purpose of this note is to GUIDE students on the possible topics that might be part ofthe upcoming Dec 2012 PNLEWHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 6: MEDICAL AND SURGICAL HEALTH NURSING (A) PNEUMONIA Administer bronchodittors 15-30 7 Inflammation of the tung parenchyma leading wo pulmonary minutes before procedure ceasoiation because alveoli led with enudates ¥ Sopp cant tolerate the procedure Provide oral care alter procedure a5 it 1. Btioilogic Agent nay affect taste sensitivity ‘L Streplococcus —pneumaniae (pneumococcal ¥ Comraindations pneumonia} Unstable WS 2 Hemophils infuenzae (bronchopnumonta) Homoptysis 3 Klebsiella pneumoniae temic & Pelee neeumcass Increased 10P (glaucoma) See ania 12, Provide pehealh tasching nd de planing + Avoidancodf praipitating factors Predisposing Factor + Prevention af complications ¥ ecais 2 Apotiaon ¥ fferingnis A Inmunocompromised Rg compliance to medatons = (AIDS = Importance of Fup carey 2 Napos's sarcoma 7 Petmocati crn Peumonia ss DOG Zidovudine (Retrovir) + Bronchogsnic Ca ‘A. lod Cettular Components 4 Probngedimnebity Qypasaepramosi) 5 Aepratonot tnd (praten ptm) he 7 & derive Zo Ses Symptons enh tony *Hem BM Ave 22-30 | icons preen of , mabecdivn soph prennies te Cap id delivers oxygen to tissue 2 Dyspnea with prolong expiratory grant ma es Bev: ils eee ger ty aie stiomatoaie YBa, | rad ctzerentage what 5. Pleuritic frietion rub a Blood © Rahsfercteson aston Abdominal isenon’> poral ee eRe 1000073 1. NURSING MANAGEMENT 1. Enforce CBR (consistent to all resp sarders) ‘Neutrophils | Most common Firstiine of defense, 2 Stereapratnysaton % aprrinbeang he 4% Adminiger medcatons as ordered Ticoncbuca:| Siteateasaline * Bice chacomin short lifespan immobilizing the a tony 1012 | patfgens ntoter etracyelin’ hours WBCs arrive ° heme > hope 1 Te A eins - =| caneriensseta i 4. -Adminiser 02 ination astiered meee | ee ey _ 5. Force fluids to liquely secretions | ane ea en teneo aa ee Ce © apa aan sgrecertionot eons eyes = DBE, ‘Coughing exercises, Pr = ae Ceapng/vrtion. “Turn and | oy Jenoctes ¥ targes woe 7. Weyland suet PRN Comedia) & Plageidientofsenifowletso high fomkers ocebosrtak|| B Cae 0 peemssay espa 3. rovllegomorablesnd huni enrenment fom | yeep 10, Providlegietary intake high in CHO, CHON, Calories ¢_Anteumor anu vue 11, Assisin pls Ange Patient ig pliced in various postion wo drain secrotiogs ia force of gravity, + Usually, iis the upper lung areas which are 50.450 | Promotes hemostasis -> thousand mm3_| prevention of blond loss + promote dotting mechanisms drained + Nursing management: % Monitor¥Sand oS Y Hest performed before mealsforeakfast or 23° hours pc. to prevent gastroesophageal reflux or vomiting (pagkagising maraming secretions dba? Nakulktha’} Encourage DBE POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE "Patterned on the previous board exams from December 2006 ~ july 2012... he purpose of this note is to GUIDE students on the possible topics that might be part ofthe upcoming Dec 2012 PNLEWHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 6: MEDICAL AND SURGICAL HEALTH NURSING (A) Te water cobble and le mally exeretabler oral forms might develop tolerance. Increase caloric intak, CHON, CHO, Fe, vir Encourage dlentto use sot bristled toothbrush and avovd tating ™mouthyrashes (remember there are rmouthsores!) Avoid heat application (there is ‘humbness remember?) > mayleadto burns B.Blood Disorder TRON DEFIGENG! | 7 Monitor orsigasofbleedingof hema ‘ANEMIA (IDA) ~ test incding urine, stool and rt hroniemeracytic | ¥ Enforee CHRso as not th overtire patient ‘anemia diet” | ¥ Encourage increased ion diet Inadequate Y —Avoldtannates in tea and cee absorption ofiron | ¥ Administer medications as ordered leading to 2 a Iypoxemie tissue NURSING MANAGEMENT injury 1 Administer with meals t lessen Git imitation 2 Use straw for liquid form Administer with orange juice or vitamin Co Fcltate absorption 4. Inform client of SE/monitor for a. Anoreca b, Nauseaand vomiting Abdominal pain 4. Diarse/constipation fe Melena Parenteral Iron Preparatio NURSING MANAGEMENT A. Administer wingz-tractmethod to prevent dscomior, discoloration andlealage 2 Avoid massaging of injection ste inetead encourage pt.to ambulate to facilitate absorption 3 Moniwrsé a. Painat injection ite b. Localized abscess © Lymphadenopathy. 4. Fever and chills “APLASTIC 7 nvoree complete BR ANEMIA stem — | ¥ Administer O2 inhalation cell lsorder Y — Reversetsolation leading to bone | ¥ Monitor for sigas of infection marow Y Avoid AM, SQ or any venipunctinesites! depression > | instal use elect raza when shaving pancytopenia(all | 7 Mdieations as ordered blood ees fF Tmunensppeessots via cent decreased) > vencus cahte neni, + Antidymphoeyte globulin ALG) leucopenia, ven withing days ~3 weeks 19 thrombocytopenia ‘ehievewiaimm derapetic eft ‘A Causes of Acute Real Failure PERNICIOUS) ANEMIA - chronie ‘anemia results from deficiency of Inernsie factor leading to Iypochlortydeia (decreased HCl secretion) 6 Heaache, Wzziness, dvspaea,pulpitaion, fold sensivy, pallor andgeneraized body malaise ¥-~Gf¥lajes: Mouth sre, Red beefy tongue, Dyspepsia or indigestion, Weight oss Jaundice RAEN changes — PA isthe most dangerous foxes of anemia, Taping semation, Paresh, Alaa, Paychons biAGNostics ‘ScuLLING's Test - indicates decreased reabsorption of vitamin B12; confirms presence of pernicious anemia NURSING MANAGEMENT. Enforce complete bed rest (consistent alltypesof anemia) Administer Vi B12 injections at MONTHLY intervals for lfeimeas ordered: common site: dorso and ventroglutea] no drug toxicity because “Acie Renal Fa Chronic Renal Failure Sidden Wabilty of the | Imeversbke loss of kidney’ Kidnays to exerste | function nite nus waste products, leads to azoteria STAGES tiguric phase ~ passage ofurine (1-2 weeks) U0, <400 milce Hyperkalemia Hypeenatremia Hyperpsphatenin HYPOCALCEMIA Hypermagaeseria Metabo acids levited BUN, Crea Diuretic Phase (2-2 weeks) 1 Incresed passage of ¥ Hypeskalemia Hyponatremia Convalescent phase (212 Metabo acidoss months) 1 lrnpmoveent in passage of urine ¥ Chanter hy complete duresis PREDISPOSING FACTORS © DM and HPN (cannon causes) = Recumentpycloephriis + Expovure 0 renal toxins STAGES > Diminidhal renal sere volume asymptomstie noma! BUN and CREA > Rena inautcieney 7% Eni-sage renal disease (ESRD) "presence of liga, zotem POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE "Patterned on the previous board exams from December 2006 ~ july 2012... he purpose of this note is to GUIDE students on the possible topics that might be part ofthe upcoming Dec 2012 PNLEWHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 6: MEDICAL AND SURGICAL HEALTH NURSING (A) NURSINGMANAGEMENT ARE /CRE ENDOCRINE NURSING Y Enlorce CBR % Sain oxygen inhalation as dered ‘A. Thyroid Gland Disorders High CHO det ow CHON, fats, High vit and minerals HYPOTHYROIDISM THPERTTITROTOSH Provide meticulous akin care Decreased 73 and Tt Thereased TS and Tt Wash with wm water fy Saar ss Mopar agian eiaaeel Soap istates ant deen skin 1 Weakness and aigue | “appetite 7 Meds ay ereted 2 Lossotappettebut | 2. (+) weightloss ft + ARRAN agents (weight gaint creased metabolism 1 Hydralarin (appresotine) increased ipolysis | 3. heatinolrance = SBiorthstauchypotonsion 3. Deskin 4 moist skin + Naticos 4 Coldintolerance | Seihbisrhes + Kayeseate enema 5. Constipation & increasca vs + Hlemannis| 6 Memoerhaga 7. ENSchanges + Antbites Late Signs ‘a retail + Supplementary vtamins and minerals 1 Britonoss of aie 3. agiotion + Phosphate binders 2 Nompiting dori Seetruors + Calcium gluconate 3. Hoarsenass of vile Gh Restossness 4. Decreasediihide © trsomnia 5. Decraseaiy’s £Aallemaions B. Nursing Management on Hemodialysis © Cysiduangen 8 Goiter Lethargy 9. Bxophthatnos + Secure consentand explain procedureto lent b Mamory 10, Amenorrhea Maintain strc aseptic technique impalrent {Dhan baseline data ~ before and q30dusng Dh rerchosts procedure T Monit STRICTLY VS, |. MositgrVS andi eoiciy vos [Oto determine to determine presence of owe resenee of ‘THYROID STORM /Crisis % Bloodexams secur allpre-procedure MYNEDEMAOOMAs | 2. Adninitermediations v0 complicaonofseyere | "as ordered hypothyroidism a AnicTayroid Agents + Havectiont void preprocedure ddnracterized bye PTU 3 toxic eflectsis + Inform ptaboutbleeding blood is hopin) a Severe AckanuLpevresis> + Monitor for signs of complications (BEDSSH), hypotension fever and chil sore Bleeding b. Bradyeardia Unroat (throat CS ¥ Embotsm © Bradypnea pls} Lanocrrosis DISEQUILIBRIUM SYNDROME resus rom rapid i iinerseaittin feut pts loss ofsitrogenous waste products patieulrly UREA Soagtisporicenis Metisse fromthe brain 1 Hyponatremia (Tupac) PN Hypothermia | 3. Highcalork dietto Disorientation iia sign 2.6 Administer sotonie correct weight loss Nausea andvomiting fhidsas ordered | 4, Provide comforable and Anorexia Administer cool environment Romie rmodiations 28 5. Institutemetctlousskin a ordored~Unyroid care srectberis hormonesoragems | 6, Maintain side rails a Hueibness (ray cause Insomnia | 7. Bikateral ee patch to Sepucemt snd heat itor) prevent drying of eyes Yopeshock 4 Providedietary intake | 8, —Assstin surgical 7 Mepatus lowin calories to. Procedure: subtotal + Avoid Baking phleBotomy, 1V madg a the site of ee per Ft blood extraction to prevent compression _ Tae + )Maintanpateney of shunt tla ene — 7 Patpe or thes, ntsc or brits ¢ eager c ica ° Instruetthat minimal bleeding is expected since ood Cerpecentirenn: | acento! 7 BEEIARE sors cctatves,and wangul savivonment vasculature and prmate svcd aI sors setatves and trance to 7. Fred Mids Atrophy ofthe thyroid plan to prevent yaaa ordered snprer estar gin 4 Proparest bedside illdog clips to prevent embolism ae % Auseltte for ruts and palpate fr thls (i (+) > patent) post-op WOF signs of THYROID STORM * agitation hyper~ thera, HPN. 1F (+) uyroid ‘orm: administer anicpyretics dnd beta-blockers: VS 10 and NWS serie siderail up, provide hypothermic Banker WOF. inadvertent or accidental removal of POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE "Patterned on the previous board exams from December 2006 ~ july 2012... he purpose of this note is to GUIDE students on the possible topics that might be part ofthe upcoming Dec 2012 PNLEWHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 6: MEDICAL AND SURGICAL HEALTH NURSING (A) parathyroid gland > bbypocalcumia or etary [(+) Lupusseu's signs (»)clvostk’s Give CaGhucslowty to prevent arrhythmia and arrest \WoF aceidental laryngeal nerve damage > hoarness of Volee > instruct cent to tak Immediately postop > if(+) tify MD WOF signs of bleeding > (4) feeling offulliessatincision site, [+ soiled dressings at baceor nape area, notify MD WOF signs of laryngeal spasm DOBandSOB > prep trache 9. Hormonal Replacement therapy for life 410. importance of FFup care 11 woiring of medie-alort bracelet B.insulin Therapy Types of Insulin A Rapid (SAN - clear, peake 2-4 hours, Regularinsulin E mtermediate Al ~ NPH_ (Non-Protamine Hagedorn) ~ cloudy, peak: 6-12 hours tang Al- Ultra lente~ cloudy, peak 12-24 hours 1. Nursing Management A Administer Insulin at reom temp to) prevent lipodystraphy-> atrophy hypertrophy of SQ tsse Insulin only refrigerated ance opened Avoid shaking insuli oll between palms only ‘ccuracy of adminadtation is important Rotate insulin sites t preven lip odystrophy Use shartbore needle gange 25-26 [No need to aspirate Administer insulin 45/80 degred@)ansle depending on amount to pts SQ tissue Most accessible route: sbalomen Aspirate CLEAR before CLOUDY Mowjprevent Contamifiation and promote accurate calibration K. Monitor forlocal eampliestions 1. valleraie actions) 2 Lipodystrophy 3 SomOcvi's PusxowiNoN rebound effec of insu charagtesized by hypoglycemia, hyperglycemia a alee POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE "Patterned on the previous board exams from December 2006 ~ july 2012... he purpose of this note is to GUIDE students on the possible topics that might be part ofthe upcoming Dec 2012 PNLE