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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-nonproductive 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
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Rash – clearly demarcated, erythematous covered with silvery scales w/c re3moved by scraping w/ pitting in the nail beds---Txhydration 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

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

Principal signs of adrenal crisis- abdominal pain, hypotension and shock-withdrawal of steroids …. Tx – steroids , And D5 .9 NSS infusion

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

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