Enhancement Lecture:

Medical-Surgical Nursing

ANEMIA
• Classifications of anemia
• Renal failure - _____________
• Bone marrow depression - _____________
• Lack of nutrition - _____________
• Bleeding or RBC structural problems - _____________
• Hallmark: _____________
• Priority in most anemia:
• Pathognomonic for pernicious anemia: _____________ _____________
• Priority in Sickle-cell anemia: _____________
• Drug of choice for renal anemia: _____________
• Drug of choice for Folic acid deficiency anemia: Folic acid supplement: _____________ mg
• Drug of choice for iron-deficiency anemia: _____________
• Best given with _____________
• Only treatment for pernicious anemia: Lifetime monthly vitamin _______ IM injection
• Confirmatory for pernicious anemia: _____________ test
• The best food source of iron for adults is _____________.
• The best food source of iron for children is _____________.
• Crisis in Sickle-cell anemia
• Pain - _____________
• Infection with parvovirus - _____________
• Congestion of major organs – _____________

ANEURYSM
• Most common site: _____________
• Common causes
• _____________
• Blood vessel damage
• Danger: _____________
• Predisposing factor for rupture: _____________
• Complications:
• _____________ shock
• _____________ shock
• Types:
• Affecting 3 walls: _____________
• Sac on one side: _____________
• Made of tumor or other objects: _____________
• Tear inside: _____________
• Drugs used to prevent rupture: ANTIHYPERTENSIVES
• _____________
• _____________
 APPENDICITIS
• Exact cause: _____________
• Gender: _____________
• Triad:
• _____________ sign
• Low-grade fever
• Leukocytosis
• Assessment: (Pain)
• Rebound tenderness on RLQ: _____________ sign
• Palpation on LLQ will cause more pain on RLQ: _____________ sign
• More pain on lateral hip flexion: _____________ sign
• Loss of pain: _____________
•
• Absolute management: _____________
• Must be done within 24-36 hours
• Anesthesia type: _____________
• Postop position: Flat on bed (_________ hours)
• Best indicator of peristalsis return: Presence of bowel sounds

ALZHEIMER'S DISEASE
• Exact cause: _____________
• Depleted neurotransmitter: _____________
• Hallmark: _____________
• Priorities: _____________ and Security
• DOC: _____________

BURNS
• Most common type: _____________
• Priority: _____________
Shock Diuretic Recovery
(Emergent) (Compensatory) (Rehabilitative)

Time

Fluid imbalances

Electrolyte imbalances

Acid-Base imbalances
 CANCER CONCEPTS
• Most common cancer (Both gender): _____________
• Most common cancer (Males): _____________
• Most common cancer (Females): _____________
• Most common cancer (Gender-specific for males): _____________
• Most common cancer (Gender-specific for females): _____________
• Most common cancer (children below 12): _____________
• First sign of bladder cancer: Painless _____________
• Cell identified in Hodgkin’s lymphoma: _____________ Cell
• Virus allegedly causing Hodgkin’s lymphoma: Epstein-Barr Virus
•
• Principles of care for a patient under radiation therapy
• All are regarded radioactive
• Safe distance: _____________
• Safe shield: _____________
• Safe time exposure: _______ mins / shift
• Absolute contraindications:
• _____________
• Children below ____ years old

CATARACT
• Most common cause: _____________
• Type of blindness: _____________
• Main symptom: __________________________
• Treatment: _____________

CHOLELITHIASIS / CHOLECYSTITIS
• The liver can produce _____________ cc of bile every 24 hours.
• The predisposing factors of gallbladder problems are:
• _____________
• Fat
• _____________
• Fertile
• Fair _____________
• Family Planning
 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Asthma Bronchitis Emphysema

Disorder Allergic Autoimmune

Involvement Ventilation Ventilation

Hallmark

Other name ROAD / RAD Blue Bloaters Pink Puffers

• Oxygen delivery: Low-flow (1-3 LPM)

• Most accurate method: _____________ _____________
• Mixes with room air: _____________ _____________
• Diet:
• Consistency: _____________
• Frequency: __________ x/ day
• The most common side effect of bronchodilators is _____________
• In asthma, the damage to the mast cells by the IgE can cause release of _____________.
• Histamine 1 can cause _____________ and vasodilation
• The best position to promote maximum lung expansion is _____________.
• In bronchitis, the excessive production of secretion is caused by the activation of _____________ cells.
• Right-sided CHF secondary to COPD is known as _____________ _____________.
• Permanent alveolar dilation is known as _____________.
• The primary symptoms of the “Blue Bloaters” are _____________ and _____________.
• Cromolyn sodium is classified as a _____________ _____________ stabilizer.
• Pulmonary hypertension may occur for a pressure exceeding ____ mmHg
• The main purpose of pursed-lip breathing is to expel more _____________ _____________.

CONGESTIVE HEART FAILURE

• The major therapy in CHF is _____________ therapy.
• Digitalis have (+) _____________ and (-) _____________ effects.
• To prevent digitalis toxicity, _____________ level must be kept normal.
• The safest diuretic is the _____________ ___________
• Bloodless phlebotomy is also known as _____________ tourniquet
• The effect of vasodilator in a client with CHF is that it decreases the _____________.
• The goal of diuretic therapy in CHF is to promote _____________, decreasing the
• blood volume.
 CORONARY ARTERY DISEASES
• The 4 E’s that predispose the attack of stable angina are
• _____________ stress
• _____________
• extreme _____________
• excessive ______________
• The pain of angina pectoris should not last more than _____ minutes.
• The drug of choice of angina pectoris is _____________.
• CAD’s are usually caused by _____________.
• The waste product of anaerobic glycolysis is _____________ acid.
• The most sensitive laboratory test for myocardial infarction is _____________.
• The most indicative laboratory test for myocardial infarction is _____________.
• The most definitive laboratory test for myocardial infarction is _____________.
• The drug of choice for myocardial infarction is _____________ _____________.
• When giving morphine sulfate, RR must be monitored because it can cause _____________
_____________
• The antidote for morphine sulfate is _____________.
• In MI, LDH flip may indicate _____________ _____________.
• The most common complication of MI is _____________.

CUSHING’S AND ADDISON’S DISEASE

• The hormones of adrenal cortex are:

• Glucocorticoids – major is _____________
• Gluconeogenesis
• Fat distribution
• Mineralocorticoids – major is _____________
• Sodium retention
• Potassium excretion
• Sex hormones – _____________, _____________, _____________
• Development of secondary sex characteristics
• The hypersecretion of adrenal cortex is known as _____________ _____________.
• Hypercorticism secondary to administration of steroids is known as _____________ _____________.
• Fat misdistribution in Cushing’s disorders may cause thinning of arms and legs, Buffalo hump and
_____________ obesity.
• Truncal obesity may cause congestion of femoral veins that may lead to _____________.
• Lability of mood in Cushing’s disease is caused by excessive _____________.
• Hypertension in Cushing’s disease is caused by excessive _____________.
• Primary adrenal hypofunction is known as _____________ disease.
• The occurrence of profound weakness, shock and infection in Addison’s disease is known as
_____________ _____________.
• The goal to a client with Addison’s disease is to prevent _____________ shock.
 DIET CUSHING’S ADDISON’S

POTASSIUM

SODIUM

CALORIE

FLUIDS

DIABETES MELLITUS
• Upon taking glucose, it will transported to the cells within _____ hours.
• Insulin lowers blood glucose level by transporting glucose to the cell and converting excess to become
_________.
• The hormone that raises blood glucose level by converting glycogen to become glucose during
hypoglycemia is _________
• _________ _________ is prolonged hyperglycemia
• Gestational DM is caused by elevation in the hormone _________ _________ _________ which
antagonizes insulin.
• The closest predisposition of IDDM is _________.
• The closest predisposition of NIDDM is _________.
• Cushing’s related DM is related to elevation in the hormone _____________.
• Polyuria in DM is secondary to _________ _________.
• Polydipsia in DM is secondary to _________ _________.
• Polyphagia in in DM is caused by _________ _________.
• The hallmark of DKA is _____________ _____________.
• The only management of DKA is _________ _________.
• The triad of management of DM are
• _________
• _________
• _________
• OHAs are only used to _________.
• The reason for rotating sites for insulin administration is to prevent _______________.
• The ideal route of insulin is ____________.
• Rebound hyperglycemia to a client taking insulin is known as the _________ phenomenon.
• The only insulin given IV is the _________ insulin.
• Complications of administering IV insulin
• _____________
• _____________
• _____________
• The most accurate test to determine blood glucose level is _________.
• The most accurate test to diagnose DM is _____________ _____________.

GUILLAIN - BARRE’ SYNDROME

• Exact cause: _____________
• Predisposing factor: _____________ exposure
• Pathophysiologic basis: _____________
• Classic sign: _____________ paralysis
• Priorities: S B A
• DOC: _____________

HYPERTENSION
• Most common type: _____________
• BP of _________ or more for 6 months or longer.
• Common complication: _____________
• Drugs used:
• Vasodilators
• Diuretics
HYPERTHYROIDISM AND HYPOTHYROIDISM
• When taken by oral route, iodine will stay in the blood for _________ hours before it is utilized by the
thyroid gland.
• The hormones of the thyroid gland are;
• T3 – _____________
• T4 – _________ production
• TC – PTH _____________
• The most dangerous symptoms of hyperthyroidism are _____________ symptoms.
• To control hypertension and tachycardia in hyperthyroidism, the drug _____________ must be given.
• The most serious side effect of thioamides is _____________ _____________ depression.
• After thyroidectomy, the client must be placed in _____________ position.
• Hypocalcemia after thyroidectomy is caused by possible damage to the _____________ glands.
• Signs of tetany are: (+) _____________ sign, (+) _____________ sign and _____________.
• Because of possible laryngospasm after thyroidectomy, _____________ set must be at bedside.
• The first sign of thyroid crisis is _____________.
• To reverse hypocalcemia, _____________ _____________ must be administered to the client.
• Exopthalmos in Grave’s disease is known as the _____________ sign.
• The priority to a client having CNS involvement in hyperthyroidism is _____________.
• The rationale for administering iodides prior to thyroidectomy is to reduce the _____________ and
_____________ of the thyroid gland.
• To assess laryngeal nerve damage after thyroidectomy, observe for _____________ of voice.
• Facial twitching upon tapping of facial nerve is known as the (+) _____________ sign.
• Carpal spasm upon occlusion of brachial nerve is known as the (+) _____________ sign.
• Hypothyroidism for the adults is known as _____________.
• Hypothyroidism for the children is known as _____________.
• Hyperlipidemia and bradycardia in hypothyroidism often leads to _____________.
• Too little T4 in hypothyroidism may cause _____________ intolerance.
• The drug of choice for hypothyroidism is _____________ (synthroid)

LIVER CIRRHOSIS
• Most common type: _____________
• Primary biliary cirrhosis is caused by obstruction of the common _____________ duct.
• RSCHF may lead to _____________ cirrhosis.
• Laboratories for liver cirrhosis:
• Most sensitive: _____________
• Most indicative: _____________
• Most definitive: _____________ _____________
• After liver biopsy, the client must be placed on the _____________ side.
• The waste product that increases in liver cirrhosis is _____________.
• Signs of hepatic encephalopathy are:
• Motor: _____________
• Psychological: Hallucinations, Illusions, _____________
• Neurological: Altered _____________
• The earliest impending signs of encephalopathy
• _____________
• _____________ _____________
• To reduce ammonia, management:
• Diet: _____________ _____________
• Lactulose
• Neomycin sulfate
• The management of choice for esophageal bleeding is _____________ _____________ tube.
• The balloon is SBT must be released every _________ minutes to avoid tissue damage.
• Emergency equipment needed in SBT is _____________.
• The most indicative sign of esophageal bleeding is frequent _____________.

MENIERE’S DISEASE
• Also known as: _____________ _____________
• Exact Cause: _____________
• Part affected: _____________
• Triad:
• _____________
 • _____________
• Sensorineural hearing loss
• Priority: _____________
• Diet: Low-_____________

MULTIPLE SCLEROSIS
• Exact cause: _____________
• Predisposing factor:
• G _____________
• U _____________ radiation exposure
• N _____________ deficits
• S low acting virus
• Pathophysiologic basis: Systemic _____________
• Earliest sign: _____________
• Hallmark: Charcot’s Triad
• _____________ _____________
• _____________ _____________
• _____________ _____________
• Priorities: S - A - B - A - P

MYASTHENIA GRAVIS
• Depleted neurotransmitter: _____________
• Hallmark: Muscle weakness
• Confirmatory Test: _____________ Test
• DOC: Neostigmine / Pyridostigmine

MUSKULO-SKELETAL SYSTEM
• The hormone the moves calcium from the bone to the blood is the _____________ hormone.
• The mainstay drug in rheumatoid arthritis is _____________.
• Aspirin is used in arthritis because of its _____________ and anti-inflammatory properties.
• The major goal in any form of arthritis is to prevent _____________ _____________.
• The effect Gold compound preparations may be noticed in _____________ months
• The only anti-rheumatoid drugs that doesn't cause GI irritation are the ________ _________
• Relevant hormonal changes in women that predisposes osteoporosis is decrease in _____________
• The back brace must be worn _______ hours a day.
• Defined as a break in the continuity of the bone is _____________
• Types of Fractures
• Crack on one side - _____________
• Bone is fragmented- _____________
• Caused by twisting force - _____________
• Bone forced to each other - _____________
• Broken bone pressed inward - ___________
6 P's of Neurovascular Assessment
• _____________
• _____________
• Paralysis
• _____________
• Poikilothermia
• _____________

Emergency Management of Fracture

• R_____________
• I_____________
• C_____________
• E_____________
• S_____________

Principles of Fracture Management

• I _____________
• R _____________
• A _____________

Osteomyelitis
• Common agent - _____________ _____________
• Complication - _____________
• DOC - _____________ (Ancef)
• Preventive surgery- _____________

Gouty Arthritis
• Common joint : _____________ _____________
• Symmetry : _____________
• Involvement : _____________
• Hallmark : _____________

Osteoarthritis
• Also known as _____________ joint disease
• Common joints : _____________
• Symmetry : _____________
• Involvement: _____________
• Hallmark: _____________

Rheumatoid Arthritis
• Common joints: _____________ _____________
• Symmetry: bilateral
• Involvement: _____________
• Hallmark: bony _____________
 PANCREATITIS
• Exact cause: _____________
• Predisposing factors:
• _____________
• middle-age
• medicine / substance
• meat / heavy meal
• _____________
• Hallmark: _____________
• Drug of choice: _____________ _____________
• Given with _____________ drugs
• Laboratories:
• Most sensitive: Elevated _____________
• Most indicative: Elevated _____________
• Most definitive: _____________

PARKINSON’S DISEASE
• Exact cause: _____________
• Depleted neurotransmitter: _____________
• Hallmarks:
• Muscle rigidity
• _____________
• Priority: _____________
• Cranial nerves affected:
• Early: _____________
• Late : _____________
• Drugs given
• Dopaminergics
• Anticholinergics

PEPTIC ULCER DISEASE

• The cells responsible in producing HCl are the _____________ cells.
• Stress ulcer is also known as _____________ ulcer.
• To obtain maximum effect, the drugs for PUD must be taken:
• Antacids – _______ hours after meals
• H2 Blockers – _____________ _____________
• Cytoprotective drugs – __________ mins. before meals.
• Diet: _____________
• Surgical management:
• _____________ - Gastroduodenostomy
• _____________ - Gastrojejunostomy
 • Complication of Billroth procedures: _____________ Syndrome
•
• Peritonitis
• Most common cause: _____________ _____________
• Classic sign: rigid, board-like abdomen
• Complications:
• _____________
• respiratory depression
• The microorganism which is thought to cause PUD is _____________.

PERIPHERAL VASCULAR DISORDERS

Raynaud’s Buerger’s
Blood vessels ____________ _____________
Extremity ____________ _____________
Gender ____________ _____________

• Pain upon dorsiflexion is known as (+) _____________ sign.

• The best time to wear the antiembolism stocking is _____________ arising from bed.
• Buerger’s disease is also known as _____________ _____________.

Heparin Warfarin
Route ________________ _____________ Labs checked ________________
_____________ Antidote ________________ _____________
Advantage Fast-acting Long half-life

PSORIASIS
• Exact cause: _____________
• Most common type: _____________
• Most serious type: _____________
• Treatments:
• Coal tars
• Steroids
• Chemotherapy

PNEUMOTHORAX
• Most common type: _____________
• Type of pain
• _____________ - more pronounced on inhalation
• Drug of choice - _____________
• Best position to promote breathing: _____________
• Oxygen delivery: _____________
• Main management: _____________ _____________
 RENAL FAILURE
• Acute
• _____________
• _____________
• Azotemia
• Chronic
• _____________
• _____________
• Azotemia
• Type of azotemia: _____________
• Most accurate diagnostic: _____________ _____________
• Diet: _____________ _____________
• All electrolytes are elevated except for _____________
• Crisis: _____________

RETINAL DETACHMENT
• Common cause: _____________
• Triad
• _____________
• Flashes of lights
• Curtain-shadow across visual field
• Type of blindness: _____________ blindness
• Surgery of choice: _____________ _____________

SHOCK
• Problems on 3 P’s
• _______________
• _______________
• _______________
• Most common type: _____________
• Most dangerous: _____________
• Types:
• _____________ - low blood volume
• _____________ - failure of the heart to maintain circulation
• Distributive - systemic vasodilation
• _____________ - infection
• _____________ - allergy
• _____________ - pain
• _____________ - physical or mechanical obstruction
•
• Primary compensatory mechanisms
• _____________
• Activation of _____________
• Activation of _____________
• Best drug to increase BP: _____________

SYSTEMIC LUPUS ERYTHEMATOSUS

• Exact cause: _____________
• Hallmark: _____________
• Pathognomonic: _____________ _____________
• Most common complication: Renal failure
• DOC: ____________

TRAUMATIC HEAD INJURY

Drugs used in treating Traumatic Head Injury

• Inflammation or swelling: _____________
• Cerebral edema: _____________
• Bleeding: _____________
• The priority to a client having seizures is _____________.
• The most common sign of autonomic dysreflexia is _____________ headache.
• The normal ICP is 0-15 mmHg

Increased ICP
• B P & temp = _____________
• R R & HR = _____________
• A ltered LOC
• I rritability
• N&V
• S _____________

Signs of Increased ICP: Cushing’s Triad

• _____________ _____________
• Widened _____________ _____________
• _____________

TRIAGE

• Primary goal: To preserve life

• Primary Survey: Used to unconscious or unable to respond
• _____________
• Breathing
• Circulation
 • _____________
• Electrolytes
• _____________
• Secondary Survey: Used to conscious victims
• Chief complaint
• _____________
• Exact location
• _____________
• Keep checking

• By color
• Immediate - _____________
• Expectant - _____________
• Delayed - _____________
• Minimal - _____________
•
• By classification:
• Care may be delayed / less chance of survival: Non-_____________
• Care within 1-2 hours: _____________
• Without fail: _____________
• Comprehensive critical care:
• Normal ward: _____________
• Multiple organs / systems involved: _____________
• 1 additional support: _____________
• Single failing organ: _____________

URINARY TRACT INFECTION

• Common pathogen: _____________
• Typesr
• Upper - _____________
• Lower
• Bladder - _____________
• Urethra – urethritis
• Classic symptoms of lower UTI:
• _____________
• _____________
• _____________
• Hallmark of pyelonephritis: _____________________
• Cause of dysuria: _____________
• DOC: _____________
• Cause of suprapubic pain: _____________ spasm
• DOC: _____________
• Management:
• Fluid intake = _____________
• Diet: _____________
• Hygiene (3W’s)
• _____________
• _____________
• _____________