Med Surg final exam review by me
Handicap: societal participation is used in WHO classification system, instead of handicap, to acknowledge that the
... [Show More] environment is always interacting with people to either assist or hinder participation in life activities
Functional Independence Measure for Chronically Ill: measures if a patient can do ADLs independently
Bleeding precautions:
o NO IM injections (minimal injections even Subcut) o Apply pressure for 5 minutes o Use electric razor o Soft bristle toothbrush o No rectal anything o No vigorous sex o No contact sports
Neutropenic precautions: o No fresh fruits or flowers, or meats o No raw foods o No crowds o Wash hands!!! o No children o Peel fruits o Talk over the phone instead of having visitors
Blood Transfusions: Acute hemolytic reaction o S/S of transfusion reactions: fever, chills, respiratory distress, low back pain, nausea, pain at IV site o Interventions: Determine client’s allergies & previous transfusion reactions
Anemia:
o Administer within 30 min. of receiving from blood bank
o First 15 minutes: 25-50 mL slowly, after 15 min. increase to 250-500 mL/hr o Never add
any meds to blood products o Check crossmatch record with 2 nurses o Infuse each unit over 2-4 hours but no longer than 4 hours o Severe reactions in first 15 min. o Blood tubing changed after 4 hours
o If there is a reaction, STOP TRANSFUSION IMMEDIATELY
o Maintain IV line (keep vein open) with NS with NEW TUBING at a slow rate
o Asses patient (vital signs) for other signs of reaction
o Notify HCP & then blood bank & send blood product with tubing back to blood bank o
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o Risks: arm stiffness and ringing in ears are complications of blood transfusions
o Patho: condition in which the hemoglobin concentration is lower than normal
o S/S: fatigue, dyspnea, tachycardia, confusion, weakness, general malaise, pallor of skin &
mucous membranes, N/V, anorexia, glossitis, cheilosis (cracks in corners of mouth), smooth
sore tongue, pica (craving for ice or clay)
o Diet: organ meats, beans, green leafy vegetables (fried liver & spinach) o Interventions: Manage Fatigue o Maintain adequate nutrition (red/organ meats) o Maintain adequate perfusion
o Risks: Heart failure, angina, paresthesias, confusion, delirium, injury r/t falls, depressed mood
Iron Deficiency Anemia:
o Patho: anemia caused by dietary problems (low iron), chronic blood loss, or malabsorption o Most common for women during menstruation; men GI bleeds o Microcytic hypochromic o S/S: smooth sore tongue, brittle & ridged nails, cheilosis (cracks in corner of mouth)
Diet: increase iron in diet (vitamin C sources enhance iron absorption- ORANGE JUICE) o Interventions: Treat underlying cause (bleeding); transfusion of packed RBCs o Give iron supplements (may cause constipation, so give stool softeners)
o **Remember: oral liquid form of iron can stain teeth; clients should use a straw or place spoon at back of mouth to take supplement and rinse mouth thoroughly afterward o DO NOT GIVE IRON WITH MILK OR ANTACIDS
Med Surg 1 Final Review
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o Caution client that bowel movement may appear greenish, black, or tarry
Vitamin B12 Deficiency: Pernicious anemia o Patho: anemia from impaired DNA synthesis b/c of lack of Vitamin B12; also r/t faulty absorption in the GI tract from a lack of intrinsic factor (Gastric Surgery); chronic use of PPI’s and metformin o Other risk factors: ulcerative colitis, alcoholism, and vegetarian diets o Macrocytic normochromic
o Disrupts the function of peripheral nerves, spinal cord, and brain o S/S: mild jaundice o Mouth and tongue soreness- Beefy red tongue (glossitis) o Neurological manifestations (paresthesias, loss of proprioception)
o Diet: organ meats (fried liver & spinach), diary products, eggs & fortified soy milk (for the vegetarian) o Interventions: 24-hour Schilling Test (a vitamin B12 absorption test) o Vitamin B12 replacement o Teach regarding diet & meds; assess for neuro deficits
Folate Deficiency:
o Patho: anemia caused by a deficiency of folic acid o Found in people w/ poor nutrition, alcoholics, people with celiac disease (malabsorption), meds, anorexia o Macrocytic normochromic o Low folate causes constipation
o S/S: mild jaundice, mouth and tongue soreness (glossitis, cheilosis) o Diet: increase folate in diet (green leafy vegetables) o Interventions: administer folic acid 1 mg daily IM
Sickle Cell Anemia:
o Patho: severe hemolytic anemia; results from inheritance of the HbS gene o Causes sickling of cells
o Triggered by: hypoxia, low body temp (being cold), exercise, & high altitude o S/S: jaundice o Chronic anemia: tachycardia, cardiac murmurs, cardiomegaly, ischemia, infarction, late sign= clubbing of fingers o Sickle Cell crisis: hypoxia, inflammation, necrosis (entrapment of erythrocytes in microcirculation) o Acute Chest Syndrome: fever, respiratory distress, new infiltrates on chest x-ray (mimic infection) o Interventions: transfusion therapy o Pain management (first priority, give 02 & hydrate to help w/ blood viscosity) o Adequate hydration (3000 mL) o Supplemental oxygen o Decrease fatigue and inflammation
Aplastic Anemia:
o Patho: deficiency of all types of blood cells caused by failure of bone marrow development (pancytopenia) o Caused by chromosomal alteration, radiation, chemical agents, toxins, viral/bacterial infections o 50% of cases are idiopathic o Fatty deposits found on bone marrow o S/S: thrombocytopenia, leukopenia, reticulocytopenia o Infections of skin and mucous membranes (WBC deficiency) o Bleeding from gums, nose, vagina or rectum (platelet deficiency) o Purpura & possible retinal hemorrhage o Interventions: implement bleeding precautions
o Implement neutropenic precautions Bleeding Disorders:
o Patho: failure of normal hemostatic mechanisms (trauma, platelet factor abnormality, coagulation factor abnormality) o S/S: petechiae, purpura o Interventions: Bleeding precautions o Electric razor
o Limit amount of injections; small gauge needles o No Aspirin o Protect from injuries
Immune Thrombocytopenic Purpura:
o Patho: destruction of platelets by unknown stimulus [Show Less]