Med-Surg Retake Review
DIABETES
1. A nurse notes a blood glucose reading of 40 mg/dL for a client who has DM. Which of the following manifestations
... [Show More] should the nurse anticipate? (select all that apply)
C. Diaphoresis.
E. Headache.
G. Irritability.
H. Confusion.
2. A nurse is caring for a client who has DM and receives the following laboratory results. Which of the following values should be reported to the health care provider?
C. Fasting blood glucose 250 mg/dL.
3. A nurse is reinforcing education regarding treatment for hypoglycemia at home with the client who has DM before discharge. Give two examples of what the client can treat manifestations of hypoglycemia with.
1. Carbohydrate
• 4 oz of orange juice
• 2 oz of grape juice
• 8 oz of milk
2. 15 mg Glucose tablet(s)
5 THINGS LEARNED FROM MY DIABETES FOCUSED REVIEW:
1. DM is a contributing factor to the development of cardiovascular disease, hypertension, kidney failure, blindness, and stroke.
2. Expected range for Glycosylated Hemoglobin (HbA1c) 4 % to 6%. (Target goal for diabetic patients is less than 7%)
3. HbA1c is the best indicator of the average blood glucose level for the past 120 days
4. Call the health care provider if: – Blood glucose is greater than 240 mg/dL. – Fever is greater than 38.9°C (102°F), does not respond to acetaminophen, or lasts more than 12 hr. – Feeling disoriented or confused. – Experiencing rapid breathing. – Vomiting occurs more than once. – Diarrhea occurs more than five times or for longer than 24 hr. – Unable to tolerate liquids. – Illness lasts longer than 2 days.
5. Treat Hypoglycemia with 2x4=8 carbohydrates
• 2 oz grape juice.
• 4 oz orange juice.
• 8 oz milk.
FRACTURES
1. A nurse is caring for a client who has just arrived into the emergency department with a greenstick fracture. What nursing interventions should the nurse provide for this client?
• Fall precautions
• Maintain proper alignment of the affected extremit
• Frequently check pain level and follow pain management protocols.
2. A nurse is caring for a client who has a traumatic injury to the right ankle. The client has an unstable fracture with only a temporary splint in place. The client is having increased pain that is unresolved with IV narcotics and has 4+ edema, pallor, and pulselessness of the right foot. What should the nurse suspect, and what interventions should be taken?
The nurse should suspect Compartment syndrome:
• Notify RN
• Elevate extremity
• Loosen the dressing/ cut the bandage or tape
• Prepare client for additional procedures, or surgery if needed
4 THINGS LEARNED FROM MY FACTURES FOCUSED REVIEW:
1. Elevate the cast during the first 24-48 hours to prevent swelling
2. If any drainage is seen on the cast, it should be outlined, dated, and timed, so it can be monitored for any additional drainage.
3. Itching under the cast can be relieved by blowing cool air from a hair dryer under the cast.
4. Use to 5 P’s to assess for compartment syndrome (Pain, Pallor, Paresthesia, Pulselessness, Paralysis)
RENAL DISORDERS
1. What are the potential complications of hemodialysis? • Hypotension, headache. • Nausea, malaise, vomiting. • Dizziness, muscle cramps. • Risk of bleeding or clotting of vascular access. • Dialysis disequilibrium syndrome ‒ Headache. ‒ Nausea, vomiting. ‒ Restlessness. ‒ Decreased level of consciousness. ‒ Seizures. ‒ Coma. ‒ Death. • Infectious diseases ‒ Hepatitis. ‒ HIV.
2. What are the potential complications of PD? Peritonitis, protein loss, infection of the PD catheter, hyperglycemia, poor dialysate inflow or outflow
3. What are the risk factors associated with UTIs? • Females. • Aging women related to decrease in estrogen. • Sexual intercourse. • Frequent use of feminine hygiene products. • Pregnancy. • Poorly fitted diaphragm. • Hormonal influences within the vaginal flora. • Synthetic underwear and pantyhose. • Wet bathing suits. • Frequent submersion into baths or hot tubs. • Indwelling urinary catheters. • Stool incontinence. • Bladder distention. • Urinary conditions. • Disease (Diabetes Mellitus), wiping from back to front
4. What are the medications used to treat renal calculi?
Analgesics: First 24 hours Opioids are used, after the24 hours NSAIDS are used for mild to moderate pain
Spasmolytic: relief of pain with a neurogenic or overactive bladder
Antibiotics: Treatment of UTI if applicable
5.Define the following terms:
Azotemia- Higher than normal levels of blood, urea, or nitrogen containing compounds found in urine
Oliguria- Scanty urination/ severely decreased urine output
Anuria- No urine output
Nephrotoxin- Damaging or destruction to kidneys
6.What are some potentially nephrotoxic substances? NSAIDS, Gentamycin, Vancomycin
7. What are the dietary recommendations for clients who have renal failure? Restrict, sodium, protein, potassium, phosphorus, and magnesium.
LOWER GI DISORDERS
1. What are the findings of a strangulated hernia? Pallor, cyanotic discoloration,
blood supply cut off to a portion of the bowel, increasing the risk for obstruction, necrosis, and perforation
2. What are the expected findings with IBS? (chronic diarrhea, constipation, bloating, abdominal pain). IBS can occur after a bowel infection related to changes in the cells and normal flora in the GI tract.
3. What are the manifestations of ulcerative colitis? • Abdominal pain/cramping – Often right-lower quadrant pain. • Anorexia and weight loss. • Fever. • Diarrhea – May have up to 15 to 20 liquid stools/day. – Mucus, blood, or pus may be present. • Abdominal distension, tenderness, or firmness upon palpitation. • High-pitched bowel sounds. • Rectal bleeding.
4. What are the manifestations of Crohn’s disease? • Abdominal pain/cramping – Often right-lower quadrant pain. • Anorexia and weight loss. • Fever. • Diarrhea – Five loose stools/day with mucous or pus. • Abdominal distension, tenderness, or firmness upon palpitation. • High-pitched bowel sounds. • Steatorrhea.
5. What are the manifestations of diverticulitis? • Abdominal pain in left-lower quadrant. • Nausea and vomiting. • Fever. • Chills. • Tachycardia [Show Less]