Med-Surg Study Guide 2020
QUIZ 1 – 25 questions.
• Traumatic Brain Injury – Glasgow Coma scale
o Moderate: 9-12
o Greater than 13: There’s
... [Show More] a minor head injury
o Severe head injury: 8 and below
• Glasgow coma scale
o Priority assessment: LOC, PERRLA (tells us the level of brain injury)
• If BP decreases on someone who has a brain injury
o There will be an increased intracranial pressure.
• Stroke
o Right side of the brain controls: the left side of the brain.
Injury: may not recognize obvious objects or faces, may have spacial unawareness – don’t know the distances
• Seizure disorder
o Do not use the tongue depressor
o Do guide them down on the floor, safety is an issue
• PT has severe head injury, projectile vomiting, bp is high, HR high, temp high, what type of CNS injury is it?
o Hemorrhagic stroke, sudden instant increase in vital signs meaning there was a vessel that ruptured.
A thrombus may cause an slow incremental increase.
Embolic stroke is when someone has a DVT, massaging the lower legs can cause it to travel. Slow increase.
• Increased Intracranial Pressure
o Restlessness is the first subtle sign
o To drowsiness, to loss of consciousness.
• Dilantin (Fentanyl)
o Teaching: Avoid grapefruit juice, no alcohol – high risk for seizures because it alters levels in the blood
• S/S of Parkinson’s disease
o Tremors
o Mask-like face
o Shuffling movement (bradykinsis)
• Epilepsy
o Same precautions with seizure disorders
o Fall precaution, environment safety, do not restrain them
• Cirrhosis of the liver with ascites because they retain fluids
o Nursing intervention:
fluid restriction,
they are on diuretic,
diet: low in sodium because sodium retains water.
• Crhon’s disease:
o Where can it occur? Any place along the GI tract.
o Many areas along the GI tract.
o Foods allowed: low-fat, low fiber, low-lactose
No milk
No buttered bread
Moderate amount of fat, glucose, and fiber is good.
• Ulcer diverticulitis: can be on one spot on the GI tract.
• End stage liver disease
o Clinical manifestations: Jaundice
o Brain: encephalopathy, swelling of brain
o Lab: high ammonia levels
o Teaching: no alcohol, Protein increase ammonia levels when protein is broken down – they need to be on low-protein diet.
• Inflammatory bowel disease:
o Diet: do not give milk or dairy based products, because it causes increase pain and increase episodes of
o Give them soy-based products.
• Pancreatitis
o What can cause pancreatitis: gallstones, alcohol,
o What questions to ask related to history?
• Cirrhosis of the liver
o Part of assessment:
v/s
mental assessment,
weigh daily
measure the abdominal girth
• Cholecystitis
o Inflammation of the gall bladder
o Diet: low-fat
o Lab values: CBC, liver function test (ALT/AST), fluid and electrolyte, complete metabolic panel, ammonia levels
Cbc with dif – NO because
Lactulose is often used to pull the ammonia out – s/s massive diarrhea.
• Similarities of Crohn’s disease and diverticulitis.
o Give them: corticosteroids, anti-inflammatory
• Aneurism precautions
o Before and after surgery, make sure they are not moving around too much, no sudden movement, where to place this patient on the unit? –low stress/low stimuli environment. They’re most likely on the ICU where they’re monitored closely but do not put them by the nursing station.
o What level height? 15-30 degrees.
45 degrees will increase intracranial pressure.
o They are on complete bed rest.
• Dysphagia as it relates to stroke
o Difficulty swallowing
Teaching: raise the head of the bed,
• thickened liquids after speech consult,
• check for pocketing (not food in the mouth),
• small bites – chopped meal, chew slowly
• Multiple sclerosis
o Avoid extreme temperatures
o Because of sensory changes: they need periods of rest. Space their therapies broadly to avoid spasms
• Client comes in with drowsiness after playing with contact sport:
o Check for neuro status every 15 minutes to make sure there is no increase in intracranial pressure
• GuillianBarret Syndrome – cause is unknown but often linked to some viral infection.
o Teaching, history assessment:
have you travelled out of the country?
have you had the flu?
have you had any sort of viral infection?
• Dementia vs. Alzheimer’s
o Dementia is slow, gradual progression. Usually starts with forgetfulness,
o Alzheimer’s, many older adults live with family members.
Include family in teaching plan
Assess their care for the client
Because of possible abuse
Quiz 2 – 25 questions.
• Menopause
o Hirsutism
o Hot flashes
o Low estrogen
o Dry mucous membranes
o
• Cervical Polyps
o Do papsmear/biopsy
o Can cause bleeding because the polyps are fragile
• Sexually transmitted diseases
o Teach adolescents about safe sex practices
• Female condoms, male condoms
o How are they transmitted? Through sex.
• Hormone therapy in women
o Predisposing condition or history of cancer, hormone therapy is not the best choice.
• Before administering or teaching who are on hormone therapy, ask if any history of cancer.
• Gonorrhea, STD
o Teaching: you and partner needs to be treated.
o Abstinence is encourage, but if needed use condoms.
• Breast examination
o Cancerous tumors in the breasts are painless
o What type of tumors in the breast are painful? Fibrous cysts, fibrocystic breast are painful. When is it most painful? Before period, because of increase hormones.
• Genital herpes – always in thee system
o How is it transmitted? Even if no lesions, you can still transmit it.
• Look through ATI book.
• Chemotherapy/radiation therapy
o All cells are affected
• CBC with dif
• WBC is decreased = client high risk for infection
• Put on neutropenia precaution, isolation if below 5.
• 5-10 normal range WBC.
• Skin assessment because it is the first line of defense.
• Client with any surgery, in recovery room
o Priority? Airway, breathing, circulation
• Client is unconscious, bleeding profusely, respirations are 8.
o Priority: respirations.
• Client asks questions,
o What is your nursing approach? Call the doctor. Advocate for patient.
• Encourage client to write down questions for the provider.
• Patient who has mastectomy
o Priority: don’t raise the arm above, no pressure on affected side, do range of motion exercises to prevent lymphedema or frozen shoulder, do not put arm in dependent position.
o First time you change the dressing, sometimes they do not want to see it because it is difficult for them for the loss.
• Chemotherapy and radiation:
o All cells are affected
o Stomatitis – primary clinical manifestations
• Nursing perspective: mouth care, do not use Listerine, foods: soft, bland foods, room temperature, swallowing is an issue – large beefy tongue
• GYN examination
o Inspecting the vulva, inspecting the urethra, and all external areas, vaginal canal
• How do you visualize the urethra, separate labia majora.
• Herpes zoster
o Pain associated with this, even after lesions are gone.
• Reproductive chapter
o BRCA One – genetic test used to determine the probability of breast cancer.
• Client who is immunocompromised
o All cells have been impacted – aplastic anemia
• Precaution:
• Protective isolation
• Check skin
• Penutropenic protective isolation
• Limit the amount of people in and out of the room
• Limit flowers, fresh fruit (because of bacteria)
• If client goes out of the floor:
• Need to wear a mask
o Pancytopenia
• Pap-smear
o Takes a smear of the cervix, and look under microscope.
o If abnormalities noted, then they do Colposcopy
o Then they use a hole puncher – if any abnormal cells to take the tissue.
• Endometrial cancer
o s/s – excessive bleeding, diagnosed late – postmenopausal women.
• Sexual transmitted infection
o Teaching: safe sex practice
o How many partners have you had? Last time you got checked for STI? When was your last pelvic exam? Any drainage? Any mucus, any burning upon urination?
• Patients who are on oral contraception’s
o Teaching: same time everyday, do not skip doses, use a back-up, no smoking, certain herbal meds can decrease birth control: st. johns wort,
o Contraindications for using birth control:
• Hx of blood clots or any blood issues
• Smoking
• Hx of cancer
• High blood pressure
• Genital herpes
o s/s – systemic effects: fever, malaise, presents like the flu, body aches.
• Hormone therapy
o Patients who are postmenopausal, part of the teaching:
• Exercise
• Should be on calcium with vitamin D because they are higher risk for osteoporosis
• Mastectomy
o Post-op client, activities that would be difficult:
• Stretching, reaching, pulling, lifting.
o Abduction – put apart
o Adduction – bring together
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• BPH, TURP – s/s painful urination, dysruria
• Breast cancer nursing management:
o self breast exam,
o treatment after mastectomy to prevent lymphedema.
• Hepatitis A – transmitted fecal oral – make sure protective equipment used.
o Hep B – bodily fluids, blood.
o Hep C – blood
o Nursing Management for hepatitis:
Reinforce safe injection practices
Never recap a needle
Use single dose vials whenever possible
• Pancreatitis: age group usually affected – older adult clients.
o Diet: bland, low-fat diet, low stimulant
• Turners sign
o Ecchymosis on the flank
• Cullen’s sign
o Bluish grey on the abdomen
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