Med Surg Final Exam Study Guide

Med-Surg Final Test Study Guide Chapter 13  Chronic Disease: Diabetes Mellitus (p. 317) o Chronic diseases develop over time o Diabetes is a chronic disease  Data Collection (Objective vs. Subjective Data) (p.315-316) o Objective is what the nurse observes o Subjective is what the patient says  Initial Assessment by Registered Nurse (327-328) o Assessment must be completed within 24 hours of admission o The RN performs the initial baseline nursing assessment  Lung Sounds: Crackles p. 332-333 o Crackles- produced by fluid in the bronchioles, short cracking or bubbling sound o Sonorous- lower pitched snoring sound that indicates mucus in the trachea  Pitting Edema (+2) p.338 o 2+ is mild deeper pit that rebounds in 10-15 seconds  Sonorous Wheezes o lower pitched snoring sound that indicates mucus in the trachea  Positioning for Assessment (Knee-Chest, Upright) p. 321 o Sitting position- assess areas of head, neck, thorax, lungs, breasts, axillae, heart, vital signs, upper extremities o Knee-chest- rectum assessment  Constipation 318 o Difficulty passing stool  Diarrhea o Frequent passage of loose stools  Jaundice o Yellow tinge to skin (liver)  Erythemao redness of the skin that looks like a mild sunburn  Scleral Icterus- sclera is yellow  Sequence of Assessment: Inspection, Palpation, Auscultation, Percussion 322 o In this order: Inspection, palpation, auscultation, percussion  Basic Nursing Assessment Tools 328 o Penlight, Stethoscope, Blood pressure cuff/nurse on stick, Thermometer, Gloves, Watch, scissors, Black pen, scissors, tongue blade Chapter 18  Dehydration & Fluid Loss (Fatal Body Fluid Loss) 490 o A loss of 20% body fluid is fatal o A loss of 10% of body fluid is serious in an adult  Osmosis 494 o Diffusion of water through a selectively permeable membrane. o Low concentration to high concentration (water concentration) o Lasix (furosemide) often prescribed for patients with edema to stimulate osmosis  Electrolyte Measurements (mEq) 494 o Electrolytes are measured in milliequivalents. It is a measurement of chemical activity of an electrolyte compared with the chemical activity of hydrogen.  Sodium (Extracellular Electrolyte) 494 o Most abundant, extracellular electrolyte  Hypernatremia 495 o Concentration of sodium is greater than normal and exceeds 145 mEq/L. o It is caused by excess of sodium or decrease in body water and presents as edema  Buffer Systems in the Body 503 o Blood buffers- bi carb and carbonic acid o Respiratory- lungs o Kidneys Chapter 22  Wound Healing by Tertiary Intention 627 o Healing where the wound is left open and closed later after infection is controlled. o Healing from the inside out  Postoperative Coughing Support (Splinting) 627 o Teach patient to use a pillow to splint themselves for coughing. o Prevents opening of incision  Wound Irrigation Techniques 638 o Clean from least contaminated to most contaminated o Hand held shower can be used at home by holding it 12 in away from the wound  Bowel Protrusion (Postoperative Priority) 639 o Evisceration o Medical emergency o Use sterile water moistened gauze to cover organs.  Drainage Documentation (Jackson-Pratt Drain) 643 o exudate or drainage in quantities greater then 300 mL in the first 24 hours is abnormal. Report to provider immediately.  Clean Wound Definition 625 o Class one o Infection risk is less than 5%  Phases of Wound Healing (Hemostasis, Inflammation, Reconstruction, Maturation) 626 o Hemostasis- clotting. Fibrin holds the wound together o Inflammation- initial increase in the flow of blood elements and water that allows the repair of cells o Reconstruction- collagen formation occurs and granulation tissue fills wound o Maturation- skin becomes stronger and keloid may appear  Surgical Suture Removal 640 o Removed 7-10 days  Serous, Purulent, Sanguineous, and Serosanguineous Drainage 629 o Serous- watery drainage o Purulent- pussy, green, tan, indicates infection. o Sanguineous- bloody, indicates active bleed o Serosanguineous- pink tinged watery drainage  Patient Assessment for Nutrition-Related Problems o Protein is needed for wound healing. o Insufficient nutrition (patient problem) o Smoking reduces the amount of function of hemoglobin which decreases oxygenation to tissues affecting the repair of tissues Chapter 23  Notification of Healthcare Provider for Abnormal Lab Results 678 o The nurse notifies the prescribing health care provider when results are abnormal.  Midstream Urine Specimen Collection o 1. Clean front to back o 2. Collect urine midstream (between initial stream and final stream) o For culture sensitivity test  Throat Culture Collection 692 o Collect at least 1 hour before meal time o 1. Assess drainage from nasal mucosa and sinuses o 2. Determine whether patient has experienced postnasal drip, sinus headache, nasal congestion, or sore throat o 3. Assess condition of posterior pharynx o 4. Assess for systemic indications of infection, including fever, chills and malaise o 5. Do not allow culture swab to touch buccal mucosa, tongue, or teeth, because such contact contaminates the specimen.  Electrocardiogram (ECG) Abnormalities 695 o Identify abnormalities of electrical conduction of the heart o A Fib  Post-Barium Enema Stool Color 663 o white  Wound Labeling and Specimen Collection 686 o Wound labeling- circle drainage, initial with time and date. Do not remove dressing without order o Specimen collection- Patients name, identification number (medical number), bed and room number, date of birth, age, sex, providers name, date/time of collection, initials of person who collected specimen, test ordered. Chapter 24  Solid Food Introduction in Infants 720 o Cereal/oatmeal first o Introduce solid foods one at a time to determine allergies allowing several days in between foods  Toddler Development (Autonomy and Finger Foods) 724 o Autonomy v shame and doubt o Potty training o Egocentric o Trial and error methods o Finger foods allow autonomy/independence  Signs and Symptoms of Menopause 736 o Irregular periods, flow changes, excess fluid retention, breast tenderness, hot flashes, night sweats, mood swings  Stages of Family Development (Establishment, Expectant) o Engagement- commitment to marry o Establishment- get married and establish a life together (marriage) o Expectant- expecting a child (pregnancy) o Parenthood- taking care of their child (begins at birth or adoption of first child) o Disengagement- when grown children depart from the home (empty nest) o Senescence- when individuals cope with large lifestyle changes (older adults)  Autoimmunity Theory of Aging o The body becomes less able to recognize and tolerate itself which results in antibodies that attack the immune system  Disengagement Theory of Aging o A natural withdrawal between the individual and society  Sudden Infant Death Syndrome (SIDS) Prevention 721 o Back sleeping, avoid soft bedding or pillows  Infant and Child Safety Guidelines 722 o Turn pot/pan handles away from edge  Piaget’s Cognitive Development (Sensorimotor & Concrete Operational Stages) 717 o Sensorimotor- birth to 2 years  Object permeance  Uses senses to understand the world and interact with it o Concrete operational- 7-11 years  Applies logical thinking to interpret experiences, more realistic views, improved memory, can focus on more than one task, cause and effect, understand basic ideas in conversation and number classification  Young Adult Challenges (Career, Family, Intimacy) 733 o Rational decisions, consequences and relationships o Career goals, building a family, intimacy in relationships Chapter 33  Social Security Act of 1935 1085 o Legislation that provides financial security for older adults  Skin Care for Pruritic Older Adults o Pruritis- dryness and itching of skin o Less frequent bathing, water based lotions o Antibacterial soap will dry out their skin  Pressure Injury Prevention (Repositioning) o Reposition every 2 hours o Adequate nutrition  Incontinence Types (Stress, Urge, Overflow, Functional) o Older adults have nocturia (frequent night urination) o Stress- pressure in abdomen that causes urination (sneezing or coughing) o Urge- sudden feeling of needing to urinate often caused by inflammation of the bladder, tumors, stones, CNS  Blood Pressure Changes Due to Aging 1095 o Orthostatic hypotension o Hypertension caused by increased atherosclerosis. o Coronary artery disease  Orthostatic Hypotension in Older Adults o Caused by decreased elasticity of heart muscle and blood vessels  Presbyopia & Glaucoma in Aging 1104 o Presbyopia- farsightedness from vision changes caused by the loss of lens elasticity o Glaucoma- leading cause of blindness from increase of ocular pressure behind eyes  Parkinson’s Disease Effects 1110 o Akinesia- abnormal state of motor and psychic hypoactivity o Progressive degenerative disease that does not impair intelligence. Chapter 41  Anatomical Directions (Medial, Proximal, Distal, etc.) 1245 o Medial- towards middle o Proximal- near o Distal- far/distant  Visceral Muscle Function (smooth muscles) 1254 o Involuntary movement of substances along respective tracts (kidneys, heart, digestive system, etc.)  Adipose and mucous membranes o Adipose tissue (fat)- helps regulate temperature. o Mucous membranes- secrete mucous that keeps membranes lubricated and protects against infection. Chapter 42  Life span considerations for older adults o the patient’s physiological status and coexisting conditions should be evaluated carefully  Preoperative Checklist Responsibilities 1282 o Medication list including herbals and vitamins o Witness informed consent o Allergies o Surgical checklist o Nurse is responsible for pre-op checklist  Preoperative Teaching Timing 1266 o Should be done a few days before the procedure o Pre-op teaching helps reduce anxiety and fear of the unknown  Electrolyte Imbalance in Surgery (Potassium Levels) 1293 o Abnormal serum potassium levels can lead to cardiac dysrhythmias during and after surgery.  Surgical Incision Support and Pain Relief 1272 o Surgical incision support  Adequate nutrition with protein to wound healing  Monitor for dehiscence  Monitor drainage  Teach splinting to cough o Pain relief  Analgesics, decrease in external stimuli, reduce interruptions, eliminate odors, reposition, allow rest times.  Bowel Sounds (Normal vs. Absent) o Auscultate bowel sounds in all 4 quadrants o 5-30 gurgles per minutes is normal o Absence of bowel sounds is determined by listening for 3-5 minutes in each quadrant with no gurgles  Postoperative Instructions o Monitor airway, breathing, consciousness, circulation and system review o Evaluate wound for drainage o Vitals every 15 minutes times 4, 30 minutes times 4, 1 hour times 4 and then every 4 hours o Pain management o Ambulate- prevent blood clots and pneumonia, wake up body systems o Deep breathe and cough  Hypovolemia Indicators and Management 1287 o restlessness o Tachycardia and hypotension o Reduced urine output Chapter 47  Phagocytosis o The process of cells eating or engulfing other cells or particles o Neutrophils use this process  Types of Anemia (Pernicious) 1516 o Pernicious anemia  B12 vitamin cannot absorb because there is a lack of intrinsic factor.  Chemotherapy and Bone Marrow Transplantation 1523 o Chemotherapy must fail before a bone marrow transplant is considered.  Child Communication through Drawing o Drawings can communicate perceptions and emotions about death and dying. o Helps a dying child maintain autonomy, choice, and control. o Therapeutic communication should be used when talking with the child about their drawing.  Leukemia Vaccines and Care 1525 o Annual flu vaccine and pneumococcal vaccine (when diagnosed and then every 5 years) o Neutropenic precautions o Increased risk for infections  Bone Pain Relief in multiple myeloma 1533 o be careful when moving and ambulating patient due to potential for bone fractures Chapter 49  COPD and Cor Pulmonale o COPD is chronic obstructive pulmonary disease that is progressive and irreversible and characterized by diminished inspiratory and expiratory capacity of the lungs (obstructs the air flow to/from the bronchioles) o Cor pulmonale is an abnormal cardiac condition characterized by hypertrophy of the right ventricle of the heart as a result of hypertension of the pulmonary circulation.  Results in edema in lower extremities, distended neck veins, enlargement of liver  A late complication of emphysema o COPD can lead to cor pulmonale  Bronchoscopy Post-Care (Gag Reflex) o Keep pt NPO until the gag reflex returns.  Pursed Lip Breathing for COPD 1667 o A breathing technique for effective breathing o Used for patients who have barrel chest from COPD  Chest Tube Maintenance 1659 o Keep below chest and keep tubing free of kinks  Asthma Pathophysiology (Mast Cells & Histamine) o Acute asthma attack can be caused by an antigen-antibody reaction in which histamine is released by mast cells o Inflammatory response by the mast cells caused by asthma trigger  Chest Tube Function and Maintenance 1655 o Chest tubes is a closed drainage system used to remove fluid and connect to a pleural drainage system with a water seal to reestablish negative pressure in the thoracic cavity