Medical Surgical Nursing
Chest X ray painless procedure
Bronchoscopy
AtSO4
Anticholinergic mimics SNR
Decreases saliva dry mouth
NPO 6 to 8 hours
Local anesthesia check gag reflex before feeding
ABG
Hyperventilation decreased CO2 increased blood pH respiratory alkalosis
Hypoventilation increased CO2 decreased blood pH respiratory acidosis
Diarrhea decreased HCO3 decreased blood pH metabolic acidosis
Vomiting gastric content decreased HCL increased blood pH metabolic alkalosis
Vomiting blood decreased O2 anaerobic metabolism formation of lactic acid decreased blood pH
metabolic acidosis
Blood pH normal 7.35 to 7.45 If increased alkalosis; If decreased acidosis
Partial CO2 normal 35 to 45 If increased Respiratory Acidosis; if decreased Respiratory Alkalosis
Partial HCO3 normal 22 to 26 If increased Metabolic alkalosis; If decreased metabolic acidosis
Cancer of the larynx CS, alcohol and over usage of voice (choir member)
A - nterior neck mass
B – urning sensation with hot beverages / Bad breath
C - hange in the voice (hoarseness)
D – ysphagia/dyspnea
Chronic Obstructive Pulmonary Disease
Chronic Bronchitis
Blue bloater
Excessive mucus production
Asthma
Periods of bronchospasm and bronchoconstriction
Emphysema
Disequilibrium of elastase and antielastase
Pink puffer
Manifestations
A – LTERATION IN
LOC decreased O2
Thoracic anatomy over distention of alveoli TD = APD barrel chest
Skin
Temperature cool clammy skin
Color pale to cyanotic
ABG Respiratory acidosis Increased CO2
B – reathing difficulty, purse lip expiration > inhalation removal of excess CO2 (diet low CHO)
C – ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2 therapy, decreased O2 demand by rest and
SFF) clubbing of the fingers and decreased TP to the kidneys causing polycythemia
D – ecreased Metabolism
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Anorexia weight loss (high calorie diet) fatigue weakness
Bronchodilators
Theophylline and aminophylline
Primary effect stimulates beta 2 receptors smooth muscle relaxation bronchodilation
Side effect stimulates beta 1 receptors increases cardiac rate need not to notify the physician
Adverse effect hypotension monitor BP sign of toxicity
Evaluation check breath sounds
Acute Respiratory Distress Syndrome
Causes
A – spiration
R – espiratory trauma (embolism)
fracture embolism ARDS
D – rug toxicity (ASA)
S – epsis and shock
Vomiting, bleeding, dehydration hypovolemia shock ARDS
Syndrome
Severe hypoxia
Bilateral infiltrates
Dyspnea
Pulmonary embolism
Restlessness earliest
Water Seal System
Drainage Bottle marked the level every shift
Water seal bottle
Presence of fluctuation normal
Absence of fluctuation lungs are fully expanded assess first patient (X ray confirm) OR presence of
obstruction
Intermittent bubbling normal
Absent obstruction
Continuous leakage
Suction Control continuous bubbling normal
Risk factors for cardiovascular disorders
R – ace non modifiable
I – ncresed blood pressure modifiable
S – tress SNR increased BP and CR, vasoconstriction modifiable
K – nowing sedentary life style modifiable
F – at foods atherosclerosis modifiable
A – lcohol (modifiable) / Age above 40 (non modifiable)
C – igarette smoking vasoconstriction (nicotine) modifiable / Contraceptive pills clotting of blood
thrombus formation
T – ype A behavior (modifiable) competitiveness, perfectionist high stress level
O – besity
R – esult of DM lipolysis increased fatty acids atherosclerosis
2
S – ex gender males > female (before menopausal because estrogen decreases PVR) after menopausal
female eversible}[inverted T wave] Injury [elevated ST segment] > male
Decreased TP in heart Ischemia (Angina) {r necrosis (MI) {irreversible}[pathologic Q wave/permanent in
the ECG]
Eating a heavy meal, strenuous exercise, sex, exposure to cold Decreased blood flow (heart) decreased
TP (heart) decreased O2 (heart) anaerobic respiration production of lactic acid PAIN
management decreased O2 demand by rest and SFF
Angina
Pain relieved by rest and NTG
NTG
Vasodilation orthostatic hypotention move gradually Monitor BP
Store in a dark and amber container
Effective tingling sensation no need to notify physician
Maximum of 3 tablets with 5 minute interval
MI
Pain relieved by Morphine SO4
Narcotic analgesic
Can cause respiratory depression monitor RR and O2 saturation
Antidote narcan
Cardioversion synchronous
Defibrillation unsynchronous
Buerger’s disease CS vasoconstriction stop CS common in men
Raynaud’s stress and cold vasoconstriction common in female
Congestive heart failure
Left sided pulmonary
Dyspnea
Crackles
Polycythemia due to decrease O2 to the kidneys
Clubbing of the fingers due to prolonged hyxia
Orthopnea
Right sided systemic
Hepatomegaly
Distended neck veins
Edema
Portal hypertension
Ascites weight gain
Varicose veins
Digoxin
Cardiac glycoside
Positive inotrophic effect increased strength of myocardial contraction
Negative chronotrophic effect decreased cardiac rate monitor CR never give if CR below 60 bpm
Adverse effect
V – omitting
A – norexia
N – ausea
D – iarrhea
3
A – bdominal pain
REMEMBER: earliest GI; late halo vision
Antidote Digibind
Decreased RBC Activity in tolerance, Fatigue, provide rest, Anemia
Decreased Platelets Prone to bleeding, avoid parenteral injection, appl pressure on injection site,
high risk for injury
Decreased WBC prone to infection, reverse isolation
Increased WBC presence of infection
First Day/Newly diagnosed Knowledge deficit
Diuretic
D – iet high K diet except aldactone
I – input and Output expected increased output
U – ndesirable effect electrolyte imbalance (K)
R – ecord weight expected decreased weight
E – lderly special precaution
T – ake in AM and with food
I – ncreased orthostatic hypotension monitor BP and move gradually
C – ancel alcohol because of mild diuretic effect
Heparin anticoagulant prevent further enlargement of clot not dissolve them monitor APTT/PTT
antidote protamine SO4
Coumadin anticoagulant prevent further enlargement of clot not dissolve it monitor PT vitamin K is
the antidote
Urokinase/Streptoase dissolves the clot
Pernicious anemia absence of intrinsic factor (gastric surgery) problem in absorption of Vitamin B12
beefy red tongue schilling’s test definitive test 24 hour urine collection life long Vitamin B12
Gastritis LUQ pain
Gastric ulcer affected area stomach pain (precipitated by food intake increased HCl) pain relieved
by antacids
Duodenal ulcer affected area duodenum pain (2 hour after eating) pain relieved by food
Ulcers bleeding (+) occult blood test (guiac) high fiber diet, avoid red meat, iron, steroids, NSAIDs,
indomethacin
Vagotomy resection of vagus nerve decreased cholinergic stimulation decreased HCl and gastric
movement
Dumping syndrome tachycardia and weakness 3 D’s (diarrhea, diaphoresis and dizziness) fluids
after meals, lie down after meals and SFF
Appendicitis RLQ pain avoid heat pads cause rupture signs of ruptured appendix sudden
cessation of pain, elevation of temperature and WBC
Diverticulitis LLQ pain low fiber diet
Diverticulosis high fiber diet
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Ulcerative colitis bloody diarrhea 20 to 30 times a day fluid volume deficit
Liver cirrhosis alcohol and malnutrition (laanec’s), infection and drugs (post necrotic), RSCHF (cardiac)
and biliary obstruction (biliary)
Portal hypertention can lead to
Blood shifted to the different collateral
Esophageal varices
Spider angioma (face and neck)
Caput medusae (abdomen)
Hemorrhoids (rectal)
Management avoid rupture avoid shouting, valsalva maneuver
Increased hydstatic pressure fluid shifting ascites
Decreased albumin decreased oncotic / colloidal osmotic pressure fluid shifting ascites
management high protein diet
CHON metabolism by product ammonia liver cannot convert to urea increased level of ammonia in the
brain Alteration of LOC and changes of behavior and asterexis hepatic encephalopathy
management low CHON diet and lactulose for removal of ammonia
Hepatitis A fecal oral prone plumber
Hepatitis B body secretion prone working in a dialysis
Cholecystitis 5 F’s (fair, female, fat, fertile and forty) RUQ pain after ingestion of fatty food
demerol to relieved pain
Cholecystectomy T tube level of the incision site drain excess bile
Pancreatitis alcohol autodigestion LUQ pain
Anterior Pituitary gland
Growth hormone
Increased before the closure of the epiphysis of the long bones gigantism tall
Increased after the closure of the epiphysis acromegaly big hands (big gloves), big feet (big shoes) and
big head (big hat)
Decreased dwarfism
Prolactin
Increased galactorrhea
Decreased decreased milk production
ACTH
Increased secondary cushing’s
Decreased secondary addison’s
TSH
Increased secondary hypethyroidism
Decreased secondary hypothyroidism
Posterior pituitary gland
ADH
5
Increased water retention oliguria edema (fluid volume excess) and weight gain concentrated urine
increased urine specific gravity
Decreased water excretion polyuria dehydration (fluid volume deficit and weight loss) diluted urine
decreased urine specific gravity
Parathyroid gland
Parathormone
Increased increased calcium in the blood and decrease calcium in the bones stone formation and
decreased bone mass osteoporosis management increased water intake
Decreased hypocalcemia calcium supplement
Thyroid Gland
Increased (hyperthyroidism)
T3 and T4 increased BMR hyperactive inability to focus insomia increased catabolism weight
loss increased appetite increased peristalsis Diarrhea fluid volume deficit Increased CR and RR
(due to increased BMR)
Increased T3 heat intolerance
Calcitonin decreased calcium in the blood tetany compensatory calcium withdraws from the bones
bone destruction (complication)
PTU decreased synthesis of TH watch out for SE (similar to signs and symptoms of hypothyroidism)
watch out for agrunulocytosis (fever, skin rash and sore throat)
Lugol’s solution decreased released of TH before thyroidectomy decreased vascularity of the thyroid
gland
Decreased (hypothyroidism)
T3 and T4 decreased BMR hypoactive sleeps a lot decreased metabolism weight gain
anorexia decreased peristalsis constipation decreased CR and RR due to decreased BMR
T3 cold intolerance
Calcitonin hypercalcemia stone formation
Synthroid and Proloid increased TH
Adrenal Gland
Incresead (cushing’s)
Glucocorticoids hyperglycemia and decrease wound healing
Mineral corticoids increased aldosterone sodium retention and potassium excretion hypernatremia and
hypokalemia
Hypernatremia water retention oliguria edema (moon face,buffalohump, fluid volume excess and
weight gain) concentrated urine increased urine specific gravity low sodium diet
Hypokalemia weakness Prominent U wave high potassium diet
Epinephrine and Norepinephrine Increased BP and CR
Sex hormones
Males gynecomastia and falling of hair
Females hirsutism and deepening of the voice
Decreased (addisons)
Glucocorticoids hypoglycemia and inability to cope with stress
Mineralcorticoids decreased aldosterone sodium excretion and potassium retention hyponatremia and
hyperkalemia
Hyponatremia water excretion polyuria (dehydration, fluid volume deficit and weight loss) diluted urine
--. Decreased urine specific gravity increased fluids and Na
6
Hyperkalemia weakness tall or peaked T waves low K diet
Epinephrine and Norepinephrine decreased BP and CR
Diabetes Mellitus
Type I absolutely no insulin thin insulin
Type II insufficient insulin obese OHA
Diet 50% CHO, 30% Fats, 20% CHON
Exercise Increased uptake of glucose Decreased insulin requirement
Oral hypoglycemic agent (OHA)
Stimulates pancreas to produce insulin
Insulin
SC; IV if DKA
Never massage the area
Never administer cold insulin
Rotate the site of injection
PREVENTS LIPODYSTROPHY
Mix
Aspirate clear first
Inject air to cloudy first
Hypoglycemia
W – eakness
H – unger pangs
A – alteration of LOC
T – achycardia and tremors
A – bdominal pain
B – blurring of vision
C – ool clammy skin
D – iaphoresis
Give orange juice (simple sugars)
DKA increased lipolysis increased ketones
Hyperglycemia polyuria, polydipsia, polyphagia, kussmaul breathing, glycosuria, ketonuria and warm flush
skin
Glycosylated hemoglobin reflect BSL for the past 3 to 4 months most accurate
Foot care
Podiatrist
Avoid removing corns and calluses
Cut toe nails straight across
Avoid walking bare foot
Hepatitis A fecal oral
Hepatitis B body and bloody secretions (hemodialysis)
Peritoneal Dialysis
Diasylate output is decreased turn patient from side to side
Complication infection monitor WBC and temperature, diasylate is cloudy boardlike and rigid abdomen
peritonitis
7
Don’t include diasylate solution in the output of the client
Expected decreased weight monitor weight before and after decreased createnine and BUN
Heart block decreased tissue perfusion
Parkinson’s diasease
Decreased dopamine in the basal ganglia levodopa to increased dopamine avoid Vit B6 foods
Cardinals signs tremors (non intentional) muscle rigidity bradykinesia
Pill rolling
Microphonia ask your client to speak aloud to be aware
Artane and Cogentin anticholinergic decreased muscle rigidity
Myasthenia Gravis
Tensilon test confirmatory test
Decreased Acetylcholine and increased cholinesterase
Muscle weakness priority airway
NO tranquilizer, Morphine SO4, Muscle relaxant and neomycin
Cholinergics (mestinon) increased muscle strength antidote ATSO4
Undermedication myasthenic crisis give cholinergics
Over medication cholinergic crisis give ATSO4
Multiple Sclerosis
Demyelinization of the myelin sheath
Charcoat’s triad
Intentional tremors
Scanning of speech
Nystagmus
Visual disturbances diplopia
Pancreatitis autodigestion alcohol bleeding shock
Elevated amylase
Rheumatoid Arthritis
No specific diagnostic test
NSAID’s and ASA (antipyretic, analgesic and anti-inflammatory)
Synovitis Pannus formation fibrous ankylosis (limited joint movement) Bony ankylosis (joint fixation)
Avoid flexion and promote prone position
Gouty Arthritis
Increased uric acid allopurinol and avoid organ meats (liver) tophi (ears)
Osteoarthritis
Most common related with aging
Pain after weight bearing exercise or activity rest to relieved pain weight reduction
Diverticulitis LLQ pain and low fiber diet
Cyclophosphamide (Cytoxan) can cause hemorrhagic cystitis to avoid increased fluid intake
Vincristine (Oncovin) increased fiber in the diet
8
Iron supplement When is the best time to take (empty stomach), How is best taken (with orange juice)
Steroids and NSAID’s
DEATH inflammation
BIRTH side effects
B – one marrow depression prone to infection monitor temperature and WBC
I – ncreased gastric irritation take it with food or after meals
R – enal toxicity
T – innitus
H – epato toxic
Cataract common cause is aging (senile) opacity of the lens position on the unaffected side
Glaucoma increased IOP decreased of peripheral vision first halo, tunnel and gun barrel vision
miotics (constricts pupils) avoid ATSO4 (dilates pupil)
Retinal detachment trauma blood clots floating spots dependent position scleral buckling
Avoid Increased Intraocular pressure PRIORITY
Avoid vomiting, coughing, valsalva maneuver, lifting heavy objects, bending, crying
Meniere’s Triad tinnitus, impaired hearing loss and vertigo low Na diet
Vertigo imbalance high risk for injury decreased vertigo by focusing on one side of the room
assume a flat or reclining position
ASA 8th cranial nerve damage tinnitus, impaired hearing loss and vertigo
Antibiotics allergic reactions
Normal Values
BUN = 10 – 20 mg/dl
Calcium = 9 to 10.5 mg/dl
Creatinine = 5 to 1.5 mg/dl
GTT = 70 to 115 mg/dl
O2 sat = 97 to 98%
Signs and Symptoms of Increased Intracranial Pressure
B – lood pressure and temperature are elevated
R – espiratory and cardiac rate are decreased
A – lteration of LOC
I – rritability
N – ote for projectile vomiting
S – eizure
“ I wish you all good luck for your LOCAL BOARD EXAM ….. “