Professional Documents
Culture Documents
Bullets in Medical Surgical Nursing
Bullets in Medical Surgical Nursing
Bronchoscopy
o AtSO4
Anticholinergic mimics SNR
Decreases saliva dry mouth
o NPO 6 to 8 hours
o Local anesthesia check gag reflex before feeding
ABG
o Hyperventilation decreased CO2 increased blood pH respiratory
alkalosis
o Hypoventilation increased CO2 decreased blood pH respiratory
acidosis
o Diarrhea decreased HCO3 decreased blood pH metabolic
acidosis
o Vomiting gastric content decreased HCL increased blood pH
metabolic alkalosis
o Vomiting blood decreased O2 anaerobic metabolism formation
of lactic acid decreased blood pH metabolic acidosis
o Blood pH normal 7.35 to 7.45 If increased alkalosis; If decreased
acidosis
o Partial CO2 normal 35 to 45 If increased Respiratory Acidosis; if
decreased Respiratory Alkalosis
o 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)
o A - nterior neck mass
o B – urning sensation with hot beverages / Bad breath
o C - hange in the voice (hoarseness)
o D – ysphagia/dyspnea
Chronic Obstructive Pulmonary Disease
o Chronic Bronchitis
Blue bloater
Excessive mucus production
o Asthma
Periods of bronchospasm and bronchoconstriction
o Emphysema
Disequilibrium of elastase and antielastase
Pink puffer
o Manifestations
A – LTERATION IN
LOC decreased O2
Thoracic anatomy over distention of alveoli TD =
APD barrel chest
Skin
o Temperature cool clammy skin
o 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
Anorexia weight loss (high calorie diet) fatigue
weakness
Bronchodilators
o 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
o Causes
A – spiration
R – espiratory trauma (embolism)
fracture embolism ARDS
D – rug toxicity (ASA)
S – epsis and shock
Vomiting, bleeding, dehydration hypovolemia shock
ARDS
o Syndrome
Severe hypoxia
Bilateral infiltrates
Dyspnea
Pulmonary embolism
o Restlessness earliest
MI
o 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
o Left sided pulmonary
Dyspnea
Crackles
Polycythemia due to decrease O2 to the kidneys
Clubbing of the fingers due to prolonged hyxia
Orthopnea
o Right sided systemic
Hepatomegaly
Distended neck veins
Edema
Portal hypertension
Ascites weight gain
Varicose veins
o 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
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
o D – iet high K diet except aldactone
o I – input and Output expected increased output
o U – ndesirable effect electrolyte imbalance (K)
o R – ecord weight expected decreased weight
o E – lderly special precaution
o T – ake in AM and with food
o I – ncreased orthostatic hypotension monitor BP and move gradually
o C – ancel alcohol because of mild diuretic effect
Liver cirrhosis alcohol and malnutrition (laanec’s), infection and drugs (post
necrotic), RSCHF (cardiac) and biliary obstruction (biliary)
o 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
o Decreased albumin decreased oncotic / colloidal osmotic pressure
fluid shifting ascites management high protein diet
o 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
o 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
o Prolactin
Increased galactorrhea
Decreased decreased milk production
o ACTH
Increased secondary cushing’s
Decreased secondary addison’s
o TSH
Increased secondary hypethyroidism
Decreased secondary hypothyroidism
A – bdominal pain
B – blurring of vision
C – ool clammy skin
D – iaphoresis
Give orange juice (simple sugars)
o DKA increased lipolysis increased ketones
o Hyperglycemia polyuria, polydipsia, polyphagia, kussmaul breathing,
glycosuria, ketonuria and warm flush skin
o Glycosylated hemoglobin reflect BSL for the past 3 to 4 months
most accurate
o 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
o Diasylate output is decreased turn patient from side to side
o Complication infection monitor WBC and temperature, diasylate is
cloudy boardlike and rigid abdomen peritonitis
o Don’t include diasylate solution in the output of the client
o Expected decreased weight monitor weight before and after
decreased createnine and BUN
Heart block decreased tissue perfusion
Parkinson’s diasease
o Decreased dopamine in the basal ganglia levodopa to increased
dopamine avoid Vit B6 foods
o Cardinals signs tremors (non intentional) muscle rigidity
bradykinesia
o Pill rolling
o Microphonia ask your client to speak aloud to be aware
o Artane and Cogentin anticholinergic decreased muscle rigidity
Myasthenia Gravis
o Tensilon test confirmatory test
o Decreased Acetylcholine and increased cholinesterase
o Muscle weakness priority airway
o NO tranquilizer, Morphine SO4, Muscle relaxant and neomycin
o Cholinergics (mestinon) increased muscle strength antidote ATSO4
Undermedication myasthenic crisis give cholinergics
Over medication cholinergic crisis give ATSO4
Multiple Sclerosis
o Demyelinization of the myelin sheath
o Charcoat’s triad
Intentional tremors
Scanning of speech
Nystagmus
o Visual disturbances diplopia
Pancreatitis autodigestion alcohol bleeding shock
o Elevated amylase
Rheumatoid Arthritis
o No specific diagnostic test
o NSAID’s and ASA (antipyretic, analgesic and anti-inflammatory)
o Synovitis Pannus formation fibrous ankylosis (limited joint
movement) Bony ankylosis (joint fixation)
o Avoid flexion and promote prone position
Gouty Arthritis
o Increased uric acid allopurinol and avoid organ meats (liver) tophi
(ears)
Osteoarthritis
o Most common related with aging
o 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
Iron supplement When is the best time to take (empty stomach), How is best
taken (with orange juice)
Steroids and NSAID’s
o DEATH inflammation
o 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
o Avoid vomiting, coughing, valsalva maneuver, lifting heavy objects,
bending, crying
Meniere’s Triad tinnitus, impaired hearing loss and vertigo low Na diet
o 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
o BUN = 10 – 20 mg/dl
o Calcium = 9 to 10.5 mg/dl
o Creatinine = 5 to 1.5 mg/dl
o GTT = 70 to 115 mg/dl
o O2 sat = 97 to 98%
Signs and Symptoms of Increased Intracranial Pressure
o B – lood pressure and temperature are elevated
o R – espiratory and cardiac rate are decreased
o A – lteration of LOC
o I – rritability
o N – ote for projectile vomiting
o S – eizure