Exam 4 Review Multiple Choice, 50 questions Med-Surg Competency - Review water reabsorption by kidney (what causes more concentrated urine or less concentrated urine) Majority of reabsorption happens in the proximal convoluted tubule then returned to circulation. Water intake = determines concentration. HIGH= dehydration, diarrhea, or narrowing od kidney artery. LOW= too much fluid intake, diabetes insipidus, kidney failure. - Review aspirin overdose in a child or adult CALL POISON CONTROL CHILD-150mg toxicity s/sx is tinnitus, hyperventilation, vomiting, dehydration, fever, double vision, feeling faint. Antidote is sodium bicarbonate. Adult- 200-300mg/kg. same s/sx The time is important of when people took the medication - Define Cells- smallest unit that makes up all living things. 3 layers are Nucleus (control center contains DNA) cytoplasm (contains mitochondria, ribosomes, endoplasmic reticulum, golgi apparatus, lysosomes, perxiosomes, cytoskeleton, centriole’s. and plasma membrane (phospholipids- contains lipid proteins) Elements- any substance that cant be decomposed into simpler substance by ordinary chemical process. Ions- Atom or molecule w/ electric charge due to the loss/gain of one or more electrons. Molecules-group of atoms bonded together, smallest unit of a chemical compound that takes part in chemical reactions. Electrolytes dissolved in water turn into IONS - Priority assessment prior to medication administration Check the 6 rights- patient, drug, dose, time, route, documentation. Always verify the MAR matches with pt ID. - Assessment prior to initiating a diet after a surgery (abdominal) Auscultate for bowel sounds in all 4 quadrants, bowels must be active before liquid diet begins. Review dressing changes (clean and aseptic techniques) - - Post spinal anesthesia complications Most commonly is headache and hypotension and risk of infection. - Interventions to prevent DVT postoperative AMBULATION, assist patient with getting out of bed and walking. Anticoagulants, and compression stockings assist - - Reasons why surgery would be postponed Patient does not sign consent form, abnormal labs, fail to comply with pre-op instructions. Notify MD if patient is really anxious and effecting vitals Review the definition of shock, types of shock, signs and symptoms, stages of shock, Shock is the state of cellular and tissue hypoxia due to either reduced oxygen, high O2 consumption, and or inadequate O2 utilization 4 types of shock- cardiogenic (heart), hypovolemic (bleeding) , anaphylactic (allergy), septic (infection) , neurogenic (watch for spinal issues) S/Sx and Stages- Diaphoretic, pale,bluish tinge to lips/fingernails, tachycardic, hyperventilate, n/v, enlarged pupils, fatigue, and thirst Refractory shock- slow and shallow . - Signs and symptoms of severe stress - Review normal and abnormal findings of neurologic assessment Best way to assess is by asking questions ‘LOC” - Babinski reflex Stroke underside of foot from sole toward the heel. ADULT: foot and toes will curl inward. INFANT: toes will fan out and big toe will move upward - Review the following diagnostic test: CT, EMG, MRI, EEG CT: (computerized tomography) series of X-ray images commonly used for brain to detect stroke. EMG: (electromypgraphy) measure nerve impulse electrical activity, often used for carpal tunnel. MRI: (magnetic resonance imaging) NO PACEMAKER magnetic field and radio waves to diagnose or monitor conditions. Commonly used for cysts, tumors, bleeding, swelling. EEG: (electroencephalogram) test that measures brain activity like epilepsy or seizure disorder. Review TIA (assessment, priority immediate interventions, risk factors, medical management, nursing interventions) Transient ischemic attack: assessment: difficulty walking, muscle weakness, problems with coordination, one sided weakness. Facial weakness, difficulty swallowing, confusion. Priority intervention: assess neuro status, altered tissue perfusion. Risk factors: age, FH, males, HBP, DM, heart disease., afib high cholesterol Medical management: can lead to stroke, take Aspirin. Nursing intervention- pt education on lifestyle changes, assist with gait, monitor vitals and review medication management. - - Review the following medications (Coumadin, Vasotec, nitroglycerin, potassium iodide SSKI Coumadin- (warfarin) blood thinner, prevents new clots forming. Monitor prothrombin time (PT)/ INR clotting test, range from 2.0-3.0 Vasotec (enalapril)- HBP, and CHF. Monitor BP, check renal function, creatinine levels. Nitroglycerine- vasodilator opening blood vessels for blood flow, used when pt c/o chest pain. Pt takes 1 tab every 5 min prn, up to 15min. no more than 3 pills in 15min. - Review Regular insulin, NPH insulin, 70/30 insulin (peak, duration, onset) Regular insulin- (Humilin R, Novolin R) short acting, assisted with dietary needs to control high blood sugar; onset: 30min, Peak- 2-3 hours, Duration 3-6 hours; NPH insulin: intermediate-acting insulin (Humulin N, Novolin N); Onset: 1-3 hours Peak 4-12 hours, duration 12-16 hours 70/30 insulin: (Novolog) mixture of 70% insulin (intermediate) NPH and 30% rapid (short acting) insulin Peak: 1-4 hours Duration: 24 hours. Remember Clear to cloudy- draw short/rapid first, then draw cloudy. - Functions of the tonsils and adenoids in children Tonsils stops germs entering the body thought the mouth and contain lot of WBC’s Adenoids- patch of tissue in back of nasal cavity, traps harmful bacteria that can be breathed or swallowed. Review physical examination of the nose Checking patency of each nostril, looking inside with light, otoscope, and note for symmetry of nose - - Review hypertension and how it affects the heart Damage arteries by making them less elastic, which causes decreased blood flow and oxygen to the heart. - Review cardioversion and what patient education is needed Procedure that returns abnormal heartbeat to a normal rhythm. Changes patients arrhythmia. Patient should not drive, work, not operate machinery, no important decisions, no alcohol, no legal binding documents. (LOC may change) all for 24 hours. Review therapeutic communication when your patient is anxious Maintain calm and relaxed posture, active listen, verbal techniques should be clear and easy to under stand - - Review heart murmurs Whooshing or swishing flow through the heart valves (extra beat) Review mitral stenosis Narrowing of the hearts mitral valve, doesn’t open, blocks flow into the main pumping chamber - Review hypothyroidism and hyperthyroidism, thyroid storm Hypothyroidism- underactive thyroid, fatigue, weight gain, puffy face. Hyperthyroidism- overactive, accelerate body metabolism Thyroid storm- thyrotoxic crisis- life-threatening hypermetabolic state induced by excessive release of thyroid hormone. - Review patient instructions for thyroid scan Radioactive iodine injection is given to patient - Review Graves disease Goiter, bulging eyes no cure. Live long levothyroxine - Review type 1 and type 2 diabetes mellitus; levels of hemoglobin A1c Type 1- no insulin production will take insulin. Pt should stay on normal routine exercise. Type 2: insulin resistance with diet, medication such as metformin A1c: check below 6 percent is normal. Review Ketoacidosis Life threatening complication of diabetes most common with type 1. Blurred vision kidneys cant decrease ketones (too acidic). Pt will hyperventilate. - - Signs and symptoms of hypoglycemia, hyperglycemia Hypoglycemia: low blood sugar, tachycardic, pale, shaky, anxiety, sweating, hunger, irrability. Pt teaching normal exercise routine. Hyperglycemia: High blood Sugar fruity smelling breath, n/v, SOB, dry mouth, confusion, coma, abd pain
