Med Surg ATI Test #1 Info 5-08
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Antacids not w/ other ulcer drugs such as H2 blockers→ decrease absorption by 10%-20%
Peptic Ulcer disease—avoid use of NSAIDs
Peptic Ulcer—milk may increase secretion of acid and not influence healing—avoid
Acute Renal failure s/s: fatigue, weight gain, fluid overload, electrolyte imbalance, ↓UO, ↑BP, neck
vein distention, confusion
Aplastic anemia (impaired erythrocyte production)—fatigue, pale skin color, exertional dyspnea,
palpations, low Hbg, signs of bleeding such as petechiae, ecchymosis
Hypothroidism → general depression of basal metabolic rate; s/s: fatigue, weakness, intolerance to
cold, constipation, menstrual irregularities, reduced appetite, dry skin, edema
Diabetes Millitus—s/s: hyperglycemia, polyuria, polydipsia, polyphagia, visual blurring, fatigue, wt loss
Systemic lupus erythematosus (SLE)—though to be an autoimmune disorder. Lesions usually located on
face, scalp, and neck are well demarcated and relatively benign. They can be located on other body parts
such as mucous membranes and do not spread like allergic dermatitis; Exacerbations may be caused by
fatigue, sun exposure, stress, and infection;
Insulin—With Regular and NPH given at 6:00—schedule a snack at 3:00 since peak of NPH is 6-12hrs,
onset is 1-2hrs; Regular peaks at 2-4hrs and a snack (15grams) would be needed at 10:00; diet should be
from 45-60% Carbohydrates;
Fat embolism syndrome--↑risk from poor hydration, surgery/trauma to skeletal system, low tidal
volume; Interventions: good respiratory care, adequate hydration, stable traction, intermittent pneumatic
compression, leg elevation, elastic stockings, meds (anticoagulant, anti-platelet); ROM not
recommended for fractured femur;
Ventricular tachycardia following a MI—use lidocaine (decreases myocardial irritability (automaticity)
Dumping syndrome—following total gastrectomy; Dumping syndrome occurs because of the rapid entry
of hypertonic food into the upper small intestine w/o undergoing the usual breakdown & dilution in the
stomach. This stimulates motility and diarrhea. Preventative measures include a moderate-fat, highprotein diet w/ limited carbohydrates. Fluids w/ meals are discouraged because they ↑ total volume and
promote diarrhea; Vit. B can't be absorbed without intrinsic factor that is normally secreted by the
parietal cells of the stomach. Clt will be at risk for pernicious anemia w/o monthly B12 shots.
Acute asthma attack—s/s: hyperresonance (air-trapping) and tachypnea, severe inspiratory/expiratory
wheezing, Tachycardia, ↑BP
Status asthmaticus—S/S: moving minimal amt of air and may not have audible wheezing, exhibit pulsus
paradoxus (accentuation of the normal decrease in SBP during inspiration RT changes in intrapleural
pressure during respiration that occurs in obstructive airway diseases. ABG values indicate respiratory
fxn and if hypoxemia is present and will determine if clt needs intubation.
CVA—priority intervention—assess respiratory fxn and maintain patent airway to support oxygenation
and cerebral perfusion. Because of motor and sensory deficits, the clt w/a CVA is at risk for aspiration
of food, fluid, secretions.
Primary prevention as it relates to drug mgmt in the elderly population focuses on prevention of
complications. Risk for injury RT polypharmacy is a primary prevention
Total hysterectomy—propping knees up (promotes pelvic congestion) is contraindicated RT venous
pooling and pelvic congestion that are common complications post hysterectomy, especially if the
lithotomy position was used. Use compression stockings & leg/foot flexion/extension exercises to
prevent thromboembolisms
Asthma attack—1st choice of drug is short-acting inhaled beta2-adrenergic agonist such as albuterol
sulfate (Proventil) or metaproterenol sulfate (Alupent). These promote muscle relaxation &
bronchodilation
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Maintenance therapy drugs for asthma include: anticholinergic (Atrovent), corticosteroid (Azmacort),
mast cell stabilizer --Cromolyn (Intal)
To verify Graft patency—assess: peripheral pulses, limb temperature, pain, pallor, sensation, & mov't
Expected effect of Meperidine (Demerol): altered perception of and response to painful stimuli; ↓BP
Anticholinergic (Robinul) are often given preop. to inhibit salivation & excess respiratory secretions
Metoclopramide (Reglan) has antiemetic / GI stimulant effects
Acute glomerulonephritis can occur 2-3 weeks following a streptococcal infection, usually of the
pharynx or tonsils; other causes hypertension, diabetes mellitus; chemicals such as certain antibiotics,
heavy metals, and solvents
Amputation stump care—Lotions that contain perfumes and alcohol will dry the skin and cause cracking
and irritation. Oils and creams soften the skin too much for safe prosthetic use. Wash with warm water
and mild soap and let air dry 20 minutes. Do not dangle stump over edge of boot to prevent swelling;
Determining LOC w/head trauma—Glasgow coma scale (eye opening, best motor response, best verbal
response)
Endotracheal suctioning—transient hypoxemia occurs and cause slow/irregular pulse. Pre-oxygenate
with 100% FIO2 and suction for < 10 seconds per pass to prevent hypoxia
Oxygenation with COPD—administer the least amount of oxygen to achieve acceptable PO2 level.
Acute respiratory failure is defined as any rapid change in respiration resulting in hypoxemia, hypercaria
or both.
Irregular apical pulse is associated with dysrhythmias such as atrial fibrillation.
Jugular vein distention is a clinical manifestation of CHF
Parkinson's disease results from degeneration of the substantia nigra, leading to ↓ in dopamine.
Levodopa is converted to dopamine in the CNS. Insufficient dopamine allows large numbers of
excitatory Ach to remain active resulting in the characteristic excessive excitation of neurons that
interfere with control or initiation of voluntary movement.
Deficiency of norepinephrine and or serotonin is thought to be a component of depression, Selective
serotonin reuptake inhibitors (SSRI) increase serotonin in the CNS
ST segment elevation on ECG is a hallmark sign of acute myocardial ischemia leading to infarction.
Acute respiratory distress syndrome (ARDS) early s/s: dyspnea, restlessness, hyperventilation, cough,
labored breathing. Late s/s: tachycardia, cyanosis, intercostals retrations, grunting respirations and
shallow breathing, adventitious breath sounds
Central venous pressure (CVP)—measures venous pressure at the level of the right atrium—low values
may indicate hypvolemia
Risk factors for developing HTN: age, male, African American, smoking, excess alcohol, heredity
Pain management –encourage use of analgesia and non-pharmacologic methods
Glaucoma, intraocular pressure rises as a result of structural resistance (open-angle) or complete
obstruction (closed-angle) to the outflow of aqueous humor through the chamber located between the
iris and corneal. Pressure is place on the optic nerve and blindness can result. Miotics (direct-acting
cholinergics) such as pilocarpine HCl are commonly used. These constrict the pupil so that the ciliary
muscle is contracted which allow better circulation. Any drug that causes mydriasis (papillary dilation)
would be contraindicated such as systemic anticholinergics.
Since bleeding is a common post-op problem in a transurethral resection of the prostate (TURP), the
nurse would want to assess for drugs that impair clotting such as ASA and NSAIDs.
Shingles, caused by the herpes zoster virus, is an infection of the dorsal nerve root ganglion. Increased
incidence occurs with impaired immune system.
Chest tube—bubbling in the water-seal chamber alerts the nurse to a possible air leak in the closed
system. During forceful expiration or coughing, bubbling is expected because air in the chest is being
expelled.
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To minimize irritation of the peripheral vein, a concentrated KCL solution should be piggybacked into a
running primary ling to help dilute the solution. If the client is not on fluid restriction—the best way to
safely administer K IV is to dilute the K in large volumes (40mEq/L); never give as a bolus or IV push.
If the clts on fluid restriction, more concentrated K solutions are used such as 10-20mEq/100mL.
Dehydration—s/s: fluid volume deficit (seen as postural HTN), ↑Na, ↑HR, dry mucous membranes, ↑T,
weight loss, ↓ UO, ↑specific gravity. As serum ↑Na rises RT loss of water→ thirst, dry, sticky mucous
membranes, rough dry tongue, ↑serum osmolality, behavioral changes such as restlessness/agitation.
Morphine sulfate is used in Acute MI to decrease anxiety and cardiac workload. It has vasodilating
effects on peripheral vessels →↓ preload. Anxiety is reduced, as chest pain is reduced →↓ myocardial
oxygen demand.
Cervical cancer—with placement of radioactive implant client shoud select a low-residue diet to prevent
abdominal distension. It is important that all untreated tissues remain in their normal position and not
come in contact with the radioactive device. Expect a foul-smelling vaginal discharge from destruction
and sloughing of cells. Visitor/staff will have limitation of time at the bedside. The client will be kept in
bed as flat as possible to prevent dislodgement of radioactive substance. Turning from side to side is
permitted for comfort.
Unilateral neglect following CVA—individual ignores the affected side of the body. Teach the client to
monitor the position of the right side to promote awareness and safety.
Ratio of HCO3 : CO2 is 20:1
Acute Renal failure (ARF)—recovery phase occurs when BUN & creatinine levels stabilize; A marked
increase in urine output occurs in the diuretic phase RT decline in the concentrating ability of renal
tubules and the osmotic diuretic effect of a high BUN. Fatigue lasts 3-12 months. A reduction of the
GFR occurs during the oliguric phase when the kidney is unable to excrete metabolic waste. This is
manifected by increased serum BUN and creatinine levels.
Most reliable clinical manifestation of fluid imbalance is daily weight
Priorities in management of DKA center on rehydration and IV insulin to control gluconeogensis and
ketogenesis.
AIDS is defined at having HIV and an opportunistic infection. Pneumocystis carinii pneumonia is the
most common opportunistic infection associated with HIV infection.
Cushing's syndrome—cortisol excess results in decreased lymphocytes and cell-mediated immunity, and
altered antibody activity. These changes increase the risk of viral and fungal infections. Fluid volume
excess is a primary concern w/ Cushings RT excess cortisol that has mineralocorticoid activity resulting
in excess retention of Na and H20. Clt is usually overweight RT changes in fat metabolism.
Spacer for metered-dose inhaler allow the finer droplets to disperse more fully and be delivered deeper
into the airways.
To reduce risk of VAP (vent. acquired Pneumonia) drain condensation in the ventilator equipment into
the designated reservoir, not back into the liquid reservoir, an by changing respiratory equipment every
24hrs; inflating the endotracheal or trachestomy cuff; use sterile technique
Aminoglycoside are nephrotoxic and ototoxic; prior to administration get a baseline of renal fxn labs
and hearing test.
Goal of the diet for CRF (chronic renal failure) is to reduce metabolic waste the requires excretion by
the kidneys (Protein). Restrict protein to 1-1.5g/kg of ideal body weight. Reduce intake of high K
foods. Calories should be obtained from CHO and fat.
Coughing and talking should be avoided during thoracentesis; required patient cooperation so no
sedation is given; client will be positioned leaning over the bedside table with their head and crossed
arms resting on several pillows and feet supported by a footstool.
Incontinence—gather precipitating factors to determine type
Eye trauma—it is important to establish a baseline and evaluate vision before initiating treatment and
post tx. (exception is chemical burns to eye—flush w/ saline immediately)
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GERD treatment—Omeprazole (Prilosec) is a proton pump inhibitor that suppresses gastric acid
secretion by > 90%.
Chronic hoarseness is the most common presenting symptom of laryngeal cancer. It is often associated
with dysphagia. Enlarged cervical nodes, pain in the adam's apple that radiates to the ear, and airway
obstruction are a late signs.
Osteoporosis—clinical sign of post-menopausal osteoporosis may be the "dowager hump" and reduced
height. There is an increased risk of fracture caused by bone fragility to the hip, writ, and vertebrae.
↓K+, ↓Mg, ↑Ca are known factors in promoting digoxin toxicity. Drugs that enhance digoxin toxicity
include quinidine, verapamil, and nifedipine.
Most sensitive indicators of ICP (increased intracranial pressure) are the subtle changes in orientation,
LOC, sluggish papillary rxns, and blurred vision. Behavioral changes may include: restlessness,
irritability, confusion, ↓GCS score. Later phases of ICP have: bradycardia, irregular respiratory pattern
(Cheyenne Stokes), fixed and dilated pupils, decreased motor activity or paralysis.
Post radical mastectomy—position arm to prevent venous pooling by having hand and elbow higher
than shoulder.
With Renal calculi, the most important or outcome is to ensure urinary elimination by measuring I & O.
An appropriate outcome would be to maintain urine output equal to intake.
Russell's traction (modified Buck's traction)—This type of traction adds vertical pull by placing a sling
under the leg about the knee. It is essential that the weights are hanging freely.
Most commom symptoms of a febrile, nonhemolytic transfusion rxn are: sudden chills, fever, headache,
flushing, anxiety. (occurs when the clt becomes sensitized to the donor's WBCs, platelets, or plasma)
Anaphylactic rxn to blood components: urticaria, wheezing, hypotension, chest tightness, s/s of shock
Mild allergic rxn to transfusion therapy—flushing, itching, Urticaria (caused by sensitivity to foreing
plasma proteins.)
S/S of circulatory overload if blood in infused rapidly or clt has CHF or renal failure: dypnea, jugular
vein distention, hypertension.
Post cast—monitor neurovascular status of the extremity: assess: color, mov't of fingers/toes, swelling,
pulses distal to case, and sensation
With acute head injury—make frequent neurological assessments. Cranial nerve exam assess: papillary
response, extra-ocular mov'ts, tracking, blink and gag reflexes, facial muscles, speech patterns.
With ascites, and Na of-145 and K-3.2, an IV of 0.9% NaCl would be contraindicated. Na is generally
restricted to 1000mg/day
Yellow drainage following a craniotomy should be reported to surgeon immediately, could be CSF
Calcium channel blocker affects: coronary dilation→ ↓ angina; systemic vasodilation→ ↓BP;
↓contractility and ↓CO, which makes them unsuitable for CHF
Alzheimer's –the client's safety is always paramount to the plan of care. These clients are prone to
wandering, agitation, confusion, and seizures. Their risk for injury is high
Grade 3 neoplasms are poorly differentiated (extensive structural changes from tissue of origin). Loss of
differentiation means a higher degree of malignancy. Stage 3 lesions involve extensive local and
regional spread. Stage 1—tumor is similar to normal tissue and slow growing; stage 2—neoplasms are
localized without spread to adjacent tissue or other organs.
Active artificial immunity is acquired through administration of vaccines or toxoids
Active natural immunity is acquired by getting a disease and developing antibodies
Passive artificial immunity is acquired by getting antibodies from an animal/human.(Immune globulin)
Passive natural immunity—antibodies are transferred from mother to baby by placenta or colostrums
Ulcerative colitis has 15-20 stools/day containing a mixture of blood, mucus and pus. Significant losses
of fluids and electrolytes can occur as well as weigh loss.
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Cholecystitis is characterized by sudden onset of pain in RUQ that radiates to the right scapula or
shoulder, and may be associated w/ eating a large or fatty meal. Bowel sounds may be decreased or
absent and anorexia, nausea, and possibly vomiting may be present.
Crohn's Disease an inflammatory bowel disease has anorexia, weight loss, stools that are large, semisolid, 3-5/day and rarely contain blood. Diffuse, colicky abdominal pain or localized pain in the RLQ
Diverticulitis may include crampy LLQ pain, low grade fever (classic sign), feeling of bloating, N/V
Vit. K is the antidote for warfarin (Coumadin)
Acetyocysteine is the antidote for acetaminophen
Naloxone is the antidote for opioid analgesics
Protamine sulfate is the antidote for heparin
Hepatitis A is transmitted by fecal-oral route, often through food contaminated by infected food
handlers. Use enteric precautions (wear gloves when handling feces/urine); Hep B via blood
Effectiveness of oxygen therapy—either PO2 or oxygen saturation
Normal value for activated partial thromboplastin time (APTT) is 25-35 sec. During heparin therapy for
DVT the APTT value should be maintained at 1.5 to 2.5 times the control and is monitored about every
6 hours. Standard protocol calls for admin of a continuous infusion of heparin for > 5 days for DVT
Appendicitis—during diagnostic period, pain medication is usually withheld until a definite diagnosis
has been made; enemas/laxatives may increase peristalsis and cause the appendix to rupture; heat should
not be used over abdomen to reduce pain because the increased circulation to the appendix can lead to
rupture
Immunization against influenza is recommended for persons at risk of adverse consequences from
infection of the lower respiratory tract. Those over 65, infants, children > 6 months with increased risk
for complications.
Esophageal varices can easily rupture causing excessive bleeding, hypovolemia, and shock. VS are 1st
priority to evaluate hemostasis.
Enlarged prostate gland impinges on the urethra and obstructs urinary flow. Bladder has less capacity,
muscle tone diminishes, and the bladder cannot empty completely, urinary stasis creates a fertile
medium for bacterial growth and infection. S/S: urinary hesitancy, difficulty starting the stream,
retention, nocturiua, dysuria, urgency, s/s of UTI.
Candida albicans, opportunistic disease assoc w/ HIV—whitish-yellow patches in the mouth (fungal).
Thrives in warm, moist environments such as mucous membranes of mouth, vagina, or intestional tract.
Cytomegalovirus (CMV) retinitis is the most clinically significant type of infection in clts with HIV and
symptoms are: floaters, decreased vision and blindness.
Kaposis sarcoma is nodular lesion of the skin on the external skin surfaces.
Pneumocystis carinii pneumonia—respiratory complication that is a life-threatening infection to clients
with AIDS; s/s: Fever, night sweats, and chronic cough
Osteoarthritis is a non-inflammatory joint disease with degeneration and loss of articular cartilage in
synovial joints.
Rheumatoid arthritis is a chronic, systemic, progressive, inflammatory CT disorder that affects primarily
the small, peripheral joints with symmetrical distribution. It affects all CT, including the collagen of the
heart, muscles, tendons, pleura, or BVs. S/S: pain, stiffness, redness, and warmth, swelling in the joints.
It has chemical or metabolic degeneration; during the acute onset of RA the clt has fever and chills, pain
and swelling of the joints. An early symptom is morning stiffness. The erythrocyte sedimentation rate
(ESR) and c-reative protein (CRP) are usually elevated during the acute and chronic states of RA.
Isoenzyme that is specific to the myocardium is CK-MB; elevation begins within 4-8 hrs after MI.
Cardiac troponin has a high specificity for myocardial injury and rises earlier than CK-MB. Both
indicate myocardial cell damage.
Iso-osmolar fluid volume deficit (Hypovolemia)—common cause hemorrhage
Hyperosmolar vascular space is from decrease in water intake
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Pure water loss, as in diabetes insipidus, results in concentration of the solutes in the vascular space and
hyperosmolarity.
Vomiting & diarrhea may result in fluid losses that are in proportion to electrolyte losses, sever vomiting
and diarrhea cause a loss of body water and greater the loss of solutes such as electrolytes, resulting in
hyperosmolar body fluid.
Peritoneal dialysis—cloudy return of dialysate may indicate peritonitis—s/s: fever, chills, abdominal
tenderness/pain, vomiting; Dialysate returning should be a clear, light yellow (straw colored)
Iron deficiency anemia symptoms are associated with chronic blood loss, inadequate iron intake of
malaborption. Hallmark sign is hypochromia (small red blood cells that are devoid of pigment). Clts
often experience generalized fatigue, and have bright red tongue
Anemia secondary to acute blood loss—s/s: hypotension, weakness, tachycardia
Hemolytic anemia caused by drugs or autoimmune response to person's RBCs—s/s: jaundice, pallor,
splenomegaly
Aplastic anemia –s/s: Easy bruising, petechiae, infection, fatigue, exertional dyspnea, and pallor
Prostatectomy—causes infertility because the loss of the prostate gland interrups the flow of the semen
and ejaculation will not occur; most aspects of sexual function will gradually return. Clients may be
impotent for several months. It is inappropriate to assure the client that sexual fxn will be completely
normal. The ability to have an erection and experience orgasm will gradually return for most clts.
In Dehydration where the client is hypotensive, the first objective is to raise the ECF volume. This is
best achieved by using an isotonic solution such as 0.9% NaCl. Once the BP is improved, other
hydration solns such as Dextrose 5% in 0.45% NaCl would be given to hydrate the cell and provide
calories.
For TPN, it is best to set up a infusion pump to prevent fluid and electrolyte imbalance.
Glaucoma—caution when driving at night because miotic (pupil contriction) eye medication may
adversely affect the client's night vision; Client needs to avoid activities that increase intraocular
pressure such as bending from the waist, sneezing, vomiting, and straining for bowel mov't.
On a mechanically ventilated pt who becomes restless/anxious and attempts to cough—first action
should be to suction the tracheotomy tube
Following a Bronchoscopy, the nurse should monitor for frank bleeding, laryngeal edema, or
laryngospasm (stridor) and increasing SOB. May indicate trauma to the larynx or vocal cords. Report
progressive dyspnea to MD. Difficulty swallowing is expected until cough and gag reflexes return,due
to local anesthetic sprayed on the tongue and oropharynx.
Digitalis preparations are the primary treatment of CHF RT ↑ force/strength of contraction & ↓HR
With insertion of permanent trach tube. Most appropriate goal 1st day post op would be for the patient to
help maintain a patent airway by coughing and mobilizing secretions.
Prerenal causes of ARF occur secondary to intravascular volume depletion from: hemorrhage,
dehydration, Diabetes Insipidus, cirrhosis, diuretics, burns, CHF, dysrhythmias
Intrarenal causes of ARF: nephrotoxic drugs, glomerulonephritis, coagulopathies, malignant HTN, antiinflammatory agents, tetracyclines, sulfonamides.
Postreanl cause of ARF: renal calculi, neoplasms, prostatic hypertrophy
Most common complication after a MI is dysrhythmias RT disruption of impulses, electrolyte imbalance
Paroxysmal nocturnal dyspnea occurs 2-5 hours after the client lies down because chest expansion
diminished in the recumbent position resulting in decreased ventilation, and venous return to the right
heart increases with elevation of the legs. The client wakes suddenly with severe SOB that subsides
only after sitting upright for 10-30 minutes. Elevate HOB or use several pillow for sleeping.
Tensilon used to differentiate between myasthenia crisis and cholinergic crisis. Clts in nyasthenic crisis
will temporary improve in muscle tone with Tensilon.
Tissue redness (erythema), slight swelling (edema) and increased warmth are signs of wound
inflammation. Fever, purulent drainage, tachypnea, and tachycardia indicate infection.