MedSurg 3 - Final Exam Review. MedSurg 3 - Final Exam Review/MedSurg 3 - Final Exam Review.

MedSurg 3 - Final Exam Review.

MedSurg 3 - Final Exam Review/MedSurg 3 - Final Exam Review.

MedSurg 3 Final Exam Review

Cardiac (24)

MAP: > 65 for adequate blood flow to major organs (MAP= 2x diastolic + Systolic/3)

Preload: Amount of blood into heart at end of diastole

Afterload: Resistance met when blood pushes out of left ventricle

SA Node: located in right atrium, natural pacemaker of the heart (60-100bpm)

AV Node: delay impulse to allow atrial contraction and ventricle

filling, then conducts impulse to the ventricles (40-60bpm)

Purkinje Fibers: ventricular pacemaker (20-40bpm)

Labs:

PT (9-12)

INR (0.9-1.2)

PTT (55-75)

ABG (pH: 7.35-7.45, CO₂: 45-35, HCO₃: 22-26)

CBC (blood)

BMP (electrolytes)

Diagnostic Tests:

CXR, EKG, Stress test, Echo, TEE, MRI

Heart Cath:

Pre- consent, prep area, NPO 6hrs, mark pulses, BUN/Cr, Fluids and mucomyst to

facilitate excretion/protection; Hold GLUCOPHAGE 24-48 hrs pre/post; ALLERGY:

shellfish/dye

Post- BEDREST, vitals, monitor site/pulse, ↑fluids (↓dye), Pain, Hematoma, ↓Vitals,

color, arrhythmia, Retroperitoneal Bleed

Nursing- no lifting > 5lbs., remove dressing in shower, don’t resume normal activities

until Dr. release, medication education

Hemodynamic Monitoring:

Measures vascular capacity, blood volume, pump effectiveness, tissue perfusion

Risks: thrombosis, hematoma, bleeding, pneumothorax, dysrhythmias, pericardial tamponade

A-Lines: into artery, DO NOT PUSH MEDS, monitor BP and ABG

Central Lines: give meds, draw blood, monitor CVP (Dry 2 ←→6 Wet)

CABG

Unstable angina, AMI, failure of percutaneous interventions

Pre- CBC, CXR, Coags, UA, coronary angiogram, blood type, teaching

Post- ↓CO (bleeding, fluid loss, meds, ↓temp, surgery, dysrhythmias, ↑afterload)

*chest tube drainage: >70mL = report

*cardiac tamponade: muffled heart sounds, ↑HR, ↓BP, ↓urine, ↓chest tube output,

↓peripheral pulses, tx- pericardiocentesis, cause

Heart Failure

Causes: HTN, CAD, substance abuse, valvular disease, DM, smoking, lung disease, MI

Dx: ↑BNP (untreated)

Tx: diuretics, ACE, ARB, nitrates, Beta blockers, inotropic agents, diet, fluid management, weight

Complications: pulmonary edema (dyspnea, cyanosis, gurgles, pink/frothy sputum, ↓O₂), shock

Nursing: weight, diet, meds, activity, risks

*Digoxin Toxicity: anorexia, fatigue, blurred vision, mental status change

Myocardial Infarction

Blood supply to the heart is reduced or stopped; “TIME IS MUSCLE”

LAB values

Hgb Women: 12-16%

Men: 13.5-18%

Hct Women: 38-47%

Men: 40-54%

RBC (million) Women: 4-5

Men: 4.5-6

WBC 4000-11000

Plt 150,000-400,000

PT 10-15 sec

INR 1-1.2 sec

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MedSurg 3 Final Exam Review

Intervention within 4-6hr of symptom onset

Sx: angina (pressure, squeezing, fullness, pain, radiating), N/V, SOA, cold sweat, lightheaded

Dx: EKG, Cardiac enzymes

Tx: Morphine, Oxygen, Nitro, Aspirin

*TPA: clot buster, within 6hr of onset, certain requirements

*CATH LAB for stent placement

Nursing: no lifting, drinking, stairs, resume activities slowly, Plavix/aspirin, SX of bleeding

Aneurysm

Aortic Aneurysm: dilation or thinning of wall, flank/abd/back pain, bruit, surgery (>7cm)

AAA- loss of pulses; TAA- SOA, hoarseness, difficulty swallowing

Aortic Dissection: tear of layer of vessel, sudden/sharp/shifting pain, surgery

ABGs

Metabolic Acidosis: ↓pH, diarrhea, dehydration, DKA,

↓BP, ↑K, kussmaul respirations

Causes: renal failure, DKA, diarrhea

Tx: NaHCO₃ (give bicarb), tx underlying cause

Metabolic Alkalosis: ↑pH, vomiting, GI suction, diuretics,

confusion, ↓K, ↓RR, ↑HR

Causes: vomiting, NG suction, ↓K, antacid abuse

Tx: K replacement, PPI, antiemetics (retain acids)

Respiratory Acidosis: anesthesia, overdose, COPD, pneumonia, ↓BP, ↑K, ↓RR, ↓LOC

Causes: CNS depression, OD, pneumothorax, RI, HF, PE, airway obstruction, emphysema

Tx: ↑ventilation and underlying cause

Respiratory Alkalosis: hyperventilation, mechanical ventilation, ↑HR, ↓BP, ↓K, ↓LOC

Causes: vomiting, NG suction, ↓K, antacid abuse

Tx: K replacement, PPI, antiemetics (retain acids)

Pulmonary (19)

Respiratory Failure:

Patient Hx: smoking, drug use, allergies, travel, area of residence, nutrition status, cough,

sputum, chest pain, dyspnea, orthopnea, PND (waking up with SOA)

Sx of respiratory failure: clubbing, wt loss, uneven muscles, skin/mucous membrane changes,

general appearance, endurance, sleep in chair

Sx of hypoxemia: (1st) neuro

Dx: ABG, CBC (↓Hgb=↓O₂), BMP, sputum, CXR (PA- front view, LA- side view), CT, ventilation

and perfusion scan, pulse ox

Pulmonary Function TestingNoninvasive: evaluate lung volume/capacity, flow rates, diffusion capacity, gas

exchange, airway resistance, distribution of ventilation [exercise testing, skin

testing, done pre-surgery to assess for vent capability]

Invasive: [Bronchoscopy] conscious sedation, numb throat, consent, monitor for

gag reflex, breath sounds, complications- bleeding, infection, pneumothorax

[Thoracentesis] aspiration of fluid/air from pleural space, hunched over table, IV

access, do not allow pt to cough, observe for shock, post CXR, watch site, prone

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MedSurg 3 Final Exam Review

[Lung Biopsy] obtain tissue, assess breath sounds Q4 for 24 hr., report

reduced/absent breath sounds immediately, monitor for hemoptysis

Pulmonary Embolism:

Prevention: TEDs, compression devices, position changes, Tx dysrhythmias, anticoagulant

therapy, NO pillows under knees; no central lines or dialysis

Sx: chest pain (worse on inspiration), sudden SOA, crackles, wheezes, ↑RR, ↑HR, cough,

hemoptysis, ↓O₂, anxiety, sense of impending doom, ↑D-Dimer {Sx same as MI}

Dx: clinical sx, ↑D-Dimer, CXR (nonspecific), V/Q scan (high probability of PE), CT scan

w/contrast, pulmonary angiogram, EKG (rule out MI)

Tx: O₂, thrombolytic, IV heparin (5days til PO therapy is effective), Lovenox, embolectomy,

inferior vena cava filter/umbrella (heart cath)

ARDS:

Cause: aspiration, pneumonia, trauma, toxic inhalation, TB, sepsis, burns, overdose, CABG

Sx: Hypoxemia w/ 100% O₂, pulmonary edema, SOA, ↑RR, respiratory alkalosis (can’t blow off

CO₂, ↑Temp, ↑HR, white out CXR, produces systemic inflammatory response

Tx: Intubation, sedation or paralytic (Norcuron), positioning, PEEP (lungs stay inflated to prevent

alveoli collapse, ↓CO, ↓venous return, ↑intrathoracic pressure)

Complications: Multiple-organ dysfunction syndrome, renal failure, disseminated intravascular

coagulation, long-term pulmonary effects associated w/ ↑O₂ therapy

Atelectasis: fluid in alveoli

COPD: emphysema and chronic bronchitis

Sx: chronic dyspnea, productive cough, hypoxemia, crackles, wheezes, rapid/shallow breathing,

use of accessory muscles, barrel chest, irregular breathing, think extremities and enlarged neck

muscle, dependent edema (right sided heart failure), clubbing fingers/toes, pallor/cyanosis of

extremities, ↓O₂ sat

Tx: High fowlers, coughing, suctioning, deep breathing, IS, O₂ (no more than 4L; ↓drive to

breathe), nutrition, ↑ fluids to 2-3L/day; diaphragmatic breathing, pursed-lip breathing,

incentive spirometer, bronchodilators, anti-inflammatory, mucolytics

Lung Cancer:

Sx: chronic cough, hemoptysis, SOA, wheezing, dull/aching chest pain, hoarseness, dysphagia,

wt loss, anorexia, fatigue, weakness, bone pain, clubbing fingers/toes

Tx: chemo, targeted radiation, surgery

Lung Abscess: liquified necrosis, antibiotics, drainage, frequent mouth care

Pulmonary Emphysema: pus in pleural space, empty empyema and re-expand lung, tx infection

Pneumothorax: air in pleural space, ↑intrathoracic pressure

Types:

Spontaneous pneumo- rupture of pulmonary bleb

Open pneumo- opening the chest wall

Tension pneumo- blunt chest

trauma (vent with PEEP)

Tx: dressing over open chest wound, O₂,

fowler’s position, chest tube placement, chest

tube

drainage monitor for subcutaneous

emphysema, tension pneumo

Pneumonia: inflammatory response to inhaled

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Category Exam (elaborations)
Release date 2022-01-18
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