NU 185
FINAL EXAM 3
STUDY GUIDE
Medical-Surgical Nursing II
Galen College of Nursing
This Document Description:
❖ This study guide for NU 185 at Galen College of Nursing
focuses on Final Exam content from the Medical-Surgical
Nursing II course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, MED/SURG 2 FINAL STUDY GUIDE
1 Fat embolisms: causes, signs and symptoms
- Fat embolism syndrome is a serious complication of fractures. Small fat droplets are
released from yellow bone marrow into the bloodstream (Table 46.2). The droplets
then travel to the lung fields, causing respiratory insufficiency. This can lead to
respiratory failure. This process occurs with long bone fractures (especially the
femoral shaft) and perhaps when the patient has multiple fractures. The older adult
patient with a fractured hip is also at a high risk for fat embolism syndrome. This
condition can occur up to 72 hours after the initial injury.
- The three primary manifestations of fat embolism syndrome are respiratory failure,
cerebral involvement, and skin petechiae. Pulmonary dysfunction is the earliest sign
and includes tachypnea, dyspnea, and cyanosis. Cerebral changes are often seen and
include confusion or drowsiness. A petechial (red, measles-like) rash on the chest,
neck, axilla, and conjunctiva appears in some patients. Other signs include
tachycardia, fever, and retinal changes. If a fat embolism is suspected, notify the HCP
immediately. Treatment interventions may include:
- Promote oxygenation by administering oxygen at 2 L/min via nasal cannula, and
apply a pulse oximeter.
- Place the patient in high-Fowler position or raise the head of the bed as tolerated.
- Maintain bedrest, and minimize movement of the extremity.
- Obtain arterial blood gas.
- Initiate venous access for medications.
- Administer corticosteroids.
- Prepare patient for a chest x-ray and an MRI of the brain.
- Provide emotional support and calm environment.
2 MRI’s – nursing interventions
- Magnetic field and radiofrequency energy are used to obtain a detailed image of
tissues. Contrast medica may be used.
- This is used to visualize structural abnormalities in organs
3 Thrombocytopenia- signs and symptoms, nursing interventions
-A reduction in platelets (thrombocytopenia) increases the risk of bruising and
bleeding. It can require platelet transfusions.
4 Blood transfusions: Nursing responsibilities, transfusion reaction
A. Blood transfusions may be given to improve oxygenation and reduce dyspnea; a
thoracentesis may promote lung expansion. These are not intended to prolong life
but to promote comfort.
5 Concussion: Nursing responsibilities, education, nursing assessments
-Cerebral concussion is considered a mild brain injury. If there is loss of consciousness, it
is for 5 minutes or less. Concussion is characterized by headache, dizziness, or nausea
and vomiting. The patient may describe amnesia of events before or after the trauma.
, On clinical examination, there is no skull or dura injury and no abnormality detected on
CT scan or MRI. Diagnostic Tests
- A CT scan is usually the first imaging test performed on a patient with a TBI (Table
48.7). It is faster and more accessible than MRI. This is particularly important for
unstable patients or those with multiple injuries. It is easier to identify skull fractures
on a CT scan than on MRI. MRI can be used later to identify damage to the brain
tissue.
- Neuropsychological testing by a trained specialist can be useful in assessing the
patient’s cognitive function. This information helps direct rehabilitation placement,
discharge planning, and return to work or school. Neuropsychological testing
identifies problems with memory, judgment, learning, and comprehension. Patients
may be able to learn compensation strategies based on the results.
- Surgical treatment of hematomas is discussed under intracranial surgery later in this
chapter.
- Medical management of TBI involves control of ICP and support of body functions.
Patients with brain injuries can be partially or completely dependent on assistance
with respiration, nutrition, elimination, movement, and skin integrity.
Table 48.7
Traumatic Brain Injury Summary
Signs and Loss or decrease in level of consciousness (LOC), depending on severity and
Symptoms type of injury
Loss of memory before or after the injury
Increased intracranial pressure
Headache, dizziness
Nausea and vomiting
Unequal pupils
Tachycardia, tachypnea
Diaphoresis
Hemiparesis
Diagnostic Computed tomography (CT) scan, magnetic resonance imaging (MRI)
Tests Skull x-rays
Routine laboratory tests (hemoglobin, electrolytes, coagulation studies, type
and crossmatch)
Neuropsychological testing
Therapeutic Control intracranial pressure
Measures Surgical management of hematoma
Maintain respiratory function
Maintain diet/nutrition
Maintain skin integrity
6 Migraine headaches
A. Migraine headaches are a neurologic disorder involving brain chemicals and
neurologic pathways. Current thought is that a trigger stimulates a release of
chemicals that cause an inflammatory response and overstimulation of the
, trigeminal nerve, resulting in pain. A migraine may or may not involve an aura, such
as vision changes or tingling, that precedes an attack. The tendency to develop
migraine headaches is often hereditary. Children who have one or both parents who
experience migraines are more likely to experience them as well. Migraines
frequently begin in childhood or adolescence and are more common in women.
Common migraine triggers include hormones (menses related), changes in
barometric pressure, specific foods, noise, bright light, alcohol, and stress.
B. Medical terminology: rhinorrhea, otorrhea, tinnitus, vertigo
C. Basilar skull fractures
D. Level of consciousness
A. Level of consciousness (LOC) exists along a continuum from full wakefulness,
alertness, and cooperation to unresponsiveness to any form of external stimuli. A
fully conscious patient responds to questions spontaneously. As consciousness
becomes impaired, a patient may show irritability, a shortened attention span, or an
inability to cooperate. LOC should be the first thing assessed during a neurologic
examination because the information obtained can be used to modify the remainder
of the examination if necessary. Keep in mind that a decrease in LOC can be caused
by problems such as hypoxia, hypoglycemia, medications, or intoxication, and not
just dysfunction of the neurologic system.
E. Glasgow Coma scale
A. Many health care institutions use the Glasgow Coma Scale (GCS), which is
an international scale used to assess LOC and document findings (Table
47.4). The GCS is used to evaluate patients who have a potential for rapid
deterioration in consciousness. When assessing LOC, consider the patient’s
physical ability to respond, taking into consideration trauma, medical
condition, and medications. For example, a patient who cannot open his or
her eyes because of facial trauma may still have an intact neurologic system.
B. Motor response is scored in the GCS based on following commands,
responding to pain, or displaying abnormal postures. Abnormal postures
include decorticate and decerebrate. In decorticate, or flexion, posturing, the
patient’s arms are flexed at the elbow, the hands are raised toward the chest,
and the legs are extended (Fig. 47.11A). This posture indicates significant
impairment of cerebral functioning. In decerebrate, or extension, posturing,
both the arms and legs are extended, and the arms are internally rotated
(Fig. 47.11B). This abnormal posturing indicates damage in the area of the
brainstem.
C. The total possible score on the GCS ranges from 3 to 15. A score of less
than 7 indicates a comatose patient and a score of 15 indicates the patient is
fully alert and oriented. When used to score the effects of a head injury, a
score of 13 or 14 indicates mild head injury, 9 to 12 indicates moderate
injury, and any score of 8 or below indicates severe head injury. For all
FINAL EXAM 3
STUDY GUIDE
Medical-Surgical Nursing II
Galen College of Nursing
This Document Description:
❖ This study guide for NU 185 at Galen College of Nursing
focuses on Final Exam content from the Medical-Surgical
Nursing II course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, MED/SURG 2 FINAL STUDY GUIDE
1 Fat embolisms: causes, signs and symptoms
- Fat embolism syndrome is a serious complication of fractures. Small fat droplets are
released from yellow bone marrow into the bloodstream (Table 46.2). The droplets
then travel to the lung fields, causing respiratory insufficiency. This can lead to
respiratory failure. This process occurs with long bone fractures (especially the
femoral shaft) and perhaps when the patient has multiple fractures. The older adult
patient with a fractured hip is also at a high risk for fat embolism syndrome. This
condition can occur up to 72 hours after the initial injury.
- The three primary manifestations of fat embolism syndrome are respiratory failure,
cerebral involvement, and skin petechiae. Pulmonary dysfunction is the earliest sign
and includes tachypnea, dyspnea, and cyanosis. Cerebral changes are often seen and
include confusion or drowsiness. A petechial (red, measles-like) rash on the chest,
neck, axilla, and conjunctiva appears in some patients. Other signs include
tachycardia, fever, and retinal changes. If a fat embolism is suspected, notify the HCP
immediately. Treatment interventions may include:
- Promote oxygenation by administering oxygen at 2 L/min via nasal cannula, and
apply a pulse oximeter.
- Place the patient in high-Fowler position or raise the head of the bed as tolerated.
- Maintain bedrest, and minimize movement of the extremity.
- Obtain arterial blood gas.
- Initiate venous access for medications.
- Administer corticosteroids.
- Prepare patient for a chest x-ray and an MRI of the brain.
- Provide emotional support and calm environment.
2 MRI’s – nursing interventions
- Magnetic field and radiofrequency energy are used to obtain a detailed image of
tissues. Contrast medica may be used.
- This is used to visualize structural abnormalities in organs
3 Thrombocytopenia- signs and symptoms, nursing interventions
-A reduction in platelets (thrombocytopenia) increases the risk of bruising and
bleeding. It can require platelet transfusions.
4 Blood transfusions: Nursing responsibilities, transfusion reaction
A. Blood transfusions may be given to improve oxygenation and reduce dyspnea; a
thoracentesis may promote lung expansion. These are not intended to prolong life
but to promote comfort.
5 Concussion: Nursing responsibilities, education, nursing assessments
-Cerebral concussion is considered a mild brain injury. If there is loss of consciousness, it
is for 5 minutes or less. Concussion is characterized by headache, dizziness, or nausea
and vomiting. The patient may describe amnesia of events before or after the trauma.
, On clinical examination, there is no skull or dura injury and no abnormality detected on
CT scan or MRI. Diagnostic Tests
- A CT scan is usually the first imaging test performed on a patient with a TBI (Table
48.7). It is faster and more accessible than MRI. This is particularly important for
unstable patients or those with multiple injuries. It is easier to identify skull fractures
on a CT scan than on MRI. MRI can be used later to identify damage to the brain
tissue.
- Neuropsychological testing by a trained specialist can be useful in assessing the
patient’s cognitive function. This information helps direct rehabilitation placement,
discharge planning, and return to work or school. Neuropsychological testing
identifies problems with memory, judgment, learning, and comprehension. Patients
may be able to learn compensation strategies based on the results.
- Surgical treatment of hematomas is discussed under intracranial surgery later in this
chapter.
- Medical management of TBI involves control of ICP and support of body functions.
Patients with brain injuries can be partially or completely dependent on assistance
with respiration, nutrition, elimination, movement, and skin integrity.
Table 48.7
Traumatic Brain Injury Summary
Signs and Loss or decrease in level of consciousness (LOC), depending on severity and
Symptoms type of injury
Loss of memory before or after the injury
Increased intracranial pressure
Headache, dizziness
Nausea and vomiting
Unequal pupils
Tachycardia, tachypnea
Diaphoresis
Hemiparesis
Diagnostic Computed tomography (CT) scan, magnetic resonance imaging (MRI)
Tests Skull x-rays
Routine laboratory tests (hemoglobin, electrolytes, coagulation studies, type
and crossmatch)
Neuropsychological testing
Therapeutic Control intracranial pressure
Measures Surgical management of hematoma
Maintain respiratory function
Maintain diet/nutrition
Maintain skin integrity
6 Migraine headaches
A. Migraine headaches are a neurologic disorder involving brain chemicals and
neurologic pathways. Current thought is that a trigger stimulates a release of
chemicals that cause an inflammatory response and overstimulation of the
, trigeminal nerve, resulting in pain. A migraine may or may not involve an aura, such
as vision changes or tingling, that precedes an attack. The tendency to develop
migraine headaches is often hereditary. Children who have one or both parents who
experience migraines are more likely to experience them as well. Migraines
frequently begin in childhood or adolescence and are more common in women.
Common migraine triggers include hormones (menses related), changes in
barometric pressure, specific foods, noise, bright light, alcohol, and stress.
B. Medical terminology: rhinorrhea, otorrhea, tinnitus, vertigo
C. Basilar skull fractures
D. Level of consciousness
A. Level of consciousness (LOC) exists along a continuum from full wakefulness,
alertness, and cooperation to unresponsiveness to any form of external stimuli. A
fully conscious patient responds to questions spontaneously. As consciousness
becomes impaired, a patient may show irritability, a shortened attention span, or an
inability to cooperate. LOC should be the first thing assessed during a neurologic
examination because the information obtained can be used to modify the remainder
of the examination if necessary. Keep in mind that a decrease in LOC can be caused
by problems such as hypoxia, hypoglycemia, medications, or intoxication, and not
just dysfunction of the neurologic system.
E. Glasgow Coma scale
A. Many health care institutions use the Glasgow Coma Scale (GCS), which is
an international scale used to assess LOC and document findings (Table
47.4). The GCS is used to evaluate patients who have a potential for rapid
deterioration in consciousness. When assessing LOC, consider the patient’s
physical ability to respond, taking into consideration trauma, medical
condition, and medications. For example, a patient who cannot open his or
her eyes because of facial trauma may still have an intact neurologic system.
B. Motor response is scored in the GCS based on following commands,
responding to pain, or displaying abnormal postures. Abnormal postures
include decorticate and decerebrate. In decorticate, or flexion, posturing, the
patient’s arms are flexed at the elbow, the hands are raised toward the chest,
and the legs are extended (Fig. 47.11A). This posture indicates significant
impairment of cerebral functioning. In decerebrate, or extension, posturing,
both the arms and legs are extended, and the arms are internally rotated
(Fig. 47.11B). This abnormal posturing indicates damage in the area of the
brainstem.
C. The total possible score on the GCS ranges from 3 to 15. A score of less
than 7 indicates a comatose patient and a score of 15 indicates the patient is
fully alert and oriented. When used to score the effects of a head injury, a
score of 13 or 14 indicates mild head injury, 9 to 12 indicates moderate
injury, and any score of 8 or below indicates severe head injury. For all
