Comprehensive Medical Surgical Exam
Blueprint (1)
Advanced Adult Health Nursing
Comprehensive Medical Surgical Exam
Blueprint
-By Khush
Chapter 11: Health care of the older adult:
KNOW signs and symptoms of, treatment for, nursing management, medications used, and complications of
specific disorders: Alzheimer’s
Alzheimer’s Disease Cx: Increasing age, genes, environment, diet,
inflammation, neurotransmitter, vacular,
stress, neurotic plaques and acetylcholine
alteration
S/S: Slow onset, wandering, pacing, restlessness,
depression, lost feeling
Dx: Rule out other conditions
Tx: Donepezil, Rivastigmine, memantine: cognition
enhancers
NurseMx: Asses, promote function/independence,
nutrition, cognitive stimulation
Chapter 13: Fluid and electrolyte, acid base disorders
KNOW LAB VALUES: CBC, chemistries, coagulation, and inflammatory indicators. Signs and symptoms of
electrolyte disorders, Treatment of electrolyte disorders, Physiology of acid base balance and imbalance,
Regulation of acid/base, ABG interpretation, Treatment of abnormal
ABG’s ( CHECK SHEET ATTACHED, labs, electrolytes, acid/base)
Anticoagulants
Monitor Reversal agent
LMWH Platelets Protamine Sulfate
Heparin PTT (25-35 Protamine Sulfate
sec)
Warfarin PT (11-14 Vitamin K/FFP
sec)/INR
(0.8-1.2)
1
,Comprehensive Medical Surgical Exam
Blueprint (1)
Chapter 14: Shock & multiple organ dysfunction
Types, etiology, stages, complications, clinical manifestations, treatments, and nursing interventions
2
,Comprehensive Medical Surgical Exam
Blueprint (1)
Stages of Shock Compensatory
1. Compensatory -SNS causes vasoconstriction, increased HR,
2. Progressive increased heart contractility to maintain BP and
3. Irreversible CO
-Body shunts blood from skin, kidneys, GI tract.
Results in cool, clammy skin, hypoactive BS,
decreased UO
-Perfusion of tissues is inadequate
-Acidosis occurs from anaerobic metabolism
-RR inc due to acidosis, may cause compensatory
resp alkalosis. Confusion can also occur
Progressive
-BP regulation can no longer compensate so
BP/MAP decrease
-Hypoperfusion to all organ with further
vasoconstriction
-Metal status further deteriorates from dec cerebral
perfusion and hypoxia
-Lungs start to fail because decreased pulmonary
blood flow causes further hypoxemia, inc CO2 levels,
alveoli collapse and pulmonary edema
-MAP <70, GFR cannot be maintained causes
acute renal failure
-Liver, GI and hematological function affected
-DIC may occur
Irreversible
-Cannot survive
-Organ damage so severe that pt does not respond to
tx
-BP low
-Renal, liver fail
-Anaerobic metabolism worsens acidosis
-Multi organ damage
3
, Comprehensive Medical Surgical Exam
Blueprint (1)
General Mx of shock -Fluid replacement: Crystalloid, colloid sln. First
line!
-Vasoactive meds
• Norepi, dopamine, phenylephrine, vasopressin:
they need fluid on board to work! (volume)
SE: tachycardia and dec peripheral perfusion
-Nutritional support
-Modified Trendelenburg can help keep BP
up. Report MAP <65
-VS q15min
-Can monitor O2 Sat via central line (70%+)
-Meds can be given thru central line if possible and
titrated to effect: risk for extravasation
Classifications of shock Hypovolemic: Decreased intravascular volume due to
4
Blueprint (1)
Advanced Adult Health Nursing
Comprehensive Medical Surgical Exam
Blueprint
-By Khush
Chapter 11: Health care of the older adult:
KNOW signs and symptoms of, treatment for, nursing management, medications used, and complications of
specific disorders: Alzheimer’s
Alzheimer’s Disease Cx: Increasing age, genes, environment, diet,
inflammation, neurotransmitter, vacular,
stress, neurotic plaques and acetylcholine
alteration
S/S: Slow onset, wandering, pacing, restlessness,
depression, lost feeling
Dx: Rule out other conditions
Tx: Donepezil, Rivastigmine, memantine: cognition
enhancers
NurseMx: Asses, promote function/independence,
nutrition, cognitive stimulation
Chapter 13: Fluid and electrolyte, acid base disorders
KNOW LAB VALUES: CBC, chemistries, coagulation, and inflammatory indicators. Signs and symptoms of
electrolyte disorders, Treatment of electrolyte disorders, Physiology of acid base balance and imbalance,
Regulation of acid/base, ABG interpretation, Treatment of abnormal
ABG’s ( CHECK SHEET ATTACHED, labs, electrolytes, acid/base)
Anticoagulants
Monitor Reversal agent
LMWH Platelets Protamine Sulfate
Heparin PTT (25-35 Protamine Sulfate
sec)
Warfarin PT (11-14 Vitamin K/FFP
sec)/INR
(0.8-1.2)
1
,Comprehensive Medical Surgical Exam
Blueprint (1)
Chapter 14: Shock & multiple organ dysfunction
Types, etiology, stages, complications, clinical manifestations, treatments, and nursing interventions
2
,Comprehensive Medical Surgical Exam
Blueprint (1)
Stages of Shock Compensatory
1. Compensatory -SNS causes vasoconstriction, increased HR,
2. Progressive increased heart contractility to maintain BP and
3. Irreversible CO
-Body shunts blood from skin, kidneys, GI tract.
Results in cool, clammy skin, hypoactive BS,
decreased UO
-Perfusion of tissues is inadequate
-Acidosis occurs from anaerobic metabolism
-RR inc due to acidosis, may cause compensatory
resp alkalosis. Confusion can also occur
Progressive
-BP regulation can no longer compensate so
BP/MAP decrease
-Hypoperfusion to all organ with further
vasoconstriction
-Metal status further deteriorates from dec cerebral
perfusion and hypoxia
-Lungs start to fail because decreased pulmonary
blood flow causes further hypoxemia, inc CO2 levels,
alveoli collapse and pulmonary edema
-MAP <70, GFR cannot be maintained causes
acute renal failure
-Liver, GI and hematological function affected
-DIC may occur
Irreversible
-Cannot survive
-Organ damage so severe that pt does not respond to
tx
-BP low
-Renal, liver fail
-Anaerobic metabolism worsens acidosis
-Multi organ damage
3
, Comprehensive Medical Surgical Exam
Blueprint (1)
General Mx of shock -Fluid replacement: Crystalloid, colloid sln. First
line!
-Vasoactive meds
• Norepi, dopamine, phenylephrine, vasopressin:
they need fluid on board to work! (volume)
SE: tachycardia and dec peripheral perfusion
-Nutritional support
-Modified Trendelenburg can help keep BP
up. Report MAP <65
-VS q15min
-Can monitor O2 Sat via central line (70%+)
-Meds can be given thru central line if possible and
titrated to effect: risk for extravasation
Classifications of shock Hypovolemic: Decreased intravascular volume due to
4
