Final Study Guide Med Surg.[LATEST]
Final Med Surg
Review
• headaches
o vascular headaches: migraines, cluster, HPT
▪ migraines: prodromal (early s/s): aura, visual field defects,
unusual smells or sounds, disorientation, paresthesia
o tension headaches
o traction-inflammation headaches
• respiratory disease- interventions- respiratory alteration? O2 status
o can only administer 2-4L of oxygen without prescription needed
o listen to lung sounds, position pt to high fowlers
• delegation
o what uaps can and can’t do- can help with ADLs, basic care and vitals
of stable pts, no medications
• hypovolemic shock- interventions- restoring blood volume- replace loss hmt
and hgb- manifestation- roles of RBCs
o can be caused due to hypovolemia-dehydration- due to vomiting,
diarrhea, hemorrhage, polyuria, inadequate fluid intake. Increase BP,
threading pulse (weak pulse), tachycardia, cold calmly skin and fleshy
skin, sunken eyes, tenting packed RBCs given to restore blood volume
and replace HMT and HGB levels- give more fluids, give albumin to
increase BP, oxygen to prevent hypoxia, sodium-bicarb due to
increase acidosis, orthostatic hypotension, oliguria, diaphoresis,
weight every 8 hrs, vitals every 15 min
• HPT- risk factors- values- assessment-intervention-teaching
o Exercise 5x/ week 30 min
o High level of potassium-obtain 12 ECG- indication of
abnormal rhythm: dysrhythmia. Typical abnormalities in
o Risk factors: smoking, race (African), obesity, stress, family
history, sedentary lifestyle, alcohol, age >60 or postmenopausal,
excessive alcohol
o Interventions: reduce BP and prevent or lessen extent of organ
damage, 12L EKG/ECG monitor for heart rhythm and report
changes
o Teaching: diet, stress reduction
,Final Study Guide Med Surg.[LATEST]
o Assessment: may be asymptomatic, headache, visual disturbance,
dizziness, chest pain, tinnitus (noise or ringing in ears), flushed face,
epistaxis (nosebleed)
o Parameters
▪ Normal: <120/ <80
▪ Pre-HPT: 120-129 systolic OR 80-89 diastolic
▪ HPT Stage 1: >140-159/ >90-99
▪ HPT Stage 2: >160/ >100
• Medications for HPT- beta blockers- ace inhibitors-s/e-
assessment- intervention-teaching- Labs-meds- risk factors
o “-il” = ace inhibitor, “-olol” = beta blockers
o Lisinopril- ACE inhibitor
▪ Prevents vasoconstriction
▪ Can cause sexual dysfunction and impotence
▪ Swelling on tongue
o Metoporlol and Ateneolol- Beta Blockers
▪ Beta blockers such as atenolol dilate peripheral arteries, sudden
position changes can cause dizziness, lightheadedness, or
syncope. These responses are most prominent when beginning
the drug. To promote safety, especially for older adults, the
nurse should teach the patient taking beta blocker to change
position very slowly.
▪ Blocks sympathetic nervous system (beta adrenergic
receptors) and produces a slower heart rate
▪ Monitor for bradycardia
▪ Can increase risk of bleeding
• Gathering subjective and objective data- assessment/physical
o Objective: heart rate, blood pressure, respirations, wound appearance,
ambulation description
o Subjective: pain, any data gathered from pt telling you something
• Pre-op consent/ pt teaching incentive/ understanding procedure- intra-
op- things to do, things happening, do for pts in post-op
o Incentive spirometer: take deep breath, inhale with device, exhale out
prevents atelectasis, improves lung expansion/oxygenation. Pt turn
and cough deep breath, ever 2 hrs, turn pts side-back-side cough
forcefully and splint if needed. Do not do in pts with ICP pressure
surgeries or ent spin surgeries.
o Pre-op:
, Final Study Guide Med Surg.[LATEST]
▪ Things that should be reported: cardiac problems, airway
concerns, recent airway infections, COPD or asthma, history
or smoking, pregnancy, eating/drinking prior to surgery
▪ Prophylactic antibiotics within 1 hr of a surgical incision
▪ Informed consent: LEGAL PREP
• Provider: discuss procedure, describe risks and benefits,
their ability to refuse, any alternatives
• RN: can only CLARIFY, witness consent after client
acknowledges understanding, it is OUT OF SCOPE if
pt doesn’t understand
• PT: pt with mental illness does not mean they cant
consent. Once consent is signed, it can still be
withdrawn
• Before anesthesia- ask pt to confirm name,
DOB, surgical procedure, site and consent
• Wrong surgical procedure and surgery performed on
wrong body part or wrong pt are defined as a sentinel
events
• Manifestations hypovolemic shock- thromboembolism risk factors
o
• VTE-what do you look out for- teaching/ manifestations dos and don’t
o Development of blood clot in deep veins- starts at DVT then develops
to embolism
o Risk factors: venous stasis, hypercoagulability, trauma of a
blood vessel, immobilization after surgery
o Manifestations: pain, edema, erythema, warmth, tenderness along vein
o Do not massage legs, anti-embolic stockings
o Measure stockings: from heel to popliteal space
• Deep vein thrombosis- most important aspect/ open-reduction
internal fixation
o Elevate the extremity above heart level
o At risk for pulmonary embolism
o Compression stocking, frequent position changes, early ambulation
o Do not massage pt legs-can travel
o Dull aching calf pain
o Compare legs size, temp, edema
o Pt at risk: given blood thinners: warfarin & heparin together due to
effectiveness- for therapeutic levels (anti-coagulant meds)
o Warfarin & ginkgo: bad reaction-cannot take with it
o Warfarin & glucosine cannot be taken together
Final Med Surg
Review
• headaches
o vascular headaches: migraines, cluster, HPT
▪ migraines: prodromal (early s/s): aura, visual field defects,
unusual smells or sounds, disorientation, paresthesia
o tension headaches
o traction-inflammation headaches
• respiratory disease- interventions- respiratory alteration? O2 status
o can only administer 2-4L of oxygen without prescription needed
o listen to lung sounds, position pt to high fowlers
• delegation
o what uaps can and can’t do- can help with ADLs, basic care and vitals
of stable pts, no medications
• hypovolemic shock- interventions- restoring blood volume- replace loss hmt
and hgb- manifestation- roles of RBCs
o can be caused due to hypovolemia-dehydration- due to vomiting,
diarrhea, hemorrhage, polyuria, inadequate fluid intake. Increase BP,
threading pulse (weak pulse), tachycardia, cold calmly skin and fleshy
skin, sunken eyes, tenting packed RBCs given to restore blood volume
and replace HMT and HGB levels- give more fluids, give albumin to
increase BP, oxygen to prevent hypoxia, sodium-bicarb due to
increase acidosis, orthostatic hypotension, oliguria, diaphoresis,
weight every 8 hrs, vitals every 15 min
• HPT- risk factors- values- assessment-intervention-teaching
o Exercise 5x/ week 30 min
o High level of potassium-obtain 12 ECG- indication of
abnormal rhythm: dysrhythmia. Typical abnormalities in
o Risk factors: smoking, race (African), obesity, stress, family
history, sedentary lifestyle, alcohol, age >60 or postmenopausal,
excessive alcohol
o Interventions: reduce BP and prevent or lessen extent of organ
damage, 12L EKG/ECG monitor for heart rhythm and report
changes
o Teaching: diet, stress reduction
,Final Study Guide Med Surg.[LATEST]
o Assessment: may be asymptomatic, headache, visual disturbance,
dizziness, chest pain, tinnitus (noise or ringing in ears), flushed face,
epistaxis (nosebleed)
o Parameters
▪ Normal: <120/ <80
▪ Pre-HPT: 120-129 systolic OR 80-89 diastolic
▪ HPT Stage 1: >140-159/ >90-99
▪ HPT Stage 2: >160/ >100
• Medications for HPT- beta blockers- ace inhibitors-s/e-
assessment- intervention-teaching- Labs-meds- risk factors
o “-il” = ace inhibitor, “-olol” = beta blockers
o Lisinopril- ACE inhibitor
▪ Prevents vasoconstriction
▪ Can cause sexual dysfunction and impotence
▪ Swelling on tongue
o Metoporlol and Ateneolol- Beta Blockers
▪ Beta blockers such as atenolol dilate peripheral arteries, sudden
position changes can cause dizziness, lightheadedness, or
syncope. These responses are most prominent when beginning
the drug. To promote safety, especially for older adults, the
nurse should teach the patient taking beta blocker to change
position very slowly.
▪ Blocks sympathetic nervous system (beta adrenergic
receptors) and produces a slower heart rate
▪ Monitor for bradycardia
▪ Can increase risk of bleeding
• Gathering subjective and objective data- assessment/physical
o Objective: heart rate, blood pressure, respirations, wound appearance,
ambulation description
o Subjective: pain, any data gathered from pt telling you something
• Pre-op consent/ pt teaching incentive/ understanding procedure- intra-
op- things to do, things happening, do for pts in post-op
o Incentive spirometer: take deep breath, inhale with device, exhale out
prevents atelectasis, improves lung expansion/oxygenation. Pt turn
and cough deep breath, ever 2 hrs, turn pts side-back-side cough
forcefully and splint if needed. Do not do in pts with ICP pressure
surgeries or ent spin surgeries.
o Pre-op:
, Final Study Guide Med Surg.[LATEST]
▪ Things that should be reported: cardiac problems, airway
concerns, recent airway infections, COPD or asthma, history
or smoking, pregnancy, eating/drinking prior to surgery
▪ Prophylactic antibiotics within 1 hr of a surgical incision
▪ Informed consent: LEGAL PREP
• Provider: discuss procedure, describe risks and benefits,
their ability to refuse, any alternatives
• RN: can only CLARIFY, witness consent after client
acknowledges understanding, it is OUT OF SCOPE if
pt doesn’t understand
• PT: pt with mental illness does not mean they cant
consent. Once consent is signed, it can still be
withdrawn
• Before anesthesia- ask pt to confirm name,
DOB, surgical procedure, site and consent
• Wrong surgical procedure and surgery performed on
wrong body part or wrong pt are defined as a sentinel
events
• Manifestations hypovolemic shock- thromboembolism risk factors
o
• VTE-what do you look out for- teaching/ manifestations dos and don’t
o Development of blood clot in deep veins- starts at DVT then develops
to embolism
o Risk factors: venous stasis, hypercoagulability, trauma of a
blood vessel, immobilization after surgery
o Manifestations: pain, edema, erythema, warmth, tenderness along vein
o Do not massage legs, anti-embolic stockings
o Measure stockings: from heel to popliteal space
• Deep vein thrombosis- most important aspect/ open-reduction
internal fixation
o Elevate the extremity above heart level
o At risk for pulmonary embolism
o Compression stocking, frequent position changes, early ambulation
o Do not massage pt legs-can travel
o Dull aching calf pain
o Compare legs size, temp, edema
o Pt at risk: given blood thinners: warfarin & heparin together due to
effectiveness- for therapeutic levels (anti-coagulant meds)
o Warfarin & ginkgo: bad reaction-cannot take with it
o Warfarin & glucosine cannot be taken together
