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) LAB values
Purkinje Fibers: ventricular pacemaker (20-40bpm) Hgb Women: 12-16%
Labs: Men: 13.5-18%
PT (9-12) Hct Women: 38-47%
INR (0.9-1.2) Men: 40-54%
PTT (55-75) RBC (million) Women: 4-5
ABG (pH: 7.35-7.45, CO₂: 45-35, HCO₃: 22-26) Men: 4.5-6
CBC (blood) WBC 4000-11000
BMP (electrolytes) Plt 150,000-400,000
Diagnostic Tests: PT 10-15 sec
CXR, EKG, Stress test, Echo, TEE, INR 1-1.2 sec
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”
, 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 Testing-
Noninvasive: 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
, 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 particles
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) LAB values
Purkinje Fibers: ventricular pacemaker (20-40bpm) Hgb Women: 12-16%
Labs: Men: 13.5-18%
PT (9-12) Hct Women: 38-47%
INR (0.9-1.2) Men: 40-54%
PTT (55-75) RBC (million) Women: 4-5
ABG (pH: 7.35-7.45, CO₂: 45-35, HCO₃: 22-26) Men: 4.5-6
CBC (blood) WBC 4000-11000
BMP (electrolytes) Plt 150,000-400,000
Diagnostic Tests: PT 10-15 sec
CXR, EKG, Stress test, Echo, TEE, INR 1-1.2 sec
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”
, 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 Testing-
Noninvasive: 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
, 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 particles
