MED SURG 1 FINAL EXAM STUDY GUIDE A+

lOMoAR cPSD| 30878495




SUSSET H. ALCOVER

MED SURG 1 FINAL EXAM STUDY GUIDE A+
~JUST IMPORTANT KEY
POINTS TO KNOW~

 Chronic Disorders
 > 3 months
 Assist with copying, and importance about compliance of Tx. and lifestyles
changes.
 Delegation
 DO NOT delegate to the LPN: assessment, teaching or evaluation
 DO NOT delegate to the UAP: task requiring nursing judgement, medication
administration, assessing, teaching, or evaluation
 Prioritization – ABC, RACE


Hematological Disorders
 Anemias
 S/S: low RBC and H/H, pallor (assess mucous membranes), fatigue (safety, risk for injury), hypoxia, decreased
BP, increased PR (monitor VS)
 Iron Deficiency Anemia
 Microcytic, hypochromic
 Results from decreased dietary intake of iron in the diet – food sources high in iron: organ meats (beef, liver),
beans, leafy green vegetables, raisins and molasses
 Most common causes: bleeding from ulcers, gastritis, IBD; menorrhagia in premenopausal women, and inadequate
iron supplement in pregnancy
 Smooth sore (inflamed) tongue, brittle nails and angular cheilosis
 Iron Supplements
o Tell the pt. taking iron supplements that is normal for the stool to be dark color, but not black tarry
o Side effects: constipation, N/V
o Important to take with vitamin C (orange juice) to enhance absorption, but not with milk or antacids (decrease
absorption)
o Take an hour before meals, because it is best absorbed in an empty stomach
o Iron supplements (liquid preparations) – mix it, use a straw, stain teeth
 Vitamin B12
 Megaloblastic Anemia – RBCs abnormally large
 Least common cause: inadequate dietary intake – occurs in strict vegetarian – Increase oral supplements with
vitamin or fortified soy milk
 Most common cause: Absence of intrinsic factor after bariatric surgery or gastrectomy  Pernicious Anemia

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, lOMoAR cPSD| 30878495




SUSSET H. ALCOVER
 Smooth, sore, red tongue – include assessment of the tongue, confused, paresthesia, loss of proprioception
(unsteady gait) – risk for injury, careful neurologic assessment, lastly jaundice is present
 Vitamin B12 injections – monthly, IM, lifelong
 Sickle Cell Anemia
 Inheritance of the hemoglobin (HbS) gene
 Higher incidence in African Americans
 Complications: Thrombosis, Hypoxia, Infection
 Pain, Hydration, Oxygen
 Careful assessment of all body systems D/T vaso-occlusive crisis  interrupt blood flow, thrombo formation,
hypoxia, ischemia


 Thrombocytopenia
 Low Platelet count – Risk for bleeding
 < 20,000 mm3 – excessive bleeding – Petechiae occurs
 Assess nasal and gingival gums for bleeding
 Promote Safety – Fall Prevention

 Blood Transfusions
 Pre-procedure
o Check there’s an order for transfusion
o Check the pt. has been typed and cross-matched
o Verify that pt. has signed a written consent form.
o Explain procedure to pt. Instruct pt. in S/S of transfusion reactions (itching,
hives, swelling, SOB, fever, chills)
o Take VS to stablish a baseline
o Hand hygiene. Gloves.
o Use a 20 gauge or larger needle for insertion in a large vein (18 is
preferable)
 Procedure
o Make sure the transfusion is initiate within 30 minutes after removal of the
packed RBCs from the blood bank refrigerator.
o For the first 15 min., run the transfusion slowly, no faster than 5 mL/min.
Observe pt. carefully for adverse effects. If not adverse effects occur during
the first 15 min., increase rate unless pt. is at high risk for circulatory
overload.
o Monitor closely for 15-30 min for S/S of reaction. If any occur, STOP
transfusion, NOTIFY PCP.
o Note that transfusion administration time does not exceed 4 hrs., because of
increased risk for bacterial proliferation

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, lOMoAR cPSD| 30878495




SUSSET H. ALCOVER
 Postprocedure
o Obtain VS. Compare with baseline measurements.
o Dispose materials properly  biohazard bag
o Document
o Monitor pt. For response and effectiveness of procedure.
 Platelet Transfusion – same thing just infuses over 30-60 min to diminish clumping over administration


Oncological Disorders




Leukemia

 AML
 Low RBC – anemia – fatigue – Risk for Injury
 Low Platelets – Thrombocytopenia – bleeding, bruises and Petechiae
 Low neutrophils – Neutropenia – Hand hygiene, sign in the door (neutropenic precautions), proper PPEs, no
flowers, or fruits or vegetables, fever and infection is present, restriction of visitors
 Bleeding and infection are the most common cause of death
 Chemotherapy Tx.
o Chemo destroy the cells leaving behind the by product and waste such as uric acid, K, P – Increased renal
stone formation which can cause renal failure. Hyperkalemia and hypocalcemia can lead to cardiac



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