se5l, medical-surgical review curse powerpoint
TRANSCRIPT
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
1/104
Medical-Surgical Nursing
Certification Review
SE5l, Medical-Surgical Review curse PowerPoint.pdf
1
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
2/104
CMSRN Exam
Given four times a year
Spring (usually May)
Fall (usually October) AMSN Annual Convention
(usually September)
Nursing 200x Symposium in theSpring
SE5l, Medical-Surgical Review curse PowerPoint.pdf
2
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
3/104
AMSN Nursing Practice Roles
Helping Role 17% (32-36)
Teaching/coaching role 17% (32-36)
Diagnostic and Patient Monitoring Role
25% (38-42)
Administering and Monitoring
Therapeutic Intervention 25% (58-62)
SE5l, Medical-Surgical Review curse PowerPoint.pdf
3
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
4/104
AMSN Nursing Practice Roles
Effective Management of Rapidly
Changing Situations 10% (18-22)
Monitoring/Ensuring Quality HealthCare Practice 3% (4-7)
Organizational and Work-Role
Competencies 3% (4-7)
SE5l, Medical-Surgical Review curse PowerPoint.pdf
4
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
5/104
Distribution Patient Problem
GI 19% (36-40)
Pulmonary 19% (36-40)
Cardiovascular 15% (28-32) Diabetes/Other endocrine 15% (28-32)
SE5l, Medical-Surgical Review curse PowerPoint.pdf
5
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
6/104
Distribution Patient Problem
Renal/GU-12%(22-29)
Musculoskeletal/Neuro 11%
(20-24) Hematological / Immune /
Integumentary 9% (16-20)
SE5l, Medical-Surgical Review curse PowerPoint.pdf
6
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
7/104
Preparing for the Test
Medsurg Nursing CertificationBoard Requirements CMSRN
credential
Minimum of 3,000 hours in Medsurgnursing as a staff nurse, clinical nurse
specialist, clinical educator, faculty,
manager, or supervisor.
SE5l, Medical-Surgical Review curse PowerPoint.pdf
7
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
8/104
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
9/104
Preparing for the Test
Contacting Medical- Surgical
Nursing Certi fication Board MSNCB Home Office
East Holly Avenue, Box 56, Pitman, NJ
08071-0056
Phone: 856-256-2323 or Toll free 866-
877-2676
Fax: 856-589-7463 (fax)
E-mail: [email protected] http://www.medsurgnurse.org
SE5l, Medical-Surgical Review curse PowerPoint.pdf
9
mailto:[email protected]:[email protected]:[email protected] -
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
10/104
Publications to review
Scope and Standards for Medical-
Surgical Nursing Practice
ANA Code for Nurses Human Rights Guidelines for Nurses in
Clinical and other Research
SE5l, Medical-Surgical Review curse PowerPoint.pdf
10
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
11/104
Preparing for the Test
AMSN Core Curriculum for Medical-
Surgical Nursing
Medical Surgical Nursing ReviewQuestions
Review Course
Examination Prep Guide
Your nursing experience
SE5l, Medical-Surgical Review curse PowerPoint.pdf
11
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
12/104
Test Taking Tips
Read questions all the way through
Eliminate obvious wrong answers
Take moment to relax occasionally Have good reason to change answers
SE5l, Medical-Surgical Review curse PowerPoint.pdf
12
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
13/104
Stress Reduction
Review prior to exam, but dont cram
especially the night before (raises
stress levels making it more difficult)
Take time during the exam to take deep
breaths and relax.
You will have 4 hours to take the exam
which has 200 questions plenty oftime!
SE5l, Medical-Surgical Review curse PowerPoint.pdf
13
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
14/104
A patient begins to experience a severe GI
bleed. The plan of care to meet the
patients fluid needs should include, as a
priority, planning for which of the following?
A. Provision for skin care
B. Monitoring vital signs frequently
C. Decreasing PH of gastric fluids D. Rapid infusion of IV blood and fluids
SE5l, Medical-Surgical Review curse PowerPoint.pdf
14
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
15/104
To prevent complications on the third day
after an uncomplicated acute MI, the nurse
would implement which action?
A. Monitor the patients ability to perform
activities of daily living without shortness
of breathB. Accompany the patient ambulating for a
short distance at least each shift
C. Apply anti-embolic hose to the legs
D. Give the patient a nitroglycerin sublingual
to prevent chest pain before all out of bed
activities
SE5l, Medical-Surgical Review curse PowerPoint.pdf
15
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
16/104
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
17/104
A patient in acute renal failure developed
acute pulmonary edema. Which of the
following interventions would beinappropriate to include in the patients
care?
A. Administration of oxygen at 3 L/min per
nasal cannula
B. Administration of morphine and
Furosemide (Lasix)
C. Place the patient in high Fowlers positionD. Replace fluids with normal saline
SE5l, Medical-Surgical Review curse PowerPoint.pdf
17
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
18/104
Fluids and Electrolytes
SE5l, Medical-Surgical Review curse PowerPoint.pdf
18
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
19/104
Fluid
Intracellular
Body water
Extracellular Body water
SE5l, Medical-Surgical Review curse PowerPoint.pdf
19
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
20/104
Electrolytes
Same electrolytes in
intracellular space as
in extracellular space
Always measure
extracellular space
SE5l, Medical-Surgical Review curse PowerPoint.pdf
20
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
21/104
Sodium
Necessary for protein synthesis
Fluid volume in extracellular spaces
SE5l, Medical-Surgical Review curse PowerPoint.pdf
21
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
22/104
Hyponatremia
Dilutional most common
Excessive fluid intake
Edema, confusion
Treatment decrease fluid intake
True
Fluid and sodium loss
Dry tissue Treatment replace both sodium and
water
SE5l, Medical-Surgical Review curse PowerPoint.pdf
22
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
23/104
Hypernatremia
Most common, fluid loss without loss
of sodium
Dry tissue
Treatment replace fluids
Increased sodium with diet rare could
occur with full strength high protein
tube feeding
SE5l, Medical-Surgical Review curse PowerPoint.pdf
23
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
24/104
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
25/104
Hyperkalemia
Causes cell wall destruction,
increased intake, renal failure
Symptoms irritable muscles
Treatment Kayexalate, calcium
gluconate, insulin
SE5l, Medical-Surgical Review curse PowerPoint.pdf
25
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
26/104
Hypokalemia
Increased loss of potassium
or increased fluid
Muscle flaccidity
Treatment potassium supplements
IV
Oral
SE5l, Medical-Surgical Review curse PowerPoint.pdf
26
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
27/104
Calcium
Sedative at the neuro level
Necessary for coagulation
SE5l, Medical-Surgical Review curse PowerPoint.pdf
27
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
28/104
Hypercalcemia
Increased intake, hyperparathyroidism
Symptoms
Sedation
Treatment
Decrease calcium intake
SE5l, Medical-Surgical Review curse PowerPoint.pdf
28
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
29/104
Hypocalcemia
Decreased calcium intake, increased
phosphate levels, renal disease
Hyperactive deep tendon reflexes
Chvosteks
Trousseaus
Laryngospasm
SE5l, Medical-Surgical Review curse PowerPoint.pdf
29
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
30/104
Phosphate
Informal inverse relationship with
calcium
Symptoms may be opposite of
calcium (hypophosphatemia looks like
hypercalcemia, etc)
SE5l, Medical-Surgical Review curse PowerPoint.pdf
30
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
31/104
Magnesium
Hypermagnesemia
Usually poor renal excretion
Muscular depression
Hypomagnesemia
Hyperactive deep tendon reflexes
SE5l, Medical-Surgical Review curse PowerPoint.pdf
31
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
32/104
Serum Osmolality
2(Na) + BUN/5 + glucose/20 = 275-295
mOsm/l
Quick and dirty 2(Na)
Higher the number, dryer the patient
SE5l, Medical-Surgical Review curse PowerPoint.pdf
32
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
33/104
IV Fluids
Hypertonic = above 295 mOsm/L
D5LR, D5NS
Isotonic = 275 295 mOsm/L
NS, LR
Hypotonic = below 275 mOsm/L
NS
SE5l, Medical-Surgical Review curse PowerPoint.pdf
33
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
34/104
A patient experiencing a sodium imbalance
must be assessed for which of the following
symptoms?
A. Changes in level of consciousness B. Irri tability of skeletal muscles
C. Depression of deep tendon reflexes
D. Evidence of acid-base imbalances
SE5l, Medical-Surgical Review curse PowerPoint.pdf
34
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
35/104
A patient who is severely dehydrated would
most likely be treated initially with which of thefollowing IVsolutions?
A. HypertonicB. Isotonic
C. Hypotonic
D. Colloidal
SE5l, Medical-Surgical Review curse PowerPoint.pdf
35
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
36/104
Which of the following assessment data are
consistent with hypovolemia?
A. Increased pulse and a swollen tongue
B. Neck vein distention and dry skinC. Weight loss and thirst
D. Increased blood pressure and a fever
SE5l, Medical-Surgical Review curse PowerPoint.pdf
36
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
37/104
Which of the following sets of signs and
symptoms would be exhibited by a patient with
a serum potassium of 6.8 mEq/L?
A. Bradycardia and constipation
B. Confusion and muscle cramps C. Paralytic ileus and paresthesias
D. Diarrhea and spastic paralysis
SE5l, Medical-Surgical Review curse PowerPoint.pdf
37
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
38/104
SE5l, Medical-Surgical Review curse PowerPoint.pdf
38
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
39/104
Immune System
Leukocytes
A. Granulocytes
1. Neutrophils first line of
defense against bacteria
2. Eosinophils phagocytize
antigen-antibody complexes
3. Basophils- containhistamine and heparin
SE5l, Medical-Surgical Review curse PowerPoint.pdf
39
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
40/104
Immune System
B. Nongranulocytes
1) Monocytes phagocytize
bacteria
2) Lymphocytes provide
immunity against foreigninvaders including transplants
C. Immune Response
1) Humoral B lymphocytes,
memory
2) Cellular T lymphocytes,foreign invaders
SE5l, Medical-Surgical Review curse PowerPoint.pdf
40
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
41/104
Compromised
Immune System Steroids
suppression of system
Chemotherapy
SE5l, Medical-Surgical Review curse PowerPoint.pdf
41
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
42/104
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
43/104
Transmission of AIDS
Blood
Semen
Vaginal fluids Breast milk
Transplacental ?
Transmitted even when asymptomatic
SE5l, Medical-Surgical Review curse PowerPoint.pdf
43
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
44/104
Pathophysiology
Retrovirus, part of the Lentivirius family
Infects CD4 lymphocytes
Carries genetic information on RNA intothe cells DNA
CD4 cells, necessary to immune function,
decrease in numbers in acute phase
SE5l, Medical-Surgical Review curse PowerPoint.pdf
44
SE5l M di l S i l R i P P i t df
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
45/104
CD 4 Classification of AIDS
Category I:>500 CD4 cells /micro L
Category II: 200-400 CD4 cells/ micro L
Category III:
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
46/104
SE5l Medical Surgical Review curse PowerPoint pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
47/104
Treatment of AIDS
Prevention
Optimal treatment includes combination of
at least 3 drugs, often referred to as
HAART
Reverse transcriptase inhibitors
Protease inhibitors
Fusion inhibitors
SE5l, Medical-Surgical Review curse PowerPoint.pdf
47
SE5l Medical Surgical Review curse PowerPoint pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
48/104
Hematologic System Erythrocytes: 120 day life span
Requires erythropoietin from kidneys(80%) and liver (20%)
Thrombocytes: 7.5 day life span, 1/3
sequestered in spleen. Increased bloodplatelet level following splenectomy
a. Clotting cascade
Extrinsic
Intrinsic
Enzymes
SE5l, Medical-Surgical Review curse PowerPoint.pdf
48
SE5l Medical Surgical Review curse PowerPoint pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
49/104
White blood cells
Neutrophils- first line of defense against
bacteria Immature cells are Bands
Eosinophils- break down antigen/antibody
complex
Basophils- work to keep blood flowing
through micro-vascular system
Monocytes-effective bacterial macrophage
SE5l, Medical-Surgical Review curse PowerPoint.pdf
49
SE5l Medical-Surgical Review curse PowerPoint pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
50/104
Lymphocytes:
T-lymphocytes-react against foreign or
abnormal cells
B-lymphocytes- becomes antibodies when
exposed to something seen as a long term
threat
SE5l, Medical-Surgical Review curse PowerPoint.pdf
50
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
51/104
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
52/104
Hematologic concerns
Anemia Blood loss, Hemolytic
Sickle cell
Iron deficiency Pernicious
Disseminated Intravascular coagulation
Hodgkins
SE5l, Medical Surgical Review curse PowerPoint.pdf
52
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
53/104
Sam Andrew had just been diagnosed with
pernicious anemia following his gastric
resection. He asked how long he will need totake the vitaminnB12. You tell him hell need to
continue:
A. Until his anemia is corrected
B. For the rest of his life
C.It depends on his physicians assessment of
him
D.Its different in everyone
SE5l, Medical Surgical Review curse PowerPoint.pdf
53
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
54/104
Which of the following laboratory results
would be considered the most indicative of
DIC?
A. High platelet count
B. Elevated blood glucose
C. Increased bleeding times
D. Presence of fibrin degradation products
(FDP)
, g p
54
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
55/104
Cardiovascular system
g p
55
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
56/104
Anatomy and Physiology
A. Heart: atria, ventricles, valves,
coronary circulation, cardiac,
conduction system
B. Cardiac Cycle: Systole, diastole
C. Peripheral vascular system:
Veins, arteries, arterioles, venioles,
capillaries
56
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
57/104
57
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
58/104
58
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
59/104
59
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
60/104
CO=HR SV
Stroke volumePreload
Afterload
Contractility Heart Rate
Impact of the ANS
60
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
61/104
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
62/104
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
63/104
Physical Assessment
Inspection
Edema, skin assessment, hair
growth
Palpation
Peripheral pulses, PMI
63
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
64/104
Heart sounds
Normal
S1
S2
AbnormalS3 lub DUB dub
S4 lub dub DUB
Murmurs Friction rub
64
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
65/104
Diagnostic studies
Cardiac enzymes & proteins
Troponins
CPK-MB, myoglobin, troponins
LDH
Doppler ultrasound
ECHO:TEE
Thallium imaging
Pericardial fluid analysis
65
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
66/104
Diagnostic procedures
Electrocardiogram
Electrophysiology
Echocardiography
Stress test
Doppler Ultrasound
Cardiac Catheterization
66
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
67/104
Acute Coronary Syndromes (ACS)
Sudden Death
Sudden Death
Stable Angina
CoronaryArterial
Thrombosis
ST-
Elevation MI
Non-ST-Elevation
MI
67
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
68/104
ECG Changes Consistent with
ACS
68
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
69/104
Anti- ischemic Options
Nitrates Dilate blood vessels; relaxes and expands
artery, increasing blood flow
Morphine Pain relief, Dilate blood vessels; relaxes and
expands artery, including blood flow
Beta blockers Slows pumping action of the heart, reduce
oxygen requirements
ACE inhibitors Dilate blood vessels, prevent fluid retention, and
ease the workload of the heart
Calcium blockers Dilate blood vessels and reduce vascular
smooth-muscle contraction
69
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
70/104
Antiplatelets and Antithrombin Agents
Salicylates: Aspirin
ADP-receptor inhibitors: Clopidogrel
Glycoprotein(GP) Iib-IIIa receptor antagonists
Heparin-unfractionated heparin (UFH)
Low- Molecular weight heparins (LMWH) with
UA/NSTEMI indications Enoxaparin
Dalteparin
Direct- acting Antithrombins
BivalirudinArgatrobran
Lepirudin
70
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
71/104
CV Conditions
CHF
Diuretics, ACE Inhibitors, Digitalis, Beta
Blockers
BNP- Brain Naturetic Peptide
Hypertension
Highest Risk: African American males in
southeast United States
Weight loss- diet management; exercise,Diuretics, Ace inhibitors, Beta blockers,
Angiotensin 2 receptor blockers
71
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
72/104
CV conditionsChronic Peripheral Circulatory DiseaseArterial( PAD-peripheral arterial disease):
Thrombolytics, antiplatelet aggregates,
revascularization-stents, arterioplasty,
bypass graftingVenous )PVD-peripheral venous disease):
elevation, wound prevention- assessment-
management, antiplatelet aggregates
DVT: Heparin, LMWH, warfarin, labs:PT/PTT/INR, D-dimer: SVC filter
72
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
73/104
Y i f ti t t MI hSE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
74/104
You are caring for a patient post MI, who
suddenly develops bradycardia and
hypotension. What is the likely cause?
A. Anxiety reaction
B. Cardiogenic shock
C. Medication overdose
D. Pulmonary edema
74
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
75/104
Mr. Jones, just returning from a coronary
angiogram, develops bradycardia and a
narrowing pulse pressure. What is themost likely cause?
A. Cardiac tamponade
B. Positional hypotension C. Myocardial infarction
D. Anaphylactic shock
75
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
76/104
Which of the following antihypertensive
should be avoided in a person with
diabetes?
A. Calcium channel blockers
B. Beta Blockers
C. ACE inhibitors
D. Nitrates
76
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
77/104
Cancer
Uncontrolled growth of cells-
Due to alteration in cells genes
Immune system fails to destroy
Etiologic factors
Chemicals
Radiation
Viruses Host-related factors (tobacco use etc)
77
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
78/104
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
79/104
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
80/104
Therapeutic modalities
Surgery- for staging and treatment
Radiation-Side effects at site of radiation
Biologic therapy-alter host responses to
malignant cells
Chemotherapy- use of chemical agents
80
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
81/104
Sue Lynn, a 50 year old diagnosed with an
autoimmune disorder, asks what that
means. You tell her:
1. The bodys ability to fight off infections has been
lost
2. She is experiencing an increase in one white
cell line
3. Her immune system is attacking her own body
cells
4. It is a short lived event which will make her
susceptible to bruising
81
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
82/104
Which of the following sets of signs and
symptoms would be exhibited by a patient
with a serum potassium of 6.8 MEq/l?
A. Bradycardia and constipationB. Confusion and muscle cramps
C. Paralytic ileus and paresthesia
D. Diarrhea and GI spasms
82
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
83/104
A patient on your unit has been diagnosed
with AIDS. He expresses concerns for
your safety during his am care. You wouldstate:
1. lets talk about what we can call body
substance isolation
2. Youre not bleeding so theres no risk
3. Its just part of my job, so I dont think
about it.
4. It is scary, but you deserve my care
83
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
84/104
Gastrointestinal system
84
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
85/104
History and subjective assessment Past history of GI disorders, Surgery, allergy,
lactose intolerance Pain: location and r/t eating (full or empty
stomach)
Condition of teeth, tongue, oral mucosa
Dysphagia, belching, indigestion/heart burn,nausea, vomiting
Weight loss, anorexia
Bowel movement frequency: Diarrhea,
constipation, laxative or enema use, presence of
dark stools or frank blood
85
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
86/104
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
87/104
Diagnostic Studies
Lab tests: Electrolytes, LFTs, fecal
studies, analysis of gastric secretions
2. Radiography: Barium swallow,
barium enema, ultrasound, ERCP,endoscopy, arteriography,
colonoscopy, nuclear medicine
imaging, CT scan
87
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
88/104
Liver Disease
Cirrhosis- Hardening of the liver
Medical treatment-paracentesis, Transjugular
intra-hepatic Porto-systemic shunting (TIPS),
organ transplant
Nursing interventions: Monitor for bleeding,albumin, B vitamin levels, serum ammonia;
treat alcoholism (refer to rehab); teach
avoidance of hepatotoxic substances and use
of OTC meds; control ammonia related
encephalopathy-neomycin, lactulose, reducedprotein intake
88
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
89/104
Esophageal varices
Medical treatment- Banding, sclerosing,
esophageal balloon tamponade,
transfusion of RBCs and clotting factors
(FFP) Nursing interventions: monitor VS, S&S of
bleeding, PT, PTT, platelets, refer to
treatment for alcoholism
89
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
90/104
Viral Hepatitis Transmission
A- Fecal-oral, contaminated food
B and C-Blood and body fluid
Medical treatment
Hepatitis A- supportive treatment, ant-diarrhea and anti ememitics
Hepatitis B gamma globulin, prevention with
hepatitis vaccine
90
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
91/104
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
92/104
Bowel disease
Inflammatory bowel disease
Medical treatment- corticosteroids, azulvidine,
surgery( Colectomy/Colostomy or ileostomy)
Nursing Interventions: monitor for S&S of
bleeding, test stools for occult blood, ostomy
care including diet teaching and address body
image
92
I it bl b l d
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
93/104
Irritable bowel syndrome Conventional medical treatment-imodium for
diarrhea; tegaserod maleate (Zelnorm) forconstipation; Alosetron hydrochloride ( Lotronex)
for diarrhea if conventional therapy is not
effective
Nursing intervention: Teach avoidance of theindividuals triggers- large meals, wheat, rye,
barley, chocolate, milk products, alcohol, drinks
with caffeine; stress or emotional upsets. Teach
avoidance of overusing saline enemas and OTC
laxatives
93
B l Di
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
94/104
Bowel Disease
Obstruction Medical treatment- NG tube, NPO, surgery
Nursing interventions: Monitor bowel
sounds, IV fluids, TPN, prepare for
diagnostic studies and surgery, treat N&V
94
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
95/104
Colon Cancer
Medical Treatment- polypectomy, tumor
resection, colectomy/ostomy, chemo and
or radiation
Nursing Interventions: Bowel prep, ostomycare, diet teaching, teach effects of chemo
and radiation
95
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
96/104
Pancreatitis
Acute: NPO, fluids, possibly TPN.
Monitor glucose, acid balance, K, Ca,
Serum Co2, and amylase, lipase. Pain
management, I7O monitoring; be alert forsigns of hemorrhage, renal and respiratory
failure
Chronic: Pancreatic enzymes, teach low
fat diet, pain management
96
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
97/104
Peptic Ulcer disease
Causes: Helicobter pylori has been found
to be the cause in most ulcers, 50% of the
population is colonized
NASAIDS are another significant factor forgastric and duodenal ulcers in individuals
over 60
Corticosteroids cause erosion of gastric
mucosa
97
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
98/104
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
99/104
Peptic Ulcer disease
Antibiotics
Histamine 2 blockers
proton pump inhibitors
Barrier medications
99
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
100/104
Peritonitis
Nursing assessment
Monitor VS, WBCs, assess pain level,
assess firmness of the abdomen(rebound
tenderness)
Treatment:
Antibiotics( intraperitoneal in peritoneal
dialysis patient)
Pain management
Antiemetics PRN
100
Mrs Stone 68 is on o r nit ith
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
101/104
Mrs. Stone, 68, is on your unit with
ascites, as a complication of her liver
cancer. Her potassium level is elevatedand would most likely be related to:
A. Hypomagnesemia
B. Increased ammonia levels
C. Decreased albumin levels
D. Poor lymphatic system
101
A li t ith d d i h i i
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
102/104
A client with advanced cirrhosis is
admitted to your unit from the E.D.
Which of the following orders shouldyou question?
A. Phenobarbital 100 mg HS
B. Neomycin sulfate 300 mgQ6 x 4 doses
C. Low protein diet
D. Serum ammonia levels daily
102
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
103/104
Nutrition
SE5l, Medical-Surgical Review curse PowerPoint.pdf
-
8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint
104/104
Nutrition
Essential for adequate functioning of allbody systems
Calculating nutrition intake is based on kcal-
Kilocalories
Carbohydrates 4 Kcal/gram Protein 4 Kcal/gram
Fat 9 Kcal/gram
Enteral feeding is preferred over parenteral
feeding because it is important to maintaining afunctioning GI tract