Med-Surg 2 Part II

Contusion is caused by blunt force trauma that cause bleeding in soft tissue.

What do you do before RRT/Code Team arrives?

Muscle mass decreases 30-40% as we age reducing strength.

Multiple wave forms beginning of Q wave and end of S wave. Represents depolarization of ventricles

Which is the most accurate test for asthma?

Early defibrillation and ACLS measures increase survival by 50-60%.

What are possible complications of acute arterial occlusion?

As soon as Code team/RRT arrives you can stop administering CPR.

Which lead is placed between the 6th and 7th intercostal space on right mid-clavicular line?

Rib fractures can damage lungs causing pneumothorax or kidneys causing blood supply loss.

What is the treatment of given for disseminated disease for Valley fever?

Early beats by atrium, P waves, and PR may vary. Noncompensatory pause. P wave may be found in T wave/P wave absent.

50% of pt who code exhibit warning signs up to ___hrs prior to arrest.

Thrombolytics are T-PA dissolves clots quickly/completely and are initiated within 12-24 hr after onset of chest pain.

What is the normal value range for QRS complex?

Male, obesity, smoking, alcohol use, age 40-65, menopause, nocturnal dysrhythmias, DM2, HF, Pulmonary HTN, are risks for

Which pacemaker produces 20-40bpm?

Fever, aches, chills, sweats, fatigue, cough, headache, LE nodular erythema

Stretch/tear of ligament surround joint ankle/knee most common s/s cannot move joint, discolored, pain, rapid swelling.

What are some indication that a pt is in need of ECG monitoring?

What musculoskeletal diagnostic testing evaluates bone density and structure with no special prep or consent needed?

Ends of two connected bones separate from extreme force put on ligament/congenital common site shoulder.

If there is no documentation on record then pt is considered No Code

Wheeze, tachypnea, sob, cough unproductive, chest pain, HR↑, anxiety, intercostal retract, nasal flare, prolong expirat.

Loud snoring, snorting, gasp during sleep, recurrent waking during sleep, choking, daytime sleepy, morning headache, HTN

ER symptoms extreme difficult breathing, bluish color lip/face, severe anxiety, chest pain, sweat, alert↓,drowsy/confuse

On an ECG graph paper, horizontal lines measures voltage.

What is the care/treatment for chronic venous insufficiency?

What can be seen in a CXR of a COPD patient?

Manifestations chest pain, HR↑, anxiety, vasoconstriction, tachypnea, BP changes, women/elderly atypical chest pain

For disseminated Valley Fever, pt is pre-medicated with which medications?

Which lead is placed between 6th and 7th intercostal space on left mid-clavicular line?

What are some medication treatment used to treat muscle spasms?

urgent intervention needed, aspiration, culture of fluid, abx therapy IV, repeated aspiration, surgical drainage/removal

RN must delegate care of an assign pt to a CNA for the shift. Which pt would be most appropriate to delegate

Sudden pain/claudication, embolus/thrombus commonly found in LE interrupting blood supply

What interventions are used for sinus tachycardia?

Myocardial cells necrosis, portion of muscle blocked-ischemic, irreversible cell damage, tissue around ischemia inflam.

Heparin is used to treat existing blood clots.

SOB,wheeze,↑nonproductive cough,pinkfrothy sputum,night sweat, anorexia,weight loss,nausea,fever,chills,fatigue,lethargy

coronary obstruct necrosis, abrupt/severe/unrelief pain, arm/neck/jaw, epig., n, sob, sweat, HR/BP↑↓, ST↑, Q wave, m: ↑

No excess RBC, fluid deficit, RBC count WNL, ↑hct, corrected by hydration

Diagnostic w/201 injected, stress test done, nuclear scan 2-3hr after to eval CAD. Need consent, vs, & assess med/coffee

Which pacemaker predominates?

Infection in fluid filled sac adjacent to tendon near large joints shoulder/elbow/hip/knees, glide surface ↓friction

Pt not physical able to do stress test, contrast, arteries affected CAD no dilate, consent NPO, no coffee, review meds

Change in HR <40/>130, systolic BP <90/>200, RR <8/>28/no airway/O2 sat, AMS, UO <50ml/4h, sepsis, MI, CVA, concern

Surgical embolectomy an incision in the occluded artery, surgeon evacuate embolus using catheter and close w/patch graft

How is carpal tunnel syndrome diagnosed?

Which vasopressor is the first line treatment used for sepsis hypotension/unresponsiveness?

A hemorrhagic stroke can occur if thrombolytics are given too late or beyond the 12-24hr window of inset chest pain.

What are the s/s of acute arterial occlusion?

Artery spasm partial occlu.unstable plaque,10min↑,epig pain,sob,hr↑,BP↓, cool/pale skin, ST dep, Twave inver, m: norm

Repolarization is systole when the heart contracts

Phosphorus levels 2.5-4.5 increase with bone tumors

HTN, smoking, high LDL, DM, obesity, physical inactivity, stress, excess ETOH are all modifiable risks associated with..

Loss of alveoli elasticity, hyperinflation of lungs

What are non modifiable risks for Acute coronary syndrome-

Long term 3mos +, PT/INR monitored, INR 2-3 venous/3-4.5 arterial, same time everyday, antidote Vit. K. no leafy greens

What are the three different muscle types?

CAD,Angi,& Mona go to CABO SAn lucas: Morph,O2,Nitrate,ASA,CA blocker, Anticoag.,beta blocker,other ↓lipid, Stat,ACE/ARB

bronchial tubes lining inflame/scar,vasodilation,congestion,mucus edema, bronchi/bronchioles spasm, pollutant/cig smoke

Faster the rate the shorter QT

Diagnostic ID CAD/valve disease, pressures in PA/heart chambers, angioplasty, consent NPO 6-8hr, leg immobile 6-8hr post

Block rule is # of QRS complexes x10

What is the non life-threatening disease treatment for Valley fever?

What is the treatment for a torn meniscus?

Where are muscle spasms commonly located?

s/s polycythemia portal/HTN,headache,dizzy,vision,hear prob,weight loss, night sweats, plethora,GI bleed,claudication

What are diagnostic tests used for Acute Arterial Occlusions?

Primary goal and treatment for soft tissue trauma?

Serum erythropoietin ↑, bone marrow studies how only red stem cells hyperplasia for secondary polycythemia diagnositcs

RN has just received report on the team. Which tasks can he/she delegate to an LVN?

Diagnosis of asthma is determined by frequency and severity of attacks

Which diagnostic test consists of ultrasound with probe in esophagus visualize back of heart. Need consent, vs, & premed

For a COPD patient, what type of medications should be used for treatment?

Gangrene and Necrosis used the same thing and can be used interchangeably.

On an ECG graph paper, vertical lines measure time.

If medications are not effective for emergent complications of acute arterial occlusion, what are other treatments used?

What is the treatment for symptomatic bradycardia?

Morphine, O2, NTG, ASA, Stent, CABG, fibrolytics within 30min, antidysrhythmics, and beta blockers treat MI

Which musculoskeletal diagnostic test evaluates MS trauma and consent is needed if IV contrast is used?

What are the joint classifications by structure?

Inadequate o2 supply for metabolic,stable angina,coronary perfusion/myocardial workload,plaque,thomb,spasm,↓perfusion

What diagnostic has a catheter inserted into coronary artery, guide wire, ballon inflated, and stent placed?

3 thousand TB droplet nuclei are expelled with 1 cough, 1 min singing, 5 min of talking

Pt assessment, ECG strip, notification Dr/orders received, treatments initial-response, post, rhythm strip,

What are the possible complications of valley fever?

What are some relieving factors for Angina?

What are causes of Acute Arterial Occlusion?

For MI core measures, pt are discharged with ACE and ARB medications.

This thrombolytic used for large clots/PE, does nothing to existing clot, PTT monitored, IVP/IV, antidote protamine sulf

Which lead is placed near right mid-clavicular, directly below the clavicle?

Which diagnostic test has the highest sensitivity and is more accurate in identifying pt with TB?

Fungal soil/spore infect lungs, can spread skin (common),internal organs, bones, meninges, severe depends on #spores/sus

What are conservative treatment for carpal tunnel syndrome

Rapid Response Team is composed of ICU nurse, RT, PT, MD, and bedside nurse.

What causes bursitis?

Success of treatment of TB is dependent largely on compliance of the pt.

What is used to diagnose a torn meniscus?

Which musculoskeletal diagnostic evaluates bone mineral density and checks for osteoporosis?

Deadly v-tach, polymorphic, tall and small waves, outline looks like a party streamer.

MI↑workload plaque narrow artery,predict.,pain neck/shoulder/arm 5-10min, relief rest,n/sob/anxiety twave inver mark:wnl

COPD ABG results will show PO2↑ and PCO2↓

What diag. evaluates avascular necrosis, osteomyelitis, tumors, disc abnorm, ligament tear, consent/questionnaire need.

What are nursing interventions for TB pt?

What are some conservative treatments for muscle spasms?

Vitamin D normal serum levels are 9-11 mg/dl

What is the diagnostic test used to for obstructive sleep apnea?

Common, erythocytosis, erythropoietin↑, affects people of any age/origin, develops in hypoxia, COPD, high altitudes

What are the two surgical procedures used to treat carpal tunnel syndrome by decompressing the nerve?

ST elevation indicates myocardial injury/myocardial infraction

What are some precipitating factors for Angina?

Q wave is 1/3 of QRS or 1 box wide, If wider it indicates Hx of MI.

What are some treatments used for obstructive sleep apnea?

What do you do to call a code blue?

What are the treatments for polycythemia?

How is MI diagnosed?

Anticoagulant ↓thrombin, no periodic labs, dc 24-48hr before elective surgery, dc drug ↑thrombus formation.

Pelvic fractures can damage bladder and bowel causing infection.

What are the MI core measures?

Muscle fatigue, heavy exercise, dehydration, low Ca/Mg, Kidney failure, hypothyroidism, ETOH abuse can cause...

What are the most important diagnositc tools for COPD?

Immune dys, DM, HIV, crowded areas, elderly, foreign people, homeless, drug/alcohol abuser, poor, HC worker are risk for

What are some cardiac marks that need to be monitored for Angina?

Each box on an ECG graph paper=0.04sec

Tear medial/lateral meniscus from twisting leg when knee flex/foot on ground, s/s pain, swell, tender, click/snap knee

Uric acid (3.5-8M; 2.8-6.8F) > 12.0 mg/dl diagnose gout

Thrombus are debris that move through the bloodstream until it lodges in a narrow vessel and blocks circulation.

90% of muscle spasms recover within 2 weeks.

Stretch injury muscle-tendon, mech overload extended past elasticity, s/s pain, limit ROM, muscle spasm, swelling, weak

Partial dislocation is called subluxation

A pt blood O2 sat level is 99% on RA. The nurse realizes O2 blood is transported to heart through what structure?

When are thrombolytics contraindicated?

Sepsis tx 1hr,retest lactate if >2,blood culture before abx,broad spec abx, 30ml/kg crystalloid↓BP/lactate 4 vasopressor

Calcium is bound to albumin. When one is low the other will be low as well.

What are the intrinsic factors that trigger an asthma attack?

Sinus bradycardia is caused by...

What are some complications seen in MI?

Polycythemia reduction of red blood cells characterized by a hct < 55%

Which diagnostic test checks for blood supply in the bone and requires consent?

Sepsis is a potentially life threatening infection triggering inflammatory response throughout body.

15 or more obstructive sleep events per hours during a sleep study confirms Obstructive Sleep Apnea

What are the different types of polycythemia?

Bone marrow studies show hyperplasia of all hematopoietic elements and serum erythropoietin WNL for Primary polycythemia

Latent TB a granuloma forms w/necrosis center= fibrosis/calci. & limit further proliferation & spread mycobacterium TB.

What are the medications for soft tissue trauma

Mycobacterium tuberculosis, acid fast bacillus, gram+ bacteria, droplets in air for hrs/airborne, found in lungs

What are some extrinsic factors that trigger an asthma attack?

cigarette smoke, air pollution, occupational substances, alpha 1 antitrypsin deficiency, barrel chest, clubbed finger

Which pacemaker produces 40-60bpm?

Impaired blood flow to myocardium, two main coronary arteries, atherosclerosis

Disorder of peripheral vascular system interferes w/ circulation caused by damage to valves in veins. Blood pools.

Rib and pelvic fractures can cause...

What are the second line medications for TB

What are the diagnostic tests used to detect valley fever?

Artifact in an ECG is when there is movement, muscle tremors/shivers/seizures, loose electrode & electrical interference

What are signs of organ dysfunction?

chest pain=↓heart blood flow, cause CAD, atherosclerosis, constrict., exercise, coke/stress, HF,vent hypertrophy, ische.

What is the normal value range for QTI interval?

Which diagnostic testing has a two dimensional, ultrasound, evaluates structures/function (pumping ability)?

For emergent intervention of an acute arterial occlusion complication what should be done?

What is the first line medication treatment for TB?

_interval is the beginning of Q wave and end of T wave.

Prevents clot formation inhibits plt aggregation

When planning care for assigned clients, what care can RN on med-surg floor safely delegate to LVN?

What are some dysrhythmias seen in MI?

Wide and bizarre beats with compensatory pause (two beats fit), wide QRS >0.10 sec

Alpha 1-antitrypsin is produced by liver and present in the lungs to protect lung tissue.

What is seen in an ECG for an MI stemi?

Fever, dehydration, infection/sepsis, anxiety, adrenergic agonists, intense physical activity all cause sinus ____

Chronic inflammatory disorder of airways, wheezing, sob, chest tightness, coughing, restricted airflow, reversible, gene

Pt was diagnosed with COPD has pulse ox reading 82% on RA. A nurse should obtain an MD order to do which intervention?

What is the joint classification by function?

What is the purpose of the skeleton?

ST elevation indicates myocardial ischemia, reciprocal changes, and or digoxin.

What are some age related changes in the musculoskeletal system?

Pt c/o calf/foot pain. Leg below knee is cool/pale, dorsalis/posterior tibial pulse absent. Priority intervention is...

O2,Epi,amiodarone,atropine,adenosine,diltiazem,digoxin,ca,lidocaine,Mg sulfate,dobutamine,dopamine,narcan,NaHCO3 in cart

How is bursitis diagnosed?

Any 2 of these qualifies as SIR Temp >100.9/<96.9, HR>90, RR>20, WBC>12,000/<4000/10%bands, BG>140 non DM, AMS, BP norm

S/s pain, ↓ROM, change bone alignment, alt in length of extremity, swelling, discoloration, crepitation, subq emphysema

RN gives report to receive RN, family care, summary printed, EKG strip chart, sheet complete, eval to RM, cart exch, doc

Which lead is placed near left mid-clavicular, directly below the clavicle?

Complications of acute arterial occlusion is seen in ICU when using vasopressors due to the constricting of vessels

What are the manifestations of angina?

What must a nurse determine before terminating airborne precautions for a pt with pulmonary TB?

Patho cilia damage, ↑airway resistance scar tissue, pulmonary infections, polycythemia develops response to hypoxemia

What is known to prolong QT intervals?

brown discoloration, ankle edema/stasis, dermatitis/no itch/rash, red/cyanotic, no claudication, blister, skin ulcer

Treated like cancer, ↑RBC production, affects European Jewish men age 40-70, cause unknown

Catecholamines, meds, elicit drugs, digitalis toxicity, acidosis/alkalosis, hypoxia, MI/Infarc, K↓↑, Ca↓, Mg↓, causes___

Which lead is placed right of the sternum at the 4th intercostal space?

What is the normal PRI rate?

Albuterol is an off label treatment for hyperkalemia