Med-Surg 2 Part II

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

What are the three different muscle types?

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

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

What are nursing interventions for TB pt?

What are some medication treatment used to treat muscle spasms?

Each box on an ECG graph paper=0.04sec

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

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

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

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

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

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

What are the possible complications of valley fever?

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

Where are muscle spasms commonly located?

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

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

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

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

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

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

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

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

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

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

Sinus bradycardia is caused by...

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

What causes bursitis?

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

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

What are some treatments used for obstructive sleep apnea?

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

Albuterol is an off label treatment for hyperkalemia

Which pacemaker predominates?

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

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

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

What are the medications for soft tissue trauma

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

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

What are some complications seen in MI?

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

How is MI diagnosed?

What is seen in an ECG for an MI stemi?

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

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

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

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

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

What are some dysrhythmias seen in MI?

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

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 treatment for a torn meniscus?

Prevents clot formation inhibits plt aggregation

What do you do before RRT/Code Team arrives?

What are the s/s of acute arterial occlusion?

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

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

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

What interventions are used for sinus tachycardia?

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

On an ECG graph paper, vertical lines measure time.

What are some precipitating factors for Angina?

What are the joint classifications by structure?

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

What are some relieving factors for Angina?

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

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

What is the normal value range for QTI interval?

What are the MI core measures?

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

Heparin is used to treat existing blood clots.

How is bursitis diagnosed?

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

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

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

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

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

Partial dislocation is called subluxation

What are some conservative treatments for muscle spasms?

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

What is the joint classification by function?

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

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

Primary goal and treatment for soft tissue trauma?

Which pacemaker produces 20-40bpm?

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

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

Which pacemaker produces 40-60bpm?

Which is the most accurate test for asthma?

What are diagnostic tests used for Acute Arterial Occlusions?

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

Repolarization is systole when the heart contracts

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

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

What is the first line medication treatment for TB?

What are causes of Acute Arterial Occlusion?

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

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

What are the most important diagnositc tools for COPD?

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

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

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

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

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

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

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

On an ECG graph paper, horizontal lines measures voltage.

90% of muscle spasms recover within 2 weeks.

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

What is the care/treatment for chronic venous insufficiency?

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

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

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

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

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

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

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

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

What are some extrinsic factors that trigger an asthma attack?

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

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

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

What are the intrinsic factors that trigger an asthma attack?

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

What is used to diagnose a torn meniscus?

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

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

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

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

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

What is known to prolong QT intervals?

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

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

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

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

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

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

How is carpal tunnel syndrome diagnosed?

What is the purpose of the skeleton?

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

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

Pelvic fractures can damage bladder and bowel causing infection.

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

COPD ABG results will show PO2↑ and PCO2↓

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

What are the treatments for polycythemia?

Block rule is # of QRS complexes x10

What are the manifestations of angina?

What are non modifiable risks for Acute coronary syndrome-

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

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

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

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

What are possible complications of acute arterial occlusion?

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

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

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

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

What is the treatment for symptomatic bradycardia?

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

When are thrombolytics contraindicated?

What is the normal value range for QRS complex?

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

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

What are some age related changes in the musculoskeletal system?

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

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

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

Rib and pelvic fractures can cause...

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

What are the second line medications for TB

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

What do you do to call a code blue?

Phosphorus levels 2.5-4.5 increase with bone tumors

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

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

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

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

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

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

What are the diagnostic tests used to detect valley fever?

Diagnosis of asthma is determined by frequency and severity of attacks

Loss of alveoli elasticity, hyperinflation of lungs

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

What is the normal PRI rate?

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

What are signs of organ dysfunction?

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

What are conservative treatment for carpal tunnel syndrome

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

What are the different types of polycythemia?

ST elevation indicates myocardial injury/myocardial infraction