intro to med-surg

8/4/2019 Intro to MED-Surg

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Marites A. Rosapapan, R.N.


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The process of Medical-Surgical Nursing is not limited

to a disease or a body system.The focus is holistic in natureand demands a broad

knowledge base that spansadult health


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Taking report on patients (atthe bedside)

Setting early priorities basedupon report and what u haveobserved at the bedside


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Providing nutrition (insulinbefore and after checking

blood glucoseObservation of amount eaten,intake and output


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Monitoring lab values(BUN/Creatinine, electrolytes)

Medication Administration(vitals first)


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IV Fluids ( adding, changing,correcting)

Administering blood andblood products

Working with tubes, IV line,

NGT, ET, IFC (both insertionand removal)


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It will blow up in your face!


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COMPREHENSION Study basic information. You need the KNOWLEDGE

to answer questions.

Case Scenario tells you something

Item Stem asks you something

Identify four critical elements

Eliminate incorrect options


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Key words: unlock critical ideas Examples:

initial early late

immediate first best most likely least likely postoperative

The Client: focus of the question Examples

Person with the health problem Relative or friend Another client A staff member

The Issue: specific problem or subject Examples:

A medication or toxic effect a medical diagnosis Client response behavior

Type of stem True response stem False response stem Comparison stem Priority stem


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True response stem False response stem

Unsafe At risk contraindicated

Comparison stem Differentiating between 2 items Comparing

Priority stem: best, initial, priority Maslows Hierarchy of Needs ABCs Critical Thinking


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Distractors: assign a symbol (+) : appropriate

(?) : not sure, maybe correct

(-) : inappropriate

Always go with what you know Eliminate at least 2 at first attempt


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Select an appropriate nursing intervention. Select an appropriate nursing diagnosis for a

given scenario.

Select PRIORITY nursing diagnosis based onthe data provided in the stem of the question Most important

First

Best


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POSITIVE ATTITUDE

I THINK I CAN . . .I KNOW I CAN.

PREPARE

If you fail to prepare, . . .

prepare to fail.


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Basic knowledge of anatomy & physiology =will lead you to the signs & symptoms ofthe disease

Apply the nursing processConsider SAFETYRemember MASLOWS HIERARCHY OF

NEEDS

Other information needed:Laboratory Tests & Normal ValuesDiagnostic ProceduresManagement: Medical & Surgical


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ANGINA MYOCARDIAL INFARCTION

HTN

PVD AAA

THROMBOPHLEBITIS

DYSRHYTHMIAS

ENDOCARDITIS VALVULAR HEART DISEASE


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A client with a mitral valve disease haspresented to the clinic for further evaluation ofthe mitral valve. Which chamber of the heartwill be affected if the mitral valve is narrowed?

a. Right atriumb. Left atrium

c. Right ventricle

d. Left ventricle


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Which female client is most at risk for

cardiovascular disease?a. A woman on hormone replacement

therapyb. A woman who has never been

pregnantc. A woman with elevated HDL (high-

density lipoprotein) levelsd. A woman with abdominal obesity


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A client with history of previous myocardialinfarction is admitted with heart failure. Whatstatement made by this client would alert thenurse to suspect the occurrence of heart

failure?a. It is getting more difficult to climb the stairsto reach the bathroom.b. I think my dose of digoxin may need to beincreased.

c. I have trouble remembering things recently.d. I drink at least two full glasses of water aday.


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A nurse is preparing a client to undergo cardiaccatheterization. What specific assessmentshould the nurse make before the procedure?

a. Ascertain if the client will require sedation.

b. Ascertain if the client is able to roll side toside.

c. Ascertain if the client has a history of diabetesmellitus.

d. Ascertain if the client has allergies to iodine-containing substances.


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a. When the clients heart rate reaches 140beats per minute.b. When the grade of the treadmill incline

reaches 10%.c. If the clients respiratory rate exceeds 36breaths/minute.d. If the clients ECG indicates significant ST-segment depression


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a. Measure urinary output.

b. Assess for shortness of breath.

c. Assess pulse oximetry every hour.

d. Measure blood pressure in the lying and

sitting positions.


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a. Assess the clients airway, breathing, and

level of consciousness.

b. Administer verapamil IV push.c. Defibrillate the client.

d. Begin cardiopulmonary resuscitation.


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PNEUMONIA CAL

COPD

EMPHYSEMA

CHRONIC BRONCHITIS

ASTHMA

CANCER OF THE LARYNX

TUBERCULOSIS

LUNG CANCER


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PARAMETER LESS THAN NORMAL VALUE MORETHANpH Acidosis 7.35-(7.40)-

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Alkalosis

pCO2(Respiratory)

Alkalosis 35 45 Acidosis

HCO3(Metabolic)

Acidosis 22 26 AlkalosisInterpret the pH: (for the first and last name of the ABG)

Is it compensated or uncompensatedcompensated; falls within the normal range

7.35 7.40 = acidosis7.41 7. 45 = alkalosis

uncompensated: falls outside the normal rangeIs it acidosis (less than 7.35) or alkalosis (more than

7.45)Determine if it is respiratory or metabolic: (for the middle name of the

ABG)What matches the pH? Look at the colors in the chart

Is it respiratory (pCO2 )Is it metabolic (HCO3)

USE OF ARROWS (ROME): Respiratory Opposite Metabolic EqualExamples: pH- 7.25 () 7.49 ()

pCO2 28 () 25 ()


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Other examples:pH 7.58 7.44 7.36 7.30

pCO2 36 52 47 70

HCO3 34 32 28 26

1. uncompensated metabolic alkalosis

2. Compensated metabolic alkalosis

3. Compensated respiratory acidosis

4. Uncompensated respiratory acidosis


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Which nursing intervention in the preparation foror implementation of tracheal suctioningprevents tissue damage?

a. Monitoring oxygen saturation whilesuctioning.

b. Applying suction only as the catheter isremoved.

c. Hyperoxygenating the client before startingthe procedure.

d. Selecting the largest catheter that fits intothe tracheal lumen.


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Which assessment finding indicates to youthat the ties are properly secured after youhave changed the tracheostomy ties? You can fit two fingers between the ties and the

neck.

The ties are fitted snugly.

The ties hang loosely around the clients neck.

The tracheal tube moves slightly with eachrespiratory cycle.


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The client has had several episodes of laryngitisfollowing

an upper respiratory infection. Which statementby the client indicates the need for clarificationregarding the causes and treatment of acutelaryngitis?

I knew I would get laryngitis this time because Icheered for hours at the ball game. At the first hint of laryngitis, I whisper instead of

talking in my regular voice. I suck on throat lozenges to keep my mouth and

throat from getting so dry. When laryngitis starts, I quit smoking until all

symptoms are gone.


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A home care nurse is visiting a client withchronic bronchitis who states that he feelsmore short of breath than usual. Whichpulmonary assessment finding alerts thenurse to the possibility of pneumonia in thisclient? Pulse oximetry reading of 92% Shallow respirations of 32 per minute. Percussion is dull in the left lower lobe. Wheezes are audible over the right and left bronchi.


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RHEUMATOID ARTHRITIS LUPUS ERYTHEMATOSUS

DJD

OSTEOPOROSIS FRACTURE

JOINT REPLACEMENT


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Which of the following best explains thedevelopment of a fat embolism as acomplication of a bone fracture?

The bone is rich in blood and platelet activity iseasily activated.

Flat bones contain additional amounts oflipoprotein that initiate the lipid cascade.

The marrow contains fat cells that can bedislodged during injury.

Open fractures tear tissue as the bone exits theskin and this tissue enters the bloodstream as anembolism.


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The nurse is caring for a client with afractured femur. What factor in the clientshistory may impede healing of the fracture?

A sedentary lifestyle

A history of smoking Oral contraceptive use

Peripheral vascular disease


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HYPER/HYPOTHYROIDISM ADDISON DISEASE

DIABETES MELLITUS


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What action should the nurse teach the

diabetic client as the most beneficial indelaying the onset of microvascular andmacrovascular complicaations? Controlling hyperglycemia

Preventing hypoglycemia Restricting fluid intake

Preventing ketosis


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Which statement made by a client whom thenurse is teaching how to self-inject insulinreflects a need for clarification of injection siteselection and rotation?

The abdominal site is best because it is closest

to the pancreas. I can reach my thigh the best, so I will use

different areas of the same thigh. By rotating the sits within one area, my chances

of having tissue increases or decreases is less. If I change injection sites from the thigh to the

arm, the rate of absorption will be different.


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What is the physiologic basis for the polyuriamanifested by individuals with untreatedDiabetes mellitus?

Inadequate secretion of antidiuretic hormone Early stage renal failure causing a loss of urine

concentrating capacity Chronic stimulation of detrusor muscle by the ketone

bodies in the urine Hyperosmolarity of the extracellular fluids secondary to

hyperglycemia


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The client who has diabetes is prescribed to takeinsulin glargine once daily and regular insulin four

times daily. The first dose of regular insulin occursat the same time of day as the insulin glarginedose. How should the nurse teach the client totake these two medications?

Draw up and inject the insulin glargine first andthen draw up the inject the dose of regularinsulin.

Draw up and inject the insulin glargine first, wait

1 hour, and then draw up and inject the dose ofregular insulin. First draw up the dose of regular insulin, and

then draw up the dose of insulin glargine in thesame syringe, mix, and inject the two insulins

together.


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Acute Renal Failure Urinary Tract Infection

Benign Prostatic Hyperplasia


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HIATAL HERNIA GERD INFLAMMATORY BOWEL DISEASE INTESTINAL OBSTRUCTION COLORECTAL CANCER CIRRHOSIS HEPATITIS PANCREATITIS CHOLECYSTITIS/CHOLELITHIASIS


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ALTERED STATE OF CONSCIOUSNESS BRAIN INJURY

SPINAL CORD INJURY

MS

MYASTHENIA GRAVIS

CVA


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ANEMIA LEUKEMIA

HODGKIN DISEASE

intro to med-surg

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