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Med Surg final exam review 2023 A+
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Med Surg final exam review 2023 A+l
Med Surg final exam review 2023 A+
Med Surg 1 Final Review
Handicap: societal participation is used in WHO classification system, instead of handicap, to acknowledge that the environment is
always interacting with people to either assist or hinder participation in life activities
Functional Independence Measure for Chronically Ill: measures if a patient can do ADLs independently
Bleeding precautions:
o NO IM injections (minimal injections even Subcut)
o Apply pressure for 5 minutes
o Use electric razor
o Soft bristle toothbrush
o No rectal anything
o No vigorous sex
o No contact sports
Neutropenic precautions:
o No fresh fruits or flowers, or meats
o No raw foods
o No crowds
o Wash hands!!!
o No children
o Peel fruits
o Talk over the phone instead of having visitors
Blood Transfusions: Acute hemolytic reaction
o S/S of transfusion reactions: fever, chills, respiratory distress, low back pain, nausea, pain at IV site
o Interventions: Determine client’s allergies & previous transfusion reactions
o Administer within 30 min. of receiving from blood bank
o First 15 minutes: 25-50 mL slowly, after 15 min. increase to 250-500 mL/hr
o Never add any meds to blood products
o Check crossmatch record with 2 nurses
o Infuse each unit over 2-4 hours but no longer than 4 hours
o Severe reactions in first 15 min.
o Blood tubing changed after 4 hours
o If there is a reaction, STOP TRANSFUSION IMMEDIATELY
o Maintain IV line (keep vein open) with NS with NEW TUBING at a slow rate
o Asses patient (vital signs) for other signs of reaction
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o Notify HCP & then blood bank & send blood product with tubing back to blood bank
o Document
o Risks: arm stiffness and ringing in ears are complications of blood transfusions
Anemia:
o Patho: condition in which the hemoglobin concentration is lower than normal
o S/S: fatigue, dyspnea, tachycardia, confusion, weakness, general malaise, pallor of skin & mucous membranes, N/V,
anorexia, glossitis, cheilosis (cracks in corners of mouth), smooth sore tongue, pica (craving for ice or clay)
o Diet: organ meats, beans, green leafy vegetables (fried liver & spinach)
o Interventions: Manage Fatigue
o Maintain adequate nutrition (red/organ meats)
o Maintain adequate perfusion
o Risks: Heart failure, angina, paresthesias, confusion, delirium, injury r/t falls, depressed mood
Iron Deficiency Anemia:
o Patho: anemia caused by dietary problems (low iron), chronic blood loss, or malabsorption
o Most common for women during menstruation; men GI bleeds
o Microcytic hypochromic
o S/S: smooth sore tongue, brittle & ridged nails, cheilosis (cracks in corner of mouth)
o Diet: increase iron in diet (vitamin C sources enhance iron absorption- ORANGE JUICE)
o Interventions: Treat underlying cause (bleeding); transfusion of packed RBCs
o Give iron supplements (may cause constipation, so give stool softeners)
o **Remember: oral liquid form of iron can stain teeth; clients should use a straw or place spoon at back of mouth to
take supplement and rinse mouth thoroughly afterward
o DO NOT GIVE IRON WITH MILK OR ANTACIDS
o Caution client that bowel movement may appear greenish, black, or tarry
Vitamin B12 Deficiency: Pernicious anemia
o Patho: anemia from impaired DNA synthesis b/c of lack of Vitamin B12; also r/t faulty absorption in the GI tract from a lack
of intrinsic factor (Gastric Surgery); chronic use of PPI’s and metformin
o Other risk factors: ulcerative colitis, alcoholism, and vegetarian diets
o Macrocytic normochromic
o Disrupts the function of peripheral nerves, spinal cord, and brain
o S/S: mild jaundice
o Mouth and tongue soreness- Beefy red tongue (glossitis)
o Neurological manifestations (paresthesias, loss of proprioception)
o Diet: organ meats (fried liver & spinach), diary products, eggs & fortified soy milk (for the vegetarian)
o Interventions: 24-hour Schilling Test (a vitamin B12 absorption test)
o Vitamin B12 replacement
o Teach regarding diet & meds; assess for neuro deficits
Folate Deficiency:
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o Patho: anemia caused by a deficiency of folic acid
o Found in people w/ poor nutrition, alcoholics, people with celiac disease (malabsorption), meds, anorexia
o Macrocytic normochromic
o Low folate causes constipation
o S/S: mild jaundice, mouth and tongue soreness (glossitis, cheilosis)
o Diet: increase folate in diet (green leafy vegetables)
o Interventions: administer folic acid 1 mg daily IM
Sickle Cell Anemia:
o Patho: severe hemolytic anemia; results from inheritance of the HbS gene
o Causes sickling of cells
o Triggered by: hypoxia, low body temp (being cold), exercise, & high altitude
o S/S: jaundice
o Chronic anemia: tachycardia, cardiac murmurs, cardiomegaly, ischemia, infarction, late sign= clubbing of fingers
o Sickle Cell crisis: hypoxia, inflammation, necrosis (entrapment of erythrocytes in microcirculation)
o Acute Chest Syndrome: fever, respiratory distress, new infiltrates on chest x-ray (mimic infection)
o Interventions: transfusion therapy
o Pain management (first priority, give 02 & hydrate to help w/ blood viscosity)
o Adequate hydration (3000 mL)
o Supplemental oxygen
o Decrease fatigue and inflammation
Aplastic Anemia:
o Patho: deficiency of all types of blood cells caused by failure of bone marrow development (pancytopenia)
o Caused by chromosomal alteration, radiation, chemical agents, toxins, viral/bacterial infections
o 50% of cases are idiopathic
o Fatty deposits found on bone marrow
o S/S: thrombocytopenia, leukopenia, reticulocytopenia
o Infections of skin and mucous membranes (WBC deficiency)
o Bleeding from gums, nose, vagina or rectum (platelet deficiency)
o Purpura & possible retinal hemorrhage
o Interventions: implement bleeding precautions
o Implement neutropenic precautions
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Bleeding Disorders:
o Patho: failure of normal hemostatic mechanisms (trauma, platelet factor abnormality, coagulation factor abnormality)
o S/S: petechiae, purpura
o Interventions: Bleeding precautions
o Electric razor
o Limit amount of injections; small gauge needles
o No Aspirin
o Protect from injuries
Immune Thrombocytopenic Purpura:
o Patho: destruction of platelets by unknown stimulus
o S/S: easy bruising, heavy menses, petechiae, mucosal bleeding (increased risk for intracranial bleeding)
o Interventions: determine cause of bleeding (NSAIDS)
o Neurological assessment
o Avoid injections and rectal procedures
o Patient education
Radiation Therapy:
o Used to treat localized lesions, kill tumor, reduce tumor size
o Diet: low residual diet (low fiber)
o Interventions: Private room, bed rest for 72 hours- log roll if turning
o Indwelling urinary catheter
o Promote nutrition
o Antidiarrheal agents
o Time limits for visitors/personnel
o Prohibit children and pregnant women visits
o Limit visitors to 30 minutes daily and to remain 6 feet from radiation source
o Protect yourself with proper PPE
o If whatever is implanted dislodges, use forceps & put it in lead container
o Risks: fatigue, malaise, anorexia
Chemotherapy:
o Treats systemic disease
o Diet: low residual diet (low fiber)
o Interventions: wear gloves, mask and gown
o Implement neutropenic precautions
o Administer antiemetic (Zofran- ondansetron) 30 min. before chemo
o Assess fluid & electrolytes and cognitive status
o Protect yourself with proper PPE
o Maintain tissue integrity (stomatitis, alopecia, malignant skin lesions)
o Promote Nutrition (anorexia, cachexia, malabsorption)
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