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MED SURG 1 Final EXAM Study Guide Complete and Updated A+ 100 %
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lOMoAR cPSD| 30878495SUSSET H. ALCOVER
MED SURG 1 FINAL EXAM STUDY GUIDE A+
~JUST IMPORTANT KEY
POINTS TO KNOW~
Chronic Disorders
> 3 months
Assist with copying, and importance about compliance of Tx. and lifestyles
changes.
Delegation
DO NOT delegate to the LPN: assessment, teaching or evaluation
DO NOT delegate to the UAP: task requiring nursing judgement, medication
administration, assessing, teaching, or evaluation
Prioritization – ABC, RACE
Hematological Disorders
Anemias
S/S: low RBC and H/H, pallor (assess mucous membranes), fatigue (safety, risk for injury), hypoxia, decreased
BP, increased PR (monitor VS)
Iron Deficiency Anemia
Microcytic, hypochromic
Results from decreased dietary intake of iron in the diet – food sources high in iron: organ meats (beef, liver),
beans, leafy green vegetables, raisins and molasses
Most common causes: bleeding from ulcers, gastritis, IBD; menorrhagia in premenopausal women, and inadequate
iron supplement in pregnancy
Smooth sore (inflamed) tongue, brittle nails and angular cheilosis
Iron Supplements
o Tell the pt. taking iron supplements that is normal for the stool to be dark color, but not black tarry
o Side effects: constipation, N/V
o Important to take with vitamin C (orange juice) to enhance absorption, but not with milk or antacids (decrease
absorption)
o Take an hour before meals, because it is best absorbed in an empty stomach
o Iron supplements (liquid preparations) – mix it, use a straw, stain teeth
Vitamin B12
Megaloblastic Anemia – RBCs abnormally large
Least common cause: inadequate dietary intake – occurs in strict vegetarian – Increase oral supplements with
vitamin or fortified soy milk
Most common cause: Absence of intrinsic factor after bariatric surgery or gastrectomy Pernicious Anemia
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SUSSET H. ALCOVER
Smooth, sore, red tongue – include assessment of the tongue, confused, paresthesia, loss of proprioception
(unsteady gait) – risk for injury, careful neurologic assessment, lastly jaundice is present
Vitamin B12 injections – monthly, IM, lifelong
Sickle Cell Anemia
Inheritance of the hemoglobin (HbS) gene
Higher incidence in African Americans
Complications: Thrombosis, Hypoxia, Infection
Pain, Hydration, Oxygen
Careful assessment of all body systems D/T vaso-occlusive crisis interrupt blood flow, thrombo formation,
hypoxia, ischemia
Thrombocytopenia
Low Platelet count – Risk for bleeding
< 20,000 mm3 – excessive bleeding – Petechiae occurs
Assess nasal and gingival gums for bleeding
Promote Safety – Fall Prevention
Blood Transfusions
Pre-procedure
o Check there’s an order for transfusion
o Check the pt. has been typed and cross-matched
o Verify that pt. has signed a written consent form.
o Explain procedure to pt. Instruct pt. in S/S of transfusion reactions (itching,
hives, swelling, SOB, fever, chills)
o Take VS to stablish a baseline
o Hand hygiene. Gloves.
o Use a 20 gauge or larger needle for insertion in a large vein (18 is
preferable)
Procedure
o Make sure the transfusion is initiate within 30 minutes after removal of the
packed RBCs from the blood bank refrigerator.
o For the first 15 min., run the transfusion slowly, no faster than 5 mL/min.
Observe pt. carefully for adverse effects. If not adverse effects occur during
the first 15 min., increase rate unless pt. is at high risk for circulatory
overload.
o Monitor closely for 15-30 min for S/S of reaction. If any occur, STOP
transfusion, NOTIFY PCP.
o Note that transfusion administration time does not exceed 4 hrs., because of
increased risk for bacterial proliferation
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SUSSET H. ALCOVER
Postprocedure
o Obtain VS. Compare with baseline measurements.
o Dispose materials properly biohazard bag
o Document
o Monitor pt. For response and effectiveness of procedure.
Platelet Transfusion – same thing just infuses over 30-60 min to diminish clumping over administration
Oncological Disorders
Leukemia
AML
Low RBC – anemia – fatigue – Risk for Injury
Low Platelets – Thrombocytopenia – bleeding, bruises and Petechiae
Low neutrophils – Neutropenia – Hand hygiene, sign in the door (neutropenic precautions), proper PPEs, no
flowers, or fruits or vegetables, fever and infection is present, restriction of visitors
Bleeding and infection are the most common cause of death
Chemotherapy Tx.
o Chemo destroy the cells leaving behind the by product and waste such as uric acid, K, P – Increased renal
stone formation which can cause renal failure. Hyperkalemia and hypocalcemia can lead to cardiac
2
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