Med Surg Final

Decompression illness

result of coming up to fast from scuba diving

acute coronary syndrome (ACS)

sudden symptoms of insufficient blood supply to the heart indicating unstable angina or acute myocardial infarction

BlUEPRINT

shows heart disease and rheumatoid arthritis risk raised by genetic changes in blood cells

open awareness of dying

both patient and MD openly talk about the illness being terminal

Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away?

Presbyopia

The anticipated care is based on what?

Primary survey

The nurse is working with a victim suffering from blast lung and resultant air emboli. The nurse should immediately place the victim in which position?

Prone left lateral

Hypothermia

< 35 celcius or < 95 Fahrenheit * more acid in ABGs - Warm pt & give crystalloids (LR or NS) & colloids (blood)

decompression sickness (the bends)

A condition seen in divers in which gas, especially nitrogen, forms bubbles in blood vessels, obstructing them. - high to low not low to high - tx = hyperbaric o2 chamber

Death with Dignity Act

A law in Oregon that allows for the practice of physician-assisted suicide seeing that very specific circumstances are met - physician prescribes medication but patient administers it

X-linked inheritance

A pattern of inheritance in which a recessive gene is carried on the X chromosome, so that males are more likely to be affected - may be recessive or dominant - if recessive females have 50/50 chance of passing it to their son - Factor VII, IX, Duchennes muscular dystrophy

Cell Divison

Mitosis = replication - received a copy Meiosis = receive half of each different type

hypovolemic shock

Most common type of shock - red of intravascular volume 15-30% - from trauma, hemorrhage, surgery, V/D, peritonitis, Diabetes insipidus, dehydration, diureses, burns and ascites

Anthrax

Most likely to be used in a biological attack - meningits is most common complication - ciprofloxacin and doxycycline could be used to prevent - AVA = anthrax vaccine absorbed * airborne, droplet & contact precautions

As a client approaches death, respirations become noisy. This is the result of which type physical event?

Musculoskeletal change

Manifestations of Acute Myeloid Leukemia

Neutropenia, Petechia, lymphadenopathy and splenomegaly

Following a motor vehicle collision, a client is brought to the ED for evaluation and treatment. The client is being assessed for intra-abdominal injuries. The client reports severe left shoulder pain (pain score of 10 on a 1 to 10 scale). The nurse suspects injury to the

Spleen

multiple myeloma

malignant tumor of bone marrow cells - classic presents with BONE PAIN - symptoms = CRAB (elevated calcium, renal insuff., anemia, bone lesions - tx= Haematopoietic stem cell transplantation

Lymphoma

malignant tumor of lymph nodes and lymph tissue 1. Hodgkin = cure 2. Non-hodgkin - not a good cure

Essential thrombocythemia

myeloproliferative disorder characterized by increase in abnormal platelets - affects women 2x as much as men - asymptomatic diagnosed by finding elevated platelets * high risk for clots - platelet count >450,000 - JAK2 mutation

Non-Hodgkin's Lymphoma

the term used to describe all lymphomas other than Hodgkin's lymphoma - not localized spreads widely to surrounding tissues

A nurse is providing inservice education for staff members about evidence collection after sexual assault. The educational session is successful when staff members focus their initial care on which step?

Supporting the client's emotional status

Envenomation

The act of injecting venom.

The nurse is caring for a client who is being prepared for the placement of a central intravenous line. The nurse recognizes this client requires this type of intravenous access for which reason?

The client requires total parenteral nutrition

What is a common source of airway obstruction in an unconscious client?

The tongue

DRIP urinary incontinece

Transient D= delirium, dehydration R = restricted mobility I = inflammation, infection, impaction P= pharmaceutical and polyuria

Abdominal assessment labs

UA Hgb & Hct WBC amylase/lipase

Alzheimer's disease

a progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and, finally, physical functioning - two types 1. familial or early onset = rare 2. sporadic or late onset = majority of cases

The nurse is caring for a patient who had a stroke and has right-sided hemiparesis. The patient is receiving physical therapy that will continue when discharged through home health care services. After what minimum period of time could this patient's medical condition be termed chronic?

3 months

Permanent brain injury or death will occur within which time frame secondary to hypoxia?

3-5 minutes

ABCDE

Airway Breathing Circulation Disability Exposure

Which is a true statement regarding pharmacologic aspects of aging?

Absorption may be affected by changes in gastric pH.

Myelodysplastic Syndrome (MDS)

Group of clonal disorders of the myeloid stem cells that causes dysplasias (abnormal dev) --> most common is dysplasia of the erthrocytes - commonly in people >70 yo and many cases evolve to AML - usually asymptomatic --> CBC reveals macrocytic anemia and low leukocyte and platelet count - CURE = bone marrow transplant

Which is also known as a proxy directive?

Durable power of attorney for health care

EMTALA

Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay,

Triage in EOP

Emergency Operations Plan Red- immediate Yellow - delayed, can wait Green - minimal Black - survival unlikely

A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect?

Excess of immature leukocytes

Spiritual Assessment FICA

Faith Importance/Influence Community Address

B symptoms

Fever, night sweats, weight loss

Internal bleeding (FAST)

Focused Assessment with Sonography for Trauma

Which term best describes a living will?

Medical Directive

What's a significant cause for persistent leukocytosis?

Hematologic malignancy or leukemia

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?

Hypercalcemia

blast cells

Immature form of cell

Which data is important for the nurse to record while assessing the client with an open wound?

Last tetanus vaccination

Most common solid organ injury

Liver

Lymphoid vs myeloid

Lymphoid - stem cells that produce lymphocytes Myeloid - stem cells that produce nonlymphoid blood cells

Interdisciplinary team for a terminally ill patient

MD, RN, Social Worker, Chaplain

Students are reviewing information about visual changes and conditions associated with aging. The group demonstrates understanding of the information when they identify which condition as the major cause of vision loss in the elderly?

Macular Degeneration

A nurse is providing care to a terminally ill client who follows Islamic traditions and is experiencing pain. When developing a plan of care for this client, an understanding of which of the following would the nurse need to integrate into the plan?

Pain is viewed as a means of cleansing by God.

suspected awareness of dying

Patient senses they are dying

Hodgkin's lymphoma

Reed-Sternberg cells malignancy - more common in men - one sided B symptoms - Curable

A client with polycythemia vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of the pathophysiological reason for this symptom?

The dead red blood cells release excess uric acid.

closed awareness of dying

The social situation in which hospital staff and physicians know the patient is dying, but the patient is unaware because she or he does not recognize signs of terminal illness.

CRISPR

Used for rapid functional study of cancer-causing genes

Autosomal Dominance

Variable expression - just cause you have the gene doesn't mean you have the disease - BRCA1 - Huntington's

Primary Myelofibrosis (PMF)

a condition characterized by the buildup of scar tissue (fibrosis) in the bone marrow, the tissue that produces blood cells. Because of the fibrosis, the bone marrow is unable to make enough normal blood cells - rarest - survival 3-10 years - massively enlarged spleen

Secondary survey

a head-to-toe physical assessment; an additional assessment of a patient to determine the existence of any injuries other than those found in the primary survey

Nondisjunction

failure of a chromosome pair to separate during cell divison resulting in abnormal chromosome numbers in daughter cells

Polycythemia Vera

general increase in red blood cells (erythremia) - clinical manifestations include --> ruddy complexion and splenomegaly - JAK2 mutation

Antidote for cyanide

amyl nitrate

antivenin

an antitoxin for venom

Primary survey

an examination of the patient to determine the presence of any life-threatening emergencies; the initial assessment of ABCDE

Hemorrhage

assess for shock - cool, moist skin, low BP & HR, delayed cap refull and dec urine output - give fluid replacement --> crystalloids, colloids, and blood products

Leukemia

cancer of white blood cells - elevates total leukocyte count --> progressive, prolonged increase

The spouse of a terminally ill client is confused by the new terminology being used during discussions regarding the client's treatment. The nurse should explain that palliative care is:

care that will reduce the client's physical discomfort and manage clinical symptoms.

Cricothyroidotomy

creation of a temporary airway by making a small opening in the throat between the thyroid cartilage and the cricoid cartilage

autosomal recessive

two copies of an abnormal gene must be present in order for the disease or trait to develop - seen in children of parents related by blood - "carriers" - cystic fibrosis, sickle cell & tay-sachs

Chronic Lymphocytic Leukemia

Common in older adults --> family history is the most important risk factor - many survive more than 20 years

Chronic Myeloid Leukemia (CML)

Develops by the BCR-ABL oncogene gives stem cells instructions to make a dysfunction protein called BCR-ABL tyrosine kinase - 90-95% of pt with CML have an abnormal chromosome called the Philadelphia chromosome thats a result of a translocation of a cancer causing gene called the BCR-ABL - Less severe then AML - insidious symptoms --> anorexia, malaise - treated with tyrosine kinase inhibitors

Signs of approaching death

- less interest in eating/drinking - dec. urine output - sleep - mental confusion - impaired vision/hearing - secretions may collect rattle and gurgle - irreg. breathing - restlessness - body temp changes - loss of bowl and bladder control - hallucinations

Neurvascular assessment of fracutured limbs

- pulse - circulation - temp - sensation - motor ability

carbon monoxide poisoning

-carbon monoxide binds with hemoglobin and reduces oxygen supply to tissues - may appear intox ** pink to cherry red skin - O2 sat may be fine

Disaster Levels

1 - Local 2 - Regional 3- State/Federal

Inheritance patterns

1. autosomal dominant = equally affects male & females & follows vertical pattern of inheritance 2. Autosomal recessive = pattern is more horizontal. relative of single generation tend to have condition

What do you assess for in crush injuries?

1. hypovolemia 2. paralysis 3. skin damage 4. organ dysfunction 5. damaged body part 6. renal dysfunction

Triage Levels ESI

1= resuscitation 2= emergent 3=urgent 4= non-urgent 5= minor

Nuclear Radiation Exposure

*** TIME, DISTANCE AND SHEILDING - how much time spent - how far away?

CNS dysfunction finding in heat strokes

- >105 degrees - hot, dry skin - anhidrosis - low BP - high HR - high RR * hypovolemic

Chemical Nerve Agents

- Sarin - Cyanides - Opioids - Defoliant (agent orange) - Antimuscarinic agents - Veicants

Chemical Respiratory Agents

- chlorine - diphosgene - phosgene

Geriatric Syndromes

- impaired mobility - dizziness - falls, falling - urinary incontinence - susceptibility to infection - altered pain, febrile responses - altered emotional impact - altered systemic response

Activated charcoal Lavage

if oral overdose --> helps prevent poison from being absorbed by stomach

A cause related to the increasing number of people with chronic conditions is

improved screening and diagnostic procedures.

Hare traction

portable in-line traction applied to the lower extremity to manage femur or hip fractures or dislocations

Which is an age-related change associated with the nervous system?

postural hypotension

Antidote for sarin

Atropine

Anthrax acquired by which method develops into the most severe?

Inhalation

Diagnostic Peritoneal Lavage (DPL)

Instills lactated ringers or normal saliene into abd. cavity to detect RBC, WBC, bile, bacteria, amylase, or GI contents

The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions?

Iron Levels

Acute Myeloid Leukemia

Results from a defect in the hematopoietic stem cell cells that differentiates into the myeloid cells - MORE WBCs that shouldn't be there and a decrease in RBC

Acute Lymphocytic Leukemia (ALL)

Results from uncontrolled proliferation of immature cells - most common in young children - responsive to treatment - reduces numbers of granulocytes, erythrocytes and platelets, enlarged spleen/liver

1m 11s A terminally ill client is receiving morphine around-the-clock for pain control. As part of the client's plan of care focusing on pain management, which nursing diagnosis would the nurse most likely identify?

Risk for constipation related to the effects of an opioid

Carboxyhemoglobin

a stable complex of hemoglobin and carbon monoxide that prevents normal oxygen uptake in the blood & hypoxemia

mutual pretense

a type of awareness in which the client, family, and health personnel know that the prognosis is terminal but do not talk about it and make an effort not to raise the subject