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
