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MED-SURG BULETS

Chest X ray painless procedure


Bronchoscopy
o AtSO4
Anticholinergic mimics SNR
Decreases saliva dry mouth
o NPO 6 to 8 hours
o Local anesthesia check gag reflex before feeding
ABG
o Hyperventilation decreased CO2 increased blood pH respiratory alkalosis
o Hypoventilation increased CO2 decreased blood pH respiratory acidosis
o Diarrhea decreased HCO3 decreased blood pH metabolic acidosis
o Vomiting gastric content decreased HCL increased blood pH metabolic alkalosis
o Vomiting blood decreased O2 anaerobic metabolism formation of lactic acid decreased blood
pH metabolic acidosis
o Blood pH normal 7.35 to 7.45 If increased alkalosis; If decreased acidosis
o Partial CO2 normal 35 to 45 If increased Respiratory Acidosis; if decreased Respiratory Alkalosis
o Partial HCO3 normal 22 to 26 If increased Metabolic alkalosis; If decreased metabolic acidosis
Cancer of the larynx CS, alcohol and over usage of voice (choir member)
o A - nterior neck mass
o B urning sensation with hot beverages / Bad breath
o C - hange in the voice (hoarseness)
o D ysphagia/dyspnea
Chronic Obstructive Pulmonary Disease
o Chronic Bronchitis
Blue bloater
Excessive mucus production
o Asthma
Periods of bronchospasm and bronchoconstriction
o Emphysema
Disequilibrium of elastase and antielastase
Pink puffer
o Manifestations
A LTERATION IN
LOC decreased O2
Thoracic anatomy over distention of alveoli TD = APD barrel chest
Skin
o Temperature cool clammy skin
o Color pale to cyanotic
ABG Respiratory acidosis Increased CO2

B reathing difficulty, purse lip expiration > inhalation removal of excess CO2 (diet

low CHO)
C ough (mucus production); Chronic hypoxia (2 to 3 lpm of O2 therapy, decreased O2 demand
by rest and SFF) clubbing of the fingers and decreased TP to the kidneys causing
polycythemia
D ecreased Metabolism
Anorexia weight loss (high calorie diet) fatigue weakness
Bronchodilators
o Theophylline and aminophylline
Primary effect stimulates beta 2 receptors smooth muscle relaxation bronchodilation

Side effect stimulates beta 1 receptors increases cardiac rate need not to notify the
physician
Adverse effect hypotension monitor BP sign of toxicity
Evaluation check breath sounds
Acute Respiratory Distress Syndrome
o Causes
A spiration

R espiratory trauma (embolism)

fracture embolism ARDS

D rug toxicity (ASA)


S epsis and shock

Vomiting, bleeding, dehydration hypovolemia shock ARDS


Syndrome
Severe hypoxia
Bilateral infiltrates
Dyspnea
Pulmonary embolism
o Restlessness earliest
Water Seal System
o Drainage Bottle marked the level every shift
o Water seal bottle
Presence of fluctuation normal
Absence of fluctuation lungs are fully expanded assess first patient (X ray confirm)
OR presence of obstruction
Intermittent bubbling normal
Absent obstruction
Continuous leakage
o Suction Control continuous bubbling normal
Risk factors for cardiovascular disorders
o R ace non modifiable
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I ncresed blood pressure modifiable


S tress SNR increased BP and CR, vasoconstriction modifiable
K nowing sedentary life style modifiable
F at foods atherosclerosis modifiable
A lcohol (modifiable) / Age above 40 (non modifiable)
C igarette smoking vasoconstriction (nicotine) modifiable / Contraceptive pills clotting of
blood thrombus formation

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o
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T ype A behavior (modifiable) competitiveness, perfectionist high stress level


O besity
R esult of DM lipolysis increased fatty acids atherosclerosis
S ex gender males > female (before menopausal because estrogen decreases PVR) after

menopausal female eversible}[inverted T wave] Injury [elevated ST segment] > male


Decreased TP in heart Ischemia (Angina) {r necrosis (MI) {irreversible}[pathologic Q wave/permanent in
the ECG]
Eating a heavy meal, strenuous exercise, sex, exposure to cold Decreased blood flow (heart) decreased TP
(heart) decreased O2 (heart) anaerobic respiration production of lactic acid PAIN management
decreased O2 demand by rest and SFF
Angina
o Pain relieved by rest and NTG

NTG

Vasodilation orthostatic hypotention move gradually Monitor BP


Store in a dark and amber container
Effective tingling sensation no need to notify physician
Maximum of 3 tablets with 5 minute interval

MI
Pain relieved by Morphine SO4
Narcotic analgesic
Can cause respiratory depression monitor RR and O2 saturation
Antidote narcan
Cardioversion synchronous
Defibrillation unsynchronous
Buergers disease CS vasoconstriction stop CS common in men
Raynauds stress and cold vasoconstriction common in female
Congestive heart failure
o Left sided pulmonary
Dyspnea
Crackles
Polycythemia due to decrease O2 to the kidneys
Clubbing of the fingers due to prolonged hyxia
Orthopnea
o Right sided systemic
Hepatomegaly
Distended neck veins
Edema
Portal hypertension
Ascites weight gain
Varicose veins
o Digoxin
Cardiac glycoside
Positive inotrophic effect increased strength of myocardial contraction
Negative chronotrophic effect decreased cardiac rate monitor CR never give if CR
below 60 bpm
Adverse effect
V omitting
A norexia
N ausea
D iarrhea
A bdominal pain
REMEMBER: earliest GI; late halo vision
Antidote Digibind
Decreased RBC Activity in tolerance, Fatigue, provide rest, Anemia
Decreased Platelets Prone to bleeding, avoid parenteral injection, appl pressure on injection site, high
risk for injury
Decreased WBC prone to infection, reverse isolation
Increased WBC presence of infection
First Day/Newly diagnosed Knowledge deficit
Diuretic
o D iet high K diet except aldactone
o I input and Output expected increased output
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U ndesirable effect electrolyte imbalance (K)


R ecord weight expected decreased weight
E lderly special precaution
T ake in AM and with food
I ncreased orthostatic hypotension monitor BP and move gradually
C ancel alcohol because of mild diuretic effect

Heparin anticoagulant prevent further enlargement of clot not dissolve them monitor APTT/PTT
antidote protamine SO4
Coumadin anticoagulant prevent further enlargement of clot not dissolve it monitor PT vitamin K is
the antidote
Urokinase/Streptoase dissolves the clot
Pernicious anemia absence of intrinsic factor (gastric surgery) problem in absorption of Vitamin B12
beefy red tongue schillings test definitive test 24 hour urine collection life long Vitamin B12
Gastritis LUQ pain
Gastric ulcer affected area stomach pain (precipitated by food intake increased HCl) pain relieved by
antacids
Duodenal ulcer affected area duodenum pain (2 hour after eating) pain relieved by food
Ulcers bleeding (+) occult blood test (guiac) high fiber diet, avoid red meat, iron, steroids, NSAIDs,
indomethacin
Vagotomy resection of vagus nerve decreased cholinergic stimulation decreased HCl and gastric
movement
Dumping syndrome tachycardia and weakness 3 Ds (diarrhea, diaphoresis and dizziness) fluids after
meals, lie down after meals and SFF
Appendicitis RLQ pain avoid heat pads cause rupture signs of ruptured appendix sudden
cessation of pain, elevation of temperature and WBC
Diverticulitis LLQ pain low fiber diet
Diverticulosis high fiber diet
Ulcerative colitis bloody diarrhea 20 to 30 times a day fluid volume deficit
Liver cirrhosis alcohol and malnutrition (laanecs), infection and drugs (post necrotic), RSCHF (cardiac)
and biliary obstruction (biliary)
o Portal hypertention can lead to
Blood shifted to the different collateral
Esophageal varices
Spider angioma (face and neck)
Caput medusae (abdomen)
Hemorrhoids (rectal)
Management avoid rupture avoid shouting, valsalva maneuver
Increased hydstatic pressure fluid shifting ascites
o Decreased albumin decreased oncotic / colloidal osmotic pressure fluid shifting ascites
management high protein diet
o CHON metabolism by product ammonia liver cannot convert to urea increased level of
ammonia in the brain Alteration of LOC and changes of behavior and asterexis hepatic
encephalopathy management low CHON diet and lactulose for removal of ammonia
Hepatitis A fecal oral prone plumber
Hepatitis B body secretion prone working in a dialysis
Cholecystitis 5 Fs (fair, female, fat, fertile and forty) RUQ pain after ingestion of fatty food
demerol to relieved pain
Cholecystectomy T tube level of the incision site drain excess bile
Pancreatitis alcohol autodigestion LUQ pain

Anterior Pituitary gland


o Growth hormone
Increased before the closure of the epiphysis of the long bones gigantism tall
Increased after the closure of the epiphysis acromegaly big hands (big gloves), big feet (big
shoes) and big head (big hat)
Decreased dwarfism
o Prolactin
Increased galactorrhea
Decreased decreased milk production
o ACTH
Increased secondary cushings
Decreased secondary addisons
TSH
Increased secondary hypethyroidism
Decreased secondary hypothyroidism
Posterior pituitary gland
o ADH
Increased water retention oliguria edema (fluid volume excess) and weight gain
concentrated urine increased urine specific gravity
Decreased water excretion polyuria dehydration (fluid volume deficit and weight loss)
diluted urine decreased urine specific gravity
Parathyroid gland
o Parathormone
Increased increased calcium in the blood and decrease calcium in the bones stone formation
and decreased bone mass osteoporosis management increased water intake
Decreased hypocalcemia calcium supplement
Thyroid Gland
o Increased (hyperthyroidism)
T3 and T4 increased BMR hyperactive inability to focus insomia increased
catabolism weight loss increased appetite increased peristalsis Diarrhea fluid
volume deficit Increased CR and RR (due to increased BMR)
Increased T3 heat intolerance
Calcitonin decreased calcium in the blood tetany compensatory calcium withdraws
from the bones bone destruction (complication)
PTU decreased synthesis of TH watch out for SE (similar to signs and symptoms of
hypothyroidism) watch out for agrunulocytosis (fever, skin rash and sore throat)
Lugols solution decreased released of TH before thyroidectomy decreased vascularity
of the thyroid gland
o Decreased (hypothyroidism)
T3 and T4 decreased BMR hypoactive sleeps a lot decreased metabolism weight
gain anorexia decreased peristalsis constipation decreased CR and RR due to
decreased BMR
T3 cold intolerance
Calcitonin hypercalcemia stone formation
Synthroid and Proloid increased TH
Adrenal Gland
o Incresead (cushings)
Glucocorticoids hyperglycemia and decrease wound healing
Mineral corticoids increased aldosterone sodium retention and potassium excretion
hypernatremia and hypokalemia
o

Hypernatremia water retention oliguria edema (moon face,buffalohump, fluid


volume excess and weight gain) concentrated urine increased urine specific gravity
low sodium diet
Hypokalemia weakness Prominent U wave high potassium diet
Epinephrine and Norepinephrine Increased BP and CR
Sex hormones
Males gynecomastia and falling of hair
Females hirsutism and deepening of the voice
Decreased (addisons)
Glucocorticoids hypoglycemia and inability to cope with stress
Mineralcorticoids decreased aldosterone sodium excretion and potassium retention
hyponatremia and hyperkalemia
Hyponatremia water excretion polyuria (dehydration, fluid volume deficit and
weight loss) diluted urine --. Decreased urine specific gravity increased fluids and
Na
Hyperkalemia weakness tall or peaked T waves low K diet
Epinephrine and Norepinephrine decreased BP and CR

Diabetes Mellitus
o Type I absolutely no insulin thin insulin
o Type II insufficient insulin obese OHA
o Diet 50% CHO, 30% Fats, 20% CHON
o Exercise Increased uptake of glucose Decreased insulin requirement
o Oral hypoglycemic agent (OHA)
Stimulates pancreas to produce insulin
o Insulin
SC; IV if DKA
Never massage the area
Never administer cold insulin
Rotate the site of injection
PREVENTS LIPODYSTROPHY
Mix
Aspirate clear first
Inject air to cloudy first
o Hypoglycemia
W eakness
A bdominal pain
H unger pangs
B blurring of vision
A alteration of LOC
C ool clammy skin
T achycardia and tremors
D iaphoresis
Give orange juice (simple sugars)
o DKA increased lipolysis increased ketones
o Hyperglycemia polyuria, polydipsia, polyphagia, kussmaul breathing, glycosuria, ketonuria and warm
flush skin
o Glycosylated hemoglobin reflect BSL for the past 3 to 4 months most accurate
o Foot care
Podiatrist
Avoid removing corns and calluses
Cut toe nails straight across
Avoid walking bare foot
Hepatitis A fecal oral
Hepatitis B body and bloody secretions (hemodialysis)

Peritoneal Dialysis
o Diasylate output is decreased turn patient from side to side
o Complication infection monitor WBC and temperature, diasylate is cloudy boardlike and rigid
abdomen peritonitis
o Dont include diasylate solution in the output of the client
o Expected decreased weight monitor weight before and after decreased createnine and BUN
Heart block decreased tissue perfusion
Parkinsons diasease
o Decreased dopamine in the basal ganglia levodopa to increased dopamine avoid Vit B6 foods
o Cardinals signs tremors (non intentional) muscle rigidity bradykinesia
o Pill rolling
o Microphonia ask your client to speak aloud to be aware
o Artane and Cogentin anticholinergic decreased muscle rigidity
Myasthenia Gravis
o Tensilon test confirmatory test
o Decreased Acetylcholine and increased cholinesterase
o Muscle weakness priority airway
o NO tranquilizer, Morphine SO4, Muscle relaxant and neomycin
o Cholinergics (mestinon) increased muscle strength antidote ATSO4
Undermedication myasthenic crisis give cholinergics
Over medication cholinergic crisis give ATSO4

Multiple Sclerosis
o Demyelinization of the myelin sheath
o Charcoats triad
Intentional tremors
Scanning of speech
Nystagmus
o Visual disturbances diplopia
Pancreatitis autodigestion alcohol bleeding shock
o Elevated amylase
Rheumatoid Arthritis
o No specific diagnostic test
o NSAIDs and ASA (antipyretic, analgesic and anti-inflammatory)
o Synovitis Pannus formation fibrous ankylosis (limited joint movement) Bony ankylosis (joint
fixation)
o Avoid flexion and promote prone position
Gouty Arthritis
o Increased uric acid allopurinol and avoid organ meats (liver) tophi (ears)
Osteoarthritis
o Most common related with aging
o Pain after weight bearing exercise or activity rest to relieved pain weight reduction
Diverticulitis LLQ pain and low fiber diet
Cyclophosphamide (Cytoxan) can cause hemorrhagic cystitis to avoid increased fluid intake
Vincristine (Oncovin) increased fiber in the diet
Iron supplement When is the best time to take (empty stomach), How is best taken (with orange juice)
Steroids and NSAIDs
o DEATH inflammation
o BIRTH side effects
B one marrow depression prone to infection monitor temperature and WBC
I ncreased gastric irritation take it with food or after meals

R enal toxicity
T innitus
H epato toxic
Cataract common cause is aging (senile) opacity of the lens position on the unaffected side
Glaucoma increased IOP decreased of peripheral vision first halo, tunnel and gun barrel vision
miotics (constricts pupils) avoid ATSO4 (dilates pupil)
Retinal detachment trauma blood clots floating spots dependent position scleral buckling
Avoid Increased Intraocular pressure PRIORITY
o Avoid vomiting, coughing, valsalva maneuver, lifting heavy objects, bending, crying
Menieres Triad tinnitus, impaired hearing loss and vertigo low Na diet
o Vertigo imbalance high risk for injury decreased vertigo by focusing on one side of the room
assume a flat or reclining position
ASA 8th cranial nerve damage tinnitus, impaired hearing loss and vertigo
Antibiotics allergic reactions
Normal Values
o BUN = 10 20 mg/dl
o GTT = 70 to 115 mg/dl
o Calcium = 9 to 10.5 mg/dl
o O2 sat = 97 to 98%
o Creatinine = 5 to 1.5 mg/dl
Signs and Symptoms of Increased Intracranial Pressure
o B lood pressure and temperature are elevated
o R espiratory and cardiac rate are decreased
o A lteration of LOC
o I rritability
o N ote for projectile vomiting
o S eizure