Medical-Surgical Nursing

119 flashcards by MentisLibrary

Adult med-surg by body system: cardiac, respiratory, GI, endocrine, renal, neuro, musculoskeletal, perioperative, oncology and wound care, with the assessment findings and nursing priorities each condition demands.

What are the hallmark signs of left-sided heart failure?
Blood backs up into the lungs, producing dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles and a dry cough.
What are the hallmark signs of right-sided heart failure?
Blood backs up into the systemic circulation, producing dependent edema, jugular vein distention, hepatomegaly, ascites and weight gain.
What does an elevated B-type natriuretic peptide suggest?
Ventricular stretch from volume overload, which supports a diagnosis of heart failure in a patient who is short of breath.
When should a scheduled dose of digoxin be held?
When the apical pulse is below 60 beats per minute in an adult, until the provider is notified.
Which early symptoms suggest digoxin toxicity?
Anorexia, nausea and vomiting, followed by visual disturbances such as halos or yellow-green vision, and new dysrhythmias.
Stable angina vs unstable angina
Stable angina is predictable, brought on by exertion and relieved by rest or nitroglycerin; unstable angina occurs at rest, is new or worsening, and is not reliably relieved.
Which laboratory marker best confirms myocardial infarction?
Cardiac troponin I or T, which rises within a few hours of injury and stays elevated for days.
How is sublingual nitroglycerin taken for chest pain at home?
One tablet under the tongue, repeated every 5 minutes for up to three doses; emergency services are called if pain persists after the first dose in most current teaching.
Why is a beta blocker never stopped abruptly?
Sudden withdrawal can cause rebound tachycardia, hypertension and angina, and may precipitate a myocardial infarction.
Peripheral arterial disease vs chronic venous insufficiency
Arterial disease causes intermittent claudication, cool pale extremities, thin shiny skin and painful punched-out ulcers on the toes; venous insufficiency causes aching, warm edematous legs, brown staining and shallow ulcers near the ankle.
What findings suggest a deep vein thrombosis in the leg?
Unilateral calf or thigh pain, swelling, warmth and redness, often with a measurable difference in limb circumference.
What INR range is usually targeted for a patient on warfarin?
An INR of about 2 to 3 for most indications, with a higher range used for some mechanical valves.
What is the priority nursing care after a femoral cardiac catheterization?
Keep the affected leg straight, maintain bed rest as ordered, and monitor the site for bleeding or hematoma along with distal pulses.
A patient reports crushing chest pressure radiating to the jaw. What is the first nursing action?
Assess the patient and the vital signs while placing them on a monitor and obtaining an ECG, then notify the provider.
What defines a hypertensive emergency?
Severely elevated blood pressure accompanied by evidence of acute organ damage such as chest pain, neurologic changes, pulmonary edema or acute kidney injury.
Why is oxygen titrated carefully in advanced COPD?
Because these patients tolerate and depend on lower oxygen levels, and excess oxygen can worsen carbon dioxide retention; therapy is titrated to a target saturation, commonly 88 to 92 percent.
What does a silent chest mean during an asthma exacerbation?
Air movement has become so poor that wheezing has stopped, which signals impending respiratory failure rather than improvement.
What are the classic assessment findings of bacterial pneumonia?
Fever, productive cough, pleuritic chest pain, tachypnea, and crackles or bronchial breath sounds over the affected lobe.
Which findings suggest a pulmonary embolism?
Sudden dyspnea, pleuritic chest pain, tachycardia, anxiety and hypoxemia, often in a patient with recent immobility, surgery or a leg clot.
What does continuous bubbling in the water seal chamber of a chest drainage system mean?
An air leak somewhere in the system, either from the patient or from a loose connection or a hole in the tubing.
What does tidaling in the water seal chamber indicate?
The fluid level rises and falls with breathing, which shows the system is patent and the lung has not yet fully reexpanded.
Which precautions are required for active pulmonary tuberculosis?
Airborne precautions: a negative pressure room, an N95 or higher respirator for staff, and a surgical mask on the patient when transport is unavoidable.
Name the four first line tuberculosis drugs and one key adverse effect of each.
Isoniazid causes hepatitis and peripheral neuropathy, rifampin turns body fluids orange and induces liver enzymes, pyrazinamide raises uric acid, and ethambutol causes optic neuritis.
Why is pyridoxine given alongside isoniazid?
Isoniazid depletes vitamin B6, and supplementation prevents the peripheral neuropathy that otherwise develops.
What defines acute respiratory distress syndrome?
Acute onset of refractory hypoxemia with bilateral infiltrates that is not explained by heart failure or fluid overload.
How is an incentive spirometer used correctly?
The patient sits upright, seals the lips around the mouthpiece, inhales slowly and deeply, holds for several seconds, then exhales and rests before repeating.
When does pulse oximetry give an unreliable reading?
With poor perfusion, hypothermia, hypotension, severe anemia, motion, dark nail polish, and in carbon monoxide poisoning where the reading stays falsely high.
How long should a single pass of tracheal suctioning last?
No longer than about 10 to 15 seconds of applied suction, with hyperoxygenation before and between passes.
What is the nursing priority immediately after a thoracentesis?
Monitor for pneumothorax: assess respiratory rate, breath sounds, oxygen saturation and any sudden dyspnea or sharp chest pain.
What lifestyle measures reduce gastroesophageal reflux?
Smaller meals, avoiding food within about 3 hours of lying down, weight loss, elevating the head of the bed, and limiting alcohol, caffeine, chocolate and fatty foods.