ATI Med Surg Proctored Exam study notes Part 1

1.    A patient with emphysema would have: Barrel Chest and Dyspnea

2.    A patient with Cushing’s would have: Buffalo hump, purple strions, and Moon face

3.    Immediately following a lumbar puncture, a nurse would: Encourage fluid intake, and monitor the puncture site for a hematoma

4.    When giving a patient hydroxyzine (for anxiety), the effects of this medication would include: Decreasing anxiety, controlling emesis, and reducing the amount of narcotics needed for pain relief

5.    Manifestations of hypoglycemia: Blurry vision, tachycardia, sweng (AKA tremors, anxiety, hypotension)

6.    Manifestations of gout: edema, erythema, tophi (nodules), tight skin

7.    Included in the plan of care for post bowel obstruction surgery: Perform exercise every 2 hours, encourage hourly incentive spirometer, document color/consistency/volume of drainage for wound

8.    Postop/discharge teaching for laryngectomy patient would include: Aid swallowing by tipping chin forward when swallowing and swallow twice after each bite

9.    Post mastectomy: Avoid Talc powder/deodorant until incision is healed, perform ROM on affected arm, exercise arm by walking it up a wall as high as possible, elevate effected arm on pillow while resting in bed

10. Postop patient in skeletal traction should expect: Redness and warmth at the pin sites

11. Lupuspatients should take ibuprofen for joint pain, use sunblock of spf of 30 or greater to reduce exacerbations of symptoms, and slight fever elevations can be an indicator of an exacerbation

12. Hypoparathyroidism– involuntary muscle spasms are an indication, because of calcium deficiency

13. Pacemaker– a patient with a new pacemaker should check their heart rate every day, do not raise arms until released to do so as it may dislodge the pacemaker, and it is SAFE to use a microwave

14. Emphysema– patients should use pursed lip breathing during periods of dyspnea, drink 2,000-3,000 mL of fluids daily to keep secretions thin and easier to expectorate

15. Multiple Sclerosis – acute episodes are usually followed by remissions, which can least varying lengths of time

16. Hyperglycemia– expectations you would see: Kussmaul respirations, decreased skin turgor, fruity breath odor, dry mouth, extreme thirst, and ketonuria

17. Hypoglycemia– expectations you would see: diaphoresis, weakness, hunger, nausea, shakiness, and confusion

18. Colostomy– There are no food restrictions unless the client chooses so because of food odors and increased gas, the colostomy should begin to function 2-6 days after surgery, normal/intact/formed stool can be expected.

19. Skull fracture – indication would be clear fluid coming from the nares or ears after head injury, and should be identified as cerebrospinal fluid

20. Concussion– indications include: headache and brief change in level of consciousness

21. Hepatitis A – spread through fecal/oral contamination

22. Hepatitis B and C – spread through blood and sexual contact

23. TB patients taking isoniazid – should NOT drink alcohol, therapy lasts between 6 and 9 months, take med on empty stomach, your liver function will need to be monitored while taking to avoid hepatotoxicity

24. TB patient taking rifampin – expected harmless effect of medication is red/orange discoloration of urine

25. Flexion contracture – a bent flexed joint that cannot be straightened actively or passively, usually caused by immobilization

26. Drainage tubes – always place them lower so the drainage doesn’t back up and gravity helps them drain fluids

27. Thrombocytopenia– Patients are at risk for bleeding so avoid any invasive procedures such as IM injections, and instruct patients to avoid flossing due to risk of bleeding at the gums

28. Low cholesterol diet – examples include: Chicken breast and all vegetables

29. Cancer tumors – are typically hard, fixed, irregular in shape, and nontender to palpation

30. Fibrocystic breast disease – indicated by multiple masses of regular shape, lumps are moveable and increase in tenderness during the menstrual period

31. Sickle Cell – promote rest (activity causes discomfort), keep client warm, oxygen should be administered as hypoxia increases sickling and client discomfort.

32. Herpes Zoster – is contagious to people who have never had chickenpox and is most contagious while fluid-filled blisters are present on the skin

33. Dialysis- Weigh the client before and after each treatment, sterile gloves w/ strict aseptic technique should be used when handling bags of dialysate fluid, dialysate fluid should be kept at room temp

34. Blepharitis– inflammation of eyelids

35. Epistaxis– nosebleed, to control pinch the soft portion of the nose for 10 minutes

36. Radiation Therapy – patients should be kept in a private room, staff entering client’s room should don a lead apron, dislodged implants should be picked up with forceps and placed in a lead container to prevent exposure.

37. Gout– to prevent uric acid stones, take allopurinol as prescribed, exercise several times a week, avoid foods high in purine such as organ meats, poultry, fish, red wine, and gravies. Increase fluid intake of 2-3 L per day. Citrus juices help alkalinize the urine which helps prevent uric acid stone formation

38. Gout medications – Colchicine for acute gout attack and Allopurinol for chronic gout andPegloticase is IV med to treat chronic gout that has not responded to normal treatments

39. Encephalitis due to West Nile virus – expected findings: Stiff neck, photophobia, lethargy

40. Transfusions– Document vital signs, use 20 gauge or larger, verify blood type/Rh and check with 2 nurses, provide RN with IV tubing that has a filter, use only normal saline

41. AIDS– use standard precautions when caring for a client that has AIDS

42. AIDS – use bleach/water solution of 1:10 to clean bathroom surfaces for adequate disinfection

43. Stomatitis– inflamed and sore mouth, interventions include: use soft toothbrush or foam swab for oral care, avoid alcohol based mouthwash, use a straw when drinking liquids to bypass areas and increase irritation, rinse mouth frequently with hydrogen peroxide, warm saline, or baking soda solution

44. Fat emboli – typically occur 12 to 48 hr. after injury when fat droplets from the marrow enter into the systemic circulation and are deposited into the lungs. This should be reported immediately, it could progress into acute respiratory failure

45. Thrombophlebitis– apply compression stockings on lower extremities to promote blood return and decrease venous stasis

46. Following hip arthroplasty, place an abduction pillow on the client to prevent dislocation of the new hip joint during position changes

47. EEG – prior to EEG instruct client to eat regularly to avoid low blood glucose, avoid sedatives and anticonvulsants before procedures because is depresses CNS function and that can alter test results

48. Endocarditis– which is inflammation inside the chambers of the heart, and patients should notify provider before dental procedures due to the need for prophylactic antibiotic therapy to reduce the risk of strep infection

49. Timolol eye drops – instill into the conjunctival sac and apply pressure to the bridge of the nose for 1 minute afterwards to prevent systemic absorption of the medication (AKA lacrimal duct)

50. Seizures– if a client is experiencing a seizure while sitting in a chair, lower the client to the floor to avoid injury

51. Following above the knee amputation – assist the client to prone position for 20-30 minutes every 3-4 hours following an amputation to reduce the risk of flexion contractures

52. Hx of unstable angina – expected finding would be chest pain when at rest

53. Client should sit upright for 30 minutes after taking medication to prevent esophageal irritation and ulceration

54. Pyelonephritis– is a bacterial infection of the kidney and renal pelvis. Reinforce wiping from front to back to avoid introducing bacteria into the urinary tract which can ultimately cause pyelonephritis

55. Otitis media – manifestations: fullness in the ear, ear pain, cracking sound when yawning, dizziness

56. Chvostek sign – facial spasm most likely caused by low calcium

57. Trousseau sign – spasm of feet or hands, likely caused by low calcium (hyperventilation induced hypocalcemia)

58. Right sided heart failure would most likely result in dependent edema from subsequent systemic venous back up

59. ALS-sign would be weakness of the distal extremities

60. Myasthenia Gravis – autoimmune disorder that destroy the communication between nerves and muscle, results in weakness of skeletal muscles, mostly affects voluntary muscles that control eyes, nose, throat, and limbs

61. Buck’s Traction – Inspect skin every 8 hours, encourage client to perform dorsiflexion of affected extremity every 2 hours, never release traction as this can increase the client’s muscle spasms

62. Airway obstruction – signs include flaring nares, intercostal retractions, restlessness, tachycardia, tachypnea

63. Guillain-Barre’ syndrome – rare autoimmune disorder which a person’s own immune system damages the nerves causing muscle weakness and sometime paralysis. Lasts a few weeks to years. Can fully recover

64. Prednisone – patient’s taking this medication are more susceptible to infection

65. Low sodium diet – fresh fruits contain little to no sodium and are a good snack (especially for HTN patients), low fat yogurt, fresh fish, or unseasoned poultry

66. Low cholesterol diet – remove skin from poultry before eating, use liquid oils such as canola, nonfat milk

67. Vasopressin – drug used to treat esophageal bleeding varices

68. Famotidine – drug used to treat stress ulcers

69. Esomeprazole – drug used to treat gastrointestinal efflux disease

70. Omeprazole – drug used to treat duodenal and gastric ulcers

71. Platelets – maintain hemostasis and coagulation by plugging disruptions in the integrity of blood vessels 72. Leukocytes – help body fight infection

73. Plasmin – help break down blood clots in the body

74. Red blood cells – produce hemoglobin molecules, which transport oxygen throughout body

75. DVT patient – should keep leg elevated when in bed, can apply warm heat to decrease pain/swelling

76. Scurvy – caused by vitamin C deficiency

77. Stroke patient – priority would be to monitor patient for increased intracranial pressure