se5l, medical-surgical review curse powerpoint

8/10/2019 SE5l, Medical-Surgical Review Curse PowerPoint

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Medical-Surgical Nursing

Certification Review

SE5l, Medical-Surgical Review curse PowerPoint.pdf

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CMSRN Exam

Given four times a year

Spring (usually May)

Fall (usually October) AMSN Annual Convention

(usually September)

Nursing 200x Symposium in theSpring


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AMSN Nursing Practice Roles

Helping Role 17% (32-36)

Teaching/coaching role 17% (32-36)

Diagnostic and Patient Monitoring Role

25% (38-42)

Administering and Monitoring

Therapeutic Intervention 25% (58-62)


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AMSN Nursing Practice Roles

Effective Management of Rapidly

Changing Situations 10% (18-22)

Monitoring/Ensuring Quality HealthCare Practice 3% (4-7)

Organizational and Work-Role

Competencies 3% (4-7)


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Distribution Patient Problem

GI 19% (36-40)

Pulmonary 19% (36-40)

Cardiovascular 15% (28-32) Diabetes/Other endocrine 15% (28-32)


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Distribution Patient Problem

Renal/GU-12%(22-29)

Musculoskeletal/Neuro 11%

(20-24) Hematological / Immune /

Integumentary 9% (16-20)


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Preparing for the Test

Medsurg Nursing CertificationBoard Requirements CMSRN

credential

Minimum of 3,000 hours in Medsurgnursing as a staff nurse, clinical nurse

specialist, clinical educator, faculty,

manager, or supervisor.


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Contacting Medical- Surgical

Nursing Certi fication Board MSNCB Home Office

East Holly Avenue, Box 56, Pitman, NJ

08071-0056

Phone: 856-256-2323 or Toll free 866-

877-2676

Fax: 856-589-7463 (fax)

E-mail: [email protected] http://www.medsurgnurse.org


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mailto:[email protected]:[email protected]:[email protected]


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Publications to review

Scope and Standards for Medical-

Surgical Nursing Practice

ANA Code for Nurses Human Rights Guidelines for Nurses in

Clinical and other Research


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AMSN Core Curriculum for Medical-

Surgical Nursing

Medical Surgical Nursing ReviewQuestions

Review Course

Examination Prep Guide

Your nursing experience


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Test Taking Tips

Read questions all the way through

Eliminate obvious wrong answers

Take moment to relax occasionally Have good reason to change answers


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Stress Reduction

Review prior to exam, but dont cram

especially the night before (raises

stress levels making it more difficult)

Take time during the exam to take deep

breaths and relax.

You will have 4 hours to take the exam

which has 200 questions plenty oftime!


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A patient begins to experience a severe GI

bleed. The plan of care to meet the

patients fluid needs should include, as a

priority, planning for which of the following?

A. Provision for skin care

B. Monitoring vital signs frequently

C. Decreasing PH of gastric fluids D. Rapid infusion of IV blood and fluids


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To prevent complications on the third day

after an uncomplicated acute MI, the nurse

would implement which action?

A. Monitor the patients ability to perform

activities of daily living without shortness

of breathB. Accompany the patient ambulating for a

short distance at least each shift

C. Apply anti-embolic hose to the legs

D. Give the patient a nitroglycerin sublingual

to prevent chest pain before all out of bed

activities


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A patient in acute renal failure developed

acute pulmonary edema. Which of the

following interventions would beinappropriate to include in the patients

care?

A. Administration of oxygen at 3 L/min per

nasal cannula

B. Administration of morphine and

Furosemide (Lasix)

C. Place the patient in high Fowlers positionD. Replace fluids with normal saline


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Fluids and Electrolytes


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Fluid

Intracellular

Body water

Extracellular Body water


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Electrolytes

Same electrolytes in

intracellular space as

in extracellular space

Always measure

extracellular space


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Sodium

Necessary for protein synthesis

Fluid volume in extracellular spaces


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Hyponatremia

Dilutional most common

Excessive fluid intake

Edema, confusion

Treatment decrease fluid intake

True

Fluid and sodium loss

Dry tissue Treatment replace both sodium and

water


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Hypernatremia

Most common, fluid loss without loss

of sodium

Dry tissue

Treatment replace fluids

Increased sodium with diet rare could

occur with full strength high protein

tube feeding


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Hyperkalemia

Causes cell wall destruction,

increased intake, renal failure

Symptoms irritable muscles

Treatment Kayexalate, calcium

gluconate, insulin


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Hypokalemia

Increased loss of potassium

or increased fluid

Muscle flaccidity

Treatment potassium supplements

IV

Oral


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Calcium

Sedative at the neuro level

Necessary for coagulation


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Hypercalcemia

Increased intake, hyperparathyroidism

Symptoms

Sedation

Treatment

Decrease calcium intake


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Hypocalcemia

Decreased calcium intake, increased

phosphate levels, renal disease

Hyperactive deep tendon reflexes

Chvosteks

Trousseaus

Laryngospasm


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Phosphate

Informal inverse relationship with

calcium

Symptoms may be opposite of

calcium (hypophosphatemia looks like

hypercalcemia, etc)


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Magnesium

Hypermagnesemia

Usually poor renal excretion

Muscular depression

Hypomagnesemia

Hyperactive deep tendon reflexes


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Serum Osmolality

2(Na) + BUN/5 + glucose/20 = 275-295

mOsm/l

Quick and dirty 2(Na)

Higher the number, dryer the patient


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IV Fluids

Hypertonic = above 295 mOsm/L

D5LR, D5NS

Isotonic = 275 295 mOsm/L

NS, LR

Hypotonic = below 275 mOsm/L

NS


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A patient experiencing a sodium imbalance

must be assessed for which of the following

symptoms?

A. Changes in level of consciousness B. Irri tability of skeletal muscles

C. Depression of deep tendon reflexes

D. Evidence of acid-base imbalances


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A patient who is severely dehydrated would

most likely be treated initially with which of thefollowing IVsolutions?

A. HypertonicB. Isotonic

C. Hypotonic

D. Colloidal


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Which of the following assessment data are

consistent with hypovolemia?

A. Increased pulse and a swollen tongue

B. Neck vein distention and dry skinC. Weight loss and thirst

D. Increased blood pressure and a fever


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Which of the following sets of signs and

symptoms would be exhibited by a patient with

a serum potassium of 6.8 mEq/L?

A. Bradycardia and constipation

B. Confusion and muscle cramps C. Paralytic ileus and paresthesias

D. Diarrhea and spastic paralysis


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Immune System

Leukocytes

A. Granulocytes

1. Neutrophils first line of

defense against bacteria

2. Eosinophils phagocytize

antigen-antibody complexes

3. Basophils- containhistamine and heparin


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Immune System

B. Nongranulocytes

1) Monocytes phagocytize

bacteria

2) Lymphocytes provide

immunity against foreigninvaders including transplants

C. Immune Response

1) Humoral B lymphocytes,

memory

2) Cellular T lymphocytes,foreign invaders


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Compromised

Immune System Steroids

suppression of system

Chemotherapy


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Transmission of AIDS

Blood

Semen

Vaginal fluids Breast milk

Transplacental ?

Transmitted even when asymptomatic


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Pathophysiology

Retrovirus, part of the Lentivirius family

Infects CD4 lymphocytes

Carries genetic information on RNA intothe cells DNA

CD4 cells, necessary to immune function,

decrease in numbers in acute phase


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SE5l M di l S i l R i P P i t df


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CD 4 Classification of AIDS

Category I:>500 CD4 cells /micro L

Category II: 200-400 CD4 cells/ micro L

Category III:


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SE5l Medical Surgical Review curse PowerPoint pdf


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Treatment of AIDS

Prevention

Optimal treatment includes combination of

at least 3 drugs, often referred to as

HAART

Reverse transcriptase inhibitors

Protease inhibitors

Fusion inhibitors


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Hematologic System Erythrocytes: 120 day life span

Requires erythropoietin from kidneys(80%) and liver (20%)

Thrombocytes: 7.5 day life span, 1/3

sequestered in spleen. Increased bloodplatelet level following splenectomy

a. Clotting cascade

Extrinsic

Intrinsic

Enzymes


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White blood cells

Neutrophils- first line of defense against

bacteria Immature cells are Bands

Eosinophils- break down antigen/antibody

complex

Basophils- work to keep blood flowing

through micro-vascular system

Monocytes-effective bacterial macrophage


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Lymphocytes:

T-lymphocytes-react against foreign or

abnormal cells

B-lymphocytes- becomes antibodies when

exposed to something seen as a long term

threat


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Hematologic concerns

Anemia Blood loss, Hemolytic

Sickle cell

Iron deficiency Pernicious

Disseminated Intravascular coagulation

Hodgkins

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Sam Andrew had just been diagnosed with

pernicious anemia following his gastric

resection. He asked how long he will need totake the vitaminnB12. You tell him hell need to

continue:

A. Until his anemia is corrected

B. For the rest of his life

C.It depends on his physicians assessment of

him

D.Its different in everyone

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Which of the following laboratory results

would be considered the most indicative of

DIC?

A. High platelet count

B. Elevated blood glucose

C. Increased bleeding times

D. Presence of fibrin degradation products

(FDP)

, g p

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Cardiovascular system

g p

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Anatomy and Physiology

A. Heart: atria, ventricles, valves,

coronary circulation, cardiac,

conduction system

B. Cardiac Cycle: Systole, diastole

C. Peripheral vascular system:

Veins, arteries, arterioles, venioles,

capillaries

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CO=HR SV

Stroke volumePreload

Afterload

Contractility Heart Rate

Impact of the ANS

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Physical Assessment

Inspection

Edema, skin assessment, hair

growth

Palpation

Peripheral pulses, PMI

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Heart sounds

Normal

S1

S2

AbnormalS3 lub DUB dub

S4 lub dub DUB

Murmurs Friction rub

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Diagnostic studies

Cardiac enzymes & proteins

Troponins

CPK-MB, myoglobin, troponins

LDH

Doppler ultrasound

ECHO:TEE

Thallium imaging

Pericardial fluid analysis

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Diagnostic procedures

Electrocardiogram

Electrophysiology

Echocardiography

Stress test

Doppler Ultrasound

Cardiac Catheterization

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Acute Coronary Syndromes (ACS)

Sudden Death

Sudden Death

Stable Angina

CoronaryArterial

Thrombosis

ST-

Elevation MI

Non-ST-Elevation

MI

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ECG Changes Consistent with

ACS

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Anti- ischemic Options

Nitrates Dilate blood vessels; relaxes and expands

artery, increasing blood flow

Morphine Pain relief, Dilate blood vessels; relaxes and

expands artery, including blood flow

Beta blockers Slows pumping action of the heart, reduce

oxygen requirements

ACE inhibitors Dilate blood vessels, prevent fluid retention, and

ease the workload of the heart

Calcium blockers Dilate blood vessels and reduce vascular

smooth-muscle contraction

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Antiplatelets and Antithrombin Agents

Salicylates: Aspirin

ADP-receptor inhibitors: Clopidogrel

Glycoprotein(GP) Iib-IIIa receptor antagonists

Heparin-unfractionated heparin (UFH)

Low- Molecular weight heparins (LMWH) with

UA/NSTEMI indications Enoxaparin

Dalteparin

Direct- acting Antithrombins

BivalirudinArgatrobran

Lepirudin

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CV Conditions

CHF

Diuretics, ACE Inhibitors, Digitalis, Beta

Blockers

BNP- Brain Naturetic Peptide

Hypertension

Highest Risk: African American males in

southeast United States

Weight loss- diet management; exercise,Diuretics, Ace inhibitors, Beta blockers,

Angiotensin 2 receptor blockers

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CV conditionsChronic Peripheral Circulatory DiseaseArterial( PAD-peripheral arterial disease):

Thrombolytics, antiplatelet aggregates,

revascularization-stents, arterioplasty,

bypass graftingVenous )PVD-peripheral venous disease):

elevation, wound prevention- assessment-

management, antiplatelet aggregates

DVT: Heparin, LMWH, warfarin, labs:PT/PTT/INR, D-dimer: SVC filter

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Y i f ti t t MI hSE5l, Medical-Surgical Review curse PowerPoint.pdf


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You are caring for a patient post MI, who

suddenly develops bradycardia and

hypotension. What is the likely cause?

A. Anxiety reaction

B. Cardiogenic shock

C. Medication overdose

D. Pulmonary edema

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Mr. Jones, just returning from a coronary

angiogram, develops bradycardia and a

narrowing pulse pressure. What is themost likely cause?

A. Cardiac tamponade

B. Positional hypotension C. Myocardial infarction

D. Anaphylactic shock

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Which of the following antihypertensive

should be avoided in a person with

diabetes?

A. Calcium channel blockers

B. Beta Blockers

C. ACE inhibitors

D. Nitrates

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Cancer

Uncontrolled growth of cells-

Due to alteration in cells genes

Immune system fails to destroy

Etiologic factors

Chemicals

Radiation

Viruses Host-related factors (tobacco use etc)

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Therapeutic modalities

Surgery- for staging and treatment

Radiation-Side effects at site of radiation

Biologic therapy-alter host responses to

malignant cells

Chemotherapy- use of chemical agents

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Sue Lynn, a 50 year old diagnosed with an

autoimmune disorder, asks what that

means. You tell her:

1. The bodys ability to fight off infections has been

lost

2. She is experiencing an increase in one white

cell line

3. Her immune system is attacking her own body

cells

4. It is a short lived event which will make her

susceptible to bruising

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Which of the following sets of signs and

symptoms would be exhibited by a patient

with a serum potassium of 6.8 MEq/l?

A. Bradycardia and constipationB. Confusion and muscle cramps

C. Paralytic ileus and paresthesia

D. Diarrhea and GI spasms

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A patient on your unit has been diagnosed

with AIDS. He expresses concerns for

your safety during his am care. You wouldstate:

1. lets talk about what we can call body

substance isolation

2. Youre not bleeding so theres no risk

3. Its just part of my job, so I dont think

about it.

4. It is scary, but you deserve my care

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Gastrointestinal system

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History and subjective assessment Past history of GI disorders, Surgery, allergy,

lactose intolerance Pain: location and r/t eating (full or empty

stomach)

Condition of teeth, tongue, oral mucosa

Dysphagia, belching, indigestion/heart burn,nausea, vomiting

Weight loss, anorexia

Bowel movement frequency: Diarrhea,

constipation, laxative or enema use, presence of

dark stools or frank blood

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Diagnostic Studies

Lab tests: Electrolytes, LFTs, fecal

studies, analysis of gastric secretions

2. Radiography: Barium swallow,

barium enema, ultrasound, ERCP,endoscopy, arteriography,

colonoscopy, nuclear medicine

imaging, CT scan

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Liver Disease

Cirrhosis- Hardening of the liver

Medical treatment-paracentesis, Transjugular

intra-hepatic Porto-systemic shunting (TIPS),

organ transplant

Nursing interventions: Monitor for bleeding,albumin, B vitamin levels, serum ammonia;

treat alcoholism (refer to rehab); teach

avoidance of hepatotoxic substances and use

of OTC meds; control ammonia related

encephalopathy-neomycin, lactulose, reducedprotein intake

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Esophageal varices

Medical treatment- Banding, sclerosing,

esophageal balloon tamponade,

transfusion of RBCs and clotting factors

(FFP) Nursing interventions: monitor VS, S&S of

bleeding, PT, PTT, platelets, refer to

treatment for alcoholism

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Viral Hepatitis Transmission

A- Fecal-oral, contaminated food

B and C-Blood and body fluid

Medical treatment

Hepatitis A- supportive treatment, ant-diarrhea and anti ememitics

Hepatitis B gamma globulin, prevention with

hepatitis vaccine

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Bowel disease

Inflammatory bowel disease

Medical treatment- corticosteroids, azulvidine,

surgery( Colectomy/Colostomy or ileostomy)

Nursing Interventions: monitor for S&S of

bleeding, test stools for occult blood, ostomy

care including diet teaching and address body

image

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Irritable bowel syndrome Conventional medical treatment-imodium for

diarrhea; tegaserod maleate (Zelnorm) forconstipation; Alosetron hydrochloride ( Lotronex)

for diarrhea if conventional therapy is not

effective

Nursing intervention: Teach avoidance of theindividuals triggers- large meals, wheat, rye,

barley, chocolate, milk products, alcohol, drinks

with caffeine; stress or emotional upsets. Teach

avoidance of overusing saline enemas and OTC

laxatives

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Bowel Disease

Obstruction Medical treatment- NG tube, NPO, surgery

Nursing interventions: Monitor bowel

sounds, IV fluids, TPN, prepare for

diagnostic studies and surgery, treat N&V

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Colon Cancer

Medical Treatment- polypectomy, tumor

resection, colectomy/ostomy, chemo and

or radiation

Nursing Interventions: Bowel prep, ostomycare, diet teaching, teach effects of chemo

and radiation

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Pancreatitis

Acute: NPO, fluids, possibly TPN.

Monitor glucose, acid balance, K, Ca,

Serum Co2, and amylase, lipase. Pain

management, I7O monitoring; be alert forsigns of hemorrhage, renal and respiratory

failure

Chronic: Pancreatic enzymes, teach low

fat diet, pain management

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Peptic Ulcer disease

Causes: Helicobter pylori has been found

to be the cause in most ulcers, 50% of the

population is colonized

NASAIDS are another significant factor forgastric and duodenal ulcers in individuals

over 60

Corticosteroids cause erosion of gastric

mucosa

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Peptic Ulcer disease

Antibiotics

Histamine 2 blockers

proton pump inhibitors

Barrier medications

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Peritonitis

Nursing assessment

Monitor VS, WBCs, assess pain level,

assess firmness of the abdomen(rebound

tenderness)

Treatment:

Antibiotics( intraperitoneal in peritoneal

dialysis patient)

Pain management

Antiemetics PRN

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Mrs. Stone, 68, is on your unit with

ascites, as a complication of her liver

cancer. Her potassium level is elevatedand would most likely be related to:

A. Hypomagnesemia

B. Increased ammonia levels

C. Decreased albumin levels

D. Poor lymphatic system

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A client with advanced cirrhosis is

admitted to your unit from the E.D.

Which of the following orders shouldyou question?

A. Phenobarbital 100 mg HS

B. Neomycin sulfate 300 mgQ6 x 4 doses

C. Low protein diet

D. Serum ammonia levels daily

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Nutrition



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Nutrition

Essential for adequate functioning of allbody systems

Calculating nutrition intake is based on kcal-

Kilocalories

Carbohydrates 4 Kcal/gram Protein 4 Kcal/gram

Fat 9 Kcal/gram

Enteral feeding is preferred over parenteral

feeding because it is important to maintaining afunctioning GI tract

se5l, medical-surgical review curse powerpoint

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