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Medical Surgical Nursing Outline B - Joshua Diao
Medical Surgical Nursing Outline B - Joshua Diao
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CARDIOVASCULAR SYSTEM
Heart
1. Pulmonary Circuit
2. Vascular Circuit
Factors to Consider for a Good Heart
P Pumping Mechanism
U Unidirectional Blood Flow (R to L )
S Significant Good Patent Vessels
O Observable Electrical Activity
Pumping Mechanism
Cardiac Output Amount of Blood Ejected per
Minute
Heart Rate Beats Per Minute
Compensations:
1. Tachycardia
2. Ventricular Dilation
3. Hypertrophy
Signs and Symptoms:
Left Sided Heart Failure Pulmonary Congestion
1. Orthopnea
2. Dyspnea
3. Cough
4. Rales
- Ensure Rest
Passive ROM
Elastic Stockings
- Avoid Salty Foods
Prudent Diet (Low Sodium and Calories)
Small Frequent Feedings
Medications 3D
1. Diuretics
Lasix (Furosemide)
HCT2
Ethacrynic Acid
NURSING MANAGEMENT
Give Early in the Morning
Avoid Hypokalemia
A Apple
B Banana
C Cantalope
D Dragon Fruit
A Asparagus
B Broccoli
C Carrots
Aortic
Atrio Ventricular Valve Mitral
(Point of Maximum Impulse)
Tricuspid
PMI Left 5th Intercostal Space Mid Clavicular
Line
S1 LAB (First Closure of AV Valve)
S2 DAB (Closure of SL Valve)
VALVULAR HEART DISORDERS
1. Congenital Marfan Syndrome (Soft
Muscle Tissues)
2. Acquired Infection
Regurgitation
Insufficiency (Failure of the Heart Valve to
Close Properly)
Backward Failure
S/Sx of Congestion
Aortic and Mitral Same with LSHF
Pulomary and Tricuspid Same With RSHF
Significant Signs:
1. Corrigans Pulse Water Hammer Pulse
2. DeMusset Sign Head Bobbing
3. Traubes Sign Pistol Shot Sensation at
Femoral Area
4. Quinckes Sign Capillary Pulsation
5. Heart Murmurs Abnormal Heart Sounds
S3 Ventricular Gallop
S4 Atrial Gallop
Surgery: Valvuloplasty
Stenosis Narrowing of the Opening
Forward Failure (Signs and Symptoms of
Ischemia)
Significant Symptom:
1. Chest Pain
2. Cyanosis
3. Syncope (Transient Loss of Consciousness)
lack of blood going to the brain
Diagnostic Test
1. Echocardiography Heart Ultrasound
Surgery: Valvulotomy
Dr. Christian Barnard First To Conduct a
Successful Open Heart Surgery
South Africa
Endocarditis Colonization of Bacteria in the
Heart of the Patient
Tooth Abcess
Untreated Tonsilities
Throat Infection
Hallmark Sign: Fever, Join Pains,
Subconjuctival Hemorrhage, Oslers Node
(Painful Nodules Seen on Fingers), Splinters
Hemorrhage (Longitudinal Bleeding on
Nailbed), Janeways Lessions (Patechia at
Sole of Feet)
Care Approach
C
A
R
D
I
T
I
S
- Altered Lipid
- Male
Diagnostic Test
1. ECG Standard Test in the 24 Hours of
Chest Pain
3 Important ECG Changes
a) ST Segment Elevation - Injury
b) Inverted T Wave
- Ischemia
Very Large Q Wave
- Infarction
2. Stress Test Treadmill Exercise Test
3. Holter Monitoring Device
a. C-Reactive Protein:
Marker of Inflammation
Do
Give
With
Viagra:
Hypote
nsion
b. Homocysteine
causes damage to endothelium
c. Lipoprotein associated Phospholipase A2
Marker of Vascular Inflammation
Cardiac Isoenzymes
1. Troponin I and T 2 Hours Post Cardiac
Arrest
THE BEST BLOOD TEST!
2. CPK
- 4 Hours Post Cardiac Arrest
3. LDH
- 24-48 Hours Post Cardiac Arrest
Cardiac Catheterization
THE BEST DIAGNOSTIC TEST BUT VERY
INVASIVE: Standard Test
3 in 1 Exam
Identifies the Patency of the Vessel
Assess Blood Flow
Functionality of Heart Valves
NSG Priority During Cardiac Catheter
1. Psychological Preparation TELL ME
MORE
2. Allergy Selfish or Iodine
3. Check the Most Distal Pulses
Nursing Intervention
1. Facilitate the disappearance in chest
pain.
a) Drug of Choice Chronic Stable Angina
Nitroglycerine SE: Headache
Sublingual: 3x at Interval of 5 Minutes
Spray
Transdermal Patch
Do not give with Viagra: Hypotension
Myocardial Infarction
Morphine and Meperidine (Demerol)
Oxygen Inhalation
Bed Rest
Work Quietly and Systematically
Maintain Hemodynamic
Stability
Most Common Cause of Death:
Ventricular Arrhythmia
a) Maintain a Patent IV Line: Access for
Emergency Medications
b) Monitor Vital Signs of the Patient
c) Monitor the Cardiac Rate of the Patient
Premature Ventricular Contraction
Precursor to Ventricular Arrhythmias >
Cause of Death
DOC: Lidocaine > Monitor for Neurotoxicity
SE: Headache, Paresthesia, Convulsion
d) Monitor the Blood Pressure of the Patient:
Decreasing : Severe Left Ventricular
Dysfunction
Maybe Developing Cardiogenic Shock
Hallmark: Low BP, Narrowing Pulse
Pressure, Oliguria, Altered LOC
Treatment:
Inotropic Drugs: Dopamine, Dobutamine >
Increase BP
Drugs:
1. Fibrinolytics - Dissolve Blood Clots
Streptokinase, Urokinase, T-PA
Fresh Blood Clots ONLY!! First 12-24 Hours
ASK: When did you last experience chest
pain?
SE: Bleeding
2. Anticoagulants Prevents Blood Clot
Formation
Heparin
Enoxaparin
PTT
= Protamine SO4
Coumadin
Subling
Warfarin
PT
= Vitamin K
ual: 3x
at
Interva NEVER GIVE GREEN LEAFY VEGETABLES:
l5
HAS VITAMIN K!
mins.
Spray
3. Antiplatelet Decrease Blood
Aggregation (Viscocity)
Transd
Aspirin
ermal
Clopidogrel (Plavix)
Patch
Ticlopidine (Ticlid)
Dipyridamole (Persantin)
4. Antilipemic
Simvastatin
(Lipitor)
Atorvastatin
When to Give: At Bedtime > Highest
Synthesis of Cholesterol is in the Evening
Check: Liver Enzyme
SE: Photosensitivity
2. Promote Psychological and Physical
Rest of the Patient
Encourage Verbalization of Feelings
Most Common Defense Mechanism: Denial
Sedation
Limit Visitors of Patient
Maintain Quit Environment
3. Promote Proper Nutrition
Prior: NPO (First 24 Hours)
Liquid Diet (Avoid Cold and Warm Diet)
(Next 24 Hours)
Soft Diet ( Low Calorie, Low Sodium,
Low Fat)
Prevent Constipation: Straining is Bad
for the Heart
Vagal Nerve Stimulation: Bradycardia
Treatment
Diet: High Fiber Diet
Drugs: Laxative
Best: Colace
4. Promote Sexual Education
Resumption of Activity:4-6 Weeks After
Attack
Physical Manifestation: Able to Climb Flight
of Stairs without Dyspnea
Best Time
: Early in the Morning (Well
Rested)
Medications::Take All Prior To Sex
Place: Do In a Familiar Place and Familiar
Partner, Prolonged Foreplay
Position: Any Comfortable Position (OLD
Side-Lying)
1.
2.
3.
4.
SA Node
> Atrial Contraction
AV Node
Bundle of His > Ventricular Contraction
Purkinje Fibers
Properties:
P Wave : Atrial Depolarization (Contraction) SA
Node > AV Node
QRS Complex: Ventricular Depolarization
(Contraction) AV Node > Purkinje Fibers
T Wave: Ventricular Repolarization
PR Interval: Transmission of Impulses from SA
Node to Purkinje Fibers
[Arrhythmias]
- Abnormal Heart Rhythms
Basic Arrhythmias
Bradyarrythmias Heart Blocks (Slow Abnormal
Electrical Heart Activity)
Pacemaker: Device that will increase the cardiac
rate.
Nursing Management
1. Pulse Monitoring > Pulse Monitoring Right
After Waking Up Before ADLs
Pacemaker Malfunctioning: Earliest Manifestation:
Hiccups!
Dizziness
Loss of Conciousness
2.Avoid Constrictive Garment
3.Contact Sports Beware
4.Electromagnetic Field
5. Report Pace Maker Failure
Tachyarrythmias Premature Contractions,
Flutter, Fibrilation
A) Mechanical
Carotid Sinus Massage
Valsalva Maneuver
B)
Chemical Intervention
Quinidine Einchonism
Procainamide
Adenosine
C) Cardioversion
Elective
Atrial
200 Joules
Synchronized
Defibrillation
Emergency
Ventricular
200-360 Joules
Asynchronous
1. Pallor
2. Poikilothermia
3. Pulse Decreased
4. Paresthesia > Earliest Sign > Lack of 02 >
Irritation of Neurons (Highly Sensitive) BINHOD!
5. Paralysis > Late Sign!
6. Pain (Anaerobic Respiration > Formation of
Lactic Acid)
Hallmark Sign:
6 Ps
Venous
Intermittent Claudication
Temperature
Cool
Temperature
Warm / Same
Pulse
Reduced / Absent
Pulse
Normal
Elevation
Pale / Pallor
Elevation
Improved Color
Lower
Erythematous
Lower
Cyanosis
Position
Flat on Bed
Position
Elevate
(+) Gangrene
(-) Gangrene
Ulcer
At Distal Portion
Ulcer
Side of Leg
(-) Edema
(+) Edema
Appearance:
Shiny, Taught Skin, Sparse
Hair
Appearance:
Brown Discoloration of Leg
(Due to Pooling of Blood)
100/80 Feet
__________
20/40 = = .5
120-80 Arms
Arterial Disorders
ASO (Atherosclerosis Obliterans) Inflammation
of Arteries Due To Fat
Pseudohypertension
False Elevation of Blood Pressure
Focus of Care
A
1.
2.
3.
4.
5.
6.
7.
8.
9.
Amputation:
Psychological Preparation
Teach About Exercises
Gluteal Setting Exercise
Quadriceps Setting
Orient About the Phantom Limb Sensation.
(True Pain)
Monitor for Bleeding >
Bedside: Tourniquet
Position: Elevate the Foot part of the Bed
No Pillows (SE: Stump Edema)
Prone Position:
Prevents Flexion Deformity
Passive ROM on the Unaffected Leg
Prevents Thrombus Formation
Prepare Client for Ambulation
Use Prosthesis or Crutches
4Cs of Hypertension
CVA
Cerebrovascular Accident
CHF
Congestive Heart Failure
CAD Coronary Artery Disease
CRF
Chronic Renal Failure
As of Hypertension
A ACE Inhibitors (-pril)
Angiotensin Receptor Blockers (-tan)
(Best Choice)
Alpha Blockers SE: Orthostatic Hypotension
(Not Commonly Used)
B Beta Blockers
(-olol)
Hydralazine
E Exercise
F Force Compliance
Venous Disorders
Thrombophlebitis
Virchows Triad
Venous Stasis
Endothelial Injury
Increased Blood Viscosity
Gas Exchange
1. Ventilation - Movement of Air In and Out of
the Lungs
2. Diffusion
Alveoli to the Blood
3. Perfusion
Blood to the Cells
V
Venous Support (JOBST Stockings) JOBST
= Pre-filled Pressure
Ulcer Treatment
Unna Paste Boot (Zinc Oxide)
>
Conducting System
Protective Devices
1. Filtration of Nasal Hair Vibrissae
(Nasal Hair)
2. Mucociliary Clearance
3. Cough Reflex > Watchdog of the
Lungs
4. Reflex Broncho Constriction
5. Alveolar Macrophage System >
Phagocytosis
Chronic Obstructive Pulmonary Disease
(COPD)
group of disorders > obstruction in gas
entry
COPD = CAL (Chronic Airflow Limitatioon)
Common Cause: Smoking
Asthma > Best Prototype of An Allergic Reaction
Antigen Antibody Reaction > Release of
Chemical Mediators
Histamine
SRS-A
ECF-A
> Bronchoconstriction
> Increase Secretion
> Mucosal Edema
Green (80-100%)
Good Control
Yellow (50-79%)
Caution: Asthma Getting
Worse
Red (Below 50%) MEDICAL ALERT
Nursing Care
A
S
Steroids (MDI vs DPI) Prednisone /
Fluticasone
T
Bronchiectasis
repeated bacterial infection
Signs and Symptoms
1. Layering of Sputum
Diagnostic Test
Assessment of Oxygenation
1. Pulmonary Function Test
Spirometer > Measure Lung Volume /
Capacity
2. Pulse Oximetry
N 95 100%
With COPD 90-100%
3. ABG Best Test to Measure ABG Reading
D
Y
S
Percussion
Vibration
Postural Drainage
Nursing Intervention
Dyspnea Reduction
Complete Bed Rest
Yank on Trigger Factors
Stop Smoking
Sputum Expectoration
Chest Physiotherapy
Postural Drainage
1. Auscultate Lungs > Determine Location of
Congestions
Lots of Phlegm on Base of Lungs >
Trendelenberg
Lots of Phlegm on Apex of Lugs > Semi
Fowlers
Lots of Phlegm on Right Middle Lobe >
Left Side Lying
2. Oral Care
P
N
Exercise
Pursed Lip Breathing (Removes C02)
Spirometer
IPPB (intermittent positive pressure breathing)
(prevents collapse of alveoli)
A
Administer Drugs
Bronchodilators
Influenza Vaccinations
Drugs:
1. Mucolytics -Acetylceysteine
3. Saturated Solution of Potassium Iodide
(KISS) > Bitter Taste
Combine With Orange Juice
4. Antitussive Inhibits Cough
Codeine
DIFFUSION Movement of 02 from Alveoli into
Blood
Restrictive Lung Disorders Problem in the Gas
Exchange
Lung Infection
Chest Injuries
Space Occupying Lesion
Chest
1.
I
P
P
A
2.
I
P
P
A
Injury
Hemothorax - Chest Lag > Unequal Chest Expansion
- Reduction of Tactile Frimitus
- Dull Sound
- Reduced Breath Sounds
Pneumothorax -PRIORITY PROBELEM
- Dyspnea
- Increase in the Tactile Fremitus
- Hyperresonant Sound
- Reduced Breath Sounds
Chest Drainage
Principle:
1. Gravity
2. Water-Seal = Vacuum that Creates
Negative Pressure
Purpose:
1. Remove and Air and Water from the
Pleura.
2. Facilitate re-expansion of the Lungs.
3. Maintain the Negative Pressure.
S = Observe the Site of Insertion > SQ
Emphysema
- Accumulation of Air Under the Tissues
- Crepitus on Palpation > Chicharon Sound
- Air Will Rise Up Into Face
- Assure Patient this will not cause Death :
Not An Emergency Situation
T = Observe the Tube Blood Clots
Milk Tube Only With Doctors Orders
Kinking Straighten Tube
O = Oscillations (Fluctuations)
Absence Due to Kinking, Blood Clot
Re-Expansion of Lungs > Equal Breath Sounds
P = Problems - Breakage of Bottle (Dip in a
Water Bottle/Glass of Water)
Accidental Removal Cover with Vasilinized
Gauze
Chest Surgeries
1. Pneumonectomy Removal of a Lung
Post Op = Position the patient on the
affected side
No Chest Tube Insertion
2. Lobectomy Removal of A Lung Lobe
3. Segmental Resection Removal of a Lung
Segment
4. Wedge Resection Removal of a Lung
Portion
Post Op = Position the patient on the
unaffected side
With Chest Tube
5. Thoracoplasty Repair of the Lung
Space Occupying Lesions
Cancer Abnormal Proliferation of Cells
Defect in Cellular Proliferation
>
Tumor
Loss of Contact Inhibition
Benign
Soft and Moveable
Encapsulated
Growth By Expansion
Well Differentiated
No Metastasis
Malignant
Hard and Fixed
Without Capsule
Growth by Depth
Poorly Differentiated
Metastasis
Epithelial
Carcinoma
Connective Tissue
Sarcoma
Lymphoid
Lymphoma
Blood
- Leukemia
Genetics
Foods
Client
Factors:
Self Breast Examination
Pap Smear
DRE
Guaiac Test
Testicular Self Examination
Calories Increased
Rest
Antibiotic
Chest Tapping
Keep Moving
Limit Going to Public Places
Encourage Fluids
Smoking Avoidance
RBC
Heme
Protoporphyrin
Globin
Fe
PERFUSSION
2
Fe Def.
Cells
45%
(Hematocrit)
RBC, WBC, Platelet
Etiology
Hallmark
Cells
Nutritional
Paracitism
Koilonychia
(Spoon S. Fingers)
Microcytic (Small)
Hypochromic (Pale)
Pica
(Crave to Eat Inedible
Food)
Plummer Vinson Syndrome
- Cheilitis (Crack in Oral Mucosa)
- Dysphagia
- Glossitis
MGT: Dietary Management
Liver
Ampalaya
Test
Hemoglobin
(hgb)
Serum Ferritin
RBC Index
Malunggay
Kangkong
Iron Supplementation
Fumarate
> Highest Source of Iron > Give with Vitamin C
Sulfate
Gluconate
Aplastic
Bone Marrow
(Bleeding Tendencies)Depression
Pancytopenia
(All Cells are Low)
Normocytic
Normochromic
BM Biopsy
Nursing Consideration
1. Protect Patient from Infection (Dec WBC) (Immunocompromised)
Reverse Isolation
2.
3.
Pernicious Anemia
(Vit B12 Def)
Only with
Neurologic
Symptoms
NSG:
1.
Malabsorption
Macrocytic
Hyperchromic
Schillings Test
(VitB12 Absorb)
24 Urine Sample
Schilling:
1. Injection of Nonradioactive Vitamin B12 Given
2. Radioactive B12 Ingested
Hemolytic Anemia
G6PD Anemia
Genetics
Jaundice
Splenomegaly
Hepatomegaly
NSG MGT:
1. Genetic Counseling
Nursing Focus
A
N
E
M
I
A
K
Keeps Us Clean
I
Institute Acid Base
D
D Regulation (Vit D)
Vit D Calcium and Phosphate Regulation
N
No To Electrolyte Imbalance
E
Erythropoietin Controls
Y
Your BP is Regulated (RAAS)
Normocytic
Normochromic
Osmotic Fragility
Urine Formation
Glomerular Filtration
Tubular Reabsroption
Tubular Excretion
Obstructive Pathology
Nephrolithiasis
Genetics
Diet
Dehydration
Infection
Diagnostic Tests
1. Urinary Analysis
(+) RBC
2. Ultrasound
3. KUB X-Ray (Kidney, Ureter, Bladder)
4. IVP Intravenous Pyelography > NSG
MGT: NPO, Allergy to Dye
Benign Prostatic Hypertrophy
Etiology
Unknown
Nursing Management
Diagnostic Test
1. Digital Rectal Exam - 40 y.o above
2. PSA Prostatic Specific Antigen > R/O
Cancer
3. Cystoscopy
Surgical Correction:
1. Prostatectomy
Transurethral Resection of the Prostate
Suprapubic Prostatectomy > Bladder >
Prostate
Retropubic Prostatectomy > Direct to
Prostate
Perineal Prostatectmy > Perinium >
Bladder
N = Narcotic Analgesics
- Morphine Sulfate
- Demerol
- Nubain
E = Encourage Ambulation
ESWL (Extracorporeal Shock-Wave
Lithotripsy) P72,000
S = Surgery (Nephrolithotomy)
S
Sexuality Concerns: Damage to Perineal
Nerve > Impotence
T
To Increase Fluids
Emotional Support
Inflammatory
More Common in Females
Anatomical Predisposition
E-Coli, Proteus, Enterobacter
Pyelonephritis
Flank Pain
Fever
Acute
Sudden Onset
Reversible
Etiology
Pre-Renal
Renal
Post-Renal
Urethritis
Dysuria
Abnormal Discharges
Diagnostic Test
1. Urine Culture
Focus of Care:
A
- Cotton Panty
- Drugs
- Encourage Fluids
Glomerolonephritis
Nephrotic Syndrome
GABHS
Autoimmune
Diagnostic Test
Urinalysis (+) RBC
Anti-Streptolycin O
Titer
Increased BUN
Increased Creatinine
Diagnostic Test
Urinalysis (+)
Albumin
Low Serum Albumin
High Lipid Profile
Diet
Low Protein
Drugs
Antibiotics
Anti
Hypertensives
Diuretics (Edema)
Drugs
Steroids
Diuretics
Renal Failure
Low Sodium
Diet
High Protein
Chronic
Progressive
Irreversible
Etiology
Diabetes Mellitus
Hypertension
Infections
Uremia
Excretion
Edema
(Uremic Frost)
Pruritus
Electrolyte Imbalance
Altered Level of Conciousness
Secretory
Weight Gain
Pallor
> No Erythropoietin
Fracture > Vit D Synthesis: Hypocalcaemia
BP Regulation
Headache
Dizziness
Renal Function Test
1. BUN
8-24 mg/dl
2. Creatinine
.6 1.3 mg/dl
3. Creatinine Clearance 100-120 ml/min
BEST TEST!
4. Uric Acid
2.5 8 mg / dl
Specimen: 24 Hour Urine Collection
Acidosis
Electrolyte Imbalance
Ingestion of Poison
Overload
Uremic Symptoms
Peritoneal Dialysis
Artificial Kidney
Peritoneum
Vascular Access
Tenckhoft Catheter
Hemodialysis
Artificial Kidney
Dialyzer
Vascular Access
AV Shunt / Fistula
Dialyzing Solution
Impersol
Note:
Protect Arm From
Injury
NO BP Taking
NO IM Injections
NO IV Insertion
Dialyzing Solution
No Need (In Machine)
Nursing Considerations
K Keeping Fluid Balance
Monitor Intake and Output
Limit Oral Fluid Intake (500-1000ml / day)
Treatment: Diuretic
I
D Dietary Instructions
Low Protein Diet
Giordano Giovanetti Diet (Low Protein)
Tx: Ketosteril - Non-Ketogenic Amino Acid
N No To Acidosis
Na HCO3
E Electrolyte Balance Maintenance (Because
of Hyperkalemia)
Monitor ECG of Patient Tall T Wave
Avoid Giving Fruits to Patient
Tx: Sorbitol (Laxative)
Kayexalate (Rectal Via Enema)
Glucose + Insulin Treatment
Hyperkalemia
- Sorbitol, Kayexalate, Glucose + Insulin
Hypocalcemia
Nursing Responsibility
Peritoneal Dialysis
1. Get the Weight of the Patient
2. Warm the Dialysate Solution
Reduce Abdominal Cramping
Vasodilation
3. Instill Solution in Patients Abdomen
and Allow to Settle for 1 Hour
4. Drain Out the Solution : Measure
Intake and Output I = O
Turn Patient from Side to Side to Facilitate
Release of Water
Watch for Complications:
1. Monitor for Signs of Infection
Fever
Abnormal Color in the Dialysate Solution
Hemodialysis
1. Get the Weight of the Patient
2. Position the Patient Comfortably on Bed
3. Vital Signs qH
Complication:
1. Dialysis Disequilibrium Syndrome
Rapid Ultra Filtration of the Blood >
Cerebral Edema
Headache
Vomiting
Convulsions
Nursing Management
Slow Down the Filtration Rate
Kidney Transplantation
1. Best Donor: Twin Brother / Sibling
2. First Come First Serve : Drivers License
Diagnostic Test
1. Imuran
2. Cyclosporine
3. Prednisone
Nursing Management
Monitor for Signs and Symptoms of Rejection
Decreased Urine Output
Edema
Generalized Body Malaise
Rise in Serum Creatinine
Abnormal Temperature
Dull Pain on Site
Manifestation
Elevated BP