*NURSING > ATI MEDICAL SURGICAL > Med-Surg 2 Conclusive Review (All)

Med-Surg 2 Conclusive Review

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Med-Surg 2 Conclusive Review Cardiac Heart failure Right sided -pooling in “rest of the body” -increased CVP -JVD, Heart murmer, abdominal pain (hepatomegaly, splenomegaly, vascular cong... estion in the GI tract) ascites, weight gain, dependent edema, dysrhythmias Left sided -“Lungs” crackles -HR increases, dyspnea on exertion, hypotension, s3 and s4 heart sounds, dry cough, frothy sputum, cyanosis, numbness and tingling (PVS sx) Cardiac Rhythms- identifying on ECG ECG flip book Defibrillation CPR- 30 compressions w/ 2 breaths Defibrillation- the treatment of choice to terminate V fib or pulseless V tach Types: monophasic and biphasic Output of a defibrillator is joules - Monophasic deliver at 360 joules - Biphasic deliver at 120 to 200 joules Pacemaker functioning Assess for malfunction -Failure to sense: check lead placement could be over or undersensing - Failure to capture: stimulus not captured therefore no depolarization will occur Angina symptoms chest px (unstable pain with rest that worsens) and (stable pain with exertion controlled with rest and nitrates, beta blockers) Cardiac Tamponade distant or muted heart sounds and anxious due to fluid build up in the pericardium, heavy feeling in test • Raise HOB and O2 w/ order • Do a pericardial window/ catheter • Dopamine or vasopressor, prednisone and diuretic • Lab values related to coronary artery disease CK-MB: lack of early elevation. • **Cardiac troponin: specific of myocardial injury o Normal: <0.5. Elevated w/n 3-6hr of MI • Myoglobin: peaks in 24hr • Lipid panel – ABNORMAL o Cholesterol >200 o Triglycerides >150 o LDL >160 o HDL <40 or <50 (for men) • CRP: elevated w/ inflammation anywhere in bidy • Homocysteine: bi-product of breakdown of protein • BNP: indicative of HF Pulmonary edema – patient teaching •S/sx of exacerbation, energy conserving behaviors •PSE of medication, diet, exercise Dietary teaching -Nutrition: DASH – restrict sodium to 2.5 grams per day, Weight Reduction, Daily weights- same time, same clothing, Weight gain of 3 lb. Over 2 days or 3-5 lb. gain in a week should be reported (for heart failure) Burns Priority setting for each burn • Thermal burns- AIRWAY is priority with inhalation burns! • Radiation burns like sunburn- Cool compresses but maintain warmth (no extreme tems or lotions or alcohol based for cancer radiation burns) • Chemical burns- tissue destruction up to 72 hours, with localized pain, redness and swelling (flush off chemicals with sterile water or NS, if powder brush off) • Electrical- Remove electrical source & Stabilize cervical spine and watch fpr myoglobinuria (give IV mannitol or Na bicarb) • Cold burns- Remove clothing and jewelry Emergent phase: -Face & Neck Burns = Intubation within 1-2 hours Fluids: -Lactated Ringer’s * First 24 hours -Albumin * Recommended after first 12-24 hours -Dextrose/Electrolyte Replacements * After 12-24 hours *** Avoid IM or SC route for adjuctive medications -Hypermetabolic StateAggressive nutritional support, Provided through enteral tube or parentally, and Diet high in protein, carbs, fats & vitamins Parkland Formula %TBSA burned * kg * 4= total ml for 24 hours needed 1st 8 hrs =50% total fluid 2nd 8 hours 25% total fluid 3rd 8 hours 25% total fluid Rule of Nines……………………………………………………………………….continued……………………………………………………….. [Show More]

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