Hondros College LPN Med Surge II full term

admin / January 19, 2018
Question Answer
How often to check VS after surgery Every 15 minutes
Signs of shock Increased HR, thready pulse, BP decreased, cool/clammy skin, urine output decreased
signs/symptoms of pulmonary embolism Sudden chest pain, dyspnea, tachycardia, cyanosis, diaphoresis, and hypotension
Interventions for pulmonary embolism HOB at 45 degrees, administer oxygen, notify dr
How often to inspect surgical dressings? every 2 to 4 hours for the first 24 hours
How much drainage in 24 hours? More than 300 ml should be treated as abnormal
Define: diplopia, strasmus, nystagmus. Diplopia: double vision. Strabismus: lazy eye. Nystagmus: jerky eyes.
What do the pons regulate? What does the cerebellum regulate? Pons: Respirations

Cerebellum: Balance

What are the 3 meninges? Dura, arachnid, and pia
What to remember about cerebral angiography 1)Allery to iodine (shellfish) 2) NPO after midnight 3)bed rest for 12 to 24 hours 4)force fluids
What to remember about lumbar puncture 1)Patient should be well hydrated 2) Inserted between l3/l4 or l4/l5 3)must lie flat for 6 to 12 hours afterwards.
Increased Intracranial Pressure causes changes in: 1)LOC 2)Pupil response 3)Speech 4)Motor function 5)Vitals
Degenerative disorder with demyelination of brain stem and nerves (CNS) Multiple sclerosis
Neuromuscular disorder – nerve impulses fail at the myoneural junction, causing weakness Myasthenia gravis
motor neurons in the brain degenerate – messages do not reach the muscles ALS/Lou Gehrigs – results in death 2 to 5 years after onset
Overactivity of dopamine; genetically transmitted Huntingtons
Cardinal symptom is chorea Huntingtons
Degeneration of the trigeminal nerve Trigeminal neuralgia
Cardinal symptom of trigeminal neuralgia excruciating, burning facial pain
Cranial nerves in Bells and Trigeminal neuralgia VII and V.
Cardinal symptom of Bells Palsy Unilateral facial paralysis
Upward progressing paralysis preceded by an infection Guilllain Barre Syndrome
Cardinal sign of meningitis Stiff neck and headache. (Kernigs and Brudzinksis signs for diagnosis).
Exaggerated sympathetic response at the T6 level – triggered by full bladder or impaction Autonomic Dysreflexia
Labyrinthitis Inflammation of the labryinthine canals in the inner ear – usually caused by a URI
Chronic, progressive deafness due to formation of spongy bone Otosclerosis
Increase in the endolymph fluid – chronic disease of inner ear and 8th cranial nerve Meniere's disease
Cardinal sign of Menieres Recurrent attacks of vertigo accompanied by tinnitus or deafness. The vertigo is severe – rotational, may cause them to be unable to stand
Abnormally low blood volume due to blood loss Hypovolemic anemia|
1000 ml loss can cause severe complications |
Manifested by hypotension, tachy, hemoglobin less than 10g, hematocrit less than 40%
Absence of intrinsic factor, loss of vitamin B12 Pernicious anemia |
Deficiency of B12 affects growth of all cells and myelination of of nerves
Manifestations of pernicious anemia Cardinal: Sore tongue, dysphagia, neurological issues
Decrease of bone marrow function aplastic anemia |
Primary = congenital, Secondary = viral, medications, chemicals
Manifestations and interventions of aplastic anemia pancytopenia, fatigue, palpitations | splenectomy, platelet transfusion, bone marrow transplant
WBC less than 200/mm3 & causes Agranulocytosis | Caused by medications, chemo, neoplastic disease, viral/bacterial infections
Manifestations & interventions of agranulocytosis ulcerations of mucous membranes, pneumonia, UTI. | Interventions – remove cause, prevent infections – strict asepsis.
Malignant neoplastic immunodeficiency of the bone marrow (+manifestations) Myeloma. Bone pain, fractures, hypercalcemia (which causes renal failure)
Inflammation of lymphatic vessels – name of disease, alternate name, and cardinal sign. Lymphangitis; blood poisoning; fine red streaks from affected area.
What do helper T's / CD4 cells do? initiate immune response
Barrier between the body and outside world againt microorganisms Innate immunity.
Composed of the thymus, spleen, bone marrow, blood, and lymph, provides a specific reaction to an antigen. adaptive/acquired immunity.
This immunity is a result of the development and presence of circulating antibodies and is divided into active and passive. Humoral immunity.
Types of hypersensitivity Level I – pollens, insects, food allergies | Level II – Blood transfusions | III – Autoimmune | IV – delayed response to an exposure (transplants or TB test)
CD4 levels 600 to 1200 = normal | 200-499 minor immune problems | below 200 severe problems
Pathophysiology of HIV kills CD4 cells, then reproduces in the lymphatic system, eventually spilling over into the blood.
Early symptomatic HIV process CD4 below 500. Night sweats, diarrhea, fatigue, lymphadenopathy
the end stage/terminal phase of HIV AIDS. CD4 count below 200.
Fever; night sweats; productive cough; short of breath PCP (pneumocystis carinii pneumonia)
Combination therapy, given around the clock, for HIV. Antiretroviral. Cannot miss a dose. Usually initiated when CD4 drops below 350.
Major side effects of chemotherapy leukopenia, anemia, thrombocytopneia, alopecia, stomatitis, n/v/d
Herpes Zoster Aka Shingles. Unilateral inflammation of ganglia, painful rash on the nerve pathway.
Virus causes scaly lesions with pink center, widespread rash within 14 days. Pityriasis Rosea – there is no treatment.
Lesions that start as macules, then develop and rupture a honey color exudate. Impetigo – caused by staph viruses, highly contagious.
Dermatophytoses – 4 types These are fungal infections. | Tinea capitis – ringworm on scalp | Tinea corporis – ringworm of body | Tinea cruris – jock itch | Tinea pedis – athletes foot
Dermatitis venenata skin rash/allergic reaction to certain plants.
Hives of the subcutaneous tissue, causing a reaction similar to anaphylaxis. Angioedema. Should be treated with epinephrine and corticosteroids.
Noninfectious raised, silvery plaques on the skin. Psoriasis
Autoimmune disorder that causes inflammation of any body part. Systemic Lupus Erythematosus.
Verruca A benign wart
A burn involving the epidermis, dermis, and subcutaneous tissue. Full thickness burn. Skin will not blanch, patient will not feel pain any longer in that area.
Treatment for burns Respiratory, Fluids, THEN Pain. First 48 hours, fluids are crucial. 48-72 hours, high protein/calorie/viatamin diet, ROM.
What functions as both an endocrine and exocrine gland? Panceas – it releases via a duct into the duodenum, and releases insulin directly in the bloodstream
Hormones secreted by the anterior pituitary gland TSH, ACTH, FSH, LH, GH. All are indirect except GH.
Hormones secreted by posterior pituitary ADH and Oxytocin.
What are the targets of TSH, ACTH, FSH, and LH? TSH – thyroid | ACTH – adrenals | FSH – ovaries | LH – testes
Hormone necessary for reabsorption of water in kidneys Antidiuretic hormone (ADH)
The gland that secretes melatonin, gonadotropin, and is a matrix for calcium Pineal gland
The 3 hormones of the thyroid gland. T3, T4, and calcitonin. | T3 and T4 regulate metabolism/growth | Calcitonin returns blood calcium to the bones.
PTH Parathormone – maintains calcium and phosphate balance in the body
2 hormones of the Thymus gland Thymosin – causes T lymphocytes to mature | Thymin – blocks transmission of neuro impulses.
Causes hypoglycemic effects by interfering with GH and glucagons Somatostatin
3 corticosteroids released by the adrenal cortex. glucocorticods – cortisol | Mineral corticoids – aldosterone | gonadocorticoids – sex hormones
Secretions of the adrenal medulla Epinephrine and norepinephrine
Disorder of the anterior pituitary in which too much GH is secreted. Hyperpituitarism. Causes gigantism if it occurs prior to the closing of the epiphysis. If in adults, its called acromegaly. The hands and feet and face enlarge, very painful skeletal growth.
Posterior pituitary secretes too much ADH SIADH – Syndrome of Inappropriate Antidiuretic Hormone | too much water is reabsorbed, diluting the blood and decreasing osmolarity.
Manifestations and treatment of SIADH Increased BP, muscle weakness, concentrated urine (Specific gravity > 1.030 | Treated by fluid restriction and diuretics
Not enough secretion of ADH Diabetes Insipidus – kidneys do not reabsorb enough water, so urine is diluted. | can be caused by tumor, meds, alcohol, or head trauma
Manifestations and treatment of Diabetes Insipidus Urinate 3 to 15 L every 24 hours, always thirsty, intense desire for ice water. Specific gravity of near 1.000. LEADS TO HYPOVOLEMIC SHOCK IF UNTREATED. | Treatment: sodium restrictions, electrolytes/fluids by IV
The main admissions information of a client with pituitary disorder? Excessive weight gain/loss, intake vs output, and a child's height/weight vs growth charts
Hyperparathyroidism aka Graves Disease | Oversecretion of T3 and T4, causing: tachy, hypertension, heat intolerance, weight loss, fatigue.
Lack of T4 & T3 Myxedema (cretinism in infants). May be autoimmune, due to iodine deficiency, or because of a thyroidectomy. Manifested by goiter, weight gain, cold intolerance.
Differentiation of types of diabetes DM1 – pancreas stops producing insulin | DM2 – pancreas produces some, but cells are resistant | Gestational – due to pregnancy | IGT – borderline diabetes | Secondary – due to pancreatic trauma or disease, birth control |
Addison's disease & crisis Low in aldosterone. Causes the skin to be a bronze color. | Addisonian crisis is life threatening, manifesting through hypotension, weak pulse, FV deficit, and collapse.
Cushings disease Overproduction of cortisol – manifested by buffalo hump, moon face, muscle wasting.
Benign tumor in adrenal medulla, causing excessive epinephrine and norepinephrine production. Pheochromacytoma. Symptoms include very high hypertension, pounding headache, tachycardia, diaphoresis.

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