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 ( Left sided Cardiac Rhythms- ... identifying on ECG Defibrillation Types: - Angina symptoms Cardiac Tamponade • diuretic • Lab values related to coronary artery disease CK-MB: lack of early elevation. o Normal: <0.5. Elevated w/n 3-6hr of MI • Myoglobin: peaks in 24hr • Lipid panel – ABNORMAL Pulmonary edema – patient teaching Dietary teaching Burns Priority setting for each burn • Thermal burns- AIRWAY • Radiation burns • Chemical burns- • Electrical- • Cold burns- Emergent phase: -Face & Neck Burns = Fluids: -Dextrose/ -Hypermetabolic State Parkland Formula Rule of Nines Assessment findings re: types of burns Electrical burns - Cold burns- Carbon monoxide poisoning- Radiation- Upper airway injuries- hermal First Degree Second Degree Third Degree + -Redness -Pain -Mild Edema -Blanching Treatment for burns Thermal Radiation Cold Electrical 1.Remove clothing and jewelry and ABC’s and IV fluids 2. IV analgesia 3.Debride blisters 4. Post amputation care if needed Escharotomy)mins AKI/CRF AV Shunt Patient Teaching • Arteriovenous fistulae or graft: Palpate for thrill, Auscultate for bruit, Never perform BP measurements or venipuncture in side with vascular access Transplant Pt that receives the kidney will forever be on immunosupressants If pt is rejecting: flank pain, tenderness, redness@ site with low urine output, high BP, weight gain Dialysis *** graft ■ Needle closer to fistula or red catheter lumen pulls blood from patient and sends to dialyzer ■ Blood is returned from dialyzer to patient through second needle or blue catheter -disequalibrium syndrome- when the solute is removed too fast, N&V, headache, seizures  slow dialysis rate - Peritoneal dialysisPeritoneal access is obtained by inserting a catheter through the anterior wall of the abdomen - Tenckhoff ■ Contra: Peritonitis, Recent Abdominal Surgery, Abdominal Adhesions, and Other GI problems i.e. diverticulitis Lab findings in renal patients Dietary considerations Emergency/Disaster Primary survey A – Airway B – Breathing C – Circulation D – Disability E - Exposure -assuring depth and rate/ rhythm -assess for flail chest and breath sounds 1.Remove clothing- KEEP PATIENT WARM Prevent heat loss with warming measures such as warm blanket, warming lights and warm fluids. Secondary survey F-full set VS G-Give comfort H-Hx and Head to toe I-inspect posterior surfaces -take vitals -Pain Management pharma and non pharm -Logroll maintain C-spine protection -Palpate Vertebral column -Look for injuries -Check rectum Bites Dog, cat, and human 1. Debridement 2. Tetanus Prophylaxis/Rabies? 3. Analgesics 4. Antibiotics 5. Loosely suture lacerations 6. Report to public health authorities (dog and cat only) 7. Take pictures for evidence (human only) Tick Spider Brown Recluse- Non-painful, Fever, chills, N/V, malaise, joint pain, Reddish Purple, Necrotic Center Snake Envenomation: Edema, Ecchymosis, Hemorrhagic Bullae, Necrosis, Lymph Node Tenderness, N/V, Numbness, Metallic Taste, Can progress to Coma *** Triage – who to treat first and Triage – classifying patients  Emergency severity ESI-1= Unstable – ESI-2= Threatened – L ESI-3= Stable ESI-4= Stable – ESI-5=Stable- Red = Emergent = Priority Yellow = Urgent Severe=Dead ONLY IN DISASTER, “they are not going to make it” (including an accident) Safety Emergency response plan [Show More]

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