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NSG223 HESI Final Study Guide

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Medical-Surgical Nursing II (NSG 223)

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Herzing University

Academic year: 2022/2023

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MOD 1 Cardiac Dysrhythmias

01. Atrial Flutter &

PAC

Etiology and pathophysiology and identify subjective and objective assessment data associated

with a diagnosis of Premature Atrial Complex, Atrial Fibrillation and Flutter.

Atrial flutter & PAC

 Irregular pulse

 Fatigue

 SOB

 C/O goes down

 Dyspnea on exertion

Rate – 250-400 beats/ min

Saw tooth appearance

Causes

 HF

 Tricuspid or mitral valve disease

 PE

 Cor pulmonale

 Inferior wall MI

 Carditis

 Digoxin toxicity

01. Atrial flutter –

treatment

Identify key pharmacological concepts related to the management of Sinus Node and Atrial

Dysrhythmias

Atrial flutter – treatment

 Stable

o CCB – diltiazem, verapamil

o BB – propranolol

 SE: decrease work load of heart, decrease BP, decrease HR, dizzy

o antiarrhythmic/antidysrhythmic – amiodarone, procainamide

o Anticoagulation – heparin (if someone come in now - immediate, warfarin

(takes a few days for therapeutic), enoxaparin

 Unstable – ventricular rate of > 150bpm  initiate cardioversion

S/S

 Chest pain

 SOB

 Low BP

Medical management

 Vagal maneuvers

 Trial administration of adenosine – block and slow conduction through AV node

 terminates tachycardia

 Adenosine

o IV, rapid administration & 20 cc saline flush & elevation of arm with IV line

to promote circulation

MOD 2 CV Disorders pt. 1

02. Angina – POC

Describe the etiology, pathophysiology and assessment data, and non-pharmacological medical

management of angina pectoris

Angina – FIRST STEP

 Give oxygen

02. Anginal Pain

Discuss the nursing process as it relates to care of the patient with angina pectoris

Anginal pain

 Cardiac pain due to decreased blood flow

 Primary goal to restore oxygen to the heart

02. Unstable Angina

– Nitroglycerin

(NTG)

ACS –

Unrelieved chest

pain

Identify key pharmacological concepts related to the management of angina pectoris.

02. Chest Pain

Algorithm (map)

Etiology, pathophysiology and identify subjective and objective assessment data

associated with a diagnosis of acute coronary syndrome (ACS)

02. Chest pain ACS

algorithm (map)

Describe the non-pharmacological medical management of acute coronary syndrome

(ACS).

o Orthopnea

o Chest pain

o Nausea

 Treatment

o Anticoagulation

o Diuretics

 Risk factors

o Pregnancy

o Alcohol

 Interventions

o Sit with legs hanging down – pulls water down

03. Pericarditis pain

Describe the pathophysiology subjective and objective assessment data and medical and

nursing of the patient with pericarditis

Pericarditis pain

 NSAIDS – ok to use

 Pain worst with breating IN

 Fever, SOB

 Bedrest till pain is gone

 Hear a friction rub, creaky

 Sitting forward can relief pain (tripod or orthopneic position)

MOD 4 Respiratory System

04. PE – 1 st action

Describe the etiology, pathophysiology, and subjective and objective assessment data

associated with a diagnosis of Pulmonary Embolism

PE – FIRST ACTION

 Nasal Oxygen

04. PE – Heparin

Identify key pharmacological concepts related to the management of pulmonary

embolism.

04. PE – ABG’s &

Hypoxia

Describe Respiratory Failure in terms of pathophysiology, identify subjective and objective

assessment data also describe the assessment and diagnostic findings aligning with the

medical and nursing management including non-pharmacological interventions

PE – ABG & Hypoxia

 Will get respiratory acidosis

04. ARDS S/S

Describe the etiology, pathophysiology, and subjective and objective assessment data

associated with a diagnosis of Acute Respiratory Distress Syndrome

ARDS – symptoms

 Hypoxia even when 100% oxygen is given (room air at 21%)

 Decreased lung compliance – loss of elasticity

 Dyspnea

 Edema

 Bilateral pulmonary edema (non-cardiac)

 Dense pulmonary infiltrates on XRAY

 Fluid in lungs

 Low BP

 HR & RR high

 Low O

 Can have increased temp

 Dysrhythmias

 Working very hard to breathe, cyanosis, external muscle, use

 Hear crackles

04.02 &

04. Pneumonia –

Frothy Sputum

ARDS – Priority

Lab

Describe the etiology, pathophysiology, and subjective and objective assessment data

associated with a diagnosis of Acute Respiratory Distress Syndrome.

Discuss the medical and nursing management including non-pharmacological

interventions for a patient with Acute Respiratory Distress Syndrome (ARDS)

04. ARDS – COPD

Discuss the nursing process as it relates to care of the patient with Acute Respiratory

Distress Syndrome (ARDS)

MOD 5 Acid-Base Balance

 Second word  whatever the ph is

Compensations

 Uncompensated

o HCO3 or CO2 is normal

 Partially compensated

o Nothing is normal

 Fully compensated

o PH is normal

o HCO3 and CO2 are opposite

MOD 6 GI System

06. Pancreatitis –

Lipase

Pancreatitis –

Amylase

Pancreatitis –

Electrolytes

Define the etiology, pathophysiology and identify subjective and objective assessment data

associated with a diagnosis of Acute Pancreatitis

AST level

 10-40 U/mL (0.34-0 U/L)

ALT level

 8-40 U/mL (0.14-0 U/)

Pancreatitis – electrolytes

 HYPOCALcemia

 HYPERglycemia

06. ACUTE

Pancreatitis –

Treatments

Discuss the medical management of acute pancreatitis including non-pharmacological

interventions of acute pancreatitis

ACUTE pancreatitis – treatments

 Opioids IV or PCA – hydromorphone (dilauded), morphine, fentanyl  if pain not

controlled, call doctor

 Strict NPO

 NG tube and hook to suction

 Bed rest – to decrease metabloic rate, semifowlers OK

 Tube feedings – TPN

o Check blood sugar Q6 hrs

 Avoid heavy meals and alcohol after recovery

 Diet: high protein, low fat

 Incentive spirometer

06. CHRONIC

Pancreatitis –

Chronic Pain

Define in terms of etiology and pathophysiology and identify subjective and objective

assessment data associated with a diagnosis of Chronic Pancreatitis

CHRONIC pancreatitis – Pain

 Inflammation that doesn’t heal

 Worsens over time

 Alcohol most common cause of chronic

 severe upper abdominal and back pain with vomiting

 some have no pain

 UNRELIEVED by large doses of opioids – can use adjunct meds  antioxidants,

antidepressants, non-narcotics

06. CHRONIC

Pancreatitis –

Treatment pt. 2

Identify key pharmacological concepts related to the management of chronic pancreatitis.

CHRONIC pancreatitis – Treatments

 Decrease acute episodes

 Help chronic pain with opioids

 Surgery  to open up duct or bypass obstruction

 How to know if pancreatic enzyme working properly?  stool appear formed and

solid

06. Hepatic Failure

Identify subjective and objective assessment data associated with a diagnosis of cirrhosis.

Hepatic failure

 Liver enlargement

 Portal obstruction and ascities

 Infection & peritonitis

 GI varices

 Edema

 Vitamin deficiency and anemia

 Mental deterioration

 Ammonia builds up  GIVE LACTULOSE – to poop out ammonia, will have

diarrhea

 Sodium restriction

MOD 7 Renal System

 Disorientation

 Inability to concentrate

 Restless legs

 Seizures

 Tremors

 Weakness and fatigue

Skin

 Coarse, thinning hair

 Dry, flaky skin

 Ecchymosis

 Gray-bronze skin color

 Pruritus

 Purpura

 Thin, brittle nails

CV

 Engorged neck veins

 Hyperkalemia

 Hyperlipidemia

 Hypertension

 Pericardial – effusion, friction rub, tamponade

07. PhosLo

Renal diet

Describe the medical management including non-pharmacological interventions for chronic

renal failure

Phoslo

 Binds phosphorous and you poop it out

 Give with meals (any time they eat)

Renal diet

 Low potassium

 Low protein

 Low sodium

 Fluid restriction 500-600 ml per day

 Take phosphate/ phosphorous binders

 Vitamin supplements needed b/c of the restrictions that doesn’t provide

necessary vitamins

07. AV Fistula

normal

Differentiate between the different types of vascular access for dialysis and associated

complications

AV fistula normal – what you should feel and listen for

 Feel for thrill

 Listen for bruit

07. Hemodialysis –

BP

Discuss the nursing process as it relates to care of the patient receiving hemodialysis

Hemodialysis – BP

 Common for them to drop to a low BP

 Hold BP medications until after dialysis b/c the process removes some

medications

07. Peritoneal

dialysis first step

Describe the procedure and complications as it relates to peritoneal dialysis

Peritoneal – dialysis first step

 Before medications are added – dialysate is warmed to body temp to prevent

discomfort and abdominal pain and to dilate vessels of the peritoneum to

increase urea clearance

 Solutions that’s too cold may cause pain, cramp, vasoconstriction, and reduce

clearance

07. Keyexalate –

evaluate

Identify key pharmacological concepts related to the management of renal failure.

Keyexalate – evaluate

 To know if working when they have diarrhea

 Eliminates potassium (keyexalate binds to potassium)

 It removes potassium

 Cardiac monitoring and labs

MOD 8 Endocrine System

08. Addison’s

Disease –

Hydrocortisone

Addison’s

disease –

Prednisone

Identify key pharmacological concepts related to the management of Addison disease

Addison’s disease – hydrocortisone (crisis med)

 Hydrocortisone IV, followed by 5% dextrose in normal saline.

 Vasopressors may be required if hypotension persists.

 Give hydrocortisone during a crisis

 injectable and give dextrose 5% because they need glucose

 Increase salt intake

Addison’s disease – prednisone

 Daily maintenance medication

 Take at 9am with food b/c that’s when body would normally produce cortisol

08. Cushing’s

Describe in terms of pathophysiology and identify the subjective and objective assessment

data for diagnosing Cushing Syndrome

risk

SIADH – findings

 Low potassium

 Hypotensive and tachycardic

 Give desmopressin

SIADH – seizure risk

 Hyponatremia (normal level: 135-145)

 Risk for seizures = 125-

 Go into seizure and coma = below 115 – 120

 When sodium is low – brain swells = encephalopathy & cerebral edema

SIADH – Findings

 Retain fluids

 low urine output

 hyponatremia and hypo-osmolality

08. Antidiuretic

hormone –

evaluate

Identify key pharmacological concepts related to the management of Diabetes Insipidus and

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

SIADH treatment

 give mannitol (free water diuretic)

 fluid restriction to 500-2000 cc a day

MOD 9 Musculoskeletal System

09. Neuro Assess –

Fracture site

Discuss the emergency and medical management of fractures

Neuro assessment – fracture site

 CWMS

o Color

o Warmth

o Movement

o Sensation

09. Closed fracture

– complications

Vascular

compromise

Define the process of fracture healing and identify the potential complications

Closed fracture – complications

 Compartment syndrome

 Fat embolism syndrome (femur fractures, long bone)

Vascular compromise

 Related to compartment syndrome  Notify provider immediately

 Patient may report decreased sensation, loss of sensation, dysesthesia,

numbness, tingling or pins/ needles

09. Fracture left hip

Patho fracture -

complication

Recognize complications resulting from casts, splints, and braces and explain appropriate

nursing responses

Hip Fractures – S/S

 Leg will shorten on the hip that’s broken

 adducted

 External rotated – foot is rotated out

 Hip and groin is in pain  pain will increase with movement

 Muscle spasms

Patho fracture – complication

 Any disruption or break in the continuity of a bone

 Types

o Incomplete fracture: bone broken but not all the way through

o Complete fracture: complete cut in bone

o Closed (simple) fracture: skin not pierced – less risk for infection of bone

o Open (compound) fracture: skin IS pierced – high risk for infection of

bone

 Get tetanus shot

 IV antibiotics given ASAP

o Comminuted fracture: tiny chunks of bone – splinted into several

fragments

o Pathological (fragility) fracture: a diseased bone

 Naloxone – reversal agent for opioids

09. Postop

circulation after

hip replacement

Define fracture of hip terms of etiology, pathophysiology, subjective and objective assessment

data and medical management.

Post op circulation – hip replacement

 anti-embolism stockings

 sequentials

 anticoagulants to prevent the formation of VTE.

 analgesic medications and monitors the patient's hydration, nutritional status,

and urine output.

 To prevent VTE  encourage intake of fluids and ankle and foot exercises.

09. Toe amputation

Discuss associated complications, medical management and rehabilitation in patients

with amputation

Post-surgical - nursing interventions

 Control pain

 Promote wound healing

 Enhance body image

 Help resolve grieving

 Promote independent self care

 Help achieve physical mobility

Amputation care

 Daily inspection

o inspect residual limb

o compression dressing – if falls off, need to put back on – to fit prosthesis

o molding – to decrease swelling

o cap refill, warmth

o infection, drainage

o Pain control prior to cares (30 min)

 Wash with mild soap/water(daily)

 Dry thoroughly before applying dressing/compression/shrinking device

 Massage regularly (desensitize area)

 Compression Drsg using figure 8 method

 First 24 hrs (only)– may elevate limb/stump

 After 24 hrs – no elevation

 Do not allow limb to be dependent (hang down- increase edema)

 Lie prone every 3 or 4 hours for 20- 30 min (hip extension)

 Address Phantom Limb Sensations

Avoid contractures – when residual limb is lifted

 Lay on belly to stretch – for prevention

 Don’t put pillow under residual limb

Diet

 Have extra protein

MOD 10 Immune disorders

10. Multiple

sclerosis –

triggers

Describe in terms of pathophysiology and identify the subjective and objective assessment

data for diagnosing Multiple Sclerosis (MS)

MS – triggers

 Avoid heat – heat, depression, anemia, deconditioning, & medication may

contribute to fatigue

 Avoid hot temp, effective treatment of depression and anemia, change in med PT

& OT – to manage fatigue

 Relapses may be associated with emotional and physical stress

10. Multiple

Sclerosis – Teach

Discuss the nursing process as it relates to care of the patient with Multiple Sclerosis (MS)

MS – teach

 Relaxation and coordination exercises promote muscle efficiency.

o The patient is encouraged to work and exercise to a point just short of

fatigue. Very strenuous physical exercise is not advisable, because it raises

the body temperature and may aggravate symptoms

 Nurses also need to be certain to include family members in interventions and

nutrition education, because they are often the gatekeepers for food preparation

and selection. Additional strategies include avoidance of alcohol and cigarette

smoking

 Bowel problems include constipation, fecal impaction, and incontinence.

Adequate fluids, dietary fiber, and a bowel training program are frequently

effective in solving these problems

 Avoid Heat

 The patient is instructed to drink a measured amount of fluid every 2 hours and

then attempt to void 30 minutes after drinking. The use of a timer or wristwatch

with an alarm may be helpful for the patient who does not have enough

sensation to signal the need to empty the bladder

Managing symptoms

 Decrease spasticity

o Walking – daily exercise

o Swimming

o Stationary biking

o Progressive weight bearing – slowly

o DON’T RUN/ DON’T do things that exert themselves due to increase risk

o Physical trauma

o Emotional stress

o Sleep disorder

o Viral infection

Don’t give opioids to patient – can give tramadol

MOD 11 Sensory disorders (eyes) & meningitis

11. Macular

Degeneration –

Patho

Describe in terms of pathophysiology, identify the subjective and objective assessment data

nursing management for a diagnosis of macular Degeneration

Macular degeneration – PATHO

 Central vision affected

 People older than 60 yrs have a few small drusen (clusters of debris or waste

material) – when drusen located in macular area – can affect vision

 Have wide range of visual loss – only small portion experience total blindness

 Retain peripheral vision

 Wet more abrupt onset and more damaging to vision than dry

 Amsler grid – done several times a week

11. Meningitis –

Hyponatremia

Describe in terms of pathophysiology and identify the subjective and objective assessment

data for diagnosing Meningitis

Meningitis symptoms – hyponatremia

 Nuchal rigidity

Kernig's sign

 thigh flexed up to abdomen

 cannot complete extend

 Brudzinski: neck flexed

 Vomiting due to increased ICP

 hyponatremia can cause brain swelling

 increased ICP

MOD 12 Acute Neurological disorders

12. Stroke – TIA

(transient

ischemic attack)

Describe in terms of pathophysiology and identify the subjective and objective assessment

data for diagnosing Ischemic Stroke

Stroke – TIA

 TIA – temporary neurologic dysfunction resulting from a BRIEF interruption in

cerebral blood flow is easy to ignore or miss, particularly if symptoms resolve by

the time the patient reaches the ER

 Symptoms of TIA resolves usually within 24 hrs

 One TIA won’t give you deficits – having multiple TIA will give you deficits

 Affects male more than females

12. Stroke –

Dysphagia

Discuss the medical and nursing management of Ischemic Stroke including non-

pharmacological interventions

Stroke – dysphagia

 Can result due to impaired function of the mouth, tongue, palate, larynx,

pharynx, or upper esophagus

 Patients must be observed for paroxysms of coughing, food dribbling out of or

pooling in one side of mouth, food retained for long periods in mouth, nasal

regurgitation when swallowing liquids

 Swallowing difficulties place the patient at risk for aspiration, pneumonia,

dehydration, and malnutrition

 For patients with dysphagia

o Tuck chin to chest when swallowing

o Thicken liquids/ purred foods

o No straws

12. Acute Brain

attack protocol

Identify key pharmacological concepts related to the management of Stroke

Pharmacologic Management

 Anticoagulants – if pt. can’t be on anticoagulant – they can go on antiplatelets (Ex.

Clopidogrel (Plavix))

o Warfarin

 INR range = 2-

 Reversal = VIT K

o Novel oral anticoagulants (NOACS)

 Dabigatran (pradaxa)

 Apixaban (eliquis)

 Edoxaban (savaysa)

 Rivaroxaban (xarelto)

 Statins

o Helpful in reducing ischemic stroke

o Off label use

 Anti-Hypertensives

o ACE inhibitor preferred with or without diuretic

 Thrombolytics – TPA, Alteplase  ONLY FOR ISCHEMIC

o It’s a clot buster

o Must be givin within 3 hour window from start of symptoms

 Oxygen

 Blood glucose

o What range want them in?  140-

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NSG223 HESI Final Study Guide

Course: Medical-Surgical Nursing II (NSG 223)

249 Documents

Students shared 249 documents in this course

University: Herzing University

Multiple Choice

Multiple Choice

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NSG223 – HESI FINAL

MOD 1 Cardiac Dysrhythmias

01.03.02

Atrial Flutter &

PAC

Etiology and pathophysiology and identify subjective and objective assessment data associated

with a diagnosis of Premature Atrial Complex, Atrial Fibrillation and Flutter.

Atrial flutter & PAC

Irregular pulse

Fatigue

SOB

C/O goes down

Dyspnea on exertion

Rate – 250-400 beats/ min

Saw tooth appearance

Causes

HF

Tricuspid or mitral valve disease

PE

Cor pulmonale

Inferior wall MI

Carditis

Digoxin toxicity

01.03.04

Atrial flutter –

treatment

Identify key pharmacological concepts related to the management of Sinus Node and Atrial

Dysrhythmias

Atrial flutter – treatment

Stable

oCCB – diltiazem, verapamil

oBB – propranolol

 SE: decrease work load of heart, decrease BP, decrease HR, dizzy

oantiarrhythmic/antidysrhythmic – amiodarone, procainamide

oAnticoagulation – heparin (if someone come in now - immediate, warfarin

(takes a few days for therapeutic), enoxaparin

Unstable – ventricular rate of > 150bpm  initiate cardioversion

S/S

Chest pain

SOB

Low BP

Medical management

Vagal maneuvers

Trial administration of adenosine – block and slow conduction through AV node