Med-Surg Test #2 Study Guide PDF

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. Med surg exam. #2 electrolytes,cancer, infection, immunity...

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Test #2 Study Guide Immunity/Hypersensitivity, Cancer, Infection, Calcium Imbalances, Potassium Imbalances This is meant to be a GUIDE to help you study. I am providing you with some basic questions that are meant to stimulate your thought process about the concepts. Being able to simply answer the following questions with a single word or sentence does not necessarily mean you are ready for the test. Remember, you are the nurse providing care to a patient. When thinking about this information, ask yourself what does this information mean for me, the nurse? What would I, the nurse, DO, if I had this information available? What does this information mean for the patient?

Immunity 10%

What is leukocytosis? Leukopenia? Neutropenia? A “left shift?” Bandemia? Why do they occur and what do they mean? Leukocytosis- high WBC count; occurs due to infection or inflammation Leukopenia- low WBC count; occurs due to bone cell or bone marrow problems, cancer and treatments of cancer, infectious disease, autoimmune disorders, malnutrition, medications Neutropenia- low neutrophil count; causes are infections (hepatitis, TB, sepsis, lyme disease), medications (chemo is the most common cause), cancer or bone marrow disease, vitamin deficiencies, and autoimmune disorders Left shift- “not enough time for body to fight infection” --the infection is present and the bone marrow is producing more WBCs and releasing immature WBCs into the blood; this occurs when an infection is present Bandemia- too many WBC being released by bone marrow into the blood; causes are leukemia, corticosteroid use, autoimmune disease, cancer, and chemotherapy What is a CRP? ESR? Rheumatoid factor? What do they tell us? CRP: C-reactive protein test through blood draw; increases when there is inflammation in the body ESR: erythrocyte sedimentation rate through blood draw; measure how quickly erythrocytes settle at the bottom of a test tube. The faster they settle, the more inflammation is in the body Rheumatoid factor- proteins produced by the immune system that can attack healthy tissue in the body; higher levels indicate autoimmune disorders like rheumatoid arthritis or Sjogren’s syndrome What are the 3 lines of defense? First line of defense- skin, mucosa, antimicrobial chemical on the skin Second line of defense- inflammation Third line of defense- specific resistance ; relies on antigens and activation of T-cells (cell-mediated immunity) What purpose does the inflammatory response serve and why does it occur? Where does it occur? How is it different from the adaptive immune response? The purpose of an inflammatory response is to protect

the tissue that has been damaged by trauma, toxins, heat, or other causes. It localizes the injury and removes damaged tissue so that the body can heal properly. The damaged cells release histamine, bradykinin, and prostaglandins which causes the swelling. The inflammatory response is triggered when innate immune cells detect infection or tissue injury, but adaptive immune response is a response to an antigen. What makes inflammation good and bad? A normal inflammatory response is considered good since it protects against further damage, recovery is generally quick, and fights off forgein invaders. Chronic inflammation is considered bad since it does not go away and can cause arthritis, asthma, atherosclerosis, blindness, cancer, and diabetes. What happens in the different stages of the inflammatory response? Stage 1- increased blood flow, redness and warmth, vascular response, increased delivery of nutrients to area, edema, swelling and pain, macrophages Stage 2 - cellular exudate, pus, neutrophils basophils and mast cells Stage 3 - tissue repair and replacement, WBC encourage cells to divide What is the difference between natural and artificial immunity? What are examples of each? Natural immunity occurs through direct contact with a disease causing agent; examples: placental transfer of IgG from mother to fetus during pregnancy, Breastfeeding Artificial immunity develops only through deliberate actions of exposure; examples: vaccines What is the difference between active and passive immunity? What are examples of each? Active immunity- production of antibodies by the immune system in response to an antigen: long term immunity; examples: recovers from a disease - has antibodies for future Passive immunity- short term immunity by antibodies that are introduced by another person or animal; examples: placenta before birth, breast milk after birth

Hypersensitivity 16%

What is a Type 1 hypersensitivity response? Type 1 hypersensitivity is an allergic response to a specific antigen. Exposure can be through injection, inhalation, ingestion, or direct contact. How do type 1 hypersensitivity responses develop? Exposure to an allergen food, dust , pollen etc. through lungs or skin. involves immunoglobulin E (IgE) mediated release of antibodies against the soluble antigen. This results in mast cell degranulation and release of histamine and other inflammatory mediators. What are clinical manifestations of a Type 1 hypersensitivity response? Nasal allergic rhinitis or hay fever Ocular allergic conjunctivitis, potentially due to seasonal allergens such as pollen or mold spores Dermatological hives, atopic eczema, or erythema

Soft tissue angioedema Pulmonary reactions, such as allergic asthma or hypoxia Systemic reaction, which is a life-threatening medical emergency, and also known as anaphylaxis. What is the difference between a localized reaction and a systemic reaction with a Type 1 hypersensitivity response? When a reaction stays with one area of the body, it's known as a localized reaction (Itching, redness, swelling) When inflammation spreads from a localized area of one organ (like the skin) to other organ systems in the body, it's known as a systemic reaction. (anaphylaxis, hives) What is anaphylaxis? And how do we care for someone experiencing it? Why is this an emergency? Consider both medical and nursing interventions. T  his severe reaction happens when an over-release of chemicals puts the person into shock. Allergies to food, insect stings, medications and latex are most frequently associated with anaphylaxis. An anaphylactic reaction should be treated immediately with an injection of epinephrine (adrenaline). What is angioedema? And how do we care for someone experiencing it? Who is at risk for this? Consider both medical and nursing interventions. Angioedema is a localized tissue swelling similar to hives in which areas of raised, itchy skin appear. However, in contrast to hives, which appear on the surface of the skin, angioedema affects deeper layers of the skin and other organs (mouth, airways, intestinal tract, etc.). Angioedema may occur anywhere, but most commonly affects the skin around the eyes and around and in the mouth. Treatments for angioedema can include steroids, antihistamines, epinephrine and other medications. In life-threatening cases, respiratory support, such as a breathing machine, may be necessary. In milder cases that do not compromise breathing, angioedema is not usually a serious condition and resolves on its own within a few days. Patients at risk: Drug reactions involving a rash or hives Allergies involving hives History of angioedema A family history of hives or angioedema Autoimmune disease such as lupus or Hashimoto's thyroiditis, for which angioedema is a possible symptom How do you implement emergency care for a patient experiencing anaphylaxis or angioedema? What medications can we use to treat a Type 1 hypersensitivity response (include medications for both localized and systemic problems). Include HOW these medications work to treat the problem (for example if a patient has hypertension and I give the antihypertensive medication lisinopril, the blood pressure is lowered because vascular resistance is reduced). Epinephrine is the medication of choice for the first-aid treatment of anaphylaxis. Through vasoconstrictor effects, it prevents or decreases upper airway mucosal edema (laryngeal edema), hypotension, and shock. In addition, it has important bronchodilator effects and cardiac inotropic and chronotropic effects. What NON-PHARMACOLIGICAL interventions do we implement for patients experiencing a Type 1 hypersensitivity response?

Avoidance of the offending agent. Oral or topical antihistamine. OTC diphenhydramine.  What education would the nurse provide to the patient with severe allergies? About the use of Epi-Pens? Early detection and treatment in order to avoid the offending agent. Recognizing the early signs and symptoms of the severe allergy and the allergic reaction. How to administer the epi-pen. How to store it. Location of injection site. How to dispose of auto-injector. What is a tissue allergy panel? How does a nurse prepare for caring for a patient having this test? Tissue allergy panel is a skin test using a liquid extract by using a technique of either a prick method, intradermally, or patch test. The extract of common allergens (pollen, mold, dust mites, animal dander, food) is injected or pricked into the outer layer of skin. How your skin reacts determines if your immune system will make the antibodies and set off chemicals to fight off the trigger. The nurse will prepare the patient for the tissue allergy panel by informing them a week before hand, the patient must stop use of antihistamines. The nurse must gather information on all medications the patient is currently taking. T  he nurse should have emergency equipment readily available in the case of anaphylaxis

Cancer 14%

Can you identify examples of both primary and secondary prevention? Primary prevention is the avoidance or effort that prevents either the precancerous or cancerous condition from starting (EX: exercise, avoid smoking, monitor sugar intake, breast exams) Secondary prevention is the discovery and removal of precancerous conditions and the discovery and removal of small cancers before they have metastasized beyond the focus of origin. How do you care for a patient who has neutropenia? What is the concern here? Neutropenia is low white blood count and neutrophil. Low blood count for patients on chemotherapy can be deadly. Therefore nurses wash hands, wear mask gown, and gloves when entering a reverse isolation room A special diet must be followed. Avoid raw or rare cooked meat, fish eggs, avoid fresh fruit and vegetables, raw nuts, yogurt and yogurt products. Dairy products must be pasteurized This diet helps protect the weakened immune system from bacteria and other harmful organisms found in some food and drinks.  What education would you provide the patient undergoing radiation therapy? We discussed several complications of cancer: TLS, hypercalcemia, SIADH, sepsis… Can you recognize these complications (assessment findings)? Why do they develop? What would you do about them?

Infection 20%

What types of symptoms will a patient with an infection experience? Consider both generalized and system specific. GENERALIZED: F  ever, Chills and sweats, change in or new cough, sore throat or new mouth sore, shortness of breath, nasal congestion, stiff neck SYSTEMIC: F  ever, fatigue, headache, inflammation, chills, extreme weakness, dizziness, lethargy or confusion, signs of compromised organ function, rash, excessive thirst, loss of appetite. What are the different ways in which infection is spread? Through the air, from direct or indirect contact with another person, soiled objects, skin or mucous membrane, saliva, urine, blood, and body secretions, sexual contact, contaminated food and water. How does knowing the way that an infection spreads impact the PPE that we use when caring for patients with a known/suspected infection? Nurses and doctors wear specific types of PPE depending on the transmission of the disease the patient has. Standard precautions are used with each patient. What kind of PPE would you choose for the different transmission types? What is the difference between standard precautions and transmission-based precautions? STANDARD PRECAUTIONS: h and hygiene, use of PPE (gloves, masks, eyewear), respiratory hygiene/cough etiquette, sharps safety, safe injection practices, and sterile instruments TRANSMISSION-BASED: c ontact, droplet, and airborne (negative airflow rooms are required to prevent airborne spread) Why do some infections become resistant to antibiotics? Antibiotics have been around for many years. Unfortunately, these drugs were commonly prescribed for conditions that did not need them or were given at higher does and for longer periods of time than necessary. As a result, a number of microorganisms have become resistant to certain antibiotics; the is drugs that were once useful no longer control these infectious agents. New antibiotics are not keeping up with preventing antimicrobial-resistant infection; therefore patients are at risk for increased morbidity and mortality. How do we know that a patient has an infection? How do we know if the infection is responding to treatment or not? What education does a patient with an infection need? What is MRSA?

Methicillin-Resistant Staphylococcus Aureus - within the past 40 years S.aureus infections have not responded to methicillin or other penicillin based drugs. MRSA = one of the fastest growing and most common in health care today. Who is at risk or developing MRSA? MRSA is spread by direct contact and invades hospitalized patients through indwelling urinary catheters, vascular access devices, open wounds, and endotracheal tubes. How is MRSA treated? Remember, there is community and health care acquired. You should consider both medical and nursing. HA-MRSA (health care MRSA) = increased hospital stays at a high cost. Some patients may be colonized with the organism. Health care staff members may also colonize. Patients who develop HA-MRSA pneumonia, abscesses, or bacteremia (bloodstream infection) can quickly progress to sepsis and death. What is C.Diff? Most common cause of antibiotic-associated diarrhea in the U.S.

Who is at risk for developing C.Diff? Patients with recent antibiotic use, or exposure to cdiff What clinical manifestations might a patient with C. Diff experience? Stomach ache/cramping, diarrhea, leukocytosis What medications would a patient with C. Diff receive? Flagyl (metronidazole), Vancomycin (oral), Dificid What NON-PHARMACOLIGICAL interventions do we implement for patients experiencing C. Diff? Enteric precautions, fecal transplant How are transmission-based precautions for C. Diff unique? Must use soap and water to wash hands-- hand sanitizer is not effective

Potassium 8%

What is the reference range for potassium? 3 .5-5 mEq/L Why is potassium important for the body? P  lays a vital role in cell metabolism, transition of nerve impulses, the functioning of cardiac,lung and muscle tissues & acid-base balance. Potassium & sodium are opposites and when one rises one falls.

What are the dietary implications when caring for a client with potassium alterations? Who is at risk for developing hypokalemia? Alkalosis, hyperinsulinism, NPO/fasting, water intoxication, Iv therapy with potassium-deficit solutions, dehydration, drains-NG suction, diuretics, vomiting. Hyperaldosteronism What would a client with hypokalemia look like (assessment)? High HR and low BP (fatigued), thready, weak pulse, orthostatic hypotension, shallow respirations, anxiety, lethargy, confusion,coma, paresthesias, hyporeflexia, hypoactive bowel sounds, constipation, nausea, vomiting, ECG changes,decreased deep tendon reflexes What interventions would the nurse implement when caring for a client with hypokalemia? You should think about not only medical (like medications), but also nursing interventions. Important to note: how is potassium administered? Oral potassium supplements, liquid potassium chloride, IV potassium that is diluted with saline. How would the nurse know the patient is improving or declining when treating hypokalemia? Who is at risk for developing hyperkalemia? A  ddison’s disease, Alcohol use disorder (alcoholism), Burns over a large part of your body, Congestive heart failure, Diabetes, Human immunodeficiency virus (HIV), Kidney disease. What would a client with hyperkalemia look like (assessment)? Abdominal (belly) pain and diarrhea. Hyperactive bowel sounds, Chest pain, Heart palpitations or arrhythmia (irregular, fast or fluttering heartbeat). Bradycardia, Muscle weakness or numbness in limbs, Nausea and vomiting, Tight and contracted heart and muscles, Confusion ,Decreased urine output, Increased deep tendon reflexes What interventions would the nurse implement when caring for a client with hyperkalemia? You should think about not only medical (like medications), but also nursing interventions. Monitor intake and output. • Monitor serum potassium and ECG closely during treatment. • Teach causes of hyperkalemia and the relationship between hemodialysis and hyperkalemia. • Discuss the importance of avoiding foods high in potassium to prevent or control hyperkalemia. Such as fruits, leafy greens IV sodium bicarbonate to correct acidosis Calcium (either gluconate or chloride): Reduces the risk of ventricular fibrillation caused by hyperkalemia, decrease muscular irritability Insulin administered with glucose: Facilitates the uptake of glucose into the cell, which results in an intracellular shift of potassium Diuretics: loop  diuretics-furosemide and thiazide diuretics Cause potassium loss through the kidney

Alkalinizing agents: Increases the pH, which results in a temporary potassium shift from the extracellular to the intracellular environment; these agents enhance the effectiveness of insulin in patients with acidemia Beta2-adrenergic agonists: Promote cellular reuptake of potassium Binding resins: Promote the exchange of potassium for sodium in the gastrointestinal (GI) system Magnesium sulfate: Has been successfully used to treat acute overdose of slow-release oral potassium How would the nurse know the patient is improving or declining when treating hyperkalemia?

Calcium 8%

What is the reference range for calcium? 9-10.5 mg/dL Why is calcium important for the body? Found in the bodys cells,bones and teeth and is needed for proper functioning of the cardiovascular,neuromuscular,endocrine systems, blood clotting and teeth formation What are the dietary implications when caring for a client with calcium alterations? Who is at risk for developing hypocalcemia? K  idney disease, polyuric disease, inhibition of calcium absorption in GI tract, increased calcium excretion, diarrhea, steatorrhea, wound drainage, low parathyroidism, laxatives, loop diuretics, corticosteroid use, wound drainage What would a client with hypocalcemia look like (assessment)? Decreased blood pressure, spasms and stridor, tetany (spasms in hands,feet cramps) diminished pulses, convulsions (sudden,violent, irregular movement of a limb), Trousseau's (arm tweak), Chvosteks (cheesy smile when touching temporal lobe), diarrhea, seizures, confusion, low clotting factor-bleeding What interventions would the nurse implement when caring for a client with hypocalcemia? You should think about not only medical (like medications), but also nursing interventions. I nitiate seizure precautions,safety for falls, fractures, bleeding Consume high calcium foods/diet (diary, leafy greens) Administer aluminum hydroxide & vitamin D, Calcium PO or IV meds, WARM Iv meds and administer slowly, avoid How would the nurse know the patient is improving or declining when treating hypocalcemia? Increase in calcium level, increase in BP Who is at risk for developing hypercalcemia? Kidney disease, thiazide diuretics, hyperparathyroidism. hyperthryoidism, malignancy(bone destruction from metastatic tumors), hemoconcentration, increased calcium absorption, decreased calcium excretion, low phosphate What would a client with hypercalcemia look like (assessment)? e xcessive urination, thirst, kidney stones, bone pain, cardiac arrest(bounding pulse) muscle weakness, decreased or absent deep tendon reflexes

What interventions ...