MED SURG 1 & 2 HESI EXAM WITH SATISFIED SOLUTIONS

MED SURG 1 & 2 HESI EXAM WITH SATISFIED SOLUTIONS

Hyperglycemia s/s - Polydipsia, poly iris, polyphagia, blurred vision, weakness, weight loss,
syncope
Encourage water, check BG, assess for ketoacidosis, insulin asdir
Hypoglycemia s/s - Headache, nausea, sweating, tremors, lethargy, hunger, confusion,
slurred speech, tingling around mouth, anxiety
Occurs rapidly, treat with complex carbs ( glucose gel, fruit juice, 10-16 jelly beans, gum
drops, life savers
Check BG, <40 May seize
Hypoglycemia s/s -
SMBG - Record results for provider,
Prediabetes - Fasting BG 100-125 or HBA1C 5.7-6.4
surgical risk factors - age; nutrition status; fluid/electrolyte status; general health (cardiac
conditions, coagulation probs => hemorrhage, URTI => surgery delayed, COPD exacerbation
possible r/t anesthesia, renal probs impair electrolyte stuff, uncontrolled DM => poor
healing and infection, meds including OTC (anticoagulants, tranquilizers - hypotension, heroin
- dec CNS response, antibiotics - incompatible w anesthetics, diuretics -electrolyte
imbalance, steroids, OTC herbs, vitamin E
Preop - time from decision to have surgery until taken to OR; Nurse gets hx, teaching,
checklist
preop history - age, allergies (iodine), current meds, hx of med/surg probs, prev. surgeries,
prev. experience w/ anesthesia, tobacco, drug abuse, understanding of procedure, coping
resources, cultural and ethical factors affecting surgery
preop teaching - regulations about valuables, food and fluid restrictions (NPO after
midnight), invasive procedures (foley, IV, NG, enema, douche), preop meds, OR,
transportation, skin prep, post-anesthesia, post op (res. care, activity - ROM, ambulation,
turning, pain control such as PCA, diet restrictions, PACU
preop checklist - informed consent; site marked by surgeon, all team members confirm; hx
and physical noted in chart; chest radiograph, ECG, and urinalysis if prescribed; hgb, hct,
electrolytes, glucose, type/crossmatch of blood; chart on hand; ID band on PT w/ allergies
noted; contacts, dentures, and all that jazz are removed; PT has voided or catheterized; PT
has gown; VS taken; premeds (antibiotics) given; skin prep performed (cleaned, hair
removed if needed, then cleaned again); nurse's signature completes
intraop care - keep quiet; SAFETY (client ID, procedure, site; sponge, needle, and instrument
counts accurate, position to prev injury, grounding device if electrocautery used; asepsis,
suction, correct labeling and handling of all specimens); monitor physical status (blood loss
- see effect on client, report VS changes to surgeon, positioning critical); psychological
(emotional support, provide info to the fam if it takes too long)
Postop care - Admission to PACU to recovery; on arrival, VS assessed along with LOC, skin
color and condition, dressing, fluids, tubes, and O2; once stabilized, PT taken back to the
floor
Postop care includes: monitor for signs of shock and hemorrhage (hypotension, narrow
pulse pressure, rapid weak pulse, cold moist skin, inc capillary refill time); position on side
to prev aspiration, side rails up; heated blanket for warmth; manage n/v w drugs; pain w IV
analgesics; check and assess drains
acute respiratory distress syndrome (ARDS) - low O2 and high CO2; hypoxemia that persists
even with 100% O2 on; dec. pulmonary compliance; dyspnea; non-cardiac pulmonary edema;
dense pulmonary infiltrates on radiography; unexpected, catastrophic; high mortality; no
abnormal sounds b/c edema happens in interstitial spaces;
causes of ARDS - COPD exacerbation; pneumonia; TB; contusion; aspiration; inhaled toxins;
emboli; OD; fluid overload; DIC; shock
assessment of ARDS - dyspnea, hyperpnea, crackles; intercostal retractions; cyanosis,
pallor; hyposemia (PaO2 < 50); anxiety, restlessness
ARDS interventions -position for max lung expansion; s/s hypoxemia; breath sounds;
emotional support; VS and cardiac monitor; monitor ABGs; vital organ status (LOC, renal
system output, apical pulse); fluids and lytes; metabolic status
ABGS - pH - 7.35-7.45
PCO2 - 35-45
HCO3 -21-28
PO2 - 80-100
O2 Sat - 95-100
Base excess - 0+-2
*perform allen test before taking blood from radial
Metformin - biguanide; careful w/ contrast dye (renal failyre and lactic acidosis)
rapid acting insulin - lispro (humalog) - 10-15 min *all peak w/in 30-60 mins
aspart (novolog) - 5-15 min
glulisine (apidra) - 5-15 min
short acting - regular (humalog r, novolin r, iletin II regular) 1-1.5h; peak in 2h; only insulin
that can be given IV
-often mixed w/ intermediate, never with long acting
intermediate acting - NPH (humulin n, iletin II lente, iletin II NPH, novolin N) 2-4h; peak in 4-
12h;
very long acting - glargine (lantus) CANNOT MIX THIS.
detemis (levemir) *onset iin 1h w/ no peak
Hypothyroidism -dec thyroid hormone; primary or secondary;
s/s: weakness, fatigue, cold intolerance, weight gain, constipation, goiter, slow speech, dry
cool skin, puffy face, dry coarse hair, thick brittle nails
Cushings - adrenal hypofunction; high adrenocortical hormones; weight gain, muscle
weakness, buffalo hump, thinning extremities w/ muscle wasting, thin fragile skin, moon
face, ruddy complexion, hirsutism, truncal obesity, broad purple striae, bruising,
hyperglycemia, hyper atresia, hypokalemia, impaired wound healing; treated w/ surgery,
HTN, radiation, or drug therapy