MedSurg3T2

Acis Base Balance

100

Conditions for metabolic acidosis

Diabetic ketoacidosis, vomiting, chronic respiratory acidosis

200

A COPD Pt.has dyspnea, confusion and rapid, shallow breathing ABGs show PH 7.30,pCO2 60 mmHg, HCO3 28 mEq/L,  what is his diagnosis and compensatory mechanism

Respiratory alkalosis or respiratory acidosis

renal excretion of bicarb or renal retention of bicarb

Respiratory acidosis with renal retention of bicarb

300

What would labs look like for Respiratory acidosis,

Respiratory alkalosis

Respiratory acidosis-Decreased PH, increased PaCo2

Respiratory alkalosis increased pH and decreased PaCo2

400

What ABG labs might you see with a COPD patient who has dyspnea and confusion

Partially compensated respiratory acidosis

ph 7.28

PaCo2 58 mmHg

HCO3 29 mE1/l

PaO2 65 mmHg

500

what signs does a patient with a chest tube need to be reported immediately to the Doctor

Finding / Sign

**1️⃣ Sudden or increased bright red drainage (>100 mL/hr) after initial stabilization

2️⃣ Sudden cessation of drainage (especially after being active)

3️⃣ Continuous bubbling in water-seal chamber

4️⃣ No tidaling (fluctuation) in water-seal chamber

5️⃣ Tube dislodgement from chest

6️⃣ Subcutaneous emphysema (crepitus) spreading rapidly

7️⃣ Sudden severe dyspnea, chest pain, tracheal deviation, or absent breath sounds on one side

8️⃣ Drainage system knocked over or broken

Perfusion

100

what are the steps for CPR in an infant

Check for responsiveness

call 911 after 2 min of CPR

begin CPR 30 compression to 2 breaths

check brachial pulse no more than 10 sec

place on firm flat surface

200

your patient is here for Chest Pain and collapses what do you do

perform CPR while someone gets the AED and places the pads

300

Signs of Cardiac shock

Signs of acute MI- S1 elevation in anterior leads

pulmonary edema-crackles, edema

low cardiac output-SOB low BP

400

what is causes of a transudative pleural effusion 

• Congestive heart failure (CHF): This is the most common cause, as it impairs the heart's ability to pump blood effectively, leading to fluid buildup.
• Cirrhosis: This liver disease can lead to low blood protein levels and increased pressure in the blood vessels, causing fluid to leak into the pleural space.
• Nephrotic syndrome: This kidney disorder can cause a loss of protein in the urine, leading to low protein levels in the blood.
• Severe hypoalbuminemia: A very low level of albumin in the blood, often caused by liver disease or kidney disorders, can reduce the pressure that keeps fluid in the blood vessels. 

500

when is a chest tube not needed

• Small, uncomplicated effusions: If the effusion is small and causing no respiratory symptoms, it may only require observation or medical management.
• Transudative effusions: Protein-poor effusions caused by conditions like heart failure or cirrhosis may not require a chest tube if the underlying condition is being managed. 

Miscellaneous

100

What are intervention after surgery

Deep breathing & cough

Ambulation to prevent complications

Strict I & O

access pain and BP

watch for bleeding & infection

200

What medication helps with heart contractility for cardiogenic shock

Dobutamine

300

Intervention for new admitted TB patient

• Place patient in an airborne isolation room with negative pressure.
• Wear an N95 respirator when caring for the patient.
• Use disposable gloves and gowns for all patient contact.
• Disinfect all surfaces and equipment that may have been contaminated.
• Educate staff and visitors about TB transmission and precautions.

400

what education do you give a TB patient going home

• Explain the treatment plan: Go over the length of therapy, the importance of daily doses, and the benefits of DOT to prevent drug resistance.
• Review side effects: Discuss potential adverse effects and provide clear instructions on when to contact a healthcare provider immediately (e.g., severe rash, fever, difficulty breathing, yellowing of skin/eyes).
• Reinforce adherence: Stress the importance of taking every dose and what to do if a dose is missed, including who to notify.
• Provide medications: Ensure the patient has medication for the initial period or has a plan to pick it up from the pharmacy.
• Follow-up: Schedule follow-up appointments and ensure the patient understands how to get to them. 

Infection control

• Isolation precautions: Advise the patient to stay home from work or school until cleared by a healthcare provider and to avoid close contact with others until they are no longer infectious.
• Respiratory hygiene: Instruct the patient to wear a mask when around others and to cover their mouth with their sleeve or elbow when coughing or sneezing, not their hands.
• Hygiene: Emphasize frequent handwashing with soap and water for at least 20 seconds. 

500

findings of a plural effusion

• Reduced or absent breath sounds: On the affected side, due to the fluid's interference with lung expansion.
• Dullness to percussion: The chest sounds flat or dull when tapped over the area of fluid accumulation.
• Tactile fremitus: Decreased fremitus (vibrations) on the affected side. 

Advanced signs of a large or severe effusion

• Hypoxia: Low oxygen levels leading to cyanosis (bluish skin) and confusion.
• Tachycardia: A rapid heart rate.
• Jugular venous distension (JVD): Prominent neck veins.
• Tracheal deviation: The trachea shifts away from the affected side. 

Respiratory

100

Post Op Day 1 patient with neck surgery is having Respiratory distress, stridor, restless, voice is hoarse and weak. What complication is he having

Swelling and causing airway obstruction

200

what is an priority action for a Surgery patient that  suddenly becomes SOB has chest pain and anxiety

apply O2 via non-rebreather mask

300

What are early signs of PE & interventions for this

mildly tachycardia, slightly SOB, with no obvious cause

raise HOB and notify provider 

400

What are signs of respiratory failure

restlessness

using accessory muscles to breath

low Q2 stats

blueness on lips

grunting

nose flaring

sweating

wheezing

siting forward 

500

when do we use intubation and mechanical ventilation

sever or worsening respiratory failure, maintain O2 exchange

Cardiac

100

Which dysrhythmia is life threatening

SB

PaC's

V-fib

A-Fib

V-fib

200

Heart rates for 

Bradycardia

Sinus Tack

Atrial Fib

V-Fib

Bradycardia-less than 60 bpm

Sinus Tack- greater than 100 bpm 100-160

A-Fib irregular 100-180 bpm

V-

fib-not measurable

300

What are serious symptoms of AAA

Sudden severe, tearing or ripping abdominal, back of flank pain

Pulsating abdominal mass

syncope, dizziness, confusion

NV, decreased urine output, hhematemesis or hematuria

sudden drop in BP, LOC, abdominal distension

400

Your patients is unresponsive and shows pulseless ventricular tachycardia what immediate priority intervention do you do?

Chest compressions and early defibrillation 

500

signs of a pneumothorax 

• Sudden onset of sharp chest pain, typically on one side
• Shortness of breath
• Difficulty breathing
• Rapid breathing rate
• Decreased breath sounds on the affected side