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Prepare for Med Surg Exam 1 at Galen College with this comprehensive study guide featuring practice questions and answers. Covers neurological disorders (headaches, epilepsy, Parkinson's, MS, stroke), respiratory conditions (asthma, COPD, pneumonia), sensory disorders, and nursing care. Essential for nursing students. Med Surg Galen, Galen Med Surg Exam, Medical Surgical Nursing, Med Surg Study Guide, Galen College Nursing, Neurological Disorders Nursing, Respiratory Nursing, Stroke Care Nursing, Epilepsy Nursing, COPD Study Guide, Nursing Exam Prep, Med Surg Practice Test, Nursing School Med Surg, Galen Exam 1, Medical Surgical Q&A
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What are the three main types of headaches? - CORRECT ANSWER - Migraine, Tension, Cluster
Steps to Pain Assessment - CORRECT ANSWER -Provoking Quality Radiation Severity Time
Provoking - CORRECT ANSWER -has anything made it better or worse
Quality - CORRECT ANSWER -Sharp, dull, achy, throbbing
Radiation - CORRECT ANSWER -Does it radiate to another part of the body
Severity - CORRECT ANSWER -Pain scale, 1-10 scale, intense pain, Other symptoms: N/V, photophobia
Time - CORRECT ANSWER -how long has it been going on? how long does it usually last?
Tension Headache - CORRECT ANSWER -Bandlike, tightness
Describe a Migraine - CORRECT ANSWER -Unilateral, supra and retro orbital, pulsating or throbbing, worse with movement, sensitivity with light and sounds
Cluster - CORRECT ANSWER -Lancinationg or stabbing, 5-30 minutes. Extreme pain
Migraine Pathophysiology - CORRECT ANSWER -Pathophysiology - Not entirely clear.; theories? Prevalence: May be seen in children and adults; Among children more common in boys; among adults more common in women. History of patient with migraine: Otherwise healthy, usually female in 30's Individualized triggers (stress, smells, foods, hormones, menses) Tyramine rich foods- chocolate, cheeses, beer, wine, cigar, sweet and low.
Magnesium
Migraine Complementary and alternative therapies - CORRECT ANSWER Acupuncture, Yoga, Stress reduction activities, Supplemental mag, Distraction sometimes works.
Pound acronym - CORRECT ANSWER -P:Pulsating O:Duration U: Unilateral location N: N/V D: Disabling
Epilepsy - CORRECT ANSWER -Chronic disorder with two or more seizures experienced by the client.
Epilepsy Assessment - CORRECT ANSWER -Inquire about the seizure activity, frequency, precipitating factors, aura (pre-ictal phase). Family history Collateral medical conditions (hx stroke, HTN, TBI, drug/alcohol abuse)
Seizure risk factors - CORRECT ANSWER -V: Vascular
I: Infection or Inherited conditions T: Trauma A: Alzheimers/Autoimmune M: Metabolic derangements I: Idiopathic N: Neoplasm S: pSychiatric
Epilepsy Triggers - CORRECT ANSWER -Sleep deprivation Stress Alcohol/ Alcohol Withdrawl MSG pg 878 Chart 42-
Aura - CORRECT ANSWER -Seizures often preceded by an aura; it is unique to that patient, not every patient has them. Somatic: rising epigastric sensation Hallucinations: Visual, gustatory, olfactory Halos, Zig-zags, h/a, paresthesias, psychiatric phenomenon, deja-vu
Epilepsy Partial: - CORRECT ANSWER -Partial (also called focal or local seizures): Occurs in a specific part of the brain. May be characterized by automatism or tic. Ex: Jerk, reflex, lip smacking (complex)
Myoclonic Epilepsy - CORRECT ANSWER -Brief muscle jerks, lasts seconds
Atonic (akinetic) Seizure (drop seizure) - CORRECT ANSWER -Involves brief loss of tone. May be confused with Fainting.
Acute Seizure Management (Observation) - CORRECT ANSWER -History (if reported) Look for underlying cause! Record time sz began and ended. Duration Types of movements Ongoing seizure observations Post-ictal assessment - often involves reorientation. Patient safety If the client is sitting or standing, place the client on the floor Continual assessment of the ABCs
Acute Seizure Management (things to do) - CORRECT ANSWER -Patent IV, suction, oxygen, padded side rails, pillow, and privacy. Side-lying position Suction secretions
No restraints Loosen restrictive clothing Never force anything into the patient's mouth Absolutely NO tongue blade! DO NOT ATTEMPT TO STOP MOVEMENTS!
Acute Seizure Management (meds) - CORRECT ANSWER -Benzos Break the seizure may include: Lorazepam (Ativan) Diazepam (Valium) IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)
Status Epilepticus - CORRECT ANSWER -Prolonged seizures that last more than 5 min or repeated seizures over course of 30 min - medical emergency! Number 1 cause is pt not taking their medication. 22% mortality rate
What to do when patient is experiencing Status Epilepticus? - CORRECT ANSWER -Establish airway ABGs IV push lorazepam, diazepam Rectal diazepam Loading dose IV phenytoin
Nursing Interventions for Status Epilepticus - CORRECT ANSWER -Look for secondary causes Evaluate most current blood level of medication, if appropriate Be aware of drug-drug/drug-food interactions Need to Stress adherence
Teaching for Status Epilepticus - CORRECT ANSWER -Driving and high reliable occupations State of FL restrictions - two years*. Rest, stress reduction, diet Ketogenic diet Medication compliance Follow-up drug levels Neurologist Medic alert tag Social service resources to assist with medication costs Evaluation of employment safety needed to decrease risks Vocational rehabilitation may be subsidized
Parkison's Disease Pathophysiology - CORRECT ANSWER -Familial, males are more affected; 3:2 male to female ratio Progressive and chronic Degradation of dopamine Substantia nigra contains dopaminergic neurons which contribute to controlled movement pattern
Parkison's Disease Onset - CORRECT ANSWER -Usually asymmetric Patient may first notice resting tremor in upper extremity, then will spread to other parts of the body in an unpredictable way
Signs reflective of bradykinesia: Decreased speed of repetitive movement Micrographia (small hand writing) Small, quiet voice with poor articulation Festinating gait
Nursing Care for Parkison's Diseases - CORRECT ANSWER - Multidisciplinary approach (SLT, PT, OT, Neurology, Dietician) Fall precautions!!! Aspiration precautions: Aspiration pneumonia is a major cause of death in Parkinson's Disease Medications on time, every time Continual nutritional assessment High-calorie, high-protein, high-fiber meal Small frequent meals I&O Screen for depression/psychosis Constipation
Drug Therapy for Parkison's Disease - CORRECT ANSWER -Multitude of drugs - often are titrated based on response. Dopaminergic (Sinemet)
Dopamine agonists (ropinirole); may cause hypotension; use with caution in patients with renal or hepatic impairment; start at LOW dosage and titrate slowly upwards COMTs (entacapone) Anti-cholinergics: Benztropine---improves tremors of PD (drys everything out) MAOI-B selegiline Tyramine interaction Page 871 Nursing safety priority (Drug food interaction, no red wine, fermented food, cured meats or aged cheese)
Multiple Sclerosis - CORRECT ANSWER -Autoimmune Life-long inflammatory disease where the axonal part of the nerve impulse undergoes demyelination. Women tend to be more affected.
Types of Multiple Sclerosis - CORRECT ANSWER -Relapsing-remitting Primary Progressive
Relapsing- remitting MS - CORRECT ANSWER -Symptoms develop and then dissipate. Most common ; requires treatment during acute symptoms but generally at baseline
Twitching of facial muscles HEAT INTOLERANCE Fatigue and dizziness Cognitive difficulties Depression/euphoria Dementia
Lumbar Puncture (MS) - CORRECT ANSWER -Obtain consent Spinal needle injected into subarachnoid space Position patient in a fetal side-lying position Local anesthetic Three to five tubes CSF collected Post LP: Obtain VS, neuro checks, observe needle site for leakage, bedrest
Nursing Care for MS (Risk for, Airway, Body, Urinary and Bowel incontinence) - CORRECT ANSWER -Risk for infection: MS drugs alter immunity, teach patents to avoid crowds and sick people Dysarthria/dysphagia: SLP referral Fatigue Encourage rest - but encourage participation to keep the client active. Plan accordingly for activities and allow time for completion Urinary and bowel incontinence Anticholinergics: Oxybutynin
UTI Surveillance - Encourage fluids Avoiding caffeinated products
Nursing Care for MS (Pain, Medications, Vision Changes) - CORRECT ANSWER -Pain Pain control, as prescribed: Baclofen, Diazepam Medications Teach how to administer parenteral forms Interferons Vision changes Eye patch for diplopia Encourage vision exams Teach the client how to scan a room (peripheral vision loss)
Drug Therapy for (MS) for Acute exacerbations - CORRECT ANSWER - with IV methylprednisolone: Iv x 2-3 days followed by po steroid taper x 3- months
Drug Therapy for Disease progression - CORRECT ANSWER -Interferon beta-1a (IM) or Interferon B-1b (SQ). Glatiramer (SQ): Relatively safe during pregnancy. These drugs are immunomodulators, makes patients vulnerable to infection. Must report any s/s infection to PMD immediately.
Natalizumab, Fingolimod: Oral drugs but second line, used less due to adverse effects
Fifth leading cause of death worldwide Classified as either ischemic (90%) or hemorrhagic (10%)
Ischemic strokes may be: - CORRECT ANSWER -Thrombotic: Due to atherosclerotic plaques
Embolic: Dislodged clot. Major risk factors include a-fib or DVT in a patient with a PFO.
Stroke Patho - CORRECT ANSWER -Ischemic stroke Most common type of stroke. Thrombotic Hx: HTN, Vascular disease Prodromal TIA Embolic Hx: AFIB, Endocarditis Hemorrhagic Hx: HTN, Vessel disorders
Stroke Numbers - CORRECT ANSWER -Accounts for 1/19 deaths in US. Ranked number 5 among cause of death in the US. 14% of patients in the hospital suffer from a stroke. They often suffer the worst prognosis.
Stroke PT history - CORRECT ANSWER -Hypertension, Hypercoagulability, Use of Oral Contraceptives, Hyperlipidemia, Diabetes, Obesity, Smokers, Genetic Factors, A-fib, Alcoholism, Illicit drug use (cocaine)
Stroke Symptoms - CORRECT ANSWER -Altered LOC, Face, Arm, Speech alterations, gait disturbances
Stroke Manifest - CORRECT ANSWER -people who are older, but always consider stroke in a patient with acute onset neurological deficits, regardless of age
Stroke Risk Factors - CORRECT ANSWER -Smoking A-Fib Age Illicit drug use (cocaine) Alcoholism Uncontrolled HTN: #1 risk factor Sedentary lifestyle Obesity Hypercoagulability Hyperlipidemia
