MEDICAL SURGICAL NURSING DAY 1 – INTENSIVE REVIEW

CARDIOLOGY • Screening Test: Total Blood Cholesterol = <200 mg/dL

o HDL (Good) = >40 mg/dL
• Heart – Pumps blood o LDL (Bad) = <100 mg/dL
• Systemic circulation  Deoxygenated Blood  o Triglycerides (N) = <135 mg/dL
SVC/IVC  Heart  Right Atrium  Tricuspid Valve  • Confirmatory Test: Angiogram/Angiography
Right Ventricle  Pulmonary Artery  Lungs (O2)  o AKA: Cardiac Catheterization;
Pulmonary Vein  Left Atrium  Mitral Valve  Left Percutaneous Transluminal Coronary
Ventricle  Aorta  O2 blood  Systemic Circulation. Angiography (PTCA)
• Enema – invasive but does not use sterile technique. o What: visualization of the coronary
• Higher workload (left ventricle) – higher oxygen circulation with the use of dye/contrast
demand – higher chance of myocardial ischemia – medium
anaerobic respiration – lactic acid – toxic to tissues: o Why: locate clots/ narrowing for repair:
o a. Inflammatory Responses: +plasty
▪ pain (dolor) → angina pectoris o Where: Radial > Femoral > Brachial
▪ reversible: provide oxygen. ▪ Radial: Allen’s Test (Ulnar
o b. Prolonged Injury: Sufficiency) N: 7 seconds
▪ necrosis → myocardial infarction o Nursing Considerations:
(Acute Coronary Syndrome –  Check: Iodine Allergy
decreased O2 in the heart) ▪ Dye is nephrotoxic: Check BUN,
▪ irreversible, not capable of Creatinine
regeneration. ▪ Shave both groins
▪ WOF: DM Type II Pt. – Metformin
ABDOMINAL AORTIC ANEURYSM (AAA)
• Hold Metformin for 48
• What: Outpouching of Aorta hrs. before and after
• Why: loss of elasticity • Metformin + Dye = 
• Atherosclerosis/CAD (Coronary Artery Disease) renal clearance
o Narrowing + hardening of the arteries + fat ▪ Promote fluid intake – flush out
plaques =  blood flow –  O2 dye
o Causes: Lifestyle, Vices • Management:
 GOAL: PREVENT RUPTURE o Antihyperlipidemic → “+statin”
• Clinical/Hallmark Sx.: ▪  LDL;  HDL
o Pulsating abdominal mass (epigastric) ▪ Priority Assessment: Muscle
o Systolic bruit (whooshing sound) Weakness (AE: rhabdomyolysis –
o Subjective sensation of heart beating at destruction of the skeletal muscle
the abdomen > micro clots > dislodged at
• Management: nephron = glomerulus 
o Type A (Ascending Aorta): w/ chest pain – filtration rates >  waste and
higher risk of rupture fluids -  renal failure
▪ STAT Surgery: Surgical Clipping ▪ Late Sx: Flank Pain
o Type B (Descending Aorta): no chest pain o Lifestyle Modifications
– lower risk of rupture
ANGINA VS MYOCARDIAL INFARCTION
▪ Goal: Decrease size of aneurysm
▪ Lifestyle modification, DM and
ANGINA MYOCARDIAL INFARCTION
HTN control
▪ Monitor size every 3 months Myocardial Ischemia Myocardial Necrosis
(Abd. UTZ): smaller size, safer for Reversible Irreversible
surgery
SaD – stabbing, dull MICE – crushing and
• Rupture: Massive Bleeding (hemorrhage)
pain excruciating pain
 flank pain/leg pain
▪ can lead to shock. <15 mins. >15 mins.
Left-sided Radiation
CAD/ATHEROSCLEROSIS Left-sided Radiation (jaw, neck,
(jaw, neck, shoulder,
shoulder, arm, and back).
•What: Narrowing/Hardening of the Artery arm, and back).
•Why: Nonmodifiable → Male, Hereditary, African
Promote rest/schedule MONATAS (Morphine, Oxygen,
American, Age (Elderly); Modifiable → Sedentary
or space activities, Nitroglycerin, Aspirin,
Lifestyle, Smoking, Alcohol, Drug Abuse, DM, HTN
oxygenation, Thrombolytics, Anticoagulants,
• Consequence:  blood flow to heart
Nitroglycerin Stool Softeners)
 Asymptomatic
Mr. Lianmuel Raymundo De Guzman DPCA – PEAK REVIEW CENTER
 MEDICAL SURGICAL NURSING DAY 1 – INTENSIVE REVIEW

NITROGLYCERIN • WOF: Bleeding

• Vasodilator 6. Anticoagulants: Warfarin (INR > PT), Heparin (PTT),
o Coronary Vasodilator -  blood flow to Enoxaparin (INR)
heart =  oxygen • SQ Route
o Peripheral Vasodilator -  bp -  7. Stool Softeners: Avoid Valsalva Maneuver
workload -  O2 demand – prevent • Docusate/Senokot
myocardial ischemia.  MI → No Laxatives (use of laxatives: surgery,
• SE (expected): barium study, cirrhosis)
o Cephalgia/Headache
▪ Paracetamol/Acetaminophen CONGESTIVE HEART FAILURE
o Blurry Vision & Dizziness
•What: Too much/excessive blood at the coronary
▪ Safety: No driving, operating
circulation
heavy machinery, no drinking
• Why:  contractility (cardiac tamponade) – high
alcohol
pressure at heart → mediastinal shifting
• Watch out for: Orthostatic Hypotension
• Fluid volume excess → renal failure → reno-cardiac
o Drop in BP (10-20 mmHg) with respect to
syndrome (if the kidney fails, heart fails)
rapid change in position
▪ Change position slowly, sit at the  Congestion
bedside or dangle legs. • Compensatory =  HR   workload   O2
• ROUTES: demand  myocardial ischemia (ACS: Angina/MI)
o Sublingual: Common  heart failure
▪ Fast absorption, highly
vascularized, no first pass (will LEFT-SIDED RIGHT-SIDED
bypass liver). Pulmonary Systemic
 Photosensitive Tablets
Focus: Edema, Pressure
• Store at amber/dark Focus: Oxygen
Sores
colored container
• Max storage: 6 months Crackles/Rales/Wet Breath Distended jugular vein:
o Patch: Intradermal Sounds = Pulmonary semi-Fowler’s to high
▪ Longer sustained effect. Congestion Fowler’s
▪ Rotate sites.
Pulmonary Edema: Frothy Weight Gain (best indicator
• Prevent overdose.
Pink Sputum of fluid volume status)
▪ Anterior chest: non-hairy
▪ 12 to 16h per patch Easy Fatigability
▪ Loss of adherence Hepatosplenomegaly r/t
• Reinforce by adding Paroxysmal Nocturnal RBC death
adhesives/micropore. Dyspnea
o Intravenous Administration Edema (pitting, nonpitting,
▪ Fastest route Pillow Orthopnea (N: 0-1)
cerebral, pedal)
▪ Hypotension
 Request Infusion Pumps Oliguria (LHF   Cardiac
Altered LOC: cerebral
Output   blood flow to
• Vital signs Q15 mins. edema
kidneys   oliguria
MONATAS
Altered LOC: earliest
Generalized edema:
1. Morphine symptom of cerebral
anasarca
o For MI – Given as a sedative -  HR and BP hypoxia
(intended) -  workload -  O2 demand
Increased HR, Increased BP, Decreased Contractility
o AE: Respiratory Depression (unintended) –
NARCAN/NALOXONE/NALTREXONE
2. Oxygenation DIGOXIN
3. Nitroglycerin • Cardiac Glycoside  Nephrotoxic (BUN, Crea)
4. Aspirin • Positive (+) Inotropic =  Contractility
o Prevent clots. • Negative (-) Chronotropic =  HR
o WOF: Bleeding o Hold if less than 60 bpm
 Contraindicated: Pediatric Patients • Take apical pulse for 1 full minute
▪ Reye’s Syndrome → encephalopathy • Normal Levels: 0.5 to 2.0 ng/mL
5. Thrombolytics (USA: Urokinase, Streptokinase,  WOF: Digoxin Toxicity: VANDAB
Alteplase) → dissolve clots o Visual Disturbances

Mr. Lianmuel Raymundo De Guzman DPCA – PEAK REVIEW CENTER

 MEDICAL SURGICAL NURSING DAY 1 – INTENSIVE REVIEW

o Anorexia Hemoglobin = Oxygen carrying capacity of the blood

o Nausea and Vomiting • Male: 14-18 g/dL (140-180 mmol/L)
o Diarrhea and Diaphoresis • Female: 12-16 g/dL (120-160 mmol/L)
o Abdominal Discomfort
o Bradycardia Hematocrit - % of RBC with respect to plasma (concentration
• Antidote for Digoxin Toxicity: of the blood)
 Digibind/Digifab  HCT  concentrated blood = Dehydrated
o WOF: Hypokalemia  HCT  diluted blood = overhydrated
▪  chances of digitalis toxicity Normal Hematocrit Count:
▪ Mgmt.: Give Vitamin K • Male: 42 – 52% (0.42 – 0.52 volume fraction)
supplement  incorporation; • Female: 37-47% (0.37 – 0.47 volume fraction)
Oral: give with orange juice;
potassium rich foods MCV: Mean Corpuscular Volume = determines the size of the
DIURETICS RBC
•  Urine Output  give in the morning. • Male: 79 – 103 fl
o Potassium Wasting • Female: 78 – 102 fl
▪ SE: Hypokalemia  MCV = Large RBCs  Macrocytic Anemia  Prone to
▪ Loop Diuretics: obstruction at blood vessel
 Furosemide/Lasix  usually o Paresthesia (pins and needles) and
paired with Digoxin + potassium Claudication (painful walking)
▪ Thiazide: hydrochlorothiazide/ A. Pernicious (Vit. 12 Deficiency)
microzide B. Folic Acid Deficiency (Vit. B9 Deficiency)
o B. Potassium Sparing  MCV  Small RBCs  Microcytic Anemia
▪ SE: Hyperkalemia A. Iron Deficiency Anemia
▪ Aldactone, Spironolactone B. Thalassemia (Greek & Italian)
DILATORS C. Sickle Cell Disease
•  BP
• Nitrates
Factor Pernicious Anemia Folic Acid Deficiency
• Beta-Blockers
o WOF: HR <60 Vitamin B9 (Grains,
Deficiency Vitamin B12 (Meat and Dairy)
• Calcium Channel Blockers (+dipine, verapamil, Oats, Wheat)
diltiazem)
Vegetarian:
• ACE Inhibitors (+pril)
Present Intrinsic Factor produced
o WOF: cough (adverse effect) at the stomach.

DIET IF: requirement for Vit. B12

•  sodium absorption at small intestine
(ileum)
o Avoid processed, instant, preservatives,
condiments Mgmt.: ORAL Vit. B12 Alcoholism: Prevents
• Limit fluid intake (1-1.5 L/day) Vit. B9 supplement:
IF Problem: ORAL
• Avoid straining Risk Factor
- Peptic Ulcer
o Administer stool softeners - Gastrectomy Jejunum Resection: Vit.
- Ileum Resection B9 Supplement: IV
- Antrectomy (removal of
HEMATOLOGY anthrum: lower part of the
stomach).
a. Billroth 1
RED BLOOD CELLS (RBCs) b. Billroth 2
• Male: 4.7 – 6.2 x 1012/L (4.7 – 6.2 x 1012/L)
Mgmt.: Vit. B12 injectables
• Female: 4.2 – 5.4 x 1012/L (4.2 – 5.4 x 1012/L) (monthly, lifetime, water-soluble)

 RBC – Polycythemia Vera =  viscosity of blood =  blood Clinical General symptoms of

 Red beefy tongue
flow Manifestations anemia.

Diagnostic Test Schilling’s Test None

Management:
• Phlebotomy
Schilling’s Test
 RBC = ANEMIA (pallor, easy fatigability, DOB)
• 24-hour urine collection
• Oxygenation, Promote Rest, Epogen (SQ) =  RBC
• Discard the first urine, save the last.
production, Severe → Blood Transfusion

Mr. Lianmuel Raymundo De Guzman DPCA – PEAK REVIEW CENTER

 MEDICAL SURGICAL NURSING DAY 1 – INTENSIVE REVIEW

• Missed 1 hr.: Repeat the whole test • Basophils (allergic infections): 15-50/mm3, 0.5 – 1%
• How: (0.02 – 0.09 x 109/L)
o Provide pt. with oral vitamin B12
(radioactive) and an injectable Vit. B12 IMMUNOCOMPROMISED STATUS
o (+) Intrinsic Factor: Oral Vitamin B12
•  Decreased WBC  Neutropenia
absorbed, injectable Vitamin B12 excess is
(Immunocompromised)
excreted in the urine = >20% Vit. B12 in the
o Reverse Isolation (regular mask)
urine
o Private Room
o (-) Intrinsic Factor: Oral Vitamin B12 not
▪ Positive Pressure Room
absorbed (feces), injectable Vitamin B12
▪ Avoid raw and fresh food
absorbed = <20% vitamin B12 in the urine.
▪ Promote handwashing
▪ Personal Protective Equipment
Iron Deficiency Thalassemia Sickle Cell Crisis ▪ Avoid crowded places
Thalassea  near the  Neupogen (SQ):  WBC
Genetic: X-linked trait
Severe Bleeding
sea (Mediterranean) ▪ Monitor signs of infection: FEVER
- Greek, Italian,
 Iron in the diet
Syrian
Mother  son  Medical Emergency
Father  daughter
 Geriatric (Early): ALOC
▪ No potted plants and fresh
Signs/Symptoms: flowers in the room
- Angular Cheilosis
(ulceration at the • Positive Pressure  air goes OUTSIDE the room
corner of the mouth) Major:
Vaso Occlusive Crisis:
o GOAL: Prevent infection on the client
- Smooth Sore - symptomatic (short (immunocompromised)
obstruction of blood flow
Tongue RBC lifespan)
- hypochromic RBC - 12 days • Negative Pressure  air goes INSIDE the room
 Priority Nursing
(pale colored RBCs) - Mgmt.: Lifetime BT
Diagnosis: PAIN
o GOAL: To contain the infection (airborne –
TB, measles, varicella)
Mgmt.: Multiple BT -  risk
S/Sx.:
 Iron Supplements for iron overload:
 Pain PLATELETS
given before meals.  Hematemesis
 Pallor
 Poikilothermic • N: 150,000 – 400,000/mm3 (150-400 x 109/L)
ORAL: absorbed in Antidote: Desferal/
 Paresthesia
acidic environment; Deferoxamine
 Pulselessness •  Platelet = Polycythemia Vera
give with Vitamin C
•  Platelet (Thrombocytopenia)
or citrus.  Chelation Therapy –
 Priority Nursing  Risk for bleeding
SE: black tarry stool, blood cleansing using
Management: HOP
vomiting, binding agent o Electric Razor
constipation succimer (Chemet)
Nsg. Considerations:
Hydration o Avoid commercial mouthwash (alcohol =
Oxygenation dryness)
 Promote fluids Minor:
Pain
 Open-mouthed Asymptomatic o Pad and raise side rails, dark-colored foods
Valsalva maneuver
Mgmt.: Genetic
Triggers: Dehydration, o Avoid rectal, vaginal and IM routes
Hypoxia, Stress, Infection o Minimize injections: smallest gauge
Liquid Tablets: Counselling
SE: Teeth staining possible
Best Drug: Hydroxyurea
 Straw  Beta Thalassemia/
IM: Tissue Staining Cooley’s Anemia
(Hydrea)  to  o No aspirins and anticoagulants
hemoglobin S, which
 Z-Track Technique (pediatric; poor
causes the sickling. APLASTIC ANEMIA
prognosis)
Iron-Rich Foods:
 Green-leafy veggies • What: ALL  (Pancytopenia: RBC, WBC, Platelet)
 Legumes • Why: Bone Marrow Suppression, Chemotherapy
• Who: Cancer
• Signs and Symptoms:
WHITE BLOOD CELLS (WBCs)
o Early: Pallor, Easy Fatigability. Lethargy
• WBC: 5000-10,000/mm3 (5-10 x 109/L) (weakness)
• Segmented Neutrophils (bacteria/virus): 62-68% (2.5 o Late: Bleeding tendencies
– 7.5 x 109/L) • CBC, BM Aspiration (flat bone – sternum/posterior
• Band Neutrophils (bacteria/virus): 0-9% (0 – 1 x iliac crest), Biopsy
109/L)  WOF: Bleeding
• Lymphocytes (bacteria/virus): 1000 – 4000/mm3 • Management: neutropenia and thrombocytopenia
(20-40%), (0.1-0.4 x 109/L) mgmt., stem cell therapy, bone marrow transplant
• Monocytes (first responders): 100-700/mm3, 2-8% ( risk of rejection by the immune system.
(0.1 – 0.7 x 109/L) Management: immunosuppressants such as
• Eosinophils (parasitic infections): (50-100/mm3, 1 – steroids, azathioprine, cyclosporin)
4% (0.00-0.5 x 109/L)

Mr. Lianmuel Raymundo De Guzman DPCA – PEAK REVIEW CENTER

 MEDICAL SURGICAL NURSING DAY 1 – INTENSIVE REVIEW

POLYCYTHEMIA VERA o Nausea and Vomiting

▪ dry crackles, ice chips,
• What: ALL 
metoclopramide (antiemetics)
o Viscous blood flow =  perfusion
o Peptic Ulcers
status
▪ Antacids, PPI, H2 blockers,
• Why: Idiopathic, autoimmune, BM hyperactive
bismuths salts (Pepto-Bismol),
• Who: Most common to middle age but can
avoid gastric irritants – caffeine,
occur in any age group
spicy, peppermint, fatty, OTC
• S/Sx.: REID
drugs (aspirin, NSAIDs, steroids)
o RUDDY COMPLEXION
o BM Suppression
o Enlarged liver ( RBC production),
▪ Pancytopenia
elevated RBC, WBC, Platelets
o Anorexia  Cachexia = Severe
o Itchiness (Pruritus)
Malnourishment
▪ Mgmt.: Calamine Lotion,
▪ Diet:  Caloric,  Protein, 
Oatmeal Bath, Sodium
Carbs,  Calcium
Bicarbonate Bath
o NGT > TPN
▪ Cut fingernails short
▪ Rich in glucose = attracts
▪ Cocoa-Butter lotion
infection = Sterile Technique
o Decreased blood flow (headache,
 ADVERSE EFFECTS:
blurry vision, concentrated blood 
o Tumor Lysis Syndrome: tumor destruction
urea crystals = GOUTY ARTHRITIS
by product:
(painful joints)
▪ Potassium
▪ Mgmt.: Avoid iron
o Hyperkalemia
supplements, Phlebotomy
▪ Uric Acid
• Diagnostics: CBC =  ALL ELEVATED
o Hyperuricemia
LEUKEMIA  Renal Stones
 Renal Failure
• What: Overproduction of abnormal immature  Gouty Arthritis
WBCs ▪ Phosphate
• Consequence: Immunocompromised Status, o Hyperphosphatemia
Anemia, and Thrombocytopenia  Antacids (phosphate
 Why: Genetic Predisposition, Chemotherapy binders =  phosphate
• Types of Leukemia: levels)
o Lymphocytic – affects the lymphocytes
(bacteria and virus)  Prevention: Chemotherapy is divided
▪ Acute (ALL)  Toxic (affected are into several sessions.
the lymphoblasts which produces
CHEMOTHERAPEUTIC DRUGS: ADVERSE EFFECTS
new abnormal WBCs)
• Prognosis: Poor (<15) 1. Cisplatin/Carboplatin
▪ Chronic (CLL) – lymphocytes o Ototoxic (Ear Pain and Tinnitus)
(nonproducing) o Nephrotoxic (Flank Pain)
• Prognosis: Better (>50) ▪ Check BUN and CREA
o Myelocytic – Myelocytes (Precursor of 2. Bleomycin
eosinophil, basophils, neutrophils) o Lung Fibrosis
▪ Acute (AML)  Myeloblasts ▪ DOB, Intubation Tray @ bedside
• Poor Prognosis: (15-39) 3. Doxorubicin
▪ Chronic (CML)  Myelocytes o Cardiotoxic (Chest pain)
• Better Prognosis: (>40) ▪ Cardiac monitor @ bedside,
Management: ▪ Check Trop I and CKMB
• Chemotherapy  affects both normal and 4. 5 Fluorouracil
abnormal cells o Gastric Toxic (Epigastric Pain – left)
5. 6 Mercaptopurine
 SIDE EFFECTS: o Hepatotoxic (Jaundice)
o Alopecia ▪ Monitor AST and ALT
▪ Altered Body Image: Wigs, Caps 6. Cyclophosphamide
o Stomatitis o Hemorrhagic Cystitis (suprapubic pain)
▪ Vit. C tablets, warm saline 7. Vincristine/Vinblastine
gargles, no commercial o Peripheral Neuropathy
mouthwash)
Mr. Lianmuel Raymundo De Guzman DPCA – PEAK REVIEW CENTER
 MEDICAL SURGICAL NURSING DAY 1 – INTENSIVE REVIEW

8. Methotrexate
o Myelosuppression (Pancytopenia)

→ Report any of these findings.

HEMOPHILIA

 What: Massive Systemic Bleeding

• Why: Deficiency in clotting factors
• Management:
o Clotting Factors
o Cryoprecipitate + Fresh Frozen Plasma
(volume expander for shock)
▪ Given 20-30 minutes
o Desmopressin (ADH)
▪ Given to hemophilia to cause
transient increase in CF 8
(Hemophilia A)
 Priority Assessment: Nasal Patency
and Blood Pressure
• Oxygenation
• Water Toxicity: Congestion

Hemophilia A
• Classic Hemophilia; Severe Hemophilia
• Most common type of hemophilia
•  synthesis of Factor VIII
• Treat with recombinant Factor VIII

Hemophilia B
•  synthesis of Factor IX
• Treat with recombinant Factor IX
• Christmas Disease/ Moderate Hemophilia

Hemophilia C
• Mild Hemophilia
• Treat with recombinant Factor XI

Mr. Lianmuel Raymundo De Guzman DPCA – PEAK REVIEW CENTER