Overview
This lecture provides a comprehensive review of key medical-surgical nursing concepts, covering anatomy, assessment, common disorders, clinical interventions, and essential lab values across major body systems.
Nervous System Assessment & Disorders
- Glasgow Coma Scale (3–15) assesses eye, verbal, and motor responses; lowest score is 3, not 0.
- PERRLA checks pupils for equality, size (3–5 mm), light reaction, and accommodation.
- Cushing’s Triad (hypertension, bradycardia, wide pulse pressure) signals increased intracranial pressure.
- Cerebrospinal Fluid (CSF) normal: clear/colorless, 60–150 mmHg pressure, 125–150 mL volume.
- Frontal lobe: emotions/judgment; parietal: sensory; temporal: auditory/language; occipital: vision; cerebellum: coordination; brainstem: vital functions.
- Sympathetic NS = fight/flight (↑HR, ↑BP, dilated pupils); Parasympathetic = rest/digest.
- Cranial nerves: II (vision), III/IV/VI (eye movement), VII (facial), VIII (hearing/balance), IX/X (gag/cardiac/resp), XII (tongue).
- Stroke risk: diabetes, hypertension, cardiac disease; ischemic (blockage) vs hemorrhagic (bleed).
- Seizure priorities: side-lying, patent airway, record duration, never stop meds abruptly.
Major Neurological Conditions
- Multiple Sclerosis: autoimmune demyelination, fluctuating symptoms, diagnosed by lumbar puncture.
- Autonomic Dysreflexia: T6+ inj., hypertension, headache, treat with head elevation, bladder/bowel check.
- Meningitis: fever, stiff neck, positive Brudzinski/Kernig, cloudy CSF; droplet/contact precautions.
- Myasthenia Gravis: weakness, anticholinesterase drugs, risk of crisis (differentiate with Edrophonium test).
- Parkinson’s: tremor, rigidity, shuffling gait; treat with high-calorie/soft diet, avoid B6 foods.
Respiratory System
- Key breath sounds: crackles (fluid), rhonchi (low-pitch, expiratory), stridor (inspiratory), wheeze (high-pitch/musical).
- Flail chest: paradoxical movement; pneumothorax: absent breath sounds, tracheal deviation.
- Pulmonary embolism: chest pain, dyspnea, feeling of doom; TB: airborne precautions, drug therapy (INH/Rifampin).
- Oxygen devices: Nasal cannula (1–6 L), face mask (5–8 L), venturi, non-rebreather; monitor for aspiration.
- Chest tube: monitor output, bubbling, manage if dislodged (sterile dressing, 3-sided tape).
Cardiovascular & Hematological Systems
- Labs: CK-MB, Troponin I/T, BNP (<100), PT/INR (warfarin), aPTT (heparin).
- MI signs: ST elevation, chest pain, female atypical symptoms; treat with ABCs, nitro, morphine.
- Heart failure: Left = pulmonary congestion, Right = edema/JVD; treat with fluid restriction, daily weights.
- Valvular disease: specific murmur types; valve replacement requires lifelong anticoagulation.
- Shock: hypotension, tachycardia, urine <30 mL/hr; treat with fluids, monitor closely.
- DVT: unilateral swelling, warmth; prevent with elevation, no massage, anticoagulants.
Renal, GI, Endocrine, & Other Systems
- AKI: monitor electrolytes (esp. potassium), fluid balance, daily weight.
- CKD: GFR <15 = dialysis, monitor for overload, hold certain meds pre-dialysis.
- Hepatitis: A/E fecal-oral, B/C/D bloodborne; rest, avoid hepatotoxins.
- Diabetes: DKA (type 1, ketones, acidosis), HHS (type 2, no ketones), hypoglycemia protocol (15g carbs, recheck).
- Electrolyte imbalances: key differences in GI, neuromuscular, cardiac symptoms.
- Acid-base: Use ROME (Respiratory Opposite, Metabolic Equal) for ABG interpretation.
Key Terms & Definitions
- Glasgow Coma Scale — neuro assessment tool, range 3–15.
- PERRLA — Pupils Equal, Round, Reactive to Light and Accommodation.
- Cushing’s Triad — hypertension, bradycardia, wide pulse pressure (↑ICP).
- Edrophonium Test — differentiates myasthenic/cholinergic crisis.
- Pulse Pressure — systolic BP minus diastolic BP.
- GFR (Glomerular Filtration Rate) — kidney function measure.
Action Items / Next Steps
- Review and understand all assessment tools and lab values.
- Memorize electrolyte imbalance signs, interventions, and key differences.
- Practice ABG interpretation using ROME.
- Study medication classes and their primary side effects/actions.
- Complete any assignments/readings as indicated in your course materials.