Med-Surge Review Lecture Notes

Nervous System Assessment

Glasgow Coma Scale

• Evaluates eye-opening, verbal, and motor responses.
• Scores range from 3 (lowest) to 15 (highest).

PERRLA

• Stands for Pupils Equal, Round, Reactive to Light, Accommodating.
• Normal pupil size is 3-5 mm.

Signs of Elevated Intracranial Pressure

• Cushing's Triad: Hypertension, Bradycardia, Wide Pulse Pressure.
• Interventions: Elevate head of bed to 30 degrees, maintain a quiet environment.

Anatomy and Physiology of the Brain

• Frontal Lobe: Emotions, judgment, motor aspects of speech.
• Parietal Lobe: Sensory information, spatial perception.
• Temporal Lobe: Auditory info, language comprehension.
• Occipital Lobe: Visual information.
• Cerebellum: Coordination of muscular function.
• Brain Stem: Respiratory and cardiac centers.
• Diencephalon: Thalamus, subthalamus, hypothalamus.

Autonomic Nervous System

• Sympathetic (fight or flight): Dilated pupils, increased HR, sweating.
• Parasympathetic (rest and digest): Constricted pupils, decreased HR.

Cranial Nerve Assessment

• I Olfactory: Smell test.
• II Optic: Visual acuity, Snellen chart.
• III Oculomotor: Eye movement, pupil constriction.
• IV Trochlear: Eye movement.
• V Trigeminal: Sensory of the face, chewing.
• VI Abducens: Eye function.
• VII Facial: Facial expression.
• VIII Acoustic: Hearing balance.
• IX Glossopharyngeal: Taste, gag reflex.
• X Vagus: Cardiac and respiratory reflex.
• XI Spinal Accessory: Muscle strength.
• XII Hypoglossal: Motor function of tongue.

Cerebrovascular Accident (Stroke)

Risk Factors:

• Diabetes, atherosclerosis, hypertension.

Types of Stroke:

• Ischemic: Due to blockage, treat with TPA.
• Hemorrhagic: Due to bleeding.

Seizure Disorders

• Epilepsy: Recurrent seizures.
• Tonic-Clonic: Confusion, drowsy post-seizure.
• Absence Seizure: Brief, no convulsive contractions.
• Complex Seizure: Brief loss of consciousness.

Nursing Intervention:

• Position on side, maintain airway, administer oxygen, suction if needed.

Neurological Disorders

• Multiple Sclerosis: Demyelinating disease.
• Myasthenia Gravis: Muscular weakness.
• Parkinson's Disease: Degenerative, affects basal ganglia.
• Bell’s Palsy: Facial paralysis due to nerve lesion.

Cardiovascular System

Cardiac Markers:

• CK-MB: Cardiac damage indicator.
• Troponin: Myocardial tissue marker.

Common Cardiac Conditions:

• Heart Failure: Left-sided (pulmonary) and right-sided (systemic).
• Valvular Heart Disease: Stenosis and insufficiency.
• Cardiac Rhythms: Bradycardia, tachycardia, atrial fibrillation.

Nursing Interventions:

• Monitor electrolyte levels, fluid restrictions, daily weights.

Respiratory System

Breath Sounds:

• Crackles: Pneumonia, fluid overload.
• Wheezes: Asthma, COPD.
• Stridor: Upper airway obstruction.

Respiratory Disorders:

• Asthma: Airway inflammation.
• COPD: Chronic bronchitis and emphysema.
• Pneumonia: Infection leading to lung stiffening.

Nursing Interventions:

• Administer bronchodilators, oxygen therapy, monitor lung sounds.

Renal System

Acute Kidney Injury (AKI):

• Phases: Oliguric, diuretic, recovery.
• Nursing Interventions: Monitor electrolytes, fluid balance.

Chronic Kidney Disease:

• Stages: Mild to end-stage requiring dialysis.

Nursing Interventions:

• Monitor for fluid overload, manage electrolytes, dietary restrictions.

Endocrine Disorders

Diabetes Management:

• Type 1: Insulin-dependent.
• Type 2: Insulin resistance.
• DKA: Insufficient insulin, treat with fluids and insulin.

Thyroid Disorders:

• Hypothyroidism: Low metabolism, treat with thyroid replacement.
• Hyperthyroidism: High metabolism, treat with anti-thyroid medications.

Gastrointestinal System

Common Conditions:

• GERD: Acid reflux, dietary modifications.
• Peptic Ulcer Disease: Ulcerations in GI tract.

Nursing Interventions:

• Monitor for signs of bleeding, dietary education, medication administration.

Musculoskeletal System

Common Injuries:

• Fractures: Closed, open, comminuted, impacted.
• Sprains/Strains: Injury to ligaments vs. muscle/tendon.

Nursing Interventions:

• RICE method, immobilization, pain management.

Chronic Conditions:

• Rheumatoid Arthritis: Autoimmune joint inflammation.
• Osteoporosis: Bone demineralization.

Hematological and Oncology

Cancer Management:

• Chemotherapy: Systemic treatment.
• Radiation: Targeted treatment.

Nursing Interventions:

• Monitor for side effects, infection prevention, patient education.

Blood Disorders:

• Anemia: Low red cell count.
• Leukemia: White blood cell disorder.

Pharmacology Overview

Key Medication Categories:

• Antibiotics: Infection control.
• Antidepressants: Mood stabilization.
• Antihypertensives: Blood pressure management.
• Bronchodilators: Respiratory function improvement.

Note:

This is a summary of key points from the lecture for Med-Surge exam preparation. For detailed studies, refer to textbooks and specific guidelines.