i hope my notes will help you on your NCLEX =)

[vadee]

here are some of the things that I take note of as I was reading my MedSurg book. Hope this helps.

Things To Remember

1.No grapefruit juice when taking Calcium Channel Blockers because of the hypotensive effect

2.Wheezes = bronchospasms

3.Crackles= heart failure

4.Hemorrhage: s/s decreased BP, increased pulse rate, increase respiration, diaphoresis

5.Bleeding assessments: internal bleeding (assess the HCT and HgB levels), stools, urine, emesis for occult blood, monitor clotting studies, check IV sites for patency, check neurologic status

6.Urosepsis: s/s fever, chill, hypotension, alter mental status

7.Warfarin: avoid food high in Vitamin K (such as cabbage, cauliflower, broccoli, asparagus, turnips, spinach, kale, fish, and liver)

8.Vasodilators: facial flushing, headaches, hypotension, dizziness ??

9.Pulmonary Embolism: s/s shortness of breath, chest pain

10.Pulmonary Edema: wheezing, tachypnea, and frothy sputum

11.Bleeding: s/s hematuria, frank or occult blood in stool, ecchoymosis, petechiae, altered level of consciousness, pain

12.PT time (Coumadin) affected by: antacids, antihistamines, aspirin, mineral oil, oral contraceptives, vitamin C

13.Wound healing promotion: zinc, vita A and C, high protein food

14.Post-OP assessments: respiratory, cardio, GI, renal, circulatory, neurological functions

15.Aneurysm rupture: diaphoresis, N/V, pallor, hypotension, tachycardia, severe pain, decreased LOC, or pulsating abdominal mass

16.Fluid loss: is a result of chest tube, wound, nasogastric drainage, diarrhea, vomiting, increased abdominal and extremity girth

17.Myocardial Infarction (MI): Md will prescribed aspirin, beta blockers after 24 hours after MI, and ACE after 48 hours ??

18.ACE-inhibitors: monitor for decreased urine output, hypotension, cough, changes in potassium level, creatinine, BUN (kidney)

19.Beta Blockers (Lopressor): assess for cough, SOB, edema, and weight gain because all are signs of heart failure. Also assess for wheezing. Monitor heart rate because bradycardia is common. Do not administer meds if heart rate is less than 50 or if systolic is less than 90mmHg.

20.Calcium Channel Blockers: Do NOT used for clients with MI. Can use for client with variant angina, HTN, and angina even with the use of beta-blockers. Monitor for hypotension and peripheral edema

21.Aspirin and Plavix: both anti-platelets together helps reduce death, MI, and stroke

22.Nitroglycerin: 0.3-0.4mg sublingually every 5 minutes, up to 3 tabs over 15 minutes. Instruct client to lie down due to hypotensive effect. Monitor for headache, dizziness due to vasodilation. Remove patch every 12 hours due to tolerance. Notify MD if not effective after 3 tabs.

23.Sudden Heart Failure: weight gain, dyspnea, edema, crackles

24.Heparin + aPTT: therapeutic level 1.5-2 times the normal

25.Septic shock: respiratory alkosis, warm flushed skin, peripheral edema, tachycardia, widening pulse pressure, bounding peripheral pulses, tachypnea, hyperventilation, crackles, decreased breath sound, "left shift"

26.Left shift or bandemia: an early indication of infection is an increase in the band cells (immature neutrophils) in the WBC

Medications

1.Thrombolytic Agents (such as Activase, APSAC, Retavase) most effective if given within 6 hours of coronary event. It must be continuously monitored when given. It is indicated for clients with pain greater than 30 minutes long that is unrelieved by nitroglycerin, with indication of transmural ischemia, and injury as shown by ECG. Clients who weigh less than 65 kgs, must reduce dose. REPORT BLEEDING immediately.

a.ABSOLUTE CONTRAINDICATIONS: recent surgery/stroke, active bleeding, allergy to streptokinase products, recent head trauma, known bleeding disorders, aortic dissection, BP of 200/120mmHg, pregnancy/recent delivery, prolonged CPR, cerebral/spinal surgery

b.RELATIVE CONTRAINDICATIONS: endocarditis, pericarditis, hemostatic effects, HTN, trauma/surgery within 10 days past, use of anticogulations, active peptic ulcers