Medical Surgical Sample Study Guide

Case scenarios and clinical decisions the new grad may encounter

Pneumonia

O2 support, antibiotics, monitor body temperature, monitor improvement by checking the CXR and vitals. Implement bronchial hygiene techniques if patient cannot mobilize secretions on their own.

Post operative atelectasis

If not fully ambulatory, the patient may need incentive spirometry teaching. If too weak, patient may benefit from IPPB or PAP therapy. May require O2 support. If patient has a history of OSA or a high BMI, use CPAP.

Pulmonary embolism

This is a risk factor for post operative patients. May arise from a sudden increase in shortness of breath and oxygen desaturations. Will need O2 support and possibly clot busting medications.

Fluid overload/chf/pulmonary edema

O2 support, positive pressure ventilation (CPAP or BIPAP). and diuretic therapy. Monitor pitting edema and urine output. Chest radiograph may show pulmonary vascular congestion.

Nocturnal desaturation

Caused by V/Q mismatching. Patient needs to be screened for possible OSA. COPD patients without OSA can have noctural desaturation. Diagnostics include an ABG, overnight oximetry study, and/or polysomnography.

sepsis & uti

Sepsis is a condition that involves infection, inflammation, and poor tissue perfusion.Check the patient’s level of consciousness. Typically, it’s low, but may be able to understand verbal commands. Assess for airway protection and obtain blood cultures. Minute ventilation may be low - monitor with end tidal CO2 or arterial blood gas for CO2 narcosis.With an infection, the patient may require antibiotics. Also, sepsis is the number one cause for patients that go into ARDS. Monitor SpO2, HR, CXR, work of breathing, and body temperature.

chest pain or post coronary event

O2 support to decrease myocardial work and analgesics for pain. Monitor for arrhythmia or changes with an ECG. Data collection includes: smoking history, history of hypertension, history of diabetes mellitus, history of high cholesterol, family history with heart disease or myocardial infarction, and body mass index. Patient may require daily lab work, including an electrolyte panel and troponin.

Blood transfusion

Most common signs and symptoms include hypoxia, nausea, fever, chills, urticaria (hives), and itching. However, respiratory distress, high fever, hypotension, and hemoglobinuria can indicate a more serious reaction. Transfusion related injuries can result in sepsis, pulmonary edema, or ARDS.