Adult Health I: Final Exam (Weeks 1-3) Flashcards
Pre-Op
What components are apart of a preoperative assessment?
Week 1: Pre/Post-Operation Care and Medication Calculation
- Complete vital signs (Report abnormals)
- Focused asessment on reported problem areas
- Assessing and reporting signs and symptoms of infection
- Assessing and reporting cautionary conditions and contraindications to surgery
- Labs, Imaging and ECGs
- Psychosocial assessment
Pre-Op
What are interventions for pre-operative patients?
Week 1: Pre/Post-Operation Care and Medication Calculation
- NPO
- Administer appropriate drugs
- Ensure intestinal preparation (if indicated)
- Perform skin prep
- Prepare patient for tubes/drains and vascular access
- Minimize anxiety
- Plan for pain management
- Teach about indentification/prevention of CV complications
- Teach about post-op interventions
Pre-op
What are things that should be reviewed for pre-operative patients?
Week 1: Pre/Post-Operation Care and Medication Calculation
- Recording vital signs within 1-2 hours of procedure
- Record height and weight fot proper dosage for anesthetic agents
- Check for completed consent forms
- Removal of dentures, prosthetic devices, hairpins, clips and hearing aids (All accessories)
- Empty patient’s bladder
- Bed in lowest position
- Answer questions and offer reassurance
Post-Op
What are components in a post-operative assessment?
Week 1: Pre/Post-Operation Care and Medication Calculation
- Airway and breathing
- Mental status
- Incision site(s)
- Vital signs
- IV fluids and connections, foley, NGT, monitor
- Pain assessment and management
Post-Op
What are interventions for post-operative complications in patients?
Week 1: Pre/Post-Operation Care and Medication Calculation
Post-Op Nausea and Vomiting
* Ondansetron, Dimenhydrinate, Scopolamine
Decreased/Diminished Peristalsis (< 24 hours)
* Monitor bowel signs
Hypoxemia
* Airway maintenance, oxygen saturation, positioning, oxygen therapy, breathing, exercise, early ambulation, q 2 turns, antiembolism stockings, peumatic compression device
Wound Infection/Delayed Healting
* Change dressin when appropriate, Drug therapy
* Asess for infection, drains/drainage
Pain
* Non-pharmaceutical therapies, drug therapy
Venous Thromboembolism
* Antiembolitic stockings, early ambulation
Post-Op
What are post-operative complications?
Week 1: Pre/Post-Operation Care and Medication Calculation
- Nausea/Vomiting
- Decreased Peristalsis
- Hypoxia
- Wound Infection/Delayed Healing
- Pain
- VTE
Post-Op
What is the difference between dehiscence and evisceration?
Week 1: Pre/Post-Operation Care and Medication Calculation
Dehiscence is the splitting open of a wound.
Evisceration is the protrusion of internal organs through the open wound.
Post-Op
When a dressing on a post-op patient is damp with drainage and you have not recieved direction from the wound care nurse/surgeon, what do you do?
Week 1: Pre/Post-Operation Care and Medication Calculation
Reinforce the dressing
Pre-Op
Which labratory test should be anticipated before surgery?
Week 1: Pre/Post-Operation Care and Medication Calculation
Urinalysis, Electrolyte Levels, Clotting Studies, Serum Creatinine
Post-Op
What are interventions for wound complications?
Week 1: Pre/Post-Operation Care and Medication Calculation
Dishiscence
* Apply sterile nonadherent/saline dressing to the wound
* Notify the surgeon
* Instruct patient to lie supine, bend the knees and avoid coughing
Evisceration
* This is a surgical emergency
* Notify the surgeon
* Apply sterile saline soaked guaze
* Instruct patient to lie supine, bend knees, avoid coughing
* Review Emergency care of the patient
ABGs
What are the Arterial Blood Gases and their values?
Week 2: ABGs and Trach Care
Pa02: 80-100 mg Hg
pH: 7.35-7.45
PaCO2 (respiratory): 35-45
HC03 (metabolic): 22-26
ABGs
What are the values, causes and treatments of respiratory alkalosis and metabolic alkalosis?
Week 2: ABGs and Trach Care
Respiratory Acidosis
* ph below 7.35 and CO2 above 45
Respiratory Alkalosis
* ph above 7.45 and CO2 below 35)
RO ME (Respiratory Opposite; Both in different directions)
ABGs
What are the values, causes and treatments of metabolic acidosis and metabolic alkalosis?
Week 2: ABGs and Trach Care
Metabolic Acidosis
* ph below 7.35 and HCO3 below 22
Metabolic Alkalosis
* ph above 7.45 and HCO3 above 26
RO ME (Metabolic Equal; Both in the same direction)
Trach Care
What are some complications that can come with a tracheostomty?
Week 2: AGBs and Trach Care
- Dislodgement
- Obstruction
- Subcutaneous emphysema (rare!)
- Skin breakdown
- Infection
- Bleeding
Trach Care (2 questions)
What interventions could we apply to trach care to prevent complications?
Week 2: ABGs and Trach Care
Remember what complications can arise
Dislodgement → Maintain extra trach and obturator at bedside
Obstruction → Suctioning, Ensue placement and patency, Aspiration percautions
Subcutaneous Emphysema → ???
Skin Breakdown → Stoma cleaning/care
Infection → Stoma cleaning/care, Frequent oral care
Bleeding → Monitor cuff pressures (14-20 mmHg)
Trach Care
What is included in stoma care?
Week 2: ABGs and Trach Care
- Cleaning the area (NS)
- Providing gauze to collect secretions around the area
- Clean multiple times throughout the day and
- Change/clean inner cannula once a day
- Change commercial ties once a week
Trach Care
What are things to remember when suctioning a patient?
Week 2: ABGs and Trach Care
- This is a STERILE PROCEDURE
- Preoxygenate to 100% O2 for 3 breaths before suction
- SOB and Coughing are expected
- Insert until resistance and back up an inch
- NO SUCTION GOING IN
- DO NOT SUCTION LONGER THAT 10-15 SECONDS
- Reoxygenate for 1-5 minutes after to baseline
Trach Care
What are the complications and interventions of suctioning?
Week 2: ABGs and Trach Care
Hypoxia → Proper oxygenation (before and after), limited suction time, correct catheter size
Mucosal Trauma → No suction against resistance, 80-120 mmHg pressure, limited suctioning time
Infection → sterile procedure
Vagal stimulation/Bronchospasm → limited suction time
Cardiac Dyshrythmias → related to hypoxia
Trach Care
What are nutritional concerns with a tracheostomy?
Week 2: ABGs and Trach Care
ASPIRATION
* Elevate HOB for 30 minutes after eating
* May need to be placed on enteral feeding
Trach Care
What is one thing to note about psychosocial care for patients with a tracheostomy?
Week 2: ABGs and Trach Care
Communication!
* Encourage writing or other communication tools
* Be patient
* Involve speech therapy
Asthma
What are common types of triggers for asthma?
Week 3: Non-infectious Respitory Illnesses
- Allergens
- Cold/Poor Air
- Exercise
- Resp. Illness
- Irritants (smoke, strong orders, dust)
- Microorganisms
- GERD
- Stress
Asthma
What assessment history would you need to gather?
Week 3: Non-infectious Respitory Illnesses
- Family Hx
- Smoking
- Triggers
- Frequency
Asthma
What are symptoms that are specific to asthma?
Week 3: Non-infectious Respitory Illnesses
- Coughing
- Chest Tightness
- Retractions (suprasternal notch and intercostal space)
- Wheezing
- Barrel Chest from prolonged asthma
Asthma
What are different diagnostic tests for asthma?
Week 3: Non-infectious Respitory Illnesses
Arterial Blood Gases
Pulmonary Funtion Tests (PFTs)
Asthma
What are interventions used for asthma?
Week 3: Non-infectious Respitory Illnesses
- Avoiding triggers or premedicating beforehand
- Review action plan and peak flow
- Teach proper use of inhalers/nebulizes, emphasizing the use of spacers
- Oxygen therapy in case of hypoxia or acute attack
- Medications: Bronchodilators and Anti-inflammatory Agents
COPD
Which two diseases are within COPD?
Week 3: Non-infectious Respitory Illnesses
Chronic Bronchitis: Inflammation of the airway with thick mucus
Emphysema: Air trapped in the alveoli causing hyperinflation of the lungs
Both are associated with smoking
COPD
What are symptoms of COPD?
Week 3: Non-infectious Respitory Illnesses
- Orthopnea
- Fatigue
- Weight loss
- Sputum (Bronchitis)
- Chronic acidiosis (Emphysema)
- Barrel Chest (Emphysema)
- Nail Clubbing, Cyanosis and Hypoxia if severe
COPD
What are diagnostic tests for COPD?
Week 3: Non-infectious Respitory Illnesses
ABGs
Sputum Sample
CBC (due to high Hgb)
Chest X-Ray
CT
PFT
COPD
What are interventions for COPD?
Week 3: Non-infectious Respitory Illnesses
- Oxygen Therapy aiming for 88-90%
- Elevate HOB
- Tripod
- Smoking Cesation
- Energy and breathing conservation (pursed lips, diaphragmatic)
- Medications: Bronchodilators, Anti-inflammatory Agents and Mucolytic Agents
COPD
What are complications for COPD?
Week 3: Non-infectious Respitory Illnesses
- Hypoxemia
- Acidosis
- Respiratory Infection
- Cardiac Failure
- Dysrrhythmias (A Fib)
Chest Tubes
What are expected and not expected actions of the chest tube chamber?
Week 3: Non-infectious Respitory Illnesses
Suction Chamber, Water Seal and Air Leak, Collection Chamber
Suction Chamber
Expected: Gentle, steady, continuous, bubbling
Not Expected: Vigorous bubbling
Water Seal Chamber and Air Leak Monitor
Expected: Tidaling with breathing that slowly diminishes with time
Not Expected: Bubbling of any kind, sudden stop of tidaling
Collection Chamber
Expected: Dark blood drainage of any amount
Not Expected: Bright red drainage > 100/mL per hour
Chest Tubes
What are some key things to remember when using the chest tube system
Week 3: Non-infectious Respiratory Illness
Patient assessment, Machine assessment, NEVER
Patient Assessment
* Check lung sounds for shortness of air
* Ask patient to turn, cough and deep breathe
* Check alignment of the trachea
* Always check the patient first, not the machine
* Check inscision site for infection or excessive bleeding
Machine Assessment
* Keep the system below the lungs
* Check the water level in the all the chambers
* Keep the chest tube as straight as possible
* Check and document amount, color and characteristics of fluid
NEVER
* NEVER Milk or strip the tube
* NEVER allow continuous bubbling in the water seal and air leak monitor chamber
* NEVER clamp a chest tube unless changing the system or checking for air leaks
