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Medsurg final > comprehensive MS1 portion > Flashcards

comprehensive MS1 portion Flashcards

1
Q

Periop priorities

A
  • Assess
  • Interpret data
  • Teaching
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2
Q

What should we teach in the periop phase?

A

teach what to expect following surgery;

  • lines,drains,splints,pain,iv
  • how to prevent complications; IS, early ambulation, SCDs(dehiscience)
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3
Q

What should the nurse assess in the periop phase?

A
  • meds
  • comorbidities
  • hx
  • allergies
  • baseline vs
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4
Q

if the patient is taking vitamin____ they are at risk for ____.

A

E, bleeding

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5
Q

Comorbidity: DM rx factors

A
  • infection
  • delayed wound healing
  • higher BS from stress
  • poor perfusion
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6
Q

Comorbidity: COPD rx factors

A
  • poor oxygenation

- poor gas exchange

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7
Q

Comorbidity: HTN rx factors

A
  • stroke rx

- if too high no surgery! >140/90

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8
Q

Comorbidity: obesity rx factors

A

anesthesia clearance will take longer=longer recovery

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9
Q

Comorbidity: Smoking rx factors

A

lungs cannot fully expand; pt will retain secretions (pneumonia/atelectasis rx)
*recommend pt stop smoking for a few days prior to surgery

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10
Q

Comorbidity: CKD rx factors

A
  • fluid volume overload rx

- inability to filter out anesthesia

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11
Q

Comorbidity: anxiety rx factors

A

death/pain, make sure ask why they’re anxious, educate/call Dr to come back and educate,
fear of death = no Sx

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12
Q

periop labs to assess

A

H/H assesses volume
Plt assess bleeding (150-400)
WBC assess infection (4.5-11)
BUN (8-25) Cr (0.6-1.3) kidney function

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13
Q

informed consent surgeon and nurse roles

A

surgeon educates – nurse obtains signature

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14
Q

periop checklist

A 
IV band
right patient
allergies
right Sx right site 
baseline vitals
Hx/Px
consent is signed
blood type/crossmatch
NPO
store valuables
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15
Q

Intraop priority

A

pt safety

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16
Q

what is a timeout

A

check right site, informed consent, allergies, done RIGHT BEFORE PROCEDURE

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17
Q

Intraoperative complications (6)

A
  • hypothermia
  • anaphylaxis
  • aspiration
  • FE imbalance/pouring
  • malignant hyperthermia
  • environmental cx
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18
Q

How to tx intraop hypothermia

A
  • warm iv fluids

- blankets

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19
Q

anaphylaxis s/s (4)

A
  • BP drop
  • coughing/wheezing
  • Increased HR
  • Increased RR
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20
Q

How to tx intraop aspiration

A
  • turn them on their side

- antiemetics as ordered

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21
Q

Malignant hyperthermia s/s (early and late 5)

A 
Early: 
- tachycardia
- increased Co2
- rigid muscles
- tachypnea
Late:
-fever
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22
Q

What is malignant hyperthermia caused by?

A

succynocholine

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23
Q

What is malignant hyperthermia Tx w?

A

DANTROLENE

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24
Q

what is an environmental complication due to?

A

fire due to volatile gases

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25
Q

Postop nursing priorities

A

assess and prevent complications

MONITOR AIRWAY AND VS

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26
Q

Postop complications (5)

A
  • Atelectasis
  • Hypovolemic shock
  • Infection
  • Dehiscence/evisceration
  • PE
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27
Q

Atelectasis presents postop when and as (7)

A

day 1: crackles, SOB, tachypnea, decreased breath sounds, restlessness, dyspnea

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28
Q

Atelectasis prevention (6)

A 
IS
TCDB
Ambulation
huff cough
ROM
deep breathing
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29
Q

Atelectasis tx (3)

A

O2
high fowlers
pulse ox

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30
Q

Hypovolemic shock presents postop when and as (3)

A

day 1: low BP, tachycardia, tachypnea

Cause: bleeding, fluid loss

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31
Q

Hypovolemic shock tx (4)

A 
IN ORDER – 
pressure to wound
Trendelenburg position
fluid/blood
notify Dr
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32
Q

Infection presents postop when and as (6)

A

Day 3: redness, edema, purulent drainage, approximation, tachycardia, incr. WBC

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33
Q

infection prevention (5)

A
  • handwashing
  • dressing changes
  • wound care AESEPTIC
  • antibiotics
  • DM mo BS
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34
Q

Dehiscence/evisceration prevention

A

abdominal binder

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35
Q

Dehiscence/evisceration tx (4)

A
  • moist dressing
  • cover w gauze
  • sit up bend knees
  • call dr
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36
Q

post op pulmonary embolism s/s (4)

A
  • dyspnea
  • chest pain
  • SOB
  • impending doom
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37
Q

PE tx (5)

A
  • blood thinners (plavix)
  • Heparin
  • high fowlers
  • bedrest
  • call dr
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38
Q

what does insulin do?

A

carries glucose out of vascular space into cell – breaks down glucose (decrease)

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39
Q

which type of diabetes does the pancreas not make insulin

A

type 1

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40
Q

which type of diabetes does the pancreas not make enough insulin

A

type 2

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41
Q

type 1 diabetes 3 ps

A
  1. polyuria
  2. polyphagia
  3. polydipsia
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42
Q

type 1 diabetic pts ___ weight

A

lose

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43
Q

type 1 diabetes tx

A

insulin

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44
Q

type 2 diabetes 2ps and s/s (4)

A
  1. polyuria
  2. polyphagia
    - prolonged wound healing
    - weight gain/loss
    - recurrent infections
    - utis
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45
Q

type 2 diabetes tx (4)

A
  • insulin
  • meds
  • exercise
  • diet
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46
Q

type 2 diabetes dx

A

fasting blood sugar (1st test) , Glucose tolerance test (sugar drink wait 2 hrs test), casual blood sugar, HgA1C
(glycosylated Hgb) goal is 6%

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47
Q

what are sick day rules

A

when a pt is diabetic and sick their BS lvls could increase

check BS more often, may need more insulin

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48
Q

diabetic foot care (3)

A

DM shoes
check feet daily
nails trimmed by podiatrist

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49
Q

what is the rule of 15s

A 
for hypoglycemia (<70) – give 15g carb (fruit), recheck 15 min
Repeat if less than 70
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50
Q

what is hypoglycemia

A 
(<70) cold and clammy, eat some candy 
-shaky
-diaphoretic
-anxious
-confused
Rule of 15, dextrose
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51
Q

what is hyperglycemia

A 
(>110) hot and dry, sugar high
3Ps
dry mouth
Insulin
medications
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52
Q

what is DKA

A

(Type 1) (BS >250) acetone breath, Kussmauls, ketonuria, N/V

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53
Q

long term DM complications (6)

A 
PVD: loss of limb
Retinopathy: vision loss
Neuropathy: loss of feeling
Angiophaty: MI, CHF, CVA
Nephropathy: ESRD
Infections
**all due to poor perfusion and not taking care of themselves**
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54
Q

normal pH
normal CO2
normal CO3

A

pH: 7.35-7.45
CO2: 35-45
CO3: 22-26

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55
Q

respiratory acidosis

A

increased CO2, COPD, kussmal resp

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56
Q

respiratory alkalosis

A

decreased O2, ARDs, paper bag to retain co2

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57
Q

metabolic acidosis

A

diarrhea

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58
Q

metabolic alkalosis

A

l/of fluids suction; vomit

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59
Q

pneumonia s/s (8)

A
  • WBC
  • fever
  • crackles
  • tachypnea
  • tachycardia
  • pleural pain
  • resp distress
  • decr. Breath sounds
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60
Q

pneumonia dx

A
  • sputum
  • xray
  • wbc
  • bronchoscopy
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61
Q

pneumonia tx

A

antibiotics

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62
Q

pneumonia Ix (6)

A 
IS
TCDB
hydration 
huff cough
O2
semifowlers
63
Q

TB s/s (3)

A
  • blood sputum
  • night sweats
  • weight loss
64
Q

TB Dx (3)

A
  • chest xray
  • acid fast bacilli
  • mantoux test= exposure
65
Q

tb tx takes ___ to ___ months

A

6-12

66
Q

TB meds

A
  • Isoniazid
  • rifampin
  • pyrazinamide
  • ethambutol
67
Q

Rifampin need to know

A

TB med; orange body fluids, new birth control

68
Q

all TB meds are ___ to the liver

A

toxic to the live; mo enzymes

69
Q

asthma patho

A

allergen makes tons of mucous and blocks airway

70
Q

asthma s/s (3)

A
  • wheezing
  • cough is the 1st sign on worsening or improvement!
  • SOB
71
Q

Asthma Tx (2)

A
  • bronchodilators

- corticosteroids (make sure pt rinses mouth)

72
Q

COPD is caused by

A

emphysema and bronchitis

73
Q

COPD patho

A

Air trapping in lungs, converts to CO2, pt stops breathing bc too much CO2

74
Q

COPD s/s (3)

A
  • tripod positioning
  • barreled chest
  • weight loss (wasting away)
75
Q

COPD Ix (4)

A
  • sm frq meals
  • high cal
  • pursed lip breathing
  • O2
76
Q

COPD education

A

prevent acute attacks – pursed lip, inhaler, diaphragmic breathing, tripod
o Effective cough - cough technique, fluids to thin mucous
o Conserving/maximizing – exercise, pace activities, simplify tasks
o Min exposure – humidifier, avoid triggers
o Prevent – recognize early signs of infection, annual flu shots, quit smoking

77
Q

what is oxygen toxicity?

A

decr. RR, resp distress, confusion, hallucinations, gets worse when increase O2, fatigue,
anxiety, restlessness, 6L & sleeping well
*Prevention by starting low O2

78
Q

what is a sprain

A

injury to ligament

79
Q

what is a strain

A

excessive stretch of muscle/tendon

80
Q

RICE

A

rest, ice, compression, elevation

81
Q

heat is used for musculoskeletal injuries after ___ hrs

A

48 hrs

82
Q

ice is used in the first ___ hrs

A

24-48hrs

83
Q

musculoskeletal injuries compression

A

30 min on 15 min off

84
Q

elevation mist occur in the first ___ to ___ hrrs to reduce edema

A

24-48hrs

85
Q

neurovascular checks; 6ps

A 
pain
pallor
pulselessness
pressure
paresthesia
paralysis
86
Q

fracture s/s (6)

A 
continuous pain
muscle spasms
edema
deformity
crepitation
loss of function
87
Q

fracture Ix (5)

A
  • neuro checks
  • elevate
  • immobilize
  • splinting
  • open fractures cover w sterile dressing
88
Q

fracture goals

A

maintain alignment and immobilize

89
Q

What is bucks traction used for

A

Bucks traction (hip Fx) preop (prevents fat emboli)

90
Q

bucks traction management (4)

A
  • skin assessments
  • trap bar to adjust and get up
  • weights hang freely
  • do not loosen traction/turn pt
91
Q

skeletal traction is

A

prolonged traction

92
Q

skeletal traction complications

A

infection

immobility

93
Q

skeletal traction skin care

A

clean crusts w qtip- aseptic

serous fluid ok

94
Q

what happens if a skeletal tractions pins come out?

A

cover and call dr

95
Q

skeletal traction pts are at greater risk for

A

osteomyelitis

96
Q

cast care

A
  • dont stick anything inside
  • cool setting blow dryer
  • elevate
  • assess for hot spots
97
Q

compartment synd s/s

A
  • 6ps poor
  • pain doesnt go away w meds
    CALL DR
98
Q

Where does a fat emboli occur and when

A

long bones; 24-48hrs q injury

99
Q

fat emboli s/s (5)

A
  • petechiae on chest
  • impending doom
  • SOB
  • decreased O2
  • decreased H/H
100
Q

osteomyelitis is a

A

bone infection

101
Q

osteomyelitis rx (3)

A
  • DM
  • open fracture
  • immunocompromise
102
Q

osteomyelitis tx

A

long term IV antibiotics

103
Q

what is osteomalacia

A

low vitamin d; soft bone

104
Q

osteomalacia Ix

A

vit D, sunlight, Calcium, eat eggs, oily fish, meat,

105
Q

osteoporosis is

A

weak bones, brittle, bone absorption exceeds deposition

106
Q

osteoporosis rx (5)

A
  • menopause
  • old
  • women
  • smoke
  • corticosteroids
107
Q

osteoporosis s/s (2)

A

fractures easily

kyphosis

108
Q

osteoporosis dx

A

bone mineral density test

tscore

109
Q

osteoporosis Tx (3)

A
  • bisphosphonates
  • increase vit d
  • weight bearing exercises
110
Q

osteoarthritis is

A

degeneration of cartilage/ lrg joints

111
Q

osteoarthritis s/s

A
  • crepitation
  • pain gets better w use
  • asymmetrical
112
Q

osteoarthritis Ix (6)

A
  • exercise
  • rest
  • decreased weight
  • splints
  • heat
  • ice packs
113
Q

Rheumatoid arthritis is

A

autoimmune, gets better with use, affects smaller joints, symmetrical

114
Q

RA s/s

A
  • stiffness in am
  • ulnar drift
  • symmetrical
115
Q

RA tx (4)

A
  • NSAIDs
  • methotrexate
  • DMARDS
  • steroids
116
Q

Gout patho

A

purines create uric acid

117
Q

Gout Tx

A

allopurinol

118
Q

gout cx

A

kidney failure due to UA

119
Q

HIV patho

A

HIV binds to CD4 cells all cells want to be like it

120
Q

HIV Dx

A

ELOSIA HIV and syphilis
Western Blot Confirms HIV
WBC
CD4 count = progression

121
Q

Normal CD4 count

A

500-1200

122
Q

phases of HIV

A 
Acute: 2-4wks after infection
      High load, highest spread risk
Asymptomatic: >500
        Low viral load
Symptomatic: 200-499
        Load increases again
AIDS: CD4 <200
123
Q

Anaphylaxis is

A

coughing and closing of airway

124
Q

anaphylaxis Ix

A

stop meds, assess airway and ensure patency, IV antihistamine to stop rejection, IV steroid, IV
epi, treat for shock

125
Q

wbcs are low if less than

A

1500

126
Q

pltlts are low if less than

A

150

127
Q

3 causes of renal failure

A
  • prerenal
  • intrarenal
  • postrenal
128
Q

Prerenal is caused by

A

poor perfusion

  • dehydration
  • shock
  • drop in BP
129
Q

Intrarenal is caused by

A

in kidneys

  • toxins
  • infection
130
Q

Postrenal is caused by

A
  • obstruction
  • UTI
  • enlarged prostate
131
Q

what is fluid vol overload

A

kidneys cant filter out NA+ and H2O

132
Q

FVO Ix

A
  • I&O
  • fluid and NA+ restriction
  • diuretics
  • daily weights
133
Q

renal comp: elevated wastes are

A
  • increased BUN
  • increased creatnine
  • increased K+
  • decreased Ca+
134
Q

renal comp: horomone chngs

A

renin increases when bp drops

135
Q

chronic renal failure is characterized as

A

3+ months, eGFR less than 60

136
Q

fistula assessments (2)

A
  • auscultate bruit

- palpate for thrill- no obstruction shows patency

137
Q

BPH is

A

enlarged prostate obstructs urinary flow

138
Q

BPH tx

A
  • flomax

- TURP procedure; surgery to remove prostate

139
Q

multiple sclerosis is

A

damage and scarring of myelin sheath; motor, speech, mem, sensory chngs

140
Q

myasthenia gravis

A

acetycholine affected

141
Q

GBS

A

ground to brain; reversible

142
Q

ischemic stroke gets

A

TPA

143
Q

hemorrhagic stroke

A

NO TPA

144
Q

HTN is

A

> 140/90

145
Q

Right sided HF s/s (4)

A

peripheral, JVD, dependent edema, ascites

146
Q

Left sided HF s/s (5)

A

lungs, dyspnea, cough, sob, crackles

147
Q

PVD

A

lower leg edema, pulse present, sores with irregular borders, yellow slough or ruddy skin, sores
on ankles ELEVATE legs

148
Q

PAD

A

intermittent claudication, round smooth sores, black eschar, sores on toes and feet **LOWER legs*

149
Q

after an endoscopy the nurse must assess

A

GAG REFLEX

150
Q

SIADH patho

A

overproduction of ADH – FV OVERLOAD

151
Q

diabetes insipidus patho

A

low ADH – FV DEFICIT

152
Q

ADH holds

A

fluid

153
Q

pernicious anemia is

A

low vitamin B12; pt will have beefy tongue

154
Q

norm hgb (pubertyyy)

A

12-17

if low pt may have palpations, dyspnea

Medsurg final (3 decks)

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