comprehensive MS1 portion Flashcards
1
Q
Periop priorities
A
- Assess
- Interpret data
- Teaching
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)
3
Q
What should the nurse assess in the periop phase?
A
- meds
- comorbidities
- hx
- allergies
- baseline vs
4
Q
if the patient is taking vitamin____ they are at risk for ____.
A
E, bleeding
5
Q
Comorbidity: DM rx factors
A
- infection
- delayed wound healing
- higher BS from stress
- poor perfusion
6
Q
Comorbidity: COPD rx factors
A
- poor oxygenation
- poor gas exchange
7
Q
Comorbidity: HTN rx factors
A
- stroke rx
- if too high no surgery! >140/90
8
Q
Comorbidity: obesity rx factors
A
anesthesia clearance will take longer=longer recovery
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
10
Q
Comorbidity: CKD rx factors
A
- fluid volume overload rx
- inability to filter out anesthesia
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
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
13
Q
informed consent surgeon and nurse roles
A
surgeon educates – nurse obtains signature
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
15
Q
Intraop priority
A
pt safety
16
Q
what is a timeout
A
check right site, informed consent, allergies, done RIGHT BEFORE PROCEDURE
17
Q
Intraoperative complications (6)
A
- hypothermia
- anaphylaxis
- aspiration
- FE imbalance/pouring
- malignant hyperthermia
- environmental cx
18
Q
How to tx intraop hypothermia
A
- warm iv fluids
- blankets
19
Q
anaphylaxis s/s (4)
A
- BP drop
- coughing/wheezing
- Increased HR
- Increased RR
20
Q
How to tx intraop aspiration
A
- turn them on their side
- antiemetics as ordered
21
Q
Malignant hyperthermia s/s (early and late 5)
A
Early: - tachycardia - increased Co2 - rigid muscles - tachypnea Late: -fever
22
Q
What is malignant hyperthermia caused by?
A
succynocholine
23
Q
What is malignant hyperthermia Tx w?
A
DANTROLENE
24
Q
what is an environmental complication due to?
A
fire due to volatile gases
25
Postop nursing priorities
assess and prevent complications
| MONITOR AIRWAY AND VS
26
Postop complications (5)
- Atelectasis
- Hypovolemic shock
- Infection
- Dehiscence/evisceration
- PE
27
Atelectasis presents postop when and as (7)
day 1: crackles, SOB, tachypnea, decreased breath sounds, restlessness, dyspnea
28
Atelectasis prevention (6)
```
IS
TCDB
Ambulation
huff cough
ROM
deep breathing
```
29
Atelectasis tx (3)
O2
high fowlers
pulse ox
30
Hypovolemic shock presents postop when and as (3)
day 1: low BP, tachycardia, tachypnea
| Cause: bleeding, fluid loss
31
Hypovolemic shock tx (4)
```
IN ORDER –
pressure to wound
Trendelenburg position
fluid/blood
notify Dr
```
32
Infection presents postop when and as (6)
Day 3: redness, edema, purulent drainage, approximation, tachycardia, incr. WBC
33
infection prevention (5)
- handwashing
- dressing changes
- wound care AESEPTIC
- antibiotics
- DM mo BS
34
Dehiscence/evisceration prevention
abdominal binder
35
Dehiscence/evisceration tx (4)
- moist dressing
- cover w gauze
- sit up bend knees
- call dr
36
post op pulmonary embolism s/s (4)
- dyspnea
- chest pain
- SOB
- impending doom
37
PE tx (5)
- blood thinners (plavix)
- Heparin
- high fowlers
- bedrest
- call dr
38
what does insulin do?
carries glucose out of vascular space into cell – breaks down glucose (decrease)
39
which type of diabetes does the pancreas not make insulin
type 1
40
which type of diabetes does the pancreas not make enough insulin
type 2
41
type 1 diabetes 3 ps
1. polyuria
2. polyphagia
3. polydipsia
42
type 1 diabetic pts ___ weight
lose
43
type 1 diabetes tx
insulin
44
type 2 diabetes 2ps and s/s (4)
1. polyuria
2. polyphagia
- prolonged wound healing
- weight gain/loss
- recurrent infections
- utis
45
type 2 diabetes tx (4)
- insulin
- meds
- exercise
- diet
46
type 2 diabetes dx
fasting blood sugar (1st test) , Glucose tolerance test (sugar drink wait 2 hrs test), casual blood sugar, HgA1C
(glycosylated Hgb) goal is 6%
47
what are sick day rules
when a pt is diabetic and sick their BS lvls could increase
| check BS more often, may need more insulin
48
diabetic foot care (3)
DM shoes
check feet daily
nails trimmed by podiatrist
49
what is the rule of 15s
```
for hypoglycemia (<70) – give 15g carb (fruit), recheck 15 min
Repeat if less than 70
```
50
what is hypoglycemia
```
(<70) cold and clammy, eat some candy
-shaky
-diaphoretic
-anxious
-confused
Rule of 15, dextrose
```
51
what is hyperglycemia
```
(>110) hot and dry, sugar high
3Ps
dry mouth
Insulin
medications
```
52
what is DKA
(Type 1) (BS >250) acetone breath, Kussmauls, ketonuria, N/V
53
long term DM complications (6)
```
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**
```
54
normal pH
normal CO2
normal CO3
pH: 7.35-7.45
CO2: 35-45
CO3: 22-26
55
respiratory acidosis
increased CO2, COPD, kussmal resp
56
respiratory alkalosis
decreased O2, ARDs, paper bag to retain co2
57
metabolic acidosis
diarrhea
58
metabolic alkalosis
l/of fluids suction; vomit
59
pneumonia s/s (8)
- WBC
- fever
- crackles
- tachypnea
- tachycardia
- pleural pain
- resp distress
- decr. Breath sounds
60
pneumonia dx
- sputum
- xray
- wbc
- bronchoscopy
61
pneumonia tx
antibiotics
62
pneumonia Ix (6)
```
IS
TCDB
hydration
huff cough
O2
semifowlers
```
63
TB s/s (3)
- blood sputum
- night sweats
- weight loss
64
TB Dx (3)
- chest xray
- acid fast bacilli
- mantoux test= exposure
65
tb tx takes ___ to ___ months
6-12
66
TB meds
- Isoniazid
- rifampin
- pyrazinamide
- ethambutol
67
Rifampin need to know
TB med; orange body fluids, new birth control
68
all TB meds are ___ to the liver
toxic to the live; mo enzymes
69
asthma patho
allergen makes tons of mucous and blocks airway
70
asthma s/s (3)
- wheezing
- cough is the 1st sign on worsening or improvement!
- SOB
71
Asthma Tx (2)
- bronchodilators
| - corticosteroids (make sure pt rinses mouth)
72
COPD is caused by
emphysema and bronchitis
73
COPD patho
Air trapping in lungs, converts to CO2, pt stops breathing bc too much CO2
74
COPD s/s (3)
- tripod positioning
- barreled chest
- weight loss (wasting away)
75
COPD Ix (4)
- sm frq meals
- high cal
- pursed lip breathing
- O2
76
COPD education
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
what is oxygen toxicity?
decr. RR, resp distress, confusion, hallucinations, gets worse when increase O2, fatigue,
anxiety, restlessness, 6L & sleeping well
*Prevention by starting low O2
78
what is a sprain
injury to ligament
79
what is a strain
excessive stretch of muscle/tendon
80
RICE
rest, ice, compression, elevation
81
heat is used for musculoskeletal injuries after ___ hrs
48 hrs
82
ice is used in the first ___ hrs
24-48hrs
83
musculoskeletal injuries compression
30 min on 15 min off
84
elevation mist occur in the first ___ to ___ hrrs to reduce edema
24-48hrs
85
neurovascular checks; 6ps
```
pain
pallor
pulselessness
pressure
paresthesia
paralysis
```
86
fracture s/s (6)
```
continuous pain
muscle spasms
edema
deformity
crepitation
loss of function
```
87
fracture Ix (5)
- neuro checks
- elevate
- immobilize
- splinting
- open fractures cover w sterile dressing
88
fracture goals
maintain alignment and immobilize
89
What is bucks traction used for
Bucks traction (hip Fx) preop (prevents fat emboli)
90
bucks traction management (4)
- skin assessments
- trap bar to adjust and get up
- weights hang freely
- do not loosen traction/turn pt
91
skeletal traction is
prolonged traction
92
skeletal traction complications
infection
| immobility
93
skeletal traction skin care
clean crusts w qtip- aseptic
| serous fluid ok
94
what happens if a skeletal tractions pins come out?
cover and call dr
95
skeletal traction pts are at greater risk for
osteomyelitis
96
cast care
- dont stick anything inside
- cool setting blow dryer
- elevate
- assess for hot spots
97
compartment synd s/s
- 6ps poor
- pain doesnt go away w meds
CALL DR
98
Where does a fat emboli occur and when
long bones; 24-48hrs q injury
99
fat emboli s/s (5)
- petechiae on chest
- impending doom
- SOB
- decreased O2
- decreased H/H
100
osteomyelitis is a
bone infection
101
osteomyelitis rx (3)
- DM
- open fracture
- immunocompromise
102
osteomyelitis tx
long term IV antibiotics
103
what is osteomalacia
low vitamin d; soft bone
104
osteomalacia Ix
vit D, sunlight, Calcium, eat eggs, oily fish, meat,
105
osteoporosis is
weak bones, brittle, bone absorption exceeds deposition
106
osteoporosis rx (5)
- menopause
- old
- women
- smoke
- corticosteroids
107
osteoporosis s/s (2)
fractures easily
| kyphosis
108
osteoporosis dx
bone mineral density test
| tscore
109
osteoporosis Tx (3)
- bisphosphonates
- increase vit d
- weight bearing exercises
110
osteoarthritis is
degeneration of cartilage/ lrg joints
111
osteoarthritis s/s
- crepitation
- pain gets better w use
- asymmetrical
112
osteoarthritis Ix (6)
- exercise
- rest
- decreased weight
- splints
- heat
- ice packs
113
Rheumatoid arthritis is
autoimmune, gets better with use, affects smaller joints, symmetrical
114
RA s/s
- stiffness in am
- ulnar drift
- symmetrical
115
RA tx (4)
- NSAIDs
- methotrexate
- DMARDS
- steroids
116
Gout patho
purines create uric acid
117
Gout Tx
allopurinol
118
gout cx
kidney failure due to UA
119
HIV patho
HIV binds to CD4 cells all cells want to be like it
120
HIV Dx
ELOSIA HIV and syphilis
Western Blot Confirms HIV
WBC
CD4 count = progression
121
Normal CD4 count
500-1200
122
phases of HIV
```
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
Anaphylaxis is
coughing and closing of airway
124
anaphylaxis Ix
stop meds, assess airway and ensure patency, IV antihistamine to stop rejection, IV steroid, IV
epi, treat for shock
125
wbcs are low if less than
1500
126
pltlts are low if less than
150
127
3 causes of renal failure
- prerenal
- intrarenal
- postrenal
128
Prerenal is caused by
poor perfusion
- dehydration
- shock
- drop in BP
129
Intrarenal is caused by
in kidneys
- toxins
- infection
130
Postrenal is caused by
- obstruction
- UTI
- enlarged prostate
131
what is fluid vol overload
kidneys cant filter out NA+ and H2O
132
FVO Ix
- I&O
- fluid and NA+ restriction
- diuretics
- daily weights
133
renal comp: elevated wastes are
- increased BUN
- increased creatnine
- increased K+
- decreased Ca+
134
renal comp: horomone chngs
renin increases when bp drops
135
chronic renal failure is characterized as
3+ months, eGFR less than 60
136
fistula assessments (2)
- auscultate bruit
| - palpate for thrill- no obstruction shows patency
137
BPH is
enlarged prostate obstructs urinary flow
138
BPH tx
- flomax
| - TURP procedure; surgery to remove prostate
139
multiple sclerosis is
damage and scarring of myelin sheath; motor, speech, mem, sensory chngs
140
myasthenia gravis
acetycholine affected
141
GBS
ground to brain; reversible
142
ischemic stroke gets
TPA
143
hemorrhagic stroke
NO TPA
144
HTN is
>140/90
145
Right sided HF s/s (4)
peripheral, JVD, dependent edema, ascites
146
Left sided HF s/s (5)
lungs, dyspnea, cough, sob, crackles
147
PVD
lower leg edema, pulse present, sores with irregular borders, yellow slough or ruddy skin, sores
on ankles *ELEVATE legs*
148
PAD
intermittent claudication, round smooth sores, black eschar, sores on toes and feet **LOWER legs*
149
after an endoscopy the nurse must assess
GAG REFLEX
150
SIADH patho
overproduction of ADH – FV OVERLOAD
151
diabetes insipidus patho
low ADH – FV DEFICIT
152
ADH holds
fluid
153
pernicious anemia is
low vitamin B12; pt will have beefy tongue
154
norm hgb (pubertyyy)
12-17
| if low pt may have palpations, dyspnea
