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Med Surg I > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

elective surgery

A

doesn’t need to happen in 24-28 hours; LEAST amt of urgency

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2
Q

urgent surgery

A

needs to be done within 24-48 hours to survive

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3
Q

emergent surgery

A

needs to be done NOW to survive; EMERGENCY

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4
Q

when does preoperative care begin?

A

as soon as patient is scheduled for surgery

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5
Q

what is priority of preoperative care? (2 things)

A
  1. safety - getting to OR safely

2. education

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6
Q

strawberry-banana allergy hx could indicate allergy to what? (surgery item)

A

latex

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7
Q

a nut allergy could indicate allergy to which surgery item?

A

propofol

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8
Q

a shellfish allergy could indicate an allergy to which surgery/healthcare item?

A

betadine

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9
Q

why is family hx and anesthesia hx important for preop assessment?

A

this info can indicate risk of developing malignant hyperthermia

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10
Q

components of informed consent

A
  1. who is performing the surgery + who is attending
  2. what the surgery is
  3. why you’re having it
  4. where the site is
  5. risks + alternatives
  6. risks of anesthesia
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11
Q

when does the informed consent process take place

A

BEFORE sedation is given or incision

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12
Q

nurses role in informed consent

A
  1. ensure patient has been given it

2. witness their signature

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13
Q

uncontrolled HTN before surgery puts pts at a risk of what?

A

bleeding

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14
Q

SUD hx puts a surgery pt at risk of what?

A

CV event

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15
Q

high HR puts patient at risk of what during surgery?

A

increased metabolic rate (impacts anaesthesia)

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16
Q

smoking hx puts a surgery pt at risk of what?

A

atelectasis

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17
Q

which surgery team members are required to scrub up?

A
  1. surgeon
  2. surgeon asst
  3. scrub tech
  4. scrub nurse
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18
Q

describe “scrubbing up”

A

don mask, wash hands 3-5 minutes with surgical soap moving from fingers to elbows, dry with sterile towel, hold hands up and get help with gown + gloves

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19
Q

role of circulating nurse in OR

A

document, make sure things run as they should, assessing patient

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20
Q

role of circulating nurse in PACU

A

hand off report with surgeon/anaesthesia to PACU nurse

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21
Q

when is time out completed?

A

BEFORE INCISION

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22
Q

what are the components of a time out?

A
  1. right patient
  2. right procedure
  3. right site
  4. ABX 1 hr before (if applicable)
  5. imaging avail (if applicable)
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23
Q

when are “final counts” done?

A

before patient leaves OR

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24
Q

malignant hyperthermia early signs

A

decreased SpO2, increased end tidal CO2, tachycardia

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25
Q

late signs of malignant hyperthermia

A

muscle rigidity, 108* temp, coke colored urine, HYPOtension

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26
Q

what is most sensitive indicator of malignant hyperthermia

A

end tidal CO2

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27
Q

tx for malignant hyperthermia

A

dantrolene

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28
Q

priority in post-op

A

airway management - ABCs!

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29
Q

what are you looking for in phase 2 of post op care?

A

pre-surgery level of alertness

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30
Q

what is the aldrete scale? what score is required for discharge?

A

scale that measures patient’s ability to manage their airway

9-10 needed for discharge

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31
Q

what is the aldrete scale assessing?

A

respirations, O2 sat, mobility, LOC, circulation

think, all major body systems

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32
Q

if a patient cannot protect their airway in PACU, what are your priorities?

A

side lying + give antiemetics

=prevent aspiration

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33
Q

snoring in the PACU, what would you do?

A

SAM: simple airway maneuver

head tilt/chin lift

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34
Q

what is happening with pneumonia? (PNA)

A

excess fluid in lungs = impaired gas exchange

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35
Q

pneumonia can be caused by what?

A
  1. infectious agent
    OR
  2. irritant
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36
Q

if pneumonia infection is caused by an infectious agent, what manifestation will you see

A

exudate

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37
Q

risk factors for pneumonia

A
  • age
  • dysphagia
  • ventilator use
  • vaccine status
  • influenza infection
  • comorbidities
  • smoking
  • respiratory illnesses
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38
Q

what is the most common cause of sepsis?

A

pneumonia

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39
Q

what is the most common type of pneumonia?

A

community acquired pneumonia

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40
Q

healthcare acquired pneumonia defined as…..

A

no dx on admission; develops 2 days after admission

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41
Q

best prevention for pneumonia; name some others too

A

vaccination ***

avoid crowds, ambulation, hydration, IS use

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42
Q

what is the protocol for pneumonia vaccination?

A

prevnar 13 1st –> 1 year later pneumovax 23

65+ yrs old

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43
Q

s+s of pneumonia

A
  • reproducible chest pain
  • tachycardia
  • dyspnea
  • crackles
  • hypoxia
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44
Q

ventilated patients should have which 3 interventions?

A
  1. elevate HOB 30*
  2. oral care q2hr
  3. PUD prophylaxis (prevent aspiration)
45
Q

influenza precautions =

A

DROPLET - surgical mask, eye protection

46
Q

s+s of influenza

A

rapid onset of fever, malaise, HA, sore throat

47
Q

best strategy to prevent influenza

A

vaccination

48
Q

interventions for influenza are mainly ___________

A

SUPPORTIVE

rest and fluids

49
Q

antivirals for influenza must be given within what time frame?

A

24-48hrs of symptom onset

50
Q

how long are adults contagious with influenza? when can they return to work? how long are kids contagious with influenza?

A

adults: 5-7 days
return: 24 hours fever free
kids: 7 days

51
Q

biggest contributor to COPD

A

smoking (20 pack year history = COPD)

52
Q

emphysema =

A

hyperinflation of lungs / air trapping

53
Q

chronic bronchitis =

A

chronic inflammation of bronchi and bronchioles

54
Q

patho of emphysema

A

proteases are breaking down elastin in lungs –> hyperinflation (cannot exhale well)

of alveoli DECREASES + they become large/flabby

55
Q

overall, what happens with emphysema

A

decreased gas exchange

CO2 retention

56
Q

overall, what happens with chronic bronchitis

A

decreased gas exchange

impaired airflow

57
Q

patho of chronic bronchitis

A

irritant –> inflammation –> mucus production –> bronchospasm (smooth muscle tightens)

58
Q

due to the increased amount of mucus, what is common with chronic bronchitis

A

infection

59
Q

what is alpha1 antitrypsin? what happens when there’s a deficiency?

A

AAT prevents protease activity, so it protects the airway from damage

a deficiency in this is a genetic disorder that puts a person at risk of developing COPD

both alleles have it….COPD @ young age

60
Q

overall, COPD results in……

A

decreased O2 and increased CO2

impaired gas exchange

61
Q

re: ABG’s, a person with chronic lung disease will show what type of values?

pH ?
CO2 ?
O2 ?
HCO3 ?

A

pH: normal (their body has compensated)
CO2: high (retaining)
O2: low
HCO3: high (compensating)

we know it’s abnormal if the pH changes

62
Q

complication of COPD regarding the heart

A

cor pulmonale: type of R sided HF b/c of the pressure to pump blood into pulmonary system. R side of heart works extra hard –> hypertrophy of R ventricle

63
Q

assessment findings of COPD

A
  • adventitious lung sounds (wheeze, crackles, diminished, rhonchi)
  • fatigue
  • barrel chest
  • tachycardia
  • tachypnea
  • increased work to breathe
  • tripod position
  • weight changes
64
Q

re: COPD, difficulty with ADL’s is a sign of what?

A

disease progression :(

65
Q

re: COPD, what would you see with H+H levels?

A

increased… to compensate for low oxygen –> make more RBCs

66
Q

what is the standard for diagnosing COPD?

A

pulmonary function test

67
Q

what is forced expiratory volume?

A

volume of air pushed out in 1st second of exhale

68
Q

re: gold classification, what is level 1

A

mild (80% of lung function)

69
Q

re: gold classification, what is level 2

A

moderate (50-80% lung function)

70
Q

re: gold classification, what is level 3

A

severe (30-50% lung function)

71
Q

re: gold classification, what is level 4

A

very severe (<30% lung function) - END STAGE COPD / end of life

72
Q

priority interventions for COPD (2)

A

positioning (elevate HOB)

administer O2

73
Q

pursed lip breathing helps with what?

A

COPD + air trapping - resistance helps to push air OUT!

74
Q

what SpO2 do we want to keep COPD patients at?

A

range of 88-92%

75
Q

what type of nutritional requirements would you see with a pt with COPD

A
  • increased calories + protein
  • avoid carbs (produces most CO2)
  • small, frequent meals
  • premedicate before eating
76
Q

asthma is caused by: (2 things) + the patho of each

A
  1. hypersensitivity: bronchospasms (smooth muscle around airway tightening)
  2. inflammation: swelling of airway + production of mucus
77
Q

overtime, with repeated asthma attacks, what will happen with the airway?

A

irreversible damage to airway

78
Q

common + unique triggers for asthma

A
  1. NSAIDs
  2. ASA
  3. GERD
79
Q

4 hallmark signs of asthma

A
  1. wheezing
  2. SHOB
  3. coughing
  4. chest tightness
80
Q

what clinical manifestation can we see with severe, long term asthma

A

barrel chest (b/c of flattened diaphragm)

81
Q

with early asthma attack, what would you see with ABG?

A

respiratory alkalosis (hyperventilation)

82
Q

with late asthma attack, what would you see with ABG?

A

respiratory acidosis (inflammation has gotten so back, they can’t push air out and holding onto CO2)

83
Q

diagnosis for asthma is done with what? what are the parameters?

A

pulmonary function test

if the peak expiratory volume or peak expiratory flow rate is 15-20% below normal value
AND
you administer a bronchodilator + there’s a 12% increase in PEV + PEFR….. likely they have asthma

84
Q

re: asthma, the methacholine test tells us what?

A

person who has hypersensitivity component of asthma will be sensitive to this test –> bronchospasms

85
Q

goal of asthma tx:

A

PREVENTION!!!

86
Q

describe a personal asthma action plan

A

goals:
-reduce severity of attacks
-increase symptom free times
self assessment:
-diary of triggers/times/attacks
-PFM testing
-meds
-when to call provider
-when to get HELP!

87
Q

describe the steps to use a peak flow meter (1st time and thereafter)

A
  1. establish personal best (baseline): when symptoms are controlled. 2x daily for 2-3 weeks
  2. test 2x daily + compare
88
Q

what is goal for PFM testing

A

to be within 80-100% of personal best (baseline)

89
Q

re: PFM (peak flow meter) testing, what is protocol if you are at 50-80% of baseline?

A

administer rescue med + try again

90
Q

re: PFM (peak flow meter) testing, what is protocol if you are at <50% of baseline?

A

administer rescue med + GET HELP!!!

91
Q

re: PFM (peak flow meter) testing, if you have repeated measurements at 50-80% of baseline, what is protocol?

A

talk with provider + adjust meds

92
Q

interventions for status asthmaticus

A
  1. high fowlers
  2. administer O2
  3. rescue med
  4. IV steroid
  5. epi
93
Q

TB requires which precautions?

A

AIRBORNE - N95, negative pressure, isolation room, patient wears mask in public

94
Q

which type of TB infection is more common?

A

latent

95
Q

how long after initial TB infection does cell-mediated immunity develop?

A

2-12 weeks after exposure

96
Q

risk factors for TB

A
  • exposure
  • crowded living situations
  • marginalized
  • immunocompromised
  • SUD
  • country of origin/immigrant
  • travel to country where TB is prevalent
97
Q

PPD test is not appropriate for people who:

A
  • are vaccinated
  • had a recent PPD test
  • are severely immunocompromised (cannot mount immune response required for test)
98
Q

S+S of TB

A
  • night sweats
  • fatigue
  • weight loss
  • productive cough
99
Q

what is the most important aspect of the psychosocial assessment for a person with TB?

A

their ability to adhere to their medication regimen

support + resources

100
Q

an effective mantoux (PPD) test for TB requires patient to have what?

A

intact immune system

101
Q

a positive result on the PPD test indicates what?

A

that they’ve been exposed to TB and have experienced an immune response

102
Q

PPD test results:

___: general public no risk factors

A

> 15mm

103
Q

PPD test results:

___: exposure to TB (HCW), living in LTCF, SNF

A

> 10mm

104
Q

PPD test results:

___: immunocompromised (HIV) or recent exposure to person with active TB

A

> 5mm

105
Q

gold standard for TB screening

A

quantiferon gold blood test

106
Q

definitive test for TB diagnosis

A

sputum culture

107
Q

parameters for sputum culture after tx to be considered noninfectious

A

3 consecutive negative sputum cultures

108
Q

interventions for TB (2)

A
  1. positioning - elevate HOB

2. administer O2

109
Q

people with TB should limit intake of _____ b/c of drug-drug interactions

A

ETOH

Med Surg I (6 decks)

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