Exam 1 Flashcards
elective surgery
doesn’t need to happen in 24-28 hours; LEAST amt of urgency
urgent surgery
needs to be done within 24-48 hours to survive
emergent surgery
needs to be done NOW to survive; EMERGENCY
when does preoperative care begin?
as soon as patient is scheduled for surgery
what is priority of preoperative care? (2 things)
- safety - getting to OR safely
2. education
strawberry-banana allergy hx could indicate allergy to what? (surgery item)
latex
a nut allergy could indicate allergy to which surgery item?
propofol
a shellfish allergy could indicate an allergy to which surgery/healthcare item?
betadine
why is family hx and anesthesia hx important for preop assessment?
this info can indicate risk of developing malignant hyperthermia
components of informed consent
- who is performing the surgery + who is attending
- what the surgery is
- why you’re having it
- where the site is
- risks + alternatives
- risks of anesthesia
when does the informed consent process take place
BEFORE sedation is given or incision
nurses role in informed consent
- ensure patient has been given it
2. witness their signature
uncontrolled HTN before surgery puts pts at a risk of what?
bleeding
SUD hx puts a surgery pt at risk of what?
CV event
high HR puts patient at risk of what during surgery?
increased metabolic rate (impacts anaesthesia)
smoking hx puts a surgery pt at risk of what?
atelectasis
which surgery team members are required to scrub up?
- surgeon
- surgeon asst
- scrub tech
- scrub nurse
describe “scrubbing up”
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
role of circulating nurse in OR
document, make sure things run as they should, assessing patient
role of circulating nurse in PACU
hand off report with surgeon/anaesthesia to PACU nurse
when is time out completed?
BEFORE INCISION
what are the components of a time out?
- right patient
- right procedure
- right site
- ABX 1 hr before (if applicable)
- imaging avail (if applicable)
when are “final counts” done?
before patient leaves OR
malignant hyperthermia early signs
decreased SpO2, increased end tidal CO2, tachycardia
late signs of malignant hyperthermia
muscle rigidity, 108* temp, coke colored urine, HYPOtension
what is most sensitive indicator of malignant hyperthermia
end tidal CO2
tx for malignant hyperthermia
dantrolene
priority in post-op
airway management - ABCs!
what are you looking for in phase 2 of post op care?
pre-surgery level of alertness
what is the aldrete scale? what score is required for discharge?
scale that measures patient’s ability to manage their airway
9-10 needed for discharge
what is the aldrete scale assessing?
respirations, O2 sat, mobility, LOC, circulation
think, all major body systems
if a patient cannot protect their airway in PACU, what are your priorities?
side lying + give antiemetics
=prevent aspiration
snoring in the PACU, what would you do?
SAM: simple airway maneuver
head tilt/chin lift
what is happening with pneumonia? (PNA)
excess fluid in lungs = impaired gas exchange
pneumonia can be caused by what?
- infectious agent
OR - irritant
if pneumonia infection is caused by an infectious agent, what manifestation will you see
exudate
risk factors for pneumonia
- age
- dysphagia
- ventilator use
- vaccine status
- influenza infection
- comorbidities
- smoking
- respiratory illnesses
what is the most common cause of sepsis?
pneumonia
what is the most common type of pneumonia?
community acquired pneumonia
healthcare acquired pneumonia defined as…..
no dx on admission; develops 2 days after admission
best prevention for pneumonia; name some others too
vaccination ***
avoid crowds, ambulation, hydration, IS use
what is the protocol for pneumonia vaccination?
prevnar 13 1st –> 1 year later pneumovax 23
65+ yrs old
s+s of pneumonia
- reproducible chest pain
- tachycardia
- dyspnea
- crackles
- hypoxia
ventilated patients should have which 3 interventions?
- elevate HOB 30*
- oral care q2hr
- PUD prophylaxis (prevent aspiration)
influenza precautions =
DROPLET - surgical mask, eye protection
s+s of influenza
rapid onset of fever, malaise, HA, sore throat
best strategy to prevent influenza
vaccination
interventions for influenza are mainly ___________
SUPPORTIVE
rest and fluids
antivirals for influenza must be given within what time frame?
24-48hrs of symptom onset
how long are adults contagious with influenza? when can they return to work? how long are kids contagious with influenza?
adults: 5-7 days
return: 24 hours fever free
kids: 7 days
biggest contributor to COPD
smoking (20 pack year history = COPD)
emphysema =
hyperinflation of lungs / air trapping
chronic bronchitis =
chronic inflammation of bronchi and bronchioles
patho of emphysema
proteases are breaking down elastin in lungs –> hyperinflation (cannot exhale well)
of alveoli DECREASES + they become large/flabby
overall, what happens with emphysema
decreased gas exchange
CO2 retention
overall, what happens with chronic bronchitis
decreased gas exchange
impaired airflow
patho of chronic bronchitis
irritant –> inflammation –> mucus production –> bronchospasm (smooth muscle tightens)
due to the increased amount of mucus, what is common with chronic bronchitis
infection
what is alpha1 antitrypsin? what happens when there’s a deficiency?
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
overall, COPD results in……
decreased O2 and increased CO2
impaired gas exchange
re: ABG’s, a person with chronic lung disease will show what type of values?
pH ?
CO2 ?
O2 ?
HCO3 ?
pH: normal (their body has compensated)
CO2: high (retaining)
O2: low
HCO3: high (compensating)
we know it’s abnormal if the pH changes
complication of COPD regarding the heart
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
assessment findings of COPD
- adventitious lung sounds (wheeze, crackles, diminished, rhonchi)
- fatigue
- barrel chest
- tachycardia
- tachypnea
- increased work to breathe
- tripod position
- weight changes
re: COPD, difficulty with ADL’s is a sign of what?
disease progression :(
re: COPD, what would you see with H+H levels?
increased… to compensate for low oxygen –> make more RBCs
what is the standard for diagnosing COPD?
pulmonary function test
what is forced expiratory volume?
volume of air pushed out in 1st second of exhale
re: gold classification, what is level 1
mild (80% of lung function)
re: gold classification, what is level 2
moderate (50-80% lung function)
re: gold classification, what is level 3
severe (30-50% lung function)
re: gold classification, what is level 4
very severe (<30% lung function) - END STAGE COPD / end of life
priority interventions for COPD (2)
positioning (elevate HOB)
administer O2
pursed lip breathing helps with what?
COPD + air trapping - resistance helps to push air OUT!
what SpO2 do we want to keep COPD patients at?
range of 88-92%
what type of nutritional requirements would you see with a pt with COPD
- increased calories + protein
- avoid carbs (produces most CO2)
- small, frequent meals
- premedicate before eating
asthma is caused by: (2 things) + the patho of each
- hypersensitivity: bronchospasms (smooth muscle around airway tightening)
- inflammation: swelling of airway + production of mucus
overtime, with repeated asthma attacks, what will happen with the airway?
irreversible damage to airway
common + unique triggers for asthma
- NSAIDs
- ASA
- GERD
4 hallmark signs of asthma
- wheezing
- SHOB
- coughing
- chest tightness
what clinical manifestation can we see with severe, long term asthma
barrel chest (b/c of flattened diaphragm)
with early asthma attack, what would you see with ABG?
respiratory alkalosis (hyperventilation)
with late asthma attack, what would you see with ABG?
respiratory acidosis (inflammation has gotten so back, they can’t push air out and holding onto CO2)
diagnosis for asthma is done with what? what are the parameters?
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
re: asthma, the methacholine test tells us what?
person who has hypersensitivity component of asthma will be sensitive to this test –> bronchospasms
goal of asthma tx:
PREVENTION!!!
describe a personal asthma action plan
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!
describe the steps to use a peak flow meter (1st time and thereafter)
- establish personal best (baseline): when symptoms are controlled. 2x daily for 2-3 weeks
- test 2x daily + compare
what is goal for PFM testing
to be within 80-100% of personal best (baseline)
re: PFM (peak flow meter) testing, what is protocol if you are at 50-80% of baseline?
administer rescue med + try again
re: PFM (peak flow meter) testing, what is protocol if you are at <50% of baseline?
administer rescue med + GET HELP!!!
re: PFM (peak flow meter) testing, if you have repeated measurements at 50-80% of baseline, what is protocol?
talk with provider + adjust meds
interventions for status asthmaticus
- high fowlers
- administer O2
- rescue med
- IV steroid
- epi
TB requires which precautions?
AIRBORNE - N95, negative pressure, isolation room, patient wears mask in public
which type of TB infection is more common?
latent
how long after initial TB infection does cell-mediated immunity develop?
2-12 weeks after exposure
risk factors for TB
- exposure
- crowded living situations
- marginalized
- immunocompromised
- SUD
- country of origin/immigrant
- travel to country where TB is prevalent
PPD test is not appropriate for people who:
- are vaccinated
- had a recent PPD test
- are severely immunocompromised (cannot mount immune response required for test)
S+S of TB
- night sweats
- fatigue
- weight loss
- productive cough
what is the most important aspect of the psychosocial assessment for a person with TB?
their ability to adhere to their medication regimen
support + resources
an effective mantoux (PPD) test for TB requires patient to have what?
intact immune system
a positive result on the PPD test indicates what?
that they’ve been exposed to TB and have experienced an immune response
PPD test results:
___: general public no risk factors
> 15mm
PPD test results:
___: exposure to TB (HCW), living in LTCF, SNF
> 10mm
PPD test results:
___: immunocompromised (HIV) or recent exposure to person with active TB
> 5mm
gold standard for TB screening
quantiferon gold blood test
definitive test for TB diagnosis
sputum culture
parameters for sputum culture after tx to be considered noninfectious
3 consecutive negative sputum cultures
interventions for TB (2)
- positioning - elevate HOB
2. administer O2
people with TB should limit intake of _____ b/c of drug-drug interactions
ETOH
