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MED SURG EXAMS > exam 1 > Flashcards

exam 1 Flashcards

1
Q

urgency surgery

A

elective: rhinosplasty
urgent: 24-48hr to take action
emergent: go in NOW (blood clot)

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2
Q

approach surgery

A

simple: appendectomy
MIS: minimally invasive (laproscopy)
radical: extensive (tumor taken out of neck)

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3
Q

preoperative initiatives

A

antibiotic: AN HOUR BEFORE SURGERY prophylactic to prevent infection

no eating, fried and fatty food- 8hr prior
no other food 6hr prior
no fluids 2hrs prior
SURGEON DOES CONSENT

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4
Q

diagnostics pre surgery

A

24 in advance
EKG to check heart functions
NPO is nurses job

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5
Q

postoperative

A

FOCUS ON BREATHING
assess airway and gases q4h MINIMUM

every 15 mins for 1st hour
every 30 mins for next 2 hours
every one hour once stable

VITAL SIGNS every 15 mins
don’t ever assume good pulse ox is actually good

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6
Q

postoperative elimination

A

ASSESS ELIMINATION
urine output - <30ml/hr

need bowel movement - inspect and palpate abdomen to assess if it’s fat or distended stomach
auscultation 5-30 mins

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7
Q

tissue integrity surgery

A

assess tissue integrity every 8 hours

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8
Q

sanguineous

A

bloody drainage

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9
Q

serosanguineous

A

yellowish mixed with light red or pink

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10
Q

serous

A

normal drainage for the FIRST COUPLE DAYS ONLY

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11
Q

national pt safety goal

A
  1. have the correct procedure done on correct pt on correct body part
  2. marking correct site one pt
  3. pausing before surgery to make sure no mistakes are being made
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12
Q

complications of wound healing after surgery

A

redness,
swelling
tenseness
odorous drainage
indicates: SSI (surgical site infection)

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13
Q

wound dehiscence

A

partial or complete desperation or the outer wound layers
*most likely to occur w patients w diabetes, obesity, immune deficiency, malnutrition or pt w steroid use

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14
Q

wound evisceration

A

total separation of all wound layers and protrusions of internal organs through the wound
SURGICAL EMERGENCY CONTACT SURGEON

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15
Q

protective pain

A

muscle spasms bc of dehydration and heat

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16
Q

warning pain

A

headache bc if hypertension

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17
Q

response pain

A

injuries (torn ACL to due overuse

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18
Q

visceral pain

A

C FIBERS
gradual onset
dull pain
long duration
pancreatitis, inflammatory bowel, cancer
gut or organs issues

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19
Q

somatic pain

A

A FIBERS
burn
sunburn
fracture
skin, muscle bone and joint pain
short duration, sharp pain

superficial - throbbing
deep- aching

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20
Q

referred pain

A

C FIBER
pain isn’t due to troubled site
pain from pancreas is felt in the back

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21
Q

radiation pain

A

A & C fiber
starts in one place spreads to the other

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22
Q

psychogenic pain

A

working yourself up so much that pain occurs
-being so nervous you’re nauseous & stomach hurts

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23
Q

pain assessment

A

PQRST

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24
Q

single modal analgesia

A

one class of med used; NSAIDS

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25
multimodal analgesia
more than one med used acetaminophen and ibuprofen
26
preemptive analgesia
pre surgery meds
27
route of admin
oral preferred - cheaper, reversible, easier to use at home IV- immediate absorption, harder input, hard to use at home IM- delayed absorption
28
basal rate (pt controlled)
continuous infusion of med
29
breakthrough dosing (pt controlled)
supplemental dose of medication
30
hierarchy of pain measures
1. obtain self report 2. consider underlying pathology 3. observe behaviors 4. evaluate psychologic indicators 5. conduct analgesic trial ADVOCATE FOR PT PLAN
31
non opioid analgesics
acetaminophen and NSAIDS
32
opioid analgesic
morphine, hydrocodine etc
33
adjuvant analgesics
largest group of meds variety muscle relaxants, anticonvulsant, antidepressants
34
prevent opioid side effects
asses for constipation: asses bowel habits record BM mild laxative- NO BULK LAX encourage fluid intake sedation & respiratory distress
35
cognitive behavioral modalities
simple prayer relaxation breathing artwork reading watching tv complex mindfulness meditation hypnosis guided imagery biofeedback
36
preventing pressure injuries
determine risk level use braden scale use proven skin care bundle ensure nutrition consultation - fluids 2000-3000 ml/day costume lots of PROTEIN reduce pressure DO NOT KEEP HEAD OF BED ELEVATED MORE THAN 30 DEGREES - prevent shearing refrain from donut pillows, use foam on either side of bony prominences reposition a minimum of 2 hours
37
physiology of wound healing
inflammatory: 2-5 days proliferation: begins around the 4th day and lats 2-3 days maturation phase: begins as early as 3 weeks and lasts 1-2 years
38
braden scale
mild risk: 15-16 moderate risk: 12-14 severe risk: 11>
39
colostomy self management
asses GI status assess condition of stoma at least weekly assess peristomal skin assess the patients and families coping skills
40
analyze diagnostics with pero operative period
AIRWAY POTASSIUM LEVELS
41
partial thickness
epidermis and dermis
42
full thickness
subcutaneous tissue and fascia
43
wet to dry dressing
A saline-soaked gauze or cotton sponge is placed within a wound with exudate or drainage. As the dressing dries, it pulls exudate out of the wound.
44
wet to damp
the dressing should be damp when it is removed and causes less trauma to healing tissue than wet to dry
45
continuous wet gauze
wound surface is continually bathed with a wetting agent.
46
hyperpnea
abnormal increase in depth of respiratory movement
47
kussmal respiration
breathing pattern fast and deep metabolic acidosis
48
melena
blood in stool
49
oliguria
urine output of less than 400ml/day
50
azotemia
excess of nitrogenous waste in blood
51
uremia
accumulation of nitrogenous waste in blood as a result of renal failure nausea and vomiting
52
sodium levels
135-145 vital for muscle contraction nerve impulse transmission influencer water balance “where sodium goes, water flows”
53
HYPERnatremia
muscle twitching, decreased cardiac contractility significance: dehydration, kidney disease
54
potassium levels
3.5-5 excitable tissues
55
HYPERkalemia
palpitations, skipped heart beats, cardiac irregularities significance: kidney disease, dehydration, acidosis
56
HYPOnatremia
confusion muscle weakness vomiting seizures coma
57
HYPOkalemia
constipation fatigue severe muscle weakness low BP
58
magnesium levels
1.8-2.6 calms nerves important for metabolism and blood coagulation
59
calcium levels
9.0-10.5 muscles maintain bone strength
60
HYPOcalcemia
painful spams chvosket & trousseu
61
HYPERcalcemia
CV changes decreased HR decreased deep tendon reflexes ded creased peristalsis
62
stage 1 AKI
serum creatinine 1.5 or 1.9 urine output 0.5> ml/kg/hr for 6-12 hrs
63
stage 2 AKI
serum creatinine: 2.0-2.9 urine output: 0.5> for 12+ hr
64
stage 3
1.0 anuria lasting for 12+ hr
65
AKI metabolic
HYPERkalemia HYPOnatriemia & calcemia
66
AKI cardiopulmonary
heart failure pulmonary embolism HYPERtension myocardial infarction (think potassium is up so heart issues are increased)
67
AKI neurological
seizures mental status change (HYPERnatremia)
68
AKI immune
pneumonia sepsis
69
AKI gastro
nasuea vomiting decreased peristalsis malnutrition
70
AKI renal
CKD end stage kidney disease
71
labs for kidney disease
ACUTE INJURY increase of 1-2 every 24-48 hr increase 1-6 in 1 week or less serum sodium: decreases as AKI progresses serum potassium: increases serum calcium: decreases serum magnesium: typically increase hemoglobin: decreases hematocrit: decreases
72
uremia s/s
metallic taste in mouth anorexic nausea vomiting cramps edema dyspnea
73
CKD stage 1
at risk, normal kidney function, urine findings indicate disease >90 ml/min risk factors: uncontrolled HT, uncontrolled diabetes, UTI abnormalities, family history, exposure to nephrotoxic substances
74
CKD stage 2
slightly reduces function >60 ml/min
75
CKD stage 4
moderately reduces function 30-59 ml/min
76
CKD stage 4
serve reduced function jaundice 15-29 ml/min educate pt about options or prepare for renal replacement therapy
77
CKD stage 5
end stage kidney disease <15 ml/min lethargy coma seizures slurred speech ataxia asterixis
78
CKD cardio
cardiomyopathy HT heart failure edema
79
CKD respiratory
tachypnea kussmaul respiration depressed cough reflex shortness of breath
80
CKD hematelogic
decreases WBC count increased risk for infection abnormal bleeding or bruising - anemia
81
CKD gastro
anorexia nausea
82
CDK integumentary
decreased skin turgor yellow grey pallor dry skin soft tissue calcifications
83
musculoskeletal CKD
osteomalacia: softening of bones ostesis fibrosa: bone rebuilds not strong bone pain fractures weakness or cramping
84
CKD pharmacological
loop diuretics furosemide bumetanide NOT EFFECTIVE WITH ESKD output wanting to be 500-1000ml/24hr monitor for loss of potassium - can be desirable
85
vitamins CKD
use to prevent effects of hypocalcemia (gi) calcium acetate calcium carbonate noncalcium phosphate binders lanthuam carbonate sevelamer take drugs with meals to increase effectiveness take within 2 hours of other drugs to prevent inhibited absorption monitor calcium and phosphorus levels monitor for constipation monitor for slow pulse, weakness or confusion
86
vitamin b or multivitamin
folic acid b12 take after dialysis to prevent vitamin being flushed out take iron supplements with meals to reduce nasuea iron ferrous sulfate ferrous funarate ferrous gluconate iron IV iron dextran iron sucrose * DO NOT MIX W OTHER DRUGS* take stool softeners with iron iron supplements change color of stool
87
vitamin D
calcitrol monitor levels for calcium- can cause hypocalcemia can lead to toxicity calcium levels stay below 10mg/dl
88
ESA’s
used to correct anemia from kidney disease epoetin alfa darbepoetin alfa monitor hemoglobin levels watch for HTN watch for MI hemoglobin no higher than 10-11g/dl report immediately: chest pain, difficulty breathing, swelling of feet or ankles
89
parathyroid modulator
cincacalcet monitor calcium and phosphorus
90
AKI
hypovolemia decreased cardiac output decreased peripheral resistance decreased renal blood flow renal artery thrombosis
91
CAUSES AKI
lupus local infection hemolytic urine syndrome pharmaceuticals: NSAIDS, antibiotics, ACE inhibitors, chemo, contrast dye N: saids A: antibiotic A: ACE C: chemo C: contrast dye
92
CKD cause of death
most common: cardiovascular diseases too much fluid volume causes heart to get tired
93
isotonic iv
0.9% NaCL, LR & D5W - hypovolemia
94
hypotonic IV
0.45 NaCl & 0.34% NS treats hypernatremia!! & cellular dehydration
95
HANDS for IV
H- hygiene clean hands and gloves A- antisepsis N- No touching D- documentation: site dressing tubing S- Scrub the Hub: make sure hub is clean for 15 seconds w alcohol
96
Midline catheters
double or single lumen insert into upper arm vein (AC) 6-14 days
97
PICC
patients for more than 14 days chemo, antibiotics, do not use on paraplegics or ppl using crutches do not lift heavy objects with that arm
98
mom-tunneled CVC
subclavian or jugular vein in neck emergency or trauma short term trendelenburg position
99
tunneled CVC
used for paraplegics when PICC isn’t a good option needing special placement
100
ports
iv needed for more than a year chemo CANNOT SWIM
101
hemodialysis catheters
tunneled or non tunneled for short term needs
102
CVC preference spot
subclavian vein
103
colloids
solutions with larger particles that do not easily pass through vascular walls into cells colloids used when required for hypovolemia: albumin dextran plasmanate hetastarch
104
ecchomysis
vein bleeding out into the tissue

MED SURG EXAMS (1 decks)

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