exam 1 Flashcards
urgency surgery
elective: rhinosplasty
urgent: 24-48hr to take action
emergent: go in NOW (blood clot)
approach surgery
simple: appendectomy
MIS: minimally invasive (laproscopy)
radical: extensive (tumor taken out of neck)
preoperative initiatives
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
diagnostics pre surgery
24 in advance
EKG to check heart functions
NPO is nurses job
postoperative
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
postoperative elimination
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
tissue integrity surgery
assess tissue integrity every 8 hours
sanguineous
bloody drainage
serosanguineous
yellowish mixed with light red or pink
serous
normal drainage for the FIRST COUPLE DAYS ONLY
national pt safety goal
- have the correct procedure done on correct pt on correct body part
- marking correct site one pt
- pausing before surgery to make sure no mistakes are being made
complications of wound healing after surgery
redness,
swelling
tenseness
odorous drainage
indicates: SSI (surgical site infection)
wound dehiscence
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
wound evisceration
total separation of all wound layers and protrusions of internal organs through the wound
SURGICAL EMERGENCY CONTACT SURGEON
protective pain
muscle spasms bc of dehydration and heat
warning pain
headache bc if hypertension
response pain
injuries (torn ACL to due overuse
visceral pain
C FIBERS
gradual onset
dull pain
long duration
pancreatitis, inflammatory bowel, cancer
gut or organs issues
somatic pain
A FIBERS
burn
sunburn
fracture
skin, muscle bone and joint pain
short duration, sharp pain
superficial - throbbing
deep- aching
referred pain
C FIBER
pain isn’t due to troubled site
pain from pancreas is felt in the back
radiation pain
A & C fiber
starts in one place spreads to the other
psychogenic pain
working yourself up so much that pain occurs
-being so nervous you’re nauseous & stomach hurts
pain assessment
PQRST
single modal analgesia
one class of med used; NSAIDS
multimodal analgesia
more than one med used
acetaminophen and ibuprofen
preemptive analgesia
pre surgery meds
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
basal rate (pt controlled)
continuous infusion of med
breakthrough dosing (pt controlled)
supplemental dose of medication
hierarchy of pain measures
- obtain self report
- consider underlying pathology
- observe behaviors
- evaluate psychologic indicators
- conduct analgesic trial
ADVOCATE FOR PT PLAN
non opioid analgesics
acetaminophen and NSAIDS
opioid analgesic
morphine, hydrocodine etc
adjuvant analgesics
largest group of meds
variety
muscle relaxants, anticonvulsant, antidepressants
prevent opioid side effects
asses for constipation:
asses bowel habits
record BM
mild laxative- NO BULK LAX
encourage fluid intake
sedation & respiratory distress
cognitive behavioral modalities
simple
prayer
relaxation breathing
artwork
reading
watching tv
complex
mindfulness
meditation
hypnosis
guided imagery
biofeedback
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
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
braden scale
mild risk: 15-16
moderate risk: 12-14
severe risk: 11>
colostomy self management
asses GI status
assess condition of stoma at least weekly
assess peristomal skin
assess the patients and families coping skills
analyze diagnostics with pero operative period
AIRWAY
POTASSIUM LEVELS
partial thickness
epidermis and dermis
full thickness
subcutaneous tissue and fascia
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.
wet to damp
the dressing should be damp when it is removed and causes less trauma to healing tissue than wet to dry
continuous wet gauze
wound surface is continually bathed with a wetting agent.
hyperpnea
abnormal increase in depth of respiratory movement
kussmal respiration
breathing pattern
fast and deep
metabolic acidosis
melena
blood in stool
oliguria
urine output of less than 400ml/day
azotemia
excess of nitrogenous waste in blood
uremia
accumulation of nitrogenous waste in blood as a result of renal failure
nausea and vomiting
sodium levels
135-145
vital for muscle contraction
nerve impulse transmission
influencer water balance
“where sodium goes, water flows”
HYPERnatremia
muscle twitching, decreased cardiac contractility
significance: dehydration, kidney disease
potassium levels
3.5-5
excitable tissues
HYPERkalemia
palpitations, skipped heart beats, cardiac irregularities
significance: kidney disease, dehydration, acidosis
HYPOnatremia
confusion
muscle weakness
vomiting
seizures
coma
HYPOkalemia
constipation
fatigue
severe muscle weakness
low BP
magnesium levels
1.8-2.6
calms nerves
important for metabolism and blood coagulation
calcium levels
9.0-10.5
muscles
maintain bone strength
HYPOcalcemia
painful spams
chvosket & trousseu
HYPERcalcemia
CV changes
decreased HR
decreased deep tendon reflexes
ded creased peristalsis
stage 1 AKI
serum creatinine
1.5 or 1.9
urine output
0.5> ml/kg/hr for 6-12 hrs
stage 2 AKI
serum creatinine: 2.0-2.9
urine output: 0.5> for 12+ hr
stage 3
1.0
anuria lasting for 12+ hr
AKI metabolic
HYPERkalemia
HYPOnatriemia & calcemia
AKI cardiopulmonary
heart failure
pulmonary embolism
HYPERtension
myocardial infarction
(think potassium is up so heart issues are increased)
AKI neurological
seizures
mental status change (HYPERnatremia)
AKI immune
pneumonia
sepsis
AKI gastro
nasuea
vomiting
decreased peristalsis
malnutrition
AKI renal
CKD
end stage kidney disease
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
uremia s/s
metallic taste in mouth
anorexic
nausea
vomiting
cramps
edema
dyspnea
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
CKD stage 2
slightly reduces function
>60 ml/min
CKD stage 4
moderately reduces function
30-59 ml/min
CKD stage 4
serve reduced function
jaundice
15-29 ml/min
educate pt about options or prepare for renal replacement therapy
CKD stage 5
end stage kidney disease <15 ml/min
lethargy
coma
seizures
slurred speech
ataxia
asterixis
CKD cardio
cardiomyopathy
HT
heart failure
edema
CKD respiratory
tachypnea
kussmaul respiration
depressed cough reflex
shortness of breath
CKD hematelogic
decreases WBC count
increased risk for infection
abnormal bleeding or bruising - anemia
CKD gastro
anorexia
nausea
CDK integumentary
decreased skin turgor
yellow grey pallor
dry skin
soft tissue calcifications
musculoskeletal CKD
osteomalacia: softening of bones
ostesis fibrosa: bone rebuilds not strong
bone pain
fractures
weakness or cramping
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
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
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
vitamin D
calcitrol
monitor levels for calcium- can cause hypocalcemia
can lead to toxicity
calcium levels stay below 10mg/dl
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
parathyroid modulator
cincacalcet
monitor calcium and phosphorus
AKI
hypovolemia
decreased cardiac output
decreased peripheral resistance
decreased renal blood flow
renal artery thrombosis
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
CKD cause of death
most common: cardiovascular diseases
too much fluid volume causes heart to get tired
isotonic iv
0.9% NaCL, LR & D5W - hypovolemia
hypotonic IV
0.45 NaCl & 0.34% NS
treats hypernatremia!! & cellular dehydration
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
Midline catheters
double or single lumen
insert into upper arm vein (AC)
6-14 days
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
mom-tunneled CVC
subclavian or jugular vein in neck
emergency or trauma
short term
trendelenburg position
tunneled CVC
used for paraplegics
when PICC isn’t a good option
needing special placement
ports
iv needed for more than a year
chemo
CANNOT SWIM
hemodialysis catheters
tunneled or non tunneled for short term needs
CVC preference spot
subclavian vein
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
ecchomysis
vein bleeding out into the tissue
