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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
Q

multimodal analgesia

A

more than one med used
acetaminophen and ibuprofen

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26
Q

preemptive analgesia

A

pre surgery meds

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27
Q

route of admin

A

oral preferred - cheaper, reversible, easier to use at home
IV- immediate absorption, harder input, hard to use at home
IM- delayed absorption

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28
Q

basal rate (pt controlled)

A

continuous infusion of med

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29
Q

breakthrough dosing (pt controlled)

A

supplemental dose of medication

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30
Q

hierarchy of pain measures

A
  1. obtain self report
  2. consider underlying pathology
  3. observe behaviors
  4. evaluate psychologic indicators
  5. conduct analgesic trial
    ADVOCATE FOR PT PLAN
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31
Q

non opioid analgesics

A

acetaminophen and NSAIDS

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32
Q

opioid analgesic

A

morphine, hydrocodine etc

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33
Q

adjuvant analgesics

A

largest group of meds
variety
muscle relaxants, anticonvulsant, antidepressants

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34
Q

prevent opioid side effects

A

asses for constipation:
asses bowel habits
record BM
mild laxative- NO BULK LAX
encourage fluid intake

sedation & respiratory distress

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35
Q

cognitive behavioral modalities

A

simple
prayer
relaxation breathing
artwork
reading
watching tv

complex
mindfulness
meditation
hypnosis
guided imagery
biofeedback

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36
Q

preventing pressure injuries

A

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

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37
Q

physiology of wound healing

A

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

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38
Q

braden scale

A

mild risk: 15-16

moderate risk: 12-14

severe risk: 11>

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39
Q

colostomy self management

A

asses GI status

assess condition of stoma at least weekly

assess peristomal skin

assess the patients and families coping skills

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40
Q

analyze diagnostics with pero operative period

A

AIRWAY
POTASSIUM LEVELS

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41
Q

partial thickness

A

epidermis and dermis

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42
Q

full thickness

A

subcutaneous tissue and fascia

43
Q

wet to dry dressing

A

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
Q

wet to damp

A

the dressing should be damp when it is removed and causes less trauma to healing tissue than wet to dry

45
Q

continuous wet gauze

A

wound surface is continually bathed with a wetting agent.

46
Q

hyperpnea

A

abnormal increase in depth of respiratory movement

47
Q

kussmal respiration

A

breathing pattern
fast and deep
metabolic acidosis

48
Q

melena

A

blood in stool

49
Q

oliguria

A

urine output of less than 400ml/day

50
Q

azotemia

A

excess of nitrogenous waste in blood

51
Q

uremia

A

accumulation of nitrogenous waste in blood as a result of renal failure
nausea and vomiting

52
Q

sodium levels

A

135-145
vital for muscle contraction
nerve impulse transmission
influencer water balance
“where sodium goes, water flows”

53
Q

HYPERnatremia

A

muscle twitching, decreased cardiac contractility

significance: dehydration, kidney disease

54
Q

potassium levels

A

3.5-5
excitable tissues

55
Q

HYPERkalemia

A

palpitations, skipped heart beats, cardiac irregularities

significance: kidney disease, dehydration, acidosis

56
Q

HYPOnatremia

A

confusion
muscle weakness
vomiting
seizures
coma

57
Q

HYPOkalemia

A

constipation
fatigue
severe muscle weakness
low BP

58
Q

magnesium levels

A

1.8-2.6
calms nerves
important for metabolism and blood coagulation

59
Q

calcium levels

A

9.0-10.5
muscles
maintain bone strength

60
Q

HYPOcalcemia

A

painful spams
chvosket & trousseu

61
Q

HYPERcalcemia

A

CV changes
decreased HR
decreased deep tendon reflexes
ded creased peristalsis

62
Q

stage 1 AKI

A

serum creatinine
1.5 or 1.9
urine output
0.5> ml/kg/hr for 6-12 hrs

63
Q

stage 2 AKI

A

serum creatinine: 2.0-2.9
urine output: 0.5> for 12+ hr

64
Q

stage 3

A

1.0

anuria lasting for 12+ hr

65
Q

AKI metabolic

A

HYPERkalemia
HYPOnatriemia & calcemia

66
Q

AKI cardiopulmonary

A

heart failure
pulmonary embolism
HYPERtension
myocardial infarction

(think potassium is up so heart issues are increased)

67
Q

AKI neurological

A

seizures
mental status change (HYPERnatremia)

68
Q

AKI immune

A

pneumonia
sepsis

69
Q

AKI gastro

A

nasuea
vomiting
decreased peristalsis
malnutrition

70
Q

AKI renal

A

CKD
end stage kidney disease

71
Q

labs for kidney disease

A

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
Q

uremia s/s

A

metallic taste in mouth
anorexic
nausea
vomiting
cramps
edema
dyspnea

73
Q

CKD stage 1

A

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
Q

CKD stage 2

A

slightly reduces function
>60 ml/min

75
Q

CKD stage 4

A

moderately reduces function
30-59 ml/min

76
Q

CKD stage 4

A

serve reduced function
jaundice
15-29 ml/min
educate pt about options or prepare for renal replacement therapy

77
Q

CKD stage 5

A

end stage kidney disease <15 ml/min

lethargy
coma
seizures
slurred speech
ataxia
asterixis

78
Q

CKD cardio

A

cardiomyopathy
HT
heart failure
edema

79
Q

CKD respiratory

A

tachypnea
kussmaul respiration
depressed cough reflex
shortness of breath

80
Q

CKD hematelogic

A

decreases WBC count
increased risk for infection
abnormal bleeding or bruising - anemia

81
Q

CKD gastro

A

anorexia
nausea

82
Q

CDK integumentary

A

decreased skin turgor
yellow grey pallor
dry skin
soft tissue calcifications

83
Q

musculoskeletal CKD

A

osteomalacia: softening of bones
ostesis fibrosa: bone rebuilds not strong

bone pain
fractures
weakness or cramping

84
Q

CKD pharmacological

A

loop diuretics
furosemide
bumetanide
NOT EFFECTIVE WITH ESKD

output wanting to be 500-1000ml/24hr

monitor for loss of potassium - can be desirable

85
Q

vitamins CKD

A

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
Q

vitamin b or multivitamin

A

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
Q

vitamin D

A

calcitrol

monitor levels for calcium- can cause hypocalcemia

can lead to toxicity
calcium levels stay below 10mg/dl

88
Q

ESA’s

A

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
Q

parathyroid modulator

A

cincacalcet
monitor calcium and phosphorus

90
Q

AKI

A

hypovolemia
decreased cardiac output
decreased peripheral resistance
decreased renal blood flow
renal artery thrombosis

91
Q

CAUSES AKI

A

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
Q

CKD cause of death

A

most common: cardiovascular diseases
too much fluid volume causes heart to get tired

93
Q

isotonic iv

A

0.9% NaCL, LR & D5W - hypovolemia

94
Q

hypotonic IV

A

0.45 NaCl & 0.34% NS
treats hypernatremia!! & cellular dehydration

95
Q

HANDS for IV

A

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
Q

Midline catheters

A

double or single lumen
insert into upper arm vein (AC)
6-14 days

97
Q

PICC

A

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
Q

mom-tunneled CVC

A

subclavian or jugular vein in neck
emergency or trauma
short term
trendelenburg position

99
Q

tunneled CVC

A

used for paraplegics
when PICC isn’t a good option
needing special placement

100
Q

ports

A

iv needed for more than a year
chemo
CANNOT SWIM

101
Q

hemodialysis catheters

A

tunneled or non tunneled for short term needs

102
Q

CVC preference spot

A

subclavian vein

103
Q

colloids

A

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
Q

ecchomysis

A

vein bleeding out into the tissue

MED SURG EXAMS (1 decks)

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