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Med Surg > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the three phases of operative nursing?

PO, IO, POP

A
  • preop
    -intraoperative
    Post op
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2
Q

What test/ exams need to be completed or examined during the pre- op phase?

A
  • Physical exam
  • medical and surgical history
  • labs
    -pre-op teaching
    -informed consent
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3
Q

Why is it important to do a complete physical exam before surgery?

A

To establish the patients baseline so if something happens they are able to assess and intervene

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4
Q

What is implied consent and when is it used?

A

It is used only in emergent situations where consent cannot be obtained

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5
Q

What is the job of the circulation nurses?

A
  • patient safety
  • documentation
  • initiates time outs
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6
Q

What is the role of the scrub nurse/ tech?

A
  • sterility
  • handing instruments to surgeon/ FA
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7
Q

What is anesthesia responsible for?

A
  • medication
  • pt. Vitals
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8
Q

What is that main priority in the post op phase?

A
  • vitals signs (A, B, C’s)
  • hand off report
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9
Q

What does the nurse need to observe before the patient is free to b e discharged?

A
  • active bowel sounds
  • Gag reflex ( if intubated during surgery)
  • patient needs to be able to pee w/o catheter
  • pain must be controlled by oral pain meds
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10
Q

What is the lateral recovery position used for?

A
  • to prevent the tongue from obstructing the airway and helps to prevent choking, reduce the risk of aspiration, and promote adequate breathing
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11
Q

What is isotonic solutions like lactated ringers or 0.9% NS used for?

A

Vascular fluid volume deficit or risk for fluid volume overload r/t renal or cardiac disorders

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12
Q

What are hypotonic solutions used for such as 0.45% NS?

A

Treats interstitial and intracelluar dehydration, hypernatremia, maintenance fluid

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13
Q

What are hypertonic solutions such as 3% NS used to treat?

A

Hyponatremia and pulmonary edema

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14
Q

Ignore

A
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15
Q

What are the S+S of fluid excess volume?

A
  • bounding pulse
  • weight gain
  • edema
  • crackles in the lungs
  • increased BP
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16
Q

What are the S+S of a fluid volume deficit?

A
  • dry mucous membranes
    -poor skin turgor
  • increased HR and RR
  • decreased cap refill
    -orthostatic hypotension
  • increased body temp
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17
Q

What labs do you have to watch in volume deficit and excess

A
  • hematocrit
  • serum sodium
  • BUN
  • plasma and urine osmolality
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18
Q

What causes sodium deficiency (hyponatremia)?

A
  • GI loss
  • heart failure
    -Inappropriate SIADH syndrome
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19
Q

What causes sodium excess (hypernatermia)?

E, DI, CS

A
  • excess oral sodium intake
  • Na+ retention due to corticosteroids
  • H2O loss due to diabetes insipidus
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20
Q

What are the clinical manifestations of hyponatremia due to FVD?

I, IHR, OH, WP

A
  • irritability
  • increased HR
  • orthostatic hypotension
  • weak pulses
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21
Q

What are the clinical manifestations of hyponatremia due to FVE?

H, MS, WG, IBP

A
  • headache
  • muscle spams
  • weight gain
  • increased BP
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22
Q

What are the clinical manifestations of hypernatremia due to FVD?

A
  • increased thirst
  • agitation
  • weakness
  • increased HR
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23
Q

What are the clinical manifestations of hypernatremia due to FVE?

A
  • restlessness
  • agitation
  • twitching
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24
Q

What are the severe clinical manifestations of Na+ imbalance?

A

Seizure, coma, and vomiting

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25
Q

What labs/ assessments should be monitored in pts with Na+ imbalance ?

A
  • daily weight
  • I and O’s
  • LOC
  • HR, BP, and pulses
  • edema
  • muscle strength
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26
Q

What are the safety precautions that she be put in place for pts with Na+ imbalance?

A
  • fall precautions
  • seizure precaution
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27
Q

What are possible treatments for pts with hyponatremia?

A
  • IV normal saline
  • IV 0.3% sodium chloride
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28
Q

What are possible treatments for pts with hypernatremia ?

A
  • change diet
  • loop diuretics
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29
Q

What does potassium (K+) play a big role in?

A

Muscles including the heart

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30
Q

What are causes of hypokalcemia?

A
  • GI loss
  • meds: loop + thiazide diuretics, corticosteroids
  • inadequate K+ intake ( ex. NPO, diet low in K+)
  • increased blood glucose = decreased K+
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31
Q

What are causes of hyperkalemia ?

A
  • renal dysfunction
  • meds: ACE, ARBs, K+ sparing diuretics, NSAIDS, spiranalactone, beta blockers
  • excess K+ intake ( K+ replacement IV/PO)
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32
Q

What are clinical manifestations for hypo and hyperkalemia?

A
  • muscle weakness
  • twitching
  • Cardiac dysrhythmia
  • Decreased LOC
  • decreased reflexes
  • paresthesia
  • N/V
33
Q

When administering K+ what should the nurse NEVER do?

Causes heart cessation

A
  • never slam K+
  • never bolus
  • never exceed infusion rate of 10mEq/L
34
Q

How is hypokalemia reversed?

A
  • ## IV infusion to replace
35
Q

How is hyperkalemia reversed?

A

Increased K+ excretion
- kayexalate ( causes pt to excrete K+ in the form of stool)
- loop thiazide ( diuretic)
- dialysis
- insulin
- albuterol
- calcium

36
Q

What labs/ assessments need to monitored in pt’s with a potassium imbalance?

A
  • ECG
  • pulses
  • IV ( K+ is a vein irritant, check pts IV for redness, swelling, pain, etc.)
  • decreased UO
37
Q

What is the cause of hypocalcemia?

HP, HPT, CAU

A
  • hypoparathyroidism
  • hyperphosphatemia
  • serum albumin
  • Chronic alcohol use
  • loop diuretics
38
Q

What is the cause of hypercalcemia?

A
  • hyperparathyroidism
  • cancers (breast, kidney, lung, bone metastasis)
  • prolonged immobility
  • meds: thiazides, calcium supplements, calcium based antacids ( tums)
39
Q

What are the clinical manifestations of hypocalcemia?

T, C+T, N+T, DBP, ECGC

A
  • tetany
  • chvostek and trousseau’s
  • numbness + tingling
  • decreased BP
  • ECG changes
40
Q

What are the clinical manifestations of hypercalcemia?

DR, IBP, ECGC, BP, PU, D

A
  • depressed reflexes
  • increased BP
  • ECG changes
  • bone pain
  • polyuria
  • dehydration
41
Q

What reverses hypocalcemia?

A
  • increase calcium intake
  • adequate hydration
42
Q

What reverses hypercalcemia?

A
  • limit foods high in calcium
  • avoid IV solutions that contain calcium (ex. LR)
  • weight bearing exercises
43
Q

What causes hypomagnesemia?

GIFL, CAU, MAS, IUO, HGLY, PPI

A
  • GI tract fluid losses
  • chronic alcohol use
  • malabsorption syndromes
  • increased UO
  • hyperglycemia
  • PPIs
44
Q

What causes hypermagnesemia?

A, IVM, RF, MBD, TLS

A
  • antacids
  • IV magnesium
  • renal failure
  • metastic bone disease
  • tumor lysis syndrome
  • hypothyroidism
45
Q

What are the clinical manifestations of hypomagnesemia?

C, MC, T, S, HATR, C+T, IBP+P

A
  • confusion
  • muscle cramps
  • tremor
  • seizures
  • hyperactive tendon reflex
  • chvostek and trousseau’s
  • increased BP and pulse
46
Q

What causes hypermagnesemia?

L, D, MW, D/ATR, DP+BP, N/V

A
  • lethargy
  • drowsiness
  • muscle weakness
  • decreased/ absent tendon reflexes
  • decreased pluses and BP
  • N and V
47
Q

What are the interventions for hypermagnesemia?

A

IV calcium gluconate

48
Q

What is the primary level of prevention for cancer prevention?

A
  • smoking cessation
  • decreased or elimination of alcohol use
  • sunscreen 15- 30 SPF or higher
  • promote healthy behaviors
49
Q

What are the warning signs of cancer?

CAUTION

A
  • Change in bladder and bowel habits
  • A sore that doesn’t heal
  • Thickening or lump in the breast or elsewhere
  • Indigestion or difficulty swelling
  • Obvious change in wart or mole
  • Nagging cough or hoarseness
50
Q

What is magnesium used primarily for treating ?

A
  • reflexes and lowers risk for seizures
51
Q

What is the main diagnostic tool for looking for cancer?

A

PET scan

52
Q

What other diagnostic tools are used to find/ diagnosis cancer?

A
  • biopsy
  • lab tests
  • radiography
  • colonoscopy’s
  • bronchial wash
53
Q

How are cancers classified

TNM

A
  • Turmeric size and invasiveness
  • Node - prescience or absence spread to regional lymph node
  • Metastasis
54
Q

What does a high score on the TNM classification test signify?

A

The worse the prognosis

55
Q

What is chemotherapy?

A
  • systemic or localized cytotoxic medication to kill of rapid dividing cells
56
Q

What other rapid dividing cells does chemotherapy kill off?

A
  • GI
  • bone marrow
  • skin, hair, and nails
57
Q

What are the main safety concerns with patients being treated by chemo?

A
  • their bodily secretions are still toxic 48 hours after treatment
58
Q

What should the nurse educate the chemo patient on 48 hours after treatment?

A
  • use separate toilet or double flush
  • replace toothbrush
  • abstain from se x
  • ALL body secretions are poisonous 48 hours after treatment
59
Q

What is the common route for chemotherapy to be administered?

A
  • IV
  • central venous access device ( CVAD)
60
Q

What is a potential complication of chemo being administered IV?

A

Infiltration because chemo is a vesicant that can cause tissue damage and loss opening the risk for infection

61
Q

What is protocol for peripheral IV extravasation?

A
  • stop the infusion immediately
  • contact HCP
  • leave IV in place
  • do not flush but pull back
  • specific chemos have an antidote
62
Q

What is protocol for a central line extravasation?

A
  • stop the infusion
  • pull drug back from the line
    -leave the line in place
  • contact HCP
63
Q

What is external radiation therapy?

A

Radiation to a specific body part marked by radiology

64
Q

What are some safety concerns for pt’s receiving external radiation therapy?

A
  • gently clean with water and mild soap (no scents)
  • avoid powders, lotions, or creams unless Rx
  • avoid sun exposure
65
Q

What are some safety concerns for pt’s receiving internal radiation?

A
  • they radioactive after treatment
  • they must have a limited amount of visitors
  • nurses must wear lead aprons and cluster care
66
Q

What is internal radiation therapy ?

A

Sealed radiative implants into the tumor or nearby the tumor

67
Q

Which therapy doesnt leave the pt radioactive after treatment?

A

External radiation therapy

68
Q

What are the adverse effects of chemo and radiation therapy?

A
  • bone marrow suppression
  • anorexia
  • nausea
    -vomiting
    Infection
  • alopecia
  • leukopenia
  • reproductive problems
69
Q

How does bone marrow suppression affect the WBCs?

A
  • increase risk for infection
70
Q

How does bone marrow suppression affect the platelets?

A

Increases risk for bleeding

71
Q

How does bone marrow suppression affect the RBCs?

A

Increased risk for severe anemia

72
Q

What are some nursing interventions that can be put into place to prevent bone marrow suppression from effecting the WBCs?

EIS, AI, APT

A
  • enhance immune system through diet, rest, and handwashing
  • avoid infection by implementing neutropenic precautions
  • asses the pt’s temp daily
73
Q

What are some nursing interventions that can be put into place to prevent bone marrow suppression from effecting the platelets?

A

Avoiding risky behaviors such as use of an electric razor, stool softeners, IM injections, aspirin products

74
Q

What are some nursing interventions that can be put into place to prevent bone marrow suppression from effecting the RBCs?

A
  • increase RBC count by iron rich foods, blood transfusions, and EPO
  • may need o2
75
Q

What should the patient report immediately to the HCP?

BTS, UexB, UB

A
  • black tarry stool
  • unexplained bruising
  • uncontrolled bleeding
76
Q

How can the nurse prevent stomatitis or mucotitis

A
  • oral hygiene
  • soft or bland high protein food @ room temp
  • straw for liquids
  • rinse mouth with water and saline topical anesthetic
77
Q

How is pain managed in cancer pt’s?

A
  • NSAIDs for moderate to severe pain
  • antidepressants and anti-seizure drugs fr neuropathic pain
78
Q

What is the most reliable measure of fluid status?

A
  • daily weights
79
Q

What is IS used for?

A
  • lung expansion

Med Surg (4 decks)

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