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Med Surge > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Metabolic cusses of alkalosis

A

Hypokalemia, massive blood transfusion, prolonged vomit, nasogastric suction, thiazides diuretic, excess antacids, drinking sodium bicarbonate

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2
Q

Important reminders about Aldosterone

A

Tells the kidneys to retain fluid

Prevents water and sodium loss

Prevents K+ from getting too high

Triggers nephrons to reabsorb Na & H20

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3
Q

How do you assess for bleeding?

A

Assess the dressing & circle the bleeding to see how much is occurring

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4
Q

What is morphine?

A

an opioid

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5
Q

Which diagnostics are required during preop?

A

Hbg, Htc, creatinine, BUN, Na, K, EKG, urinalysis, preg test, chest X-ray, platelets, glucose

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6
Q

What is Acetaminophen used for?

A

Used to tx pain

Has liver and kidney damage potential

Max 3000mg a day

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7
Q

Commonly transfused blood products: describe packed red blood cells

A

250mL of whole blood, RBC, WBC, platelets and plasma, 80% of plasma removed, this is half of the volume of whole blood. This is mostly used.
Used to increase red blood cell mass and oxygen caring capacity in chronic anemia not due to nutritional or drug therapy and other bleeding conditions
Must be ABO and Rh compatible
Must infuse within a 4-hour window

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8
Q

S/S of anemia

A

Pale, tachycardia, fatigue, SOB on exertion, dizzy, orthostatic hypotension, chest pain

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9
Q

Expected findings post op

A

Lungs should be clear, flatus, normal vitals

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10
Q

Causes of Hypovolemia

A

Diarrhea, hemorrhage, vomiting, burns, dehydration, excessive diuretic use

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11
Q

What should you monitor post up in the med Surg unit?

A

ABC’s, nausea and vomiting, I&O’s, hydration, acid base balance, pulmonary hygiene and pain control

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12
Q

Wound Healing: dehiscence

A

Abdominal surgery, overweight patients, and older adults are at risk. Teach Splinting

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13
Q

What happens when you have diarrhea?

A

Lose base

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14
Q

What is DS 1/2 NS

A

5% dextrose & 1/2 Normal saline

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15
Q

S/S of malignant hypothermia

A

105-106* fever, Increased HR, stiff muscles, seizures, and death

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16
Q

3rd line of defense

A

Kidneys

Stronger defense but takes much longer

Can take 24-48 hrs to complete

Uses renal/tubules to move acids and bases

Kidneys excrete bicarbonate

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17
Q

What is basal rate PCA pump?

A

Continuous infusion

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18
Q

What is PACU and what does it do?

A

Post anesthesia Care unit

Responsible for waking patient up, monitoring ABC’s and complications

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19
Q

What regulates BP?

A

Fluid in the body

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20
Q

What must be assessed during regional anesthesia

A

vitals!

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21
Q

Who are the surgical personnel?

A

Surgeon, PA, anesthesiologist, scrub nurse or tech, circulating nurse

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22
Q

Describe wound drainage: sanguineous

A

red, fresh blood drainage

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23
Q

S/S of anesthesia overdose

A

RR<10, low O2 sat

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24
Q

SCIP

A

Surgical Care improvement project

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25
Q

How to treat Hypernatremia?

A

Assess DTR for decrease or absence

Assess LOC

BP & HR can vary-not good indicator

May req dialysis

Prevent hyponatremia & dehydration

Rehydrate with PO & IV 0.9% NaCl or dextrose 5%

Limit sodium intake

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26
Q

How to treat Sickle cell disease

A

Manage pain, hydrate pt, reduce activity, use CAM (distracting, relaxation, guided imagery)

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27
Q

Who can consent if a patient is not conscious and there’s no one else around?

A

The Dr

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28
Q

What are the signs & symptoms of hypocalcemia? Remember CATS

A

C – convulsions
A – arrythmias
T – tetany
S – spasms and stridor

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29
Q

What are some examples of CAM?

A

Massage, guided imagery, essential oils

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30
Q

Blood Transfusion Reactions: Febrile Reaction

A

Chills, fever, headache, flushing, tachycardia, increased anxiety

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31
Q

How can a blind person sign a surgical consent?

A

with the letter “X” and witnessed by two nurses.

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32
Q

How do you treat anemia?

A

Blood transfusion

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33
Q

What is NS (0.9% sodium)

A

Normale Saline (isotonic solution)

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34
Q

What are signs and symptoms of hyperkalemia – MURDER

A 
M-Muscle weakness
U-Urine -- oliguria, anuria
R-Respiratory distress
D-Decreased cardiac contractility
E-ECG changes
R-reflexes -- hyperreflexia
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35
Q

S/S Hypovolemia

A

Tachycardia, tachpnea, flat neck veins, weak pulse, hypotension, dry mucous membrane, changes in LOC, low grade fever, oliguria

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36
Q

Open vs Lap surgery (main difference)

A

Open- no gas

Lap- use gas, which can get trapped in shoulders. Pt will need to ambulated post surgery to get the air out

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37
Q

Platelet Count

A

150-400mm3

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38
Q

Foods that are higher in iron?

A

Red meat, organ meat, egg yolk, kidney beans, leafy greens

And supplement

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39
Q

What is informed consent?

A

This is where the Physician explained the complications about the surgery to the patient. Nurses ARE NOT able to give informed consent. Nurses can only certain questions.

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40
Q

Commonly transfused blood products: describe white blood cells

A

150mL of WBC (leukocytes suspended in 20% of plasma.
Used to treat sepsis that has been unresponsive to antibiotics with positive blood cultures, persistent fever and granulocytopenia
Must be ABO and Rh compatible

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41
Q

Can you give K+ by IV?

A

NO! It can cause cardiac arrest

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42
Q

What happens when you vomit?

A

Lose Acid

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43
Q

How long does it take to see infection post op?

A

24-48 hours

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44
Q

Magnesium lab levels

A

1.5-2.5 mEq/L

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45
Q

Blood Transfusion Reactions: Severe allergic reaction

A

Shortness of Breath, bronchospasm, anxiety

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46
Q

When is the urinary catheter removed?

A

Post-op Day 1 or Post-op Day 2 with day of surgery being day zero SCIP Inf-9

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47
Q

Wound Healing: evisceration

A

Cover with gauze wet with NS, keep area covered with sterile gauze but it must be kept moist.

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48
Q

What is lorazepam?

A

anti anxiety, BENZO!

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49
Q

In the event that the patient cannot sign, who can sign for the patient?

A

The next of Kin or the P.O.A. can sign the consent. For verbal consent two nurses must witness and sign the surgical consent.

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50
Q

Post Op- Complications: How do you asses for bleeding?

A

when checking the dressing, if there is a spot of blood, circle it, wait an hour, check again to see if area of bleeding or leaking is bigger or not

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51
Q

What is Folic Acid Anemia caused by?

A

Caused by poor diet and Malabsorption Syndrome (Chronis, diverticulitis)

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52
Q

What is Hypertonic?

A

High concentration of Na+

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53
Q

What does CAM stand for?

A

Comp alternative medicine

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54
Q

Alkalosis

A

Occurs if you breath out too much O2; your RR will decrease

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55
Q

Types of drains

A

Hemovac: 400-500ml

Jackson Pratt: 100ml

Pin hose: drops of blood

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56
Q

What is calcium carbonate

A

treatment and prevention of hypocalcemia

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57
Q

Normal daily urine output

A

Minimum 30 ml/hr

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58
Q

What are the two types of causes of acidosis & alkalosis

A

Respiratory and metabolic

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59
Q

Causes of Hypercalcemia

A

Hyperparathyroidism

Malignancy

Vit d overdose

Prolonged immobilization (Ca+ leaks into the system)

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60
Q

What is sickle cell disease

A

Genetic disorder in which the RBC sickle and stick together; commonly seen in African Americans

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61
Q

Which insulin can be given by IV?

A

Regular (Humulin R)

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62
Q

Blood Transfusion Reactions: Mild allergic reaction

A

Hives, pruritus, facial flushing,

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63
Q

How to tx Hypercalcemia?

A

Calcitonin, rehydrate, dialysis, cardiac monitor, add loop diuretic (Lasix)

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64
Q

Who is the Joint Commission?

A

An organization that accredits hospitals and ambulatory care clinics

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65
Q

What is demand rate PCA pump?

A

Patient controlled; can be time set specific-pt receives a bolus dose every time the pt clicks a button at the designated time

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66
Q

What is warfarin

A

anticoagulant

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67
Q

S/S of Acidosis

A 
Bradycardia
Tall T wave
Hypotension 
Thready peripheral pulse
Decreased CNS
Hyporeflexia 
Paralysis 
Warm flushed skin  
Kussmaul breathing 
Pale to cyanotic 
Dry skin
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68
Q

What members are involved in a surgical time out?

A

Surgeon, anesthesia provider, circulating nurse, scrub person, and any other active participants.

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69
Q

What is regional anesthesia used for?

A

One area of body, nerve block

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70
Q

Problems associated with metabolic alkalosis

A 
Hypokalemia
Massive blood transfusion 
Prolonged vomiting 
Nasogastric suctioning
Thiazide Diuretics
Excess antacids
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71
Q

What is THE priority before surgery?

A

Consent form

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72
Q

Potassium lab levels

A

3.5-5 mEq/L

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73
Q

Hemoglobin

A

12-18

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74
Q

What is hypokalemia?

A

low potassium in blood

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75
Q

Broken teeth and caps, swollen lips, vocal cord trauma
Improper neck extension during intubation may cause injury
Causes tracheal irritation and edema
Often patients have sore throat after surgery

are all complications of what?

A

Intubation

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76
Q

What MACHINE causes hyperkalemia?

A

M-Medication: Ace inhibitors, NSAIDS, spironolactone
A-Acidosis: metabolic and respiratory
C-Cellular destruction: burns, traumatic injury
H-Hypoaldosteronism: Addison’s disease
I-Intake: Excessive potassium intake
N-Nephrons: renal failure
E-Excretion: impaired

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77
Q

What does Perioperative mean

A

Before, during and after surgery

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78
Q

How to assess for Hypocalcemia

A

Trousseau & chvostek tests

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79
Q

White Blood Cell count

A

5-10mm3

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80
Q

Discharge teaching for sickle cell patient?

A

Avoid triggers such as cold, stress, dehydration

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81
Q

Causes of Hyponatremia

A

Diuretics, over hydration, excessive sweating, wound drainage

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82
Q

What happens with SALT LOSS (signs and symptoms of hyponatremia?

A

S–stupor/coma
A–anorexia, n/v
L–lethargy
T–tendon reflexes decreased

L–limp muscles (weakness)
O–orthostatic hypotension
S–seizures/headache
S–stomach cramping

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83
Q

Post Op- Complications: How do you asses for over sedation

A

patient not waking, aspirating, lower HR and B/P

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84
Q

Metabolic process is determined by which chemical?

A

HCO3

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85
Q

What is important to remember regarding a blood transfusion

A

Never put blood through IV pump- breaks it apart before getting to the patient

Always put blood on a roller clamp

Don’t put any other medications in the site designated for Blood transfusion

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86
Q

Acidosis

A

Occurs if you hold your breath in or decrease breathing & you increase the amount of CO2 in the body; RR will increase

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87
Q

What is important to know regarding DNR/ advanced directives and surgical procedures

A

A patients DNR or Advanced Directive is suspended during the surgical procedure and for 24 hr post procedure.

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88
Q

Creatinine FEMALE

A

0.5-1.1

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89
Q

Who are at risk for dehiscence

A

Elderly and overweight patients and those on an immunosuppressant

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90
Q

Side effect of iron supplement

A

Constipation–give fiber and increase water intake and activity

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91
Q

Commonly transfused blood products: describe fresh frozen plasma

A

200-250mL of plasma and clotting factors
Bleeding, coagulation factor deficiencies, Warfarin reversal thrombotic thrombocytopenic purpura
Must be ABO compatible Rh is not required
Infuse rapidly

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92
Q

Post Op- Complications: How do you asses for VTE prophylaxis

A

SCD pumps, have pt perform ROM exercises in dorsal area, moving foot back and forth in walking motion

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93
Q

What is the job of the circulation nurse?

A 
Oversees sterile procedure
Monitors VSS, urinary output, IV fluids
Is the “go-fer”
Charts
Ensures pt safety
Monitors traffic in the room 
Communicates with patient family
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94
Q

Foods to improve vit B12 deficiency

A

Nuts , animal protein, fish and eggs

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95
Q

Causes of Hypernatremia

A

Renal failure, over ingestion of salt

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96
Q

When does Peri-operative period begin and end?

A

This period starts when the order is written, to the point that the patient is wheeled into surgery.

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97
Q

What is SCIP Inf-5?

A

Surgery patients with appropriate hair removal

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98
Q

What is the function of fluid & electrolyte balance?

A

Prevent blood loss, maintain blood volume at a sufficient level

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99
Q

How to assess for pneumonia

A

Low O2 sat, yellow green cough

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100
Q

Describe wound drainage: serosanguineous

A

clear, bloody

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101
Q

What is 0.225% NaCl

A

1/4 Normal saline

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102
Q

How to assess LOC?

A

Glasgow coma scale (highest score is 15)

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103
Q

How to tx hypervolemia

A

Diuretics, low sodium diet, monitor daily weight and I&O’s, assess lungs and respiratory system (SOB is a concern)

104
Q

What is used by a nurse to ensure everything is done before surgery?

A

Pre op checklist

105
Q

How to prevent DVT

A

Ambulate, ROM exercises, SCD’s, anticoagulant therapy

106
Q

K+ lab level

A

3.5-5

107
Q

Why is NPO status implemented

A

to decrease the risk of aspiration during surgery. The patient’s fluids and food are held the night before till post op when the patients gag reflex returns. It is very important that the nurse notifies the surgical staff and the surgeon if the NPO for the patient has been broken.

108
Q

What are skin age related changes

A

Dry with less subcutaneous fat makes the skin at greater risk for damage, slower skin healing increases risk of infection

109
Q

What happens to the fluid of Na+ is high

A

Fluids decease

110
Q

What is Vitamin B12 deficiency

A

Megablastic anemia; due to a dietary deficiency, malabsorption issue or partial gastrectomy

111
Q

What is an intubation problem?

A

If they intubate the esophagus instead of trachea

112
Q

Describe wound drainage: serous

A

clear blistery drainage

113
Q

What is Naproxen?

A

NSAID

114
Q

Sign of bleeding

A

increased HR

115
Q

How can a cognitively impaired person sign a surgical consent?

A

with the letter “X” and witnessed by two nurses.

116
Q

Hematocrit

A

37-52 %

117
Q

Chemical buffer

A 
Base= bicarbonate
Acid= phosphate
118
Q

Care of elderly patients during surgery considerations

A

Cover head to toe, put padding underneath to prevent skin breakdown

119
Q

Na+ lab level

A

135-145

120
Q

What is Dehiscence?

A

Sutures break apart

121
Q

Important reminders about ADH (antidiuretic hormone)

A

Produced in pituitary gland

Tells kidneys to excrete or hold onto water

Increases fluid retention

Increases BP

122
Q

Can an illiterate patient sign a consent?

A

Yes, with an X but it needs 2 nurses as witnesses

123
Q

Respiratory cause of alkalosis

A

Hyperventilation (anxiety) & high altitudes

124
Q

Metabolic causes of acidosis

A

Starvation, heavy exercise, seizure, kidney failure (Hyperkalemia), dehydration, liver failure, diarrhea, wound drainage

125
Q

What is Hypotonic?

A

Low concentration of Na+

126
Q

Commonly transfused blood products: describe whole blood

A

500mL of all blood components, RBC, WBC, plasma, platelets, clotting factors
used to increase blood volume and oxygen carrying capacity after hemorrhage
Must be ABO and Rh compatible
Must infuse within a 4-hour window

127
Q

Pulmonary hygiene after surgery

A

Cough, deep breathe, splitting the wound when coughing, incentive spirometry

128
Q

S/S hypervolemia

A

SOB, crackles, JVD, pitting edema, skin breakdown, pale and cool skin, weight gain, altered LOC

129
Q

S/S of overdose?

A

Sedation, lethargy, loss of consciousness, combative, hallucinations, low RR

130
Q

Respiratory causes of acidosis

A

Respiratory depression due to drugs, anesthetic, muscle weakness, airway obstruction, asthma and COPD

131
Q

Problems associated with Respiratory acidosis

A 
Respiratory Depression				
Anesthetics
Drugs
Muscle weakness
Airway obstruction like Asthma or COPD
132
Q

What is calcitonin?

A

hormone/ lowering of serum calcium

133
Q

What MODEL causes hypernatremia?

A 
M medications/ meals
O osmotic diuretics
D diabetes insipidus
E excessive weight loss
L low water intake
134
Q

Which type of anemia is the most common?

A

iron deficient

135
Q

What is Kussmaul breathing

A

Fast and deep breathing; trying to get rid of CO2

136
Q

What can result of Hypocalcemia is not corrected?

A

Osteoporosis

137
Q

Wound Healing: prevent infection

A

Instruct patient and family members on importance of hand hygiene when changing dressings or touching the wound area.

Teach patient that a diet high in protein, calories, and vitamin C promotes wound healing

138
Q

What is surgical consent?

A

This is the physical piece of paper that must be signed by the patient. This reiterated the the risk and complicates that can happen with the surgery. These should have been explained to the patient by the surgeon in the Informed Consent. Surgical Consent forms must be signed by the nurse. The nurse is witnessing the patients signature not that risk and complications were explained.

139
Q

Describe Iron deficiency anemia

A

Lack of iron for developing RBC

Results in microscopic cells- the pt has a normal cell count but they’re smaller than normal which cannot carry as much O2

140
Q

What degree is patients bed at after procedure?

A

30-45 degrees and head is midline to the body

141
Q

What must be assessed during local anesthesia

A

Assess the site and sometimes vitals

142
Q

What happens to the fluids if Na+ is low

A

Fluids increase to compensate

143
Q

Overdose on Anesthesia can lead to

A

NV, Respiratory Distress, Hypothermia, Hallucinations, Seizures, Mental or Physical Impairment, Dementia, Prolonged Unconsciousness

144
Q

Can a nurse give consent for a patient?

A

NO! Only a dr can

145
Q

Which mode of PCA pumps poses a risk for overdose?

A

Basal rate because it is continuous

146
Q

Nursing interventions for blood transfusion reactions

A 
Call for help immediately 
Stop transfusion and notify Physician 
Change IV tubing and begin NS
Treat symptoms O2, fluids, epinephrine
Check vitals Q15mins
Recheck cross match and send blood with tubing back to blood bank for testing
Obtain blood sample
Monitor fluid/electrolyte balance
Evaluate serum calcium levels
147
Q

Post Op- Complications: How do you asses for infection?

A

wound edges remaining together, no purulent drainage, induration, or redness, in from, or around incision, pt should also remain afebrile

148
Q

Post Op- Complications: How do you asses for bowl obstructions

A

bowel sounds, stomach pain and sensitivity, nausea/vomiting

149
Q

Protein buffers

A

Albumin or globulins and hemoglobin

150
Q

What is Hypernatremia?

A

High sodium levels in the blood

151
Q

How to assess for over sedation

A

Low RR, low O2 sat, patient not waking up

152
Q

Problems associated with metabolic acidosis

A 
Starvation 
Heavy Exercise
Seizures
Kidney Failure
Pancreatitis
Dehydration 
Liver Failure
Diarrhea
153
Q

BUN

A

10-20

154
Q

How to Tx Hypovolemia

A

Fluid replacement-oral and IV fluids, monitor I&O, monitor for decreased LOC and urinary output, prevent falls by monitoring orthostatic hypotension

155
Q

Calcium lab levels

A

8.5-12.5 mg/dL

156
Q

What is Visceral pain?

A

Arises from organs

157
Q

Causes of Hyperkalemia

A

Massive intake of K, salt substitute, impaired renal excretion, burns, potassium sparing diuretics, ACE inhibitors (they hold onto K)

158
Q

What is Malignant hyperthermia

A

Can occur during or post op

Allergic reaction to anesthesia

Give dantrolene

159
Q

What’s the most type of common cause of long term disability?

A

Chronic pain

160
Q

Monitor ABC’s after surgery– what is C?

A

Assess for bleeding and patient’s B/P, check dressing for excessive blood loss, if excessive notify surgeon. Systolic >100 diastolic <90.

161
Q

Respiration is determined by which chemical

A

PCO2

162
Q

Side effects of opiod pain management

A

Constipation and overdose

163
Q

What is Somatic pain

A

Arises from skin and musculoskeletal structure

164
Q

Commonly transfused blood products: describe platelets

A

35-50mL of platelet sediment form RBC’s or plasma
Used to treat bleeding from thrombocytopenia, decreased platelet counts or presence of abnormal platelets, leukemia, aplastic anemia, DIC, post transfusion thrombocytopenia.
Must be ABO compatible if Rh compatibility is possible it is preferred
Infuse at a rate of 100mL per 15 mins
Platelet count should be drawn 1-3 hours after transfusion is complete

165
Q

When should you give patient post op teaching for surgery?

A

Before surgery at the pre op appt

166
Q

Post Op- Complications: How do you asses for constipation

A

assess bowel sounds, presence of

167
Q

What is an interoperative time out?

A

Before starting a procedure, facilities use a “time-out” procedure to verify the correct site, patient, and procedure.

168
Q

What is cefazolin?

A

anti-infective cephalosporin

169
Q

What medication treats malignant hyperthermia?

A

Dantrium/Dantrolene

170
Q

1st line of defense

A

Chemical balance- buffers

171
Q

How do you assess for infection

A

Temp, REEDA, assess mental status, ABC’s

172
Q

Symptoms of Sickle Cell Disease

A

Pain, SOB, Fatigue, Weakness, Jaundice, Leads to Chronic Kidney Failure, Low grade Temp.
Chronically low HCT 20-30%
Critically low during crisis less than 20%

173
Q

Sodium lab levels

A

135-145 mEq/L

174
Q

When is a prophylactic antibiotic received?

A

Within one hour prior to surgical incision

SCIP INF-1

175
Q

Performed by a nurse that’s trained specifically to do so; given by IV

Assessing ABC’s

Ex: versed and propofol

the above describes?

A

Moderate sedation

176
Q

Hydrogen Ions regulate Acid Base Balances. Alkalosis would show what with hydrogen ions?

A

A decrease

177
Q

Causes Hypocalcemia

A

Vit D deficiency

Mg depletion

Chronic renal failure

Hypoparathyroidism

Alcoholism

178
Q

Causes of hypervolemia

A

Excessive fluid replacement, late stage kidney failure, heart failure, long term steroid therapy, water intoxification

Can occur in sickle cell pt if they intake too much fluid

179
Q

What is diphenydramine

A

antihistamine (benadryl)

180
Q

What is general anesthesia

A

This completely knocks pt out, this is done thorough gas or IV medication, this stops the Resp. drive, GI mobility, the patient feels nothing

181
Q

What does ABC stand for?

A

Airway-pt is talking

Breathing- check RR, lung sounds, chest expansion, color, cap refill, labored breathing, stern all retraction

Circulation- edema, bleeding, check pulse, blood pressure

182
Q

What is 0.45% NaCl

A

1/2 Normal saline

183
Q

What is hyponatremia?

A

low sodium levels in blood

184
Q

What are the 6 L’s for signs and symptoms of hypokalemia

A
  1. Lethargy
  2. Leg cramps
  3. Limp muscles
  4. Low, shallow respiration
  5. Lethal cardiac dysrhythmias
  6. Lots of urine (oliguria)
185
Q

Who is first in line to sign the consent when the patient can’t?

A

POA or spouse, then kids and then next of kin

186
Q

What’s given to patients before surgery?

A

Antibiotic 1 hour before cut time and anxiety medication

Make sure pt goes to bathroom before giving anxiety medication

187
Q

S/S of alkalosis

A 
Tachycardia 
Normal to low BP 
Increased neuro activity
Anxiety 
Irritability  
Tetany 
Chvostek’s signs 
Trousseau’s sign 
Decreased Respiratory effort
188
Q

What is Nociceptive pain

A

Normal pain processing, sustained by tissue damage or inflammation

189
Q

How do you ensure you have the correct patient?

A

Use 2 pt identifiers

190
Q

What does SCIP’s current plan focus on?

A

Infection Prevention
Prevention of serious cardiac events
Prevention of DVT or VTE Venous thromboembolism

191
Q

What is Neuropathic pain?

A

Sustained from abnormal processing of stimuli and can occur in absence of either tissue or inflammation

Difficult to tx & resistant to first line pain agents usually

192
Q

What are muskuloskeletal age related changes?

A

Increased incidence of deformities related to osteoporosis or arthritis

193
Q

Acidosis characteristics

A

Bradycardia, tall t wave, hypotension, threads peripheral pulse, decreased CNS (loc), hyporeflexia, warm flushed skin, paralysis, pale to cyanotic color, dry skin, kussmaul breathing

194
Q

S/S DVT

A

Pain in leg, redness, edema, warmth

195
Q

What should you monitor when you are giving IV fluids to a sickle cell pt?

A

Assess for fluid over load (decreases O2 sat, SOB, crackled lungs)

196
Q

What is moderate anesthesia

A

This is a twilight sleep. IV medication causes an amnesia effect. (Propofol, Versed) only Physician or trained ACLS nurse can administer moderate sedation. (Cardioversions, Pacemakers, Endoscopy)

197
Q

What is the #1 priority?

A

Patient safety

198
Q

Describe water intoxication?

A

When you dilute your Na so much that it results in cerebral edema and death as a result

199
Q

Why is patient teaching done before surgery?

A

This is so that the patient and family questions can be answered before surgery begins. It is also good time for teaching the patient on the restrictions that they might encounter.

200
Q

Wound Healing: wound care

A

Teach patient and family how to properly care for the wound with teach back a must in proper demonstration

201
Q

How do you position a patient after surgery?

A

Head of the bed up (not 90*) and no pillows under the legs

202
Q

Post Op- Complications: How do you asses for pneumonia

A

assess lung sounds, teach patient turn, cough, and deep breath (with splinting) and teach patient proper use of incentive spirometer

203
Q

When should patient teaching occur?

A

All teaching should be done in the Preoperative phase.

204
Q

What do you do when there is a blood transfusion reaction?

A

STOP the transfusion but don’t take the IV out

Call for help them stop the infusion (prioritize)

Start 0.9% NS

Do not discard blood

205
Q

Problems associated with Respiratory alkalosis

A

Hyperventilation
Anxiety
Salicylate toxicity
High altitudes

206
Q

What should patient teaching involve?

A

Fears and anxieties about surgery, surgical procedure, routines of preoperative procedures (NPO, Lab work, Preps), post op recovery, use of an IS, stockings and pneumatic devices, ambulation, splinting, and pain management.

207
Q

If a patient is bleeding on the dressing, what do you do?

A

Mark the dressing with a marker so all staff can look for changes – also watch for dehiscence of surgical site

208
Q

Describe wound drainage: purulent

A

pussy (can be sign of infection, can be blue, yellow, green)

209
Q

What is prednisone?

A

anti inflammatory

210
Q

What is important about the RAS system?

A

Low blood volume activates the system

Angiotensinogen (weak) activates ACE

ACE then converts the angiotensin I into II

Angiotensin II is responsible for vasoconstriction, reduces urine output and causes secretion of aldosterone

211
Q

Commonly transfused blood products: describe 5% Albumin/10% Albumin

A

5% contains 12.5 grams of Albumin in 250mL
10% contains 12.5 grams of Albumin in 50mL
replaces volume lost by shock in pts with burns, trauma, surgery or infections, hypoproteinemia
ABO/Rh is compatibility is not required
Blood Transfusion Reactions

212
Q

When are prophylactic antibiotics discontinued?

A

Within 24 hours after surgery end SCIP INF-3

213
Q

What is Hydroxyurea?

A

Medication given for controlling sickle cell disease

** Not advisable for pregnant women

214
Q

What is D5NS

A

5% dextrose, 0.9% NS

215
Q

Creatinine MALE

A

0.6-1.2

216
Q

What are signs and symptoms of hypernatremia? FRIED SWINE SALT

A 
F flushed skin
R restlessness, irritability
I increased fluid retention and BP
E edema
D Decreased urine output and dry mouth
S sleepy
W weakness
I irritability
N neuro-muscular excitability
E edema

S skin is flushed
A agitation
L low grade fever
T thirst

217
Q

What is at risk for folic acid anemia

A

Pts at risk older, debilitated, and alcoholics

218
Q

What is hydrochlorothiazide

A

thiazide diuretic–lowing BP in hypertensive patients and diuresis with mobilization of edema

219
Q

How should a patient cough after surgery?

A

Splint the surgical incision site

220
Q

What is hyperkalemia?

A

High potassium in blood

221
Q

Nursing considerations for Anemia

A

ABC’s, monitor RR, check O2 sat, allow rest periods, do not overexert, increase iron rich foods, supplements, prevent constipation

222
Q

What do you do when dealing with evisceration?

A

Call rapid response first THEN put the bed up, cradle position, don’t touch it and just put sterile Saline wet dressing on it

223
Q

Sickle cell disease symptoms

A

Pain, SOB, fatigue, weak, jaundice (late stage), pallor, cyanosis, chest pain, low grade fever, critically low hematocrit during crisis (<20%)

224
Q

Causes of hypokalemia

A

Wound drainage, NPO status, excess sweating, diuretics, water intox, abnormal loss from kidney or gi Tract (vomit or diarrhea)

225
Q

Used for big operative procedures

Totally knocks the patient out

Assess ABC’s during

A

General anesthesia

226
Q

2nd lines of defense

A

Respiratory balance

227
Q

What is Naloxone used for?

A

Antidote for opioids

228
Q

What are renal/urinary age related changes?

A

Decreased blood flow to the kidneys
Reduced ability to execrate waste
Decline in glomerular filtration rate
Nocturia common

229
Q

What is isotonic?

A

Neutral- 0.9% saline and lactate ringers

230
Q

What is calcium chloride?

A

replacement of calium in defiency state

231
Q

Monitor ABC’s after surgery– what is A?

A

listen to lungs, HOB 30-35 degrees up, head of pt midline, if needed head tilt chin lift, no pillow under legs.

232
Q

What is the job of the Scrub nurse?

A

Keeps sterile field
Hands on with surgeon
Gives tools to surgeon

233
Q

Alkalosis characteristics

A

Tachycardia, normal to low BP, increased neuro activity, decreased respiratory effort

234
Q

Blood Transfusion Reactions: Hemolytic Transfusion Reaction

A

Increased anxiety, low back pain, hypotension, tachycardia, fever and chills, chest pain, tachypnea, hemoglobinuria
**This may have immediate onset

235
Q

Can a UAP take the patients first vitals after surgery?

A

No- it’s a baseline assessment so an RN must do it

236
Q

Types of local anesthesia

A

Novocain, Creams

237
Q

What is SCIP Inf-4: ?

A

Cardiac surgery patients with controlled 6am postoperative Blood Glucose

238
Q

S/S of malignant hyperthermia

A

tachycardia, muscle rigidity, fever development, seizure

239
Q

Why is a salt substitute dangerous for Hyperkalemia pt’s?

A

It has a K+ in it

240
Q

Types of PCA pumps

A

Basal rate and demand rate

241
Q

What is Evisceration?

A

Organs fall out

242
Q

What are respiratory age related changes?

A

Reduced vital capacity
Loss of lung elasticity
Decreased oxygenation of blood

243
Q

Why should a pt ambulate post op?

A

Prevent DVT, eliminate painful gas and increase GI motility

244
Q

What can cause a sickle cell crisis?

A

Stress
Dehydration
And cold weather

245
Q

Blood pH

A

7.35-7.45

246
Q

IV infusion for exacerbated sickle cell disease pt

A

> 250 ml/Hr for first 4 hours then 125ml/hr after

247
Q

Common side effects of opioids

A

Nausea, vomiting, constipation, sedation, respiratory depression

248
Q

Hydrogen Ions regulate Acid Base Balances. Acidosis would show what with hydrogen ions?

A

An excess

249
Q

Monitor ABC’s after surgery– what is B?

A

Resp rate, pulse ox, auscultate the lungs, SPO2 >95% or pts regular baseline

250
Q

What is hypocalcemia?

A

Low calcium levels in blood

251
Q

What are cardio age related changes?

A

Decreased cardiac output
Increased Blood Pressure
Decreased peripheral circulation

252
Q

Which patients are at high risk of under treatment for pain?

A

Those with cognitive problems

253
Q

What is anemia?

A

Reduction in RBC, Hbg/Hct

A clinical sign, NOT a diagnosis

254
Q

What can you NOT delegate?

A

EAT

E: evaluate
A: assess
T: teaching

255
Q

What are core measures?

A

Evidence based practice set by joint commission

Med Surge (4 decks)

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