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
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
3
Q
How do you assess for bleeding?
A
Assess the dressing & circle the bleeding to see how much is occurring
4
Q
What is morphine?
A
an opioid
5
Q
Which diagnostics are required during preop?
A
Hbg, Htc, creatinine, BUN, Na, K, EKG, urinalysis, preg test, chest X-ray, platelets, glucose
6
Q
What is Acetaminophen used for?
A
Used to tx pain
Has liver and kidney damage potential
Max 3000mg a day
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
8
Q
S/S of anemia
A
Pale, tachycardia, fatigue, SOB on exertion, dizzy, orthostatic hypotension, chest pain
9
Q
Expected findings post op
A
Lungs should be clear, flatus, normal vitals
10
Q
Causes of Hypovolemia
A
Diarrhea, hemorrhage, vomiting, burns, dehydration, excessive diuretic use
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
12
Q
Wound Healing: dehiscence
A
Abdominal surgery, overweight patients, and older adults are at risk. Teach Splinting
13
Q
What happens when you have diarrhea?
A
Lose base
14
Q
What is DS 1/2 NS
A
5% dextrose & 1/2 Normal saline
15
Q
S/S of malignant hypothermia
A
105-106* fever, Increased HR, stiff muscles, seizures, and death
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
17
Q
What is basal rate PCA pump?
A
Continuous infusion
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
19
Q
What regulates BP?
A
Fluid in the body
20
Q
What must be assessed during regional anesthesia
A
vitals!
21
Q
Who are the surgical personnel?
A
Surgeon, PA, anesthesiologist, scrub nurse or tech, circulating nurse
22
Q
Describe wound drainage: sanguineous
A
red, fresh blood drainage
23
Q
S/S of anesthesia overdose
A
RR<10, low O2 sat
24
Q
SCIP
A
Surgical Care improvement project
25
How to treat Hypernatremia?
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
26
How to treat Sickle cell disease
Manage pain, hydrate pt, reduce activity, use CAM (distracting, relaxation, guided imagery)
27
Who can consent if a patient is not conscious and there's no one else around?
The Dr
28
What are the signs & symptoms of hypocalcemia? Remember CATS
C -- convulsions
A -- arrythmias
T -- tetany
S -- spasms and stridor
29
What are some examples of CAM?
Massage, guided imagery, essential oils
30
Blood Transfusion Reactions: Febrile Reaction
Chills, fever, headache, flushing, tachycardia, increased anxiety
31
How can a blind person sign a surgical consent?
with the letter "X" and witnessed by two nurses.
32
How do you treat anemia?
Blood transfusion
33
What is NS (0.9% sodium)
Normale Saline (isotonic solution)
34
What are signs and symptoms of hyperkalemia -- MURDER
```
M-Muscle weakness
U-Urine -- oliguria, anuria
R-Respiratory distress
D-Decreased cardiac contractility
E-ECG changes
R-reflexes -- hyperreflexia
```
35
S/S Hypovolemia
Tachycardia, tachpnea, flat neck veins, weak pulse, hypotension, dry mucous membrane, changes in LOC, low grade fever, oliguria
36
Open vs Lap surgery (main difference)
Open- no gas
Lap- use gas, which can get trapped in shoulders. Pt will need to ambulated post surgery to get the air out
37
Platelet Count
150-400mm3
38
Foods that are higher in iron?
Red meat, organ meat, egg yolk, kidney beans, leafy greens
And supplement
39
What is informed consent?
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.
40
Commonly transfused blood products: describe white blood cells
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
41
Can you give K+ by IV?
NO! It can cause cardiac arrest
42
What happens when you vomit?
Lose Acid
43
How long does it take to see infection post op?
24-48 hours
44
Magnesium lab levels
1.5-2.5 mEq/L
45
Blood Transfusion Reactions: Severe allergic reaction
Shortness of Breath, bronchospasm, anxiety
46
When is the urinary catheter removed?
Post-op Day 1 or Post-op Day 2 with day of surgery being day zero SCIP Inf-9
47
Wound Healing: evisceration
Cover with gauze wet with NS, keep area covered with sterile gauze but it must be kept moist.
48
What is lorazepam?
anti anxiety, BENZO!
49
In the event that the patient cannot sign, who can sign for the patient?
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.
50
Post Op- Complications: How do you asses for bleeding?
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
51
What is Folic Acid Anemia caused by?
Caused by poor diet and Malabsorption Syndrome (Chronis, diverticulitis)
52
What is Hypertonic?
High concentration of Na+
53
What does CAM stand for?
Comp alternative medicine
54
Alkalosis
Occurs if you breath out too much O2; your RR will decrease
55
Types of drains
Hemovac: 400-500ml
Jackson Pratt: 100ml
Pin hose: drops of blood
56
What is calcium carbonate
treatment and prevention of hypocalcemia
57
Normal daily urine output
Minimum 30 ml/hr
58
What are the two types of causes of acidosis & alkalosis
Respiratory and metabolic
59
Causes of Hypercalcemia
Hyperparathyroidism
Malignancy
Vit d overdose
Prolonged immobilization (Ca+ leaks into the system)
60
What is sickle cell disease
Genetic disorder in which the RBC sickle and stick together; commonly seen in African Americans
61
Which insulin can be given by IV?
Regular (Humulin R)
62
Blood Transfusion Reactions: Mild allergic reaction
Hives, pruritus, facial flushing,
63
How to tx Hypercalcemia?
Calcitonin, rehydrate, dialysis, cardiac monitor, add loop diuretic (Lasix)
64
Who is the Joint Commission?
An organization that accredits hospitals and ambulatory care clinics
65
What is demand rate PCA pump?
Patient controlled; can be time set specific-pt receives a bolus dose every time the pt clicks a button at the designated time
66
What is warfarin
anticoagulant
67
S/S of Acidosis
```
Bradycardia
Tall T wave
Hypotension
Thready peripheral pulse
Decreased CNS
Hyporeflexia
Paralysis
Warm flushed skin
Kussmaul breathing
Pale to cyanotic
Dry skin
```
68
What members are involved in a surgical time out?
Surgeon, anesthesia provider, circulating nurse, scrub person, and any other active participants.
69
What is regional anesthesia used for?
One area of body, nerve block
70
Problems associated with metabolic alkalosis
```
Hypokalemia
Massive blood transfusion
Prolonged vomiting
Nasogastric suctioning
Thiazide Diuretics
Excess antacids
```
71
What is THE priority before surgery?
Consent form
72
Potassium lab levels
3.5-5 mEq/L
73
Hemoglobin
12-18
74
What is hypokalemia?
low potassium in blood
75
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?
Intubation
76
What MACHINE causes hyperkalemia?
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
77
What does Perioperative mean
Before, during and after surgery
78
How to assess for Hypocalcemia
Trousseau & chvostek tests
79
White Blood Cell count
5-10mm3
80
Discharge teaching for sickle cell patient?
Avoid triggers such as cold, stress, dehydration
81
Causes of Hyponatremia
Diuretics, over hydration, excessive sweating, wound drainage
82
What happens with SALT LOSS (signs and symptoms of hyponatremia?
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
83
Post Op- Complications: How do you asses for over sedation
patient not waking, aspirating, lower HR and B/P
84
Metabolic process is determined by which chemical?
HCO3
85
What is important to remember regarding a blood transfusion
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
86
Acidosis
Occurs if you hold your breath in or decrease breathing & you increase the amount of CO2 in the body; RR will increase
87
What is important to know regarding DNR/ advanced directives and surgical procedures
A patients DNR or Advanced Directive is suspended during the surgical procedure and for 24 hr post procedure.
88
Creatinine FEMALE
0.5-1.1
89
Who are at risk for dehiscence
Elderly and overweight patients and those on an immunosuppressant
90
Side effect of iron supplement
Constipation--give fiber and increase water intake and activity
91
Commonly transfused blood products: describe fresh frozen plasma
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
92
Post Op- Complications: How do you asses for VTE prophylaxis
SCD pumps, have pt perform ROM exercises in dorsal area, moving foot back and forth in walking motion
93
What is the job of the circulation nurse?
```
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
```
94
Foods to improve vit B12 deficiency
Nuts , animal protein, fish and eggs
95
Causes of Hypernatremia
Renal failure, over ingestion of salt
96
When does Peri-operative period begin and end?
This period starts when the order is written, to the point that the patient is wheeled into surgery.
97
What is SCIP Inf-5?
Surgery patients with appropriate hair removal
98
What is the function of fluid & electrolyte balance?
Prevent blood loss, maintain blood volume at a sufficient level
99
How to assess for pneumonia
Low O2 sat, yellow green cough
100
Describe wound drainage: serosanguineous
clear, bloody
101
What is 0.225% NaCl
1/4 Normal saline
102
How to assess LOC?
Glasgow coma scale (highest score is 15)
103
How to tx hypervolemia
Diuretics, low sodium diet, monitor daily weight and I&O's, assess lungs and respiratory system (SOB is a concern)
104
What is used by a nurse to ensure everything is done before surgery?
Pre op checklist
105
How to prevent DVT
Ambulate, ROM exercises, SCD's, anticoagulant therapy
106
K+ lab level
3.5-5
107
Why is NPO status implemented
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
What are skin age related changes
Dry with less subcutaneous fat makes the skin at greater risk for damage, slower skin healing increases risk of infection
109
What happens to the fluid of Na+ is high
Fluids decease
110
What is Vitamin B12 deficiency
Megablastic anemia; due to a dietary deficiency, malabsorption issue or partial gastrectomy
111
What is an intubation problem?
If they intubate the esophagus instead of trachea
112
Describe wound drainage: serous
clear blistery drainage
113
What is Naproxen?
NSAID
114
Sign of bleeding
increased HR
115
How can a cognitively impaired person sign a surgical consent?
with the letter "X" and witnessed by two nurses.
116
Hematocrit
37-52 %
117
Chemical buffer
```
Base= bicarbonate
Acid= phosphate
```
118
Care of elderly patients during surgery considerations
Cover head to toe, put padding underneath to prevent skin breakdown
119
Na+ lab level
135-145
120
What is Dehiscence?
Sutures break apart
121
Important reminders about ADH (antidiuretic hormone)
Produced in pituitary gland
Tells kidneys to excrete or hold onto water
Increases fluid retention
Increases BP
122
Can an illiterate patient sign a consent?
Yes, with an X but it needs 2 nurses as witnesses
123
Respiratory cause of alkalosis
Hyperventilation (anxiety) & high altitudes
124
Metabolic causes of acidosis
Starvation, heavy exercise, seizure, kidney failure (Hyperkalemia), dehydration, liver failure, diarrhea, wound drainage
125
What is Hypotonic?
Low concentration of Na+
126
Commonly transfused blood products: describe whole blood
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
Pulmonary hygiene after surgery
Cough, deep breathe, splitting the wound when coughing, incentive spirometry
128
S/S hypervolemia
SOB, crackles, JVD, pitting edema, skin breakdown, pale and cool skin, weight gain, altered LOC
129
S/S of overdose?
Sedation, lethargy, loss of consciousness, combative, hallucinations, low RR
130
Respiratory causes of acidosis
Respiratory depression due to drugs, anesthetic, muscle weakness, airway obstruction, asthma and COPD
131
Problems associated with Respiratory acidosis
```
Respiratory Depression
Anesthetics
Drugs
Muscle weakness
Airway obstruction like Asthma or COPD
```
132
What is calcitonin?
hormone/ lowering of serum calcium
133
What MODEL causes hypernatremia?
```
M medications/ meals
O osmotic diuretics
D diabetes insipidus
E excessive weight loss
L low water intake
```
134
Which type of anemia is the most common?
iron deficient
135
What is Kussmaul breathing
Fast and deep breathing; trying to get rid of CO2
136
What can result of Hypocalcemia is not corrected?
Osteoporosis
137
Wound Healing: prevent infection
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
What is surgical consent?
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
Describe Iron deficiency anemia
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
What degree is patients bed at after procedure?
30-45 degrees and head is midline to the body
141
What must be assessed during local anesthesia
Assess the site and sometimes vitals
142
What happens to the fluids if Na+ is low
Fluids increase to compensate
143
Overdose on Anesthesia can lead to
NV, Respiratory Distress, Hypothermia, Hallucinations, Seizures, Mental or Physical Impairment, Dementia, Prolonged Unconsciousness
144
Can a nurse give consent for a patient?
NO! Only a dr can
145
Which mode of PCA pumps poses a risk for overdose?
Basal rate because it is continuous
146
Nursing interventions for blood transfusion reactions
```
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
Post Op- Complications: How do you asses for infection?
wound edges remaining together, no purulent drainage, induration, or redness, in from, or around incision, pt should also remain afebrile
148
Post Op- Complications: How do you asses for bowl obstructions
bowel sounds, stomach pain and sensitivity, nausea/vomiting
149
Protein buffers
Albumin or globulins and hemoglobin
150
What is Hypernatremia?
High sodium levels in the blood
151
How to assess for over sedation
Low RR, low O2 sat, patient not waking up
152
Problems associated with metabolic acidosis
```
Starvation
Heavy Exercise
Seizures
Kidney Failure
Pancreatitis
Dehydration
Liver Failure
Diarrhea
```
153
BUN
10-20
154
How to Tx Hypovolemia
Fluid replacement-oral and IV fluids, monitor I&O, monitor for decreased LOC and urinary output, prevent falls by monitoring orthostatic hypotension
155
Calcium lab levels
8.5-12.5 mg/dL
156
What is Visceral pain?
Arises from organs
157
Causes of Hyperkalemia
Massive intake of K, salt substitute, impaired renal excretion, burns, potassium sparing diuretics, ACE inhibitors (they hold onto K)
158
What is Malignant hyperthermia
Can occur during or post op
Allergic reaction to anesthesia
Give dantrolene
159
What's the most type of common cause of long term disability?
Chronic pain
160
Monitor ABC's after surgery-- what is C?
Assess for bleeding and patient’s B/P, check dressing for excessive blood loss, if excessive notify surgeon. Systolic >100 diastolic <90.
161
Respiration is determined by which chemical
PCO2
162
Side effects of opiod pain management
Constipation and overdose
163
What is Somatic pain
Arises from skin and musculoskeletal structure
164
Commonly transfused blood products: describe platelets
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
When should you give patient post op teaching for surgery?
Before surgery at the pre op appt
166
Post Op- Complications: How do you asses for constipation
assess bowel sounds, presence of
167
What is an interoperative time out?
Before starting a procedure, facilities use a “time-out” procedure to verify the correct site, patient, and procedure.
168
What is cefazolin?
anti-infective cephalosporin
169
What medication treats malignant hyperthermia?
Dantrium/Dantrolene
170
1st line of defense
Chemical balance- buffers
171
How do you assess for infection
Temp, REEDA, assess mental status, ABC's
172
Symptoms of Sickle Cell Disease
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
Sodium lab levels
135-145 mEq/L
174
When is a prophylactic antibiotic received?
Within one hour prior to surgical incision
| SCIP INF-1
175
Performed by a nurse that's trained specifically to do so; given by IV
Assessing ABC's
Ex: versed and propofol
the above describes?
Moderate sedation
176
Hydrogen Ions regulate Acid Base Balances. Alkalosis would show what with hydrogen ions?
A decrease
177
Causes Hypocalcemia
Vit D deficiency
Mg depletion
Chronic renal failure
Hypoparathyroidism
Alcoholism
178
Causes of hypervolemia
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
What is diphenydramine
antihistamine (benadryl)
180
What is general anesthesia
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
What does ABC stand for?
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
What is 0.45% NaCl
1/2 Normal saline
183
What is hyponatremia?
low sodium levels in blood
184
What are the 6 L's for signs and symptoms of hypokalemia
1. Lethargy
2. Leg cramps
3. Limp muscles
4. Low, shallow respiration
5. Lethal cardiac dysrhythmias
6. Lots of urine (oliguria)
185
Who is first in line to sign the consent when the patient can't?
POA or spouse, then kids and then next of kin
186
What's given to patients before surgery?
Antibiotic 1 hour before cut time and anxiety medication
Make sure pt goes to bathroom before giving anxiety medication
187
S/S of alkalosis
```
Tachycardia
Normal to low BP
Increased neuro activity
Anxiety
Irritability
Tetany
Chvostek’s signs
Trousseau’s sign
Decreased Respiratory effort
```
188
What is Nociceptive pain
Normal pain processing, sustained by tissue damage or inflammation
189
How do you ensure you have the correct patient?
Use 2 pt identifiers
190
What does SCIP's current plan focus on?
Infection Prevention
Prevention of serious cardiac events
Prevention of DVT or VTE Venous thromboembolism
191
What is Neuropathic pain?
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
What are muskuloskeletal age related changes?
Increased incidence of deformities related to osteoporosis or arthritis
193
Acidosis characteristics
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
S/S DVT
Pain in leg, redness, edema, warmth
195
What should you monitor when you are giving IV fluids to a sickle cell pt?
Assess for fluid over load (decreases O2 sat, SOB, crackled lungs)
196
What is moderate anesthesia
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
What is the #1 priority?
Patient safety
198
Describe water intoxication?
When you dilute your Na so much that it results in cerebral edema and death as a result
199
Why is patient teaching done before surgery?
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
Wound Healing: wound care
Teach patient and family how to properly care for the wound with teach back a must in proper demonstration
201
How do you position a patient after surgery?
Head of the bed up (not 90*) and no pillows under the legs
202
Post Op- Complications: How do you asses for pneumonia
assess lung sounds, teach patient turn, cough, and deep breath (with splinting) and teach patient proper use of incentive spirometer
203
When should patient teaching occur?
All teaching should be done in the Preoperative phase.
204
What do you do when there is a blood transfusion reaction?
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
Problems associated with Respiratory alkalosis
Hyperventilation
Anxiety
Salicylate toxicity
High altitudes
206
What should patient teaching involve?
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
If a patient is bleeding on the dressing, what do you do?
Mark the dressing with a marker so all staff can look for changes -- also watch for dehiscence of surgical site
208
Describe wound drainage: purulent
pussy (can be sign of infection, can be blue, yellow, green)
209
What is prednisone?
anti inflammatory
210
What is important about the RAS system?
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
Commonly transfused blood products: describe 5% Albumin/10% Albumin
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
When are prophylactic antibiotics discontinued?
Within 24 hours after surgery end SCIP INF-3
213
What is Hydroxyurea?
Medication given for controlling sickle cell disease
** Not advisable for pregnant women
214
What is D5NS
5% dextrose, 0.9% NS
215
Creatinine MALE
0.6-1.2
216
What are signs and symptoms of hypernatremia? FRIED SWINE SALT
```
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
What is at risk for folic acid anemia
Pts at risk older, debilitated, and alcoholics
218
What is hydrochlorothiazide
thiazide diuretic--lowing BP in hypertensive patients and diuresis with mobilization of edema
219
How should a patient cough after surgery?
Splint the surgical incision site
220
What is hyperkalemia?
High potassium in blood
221
Nursing considerations for Anemia
ABC's, monitor RR, check O2 sat, allow rest periods, do not overexert, increase iron rich foods, supplements, prevent constipation
222
What do you do when dealing with evisceration?
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
Sickle cell disease symptoms
Pain, SOB, fatigue, weak, jaundice (late stage), pallor, cyanosis, chest pain, low grade fever, critically low hematocrit during crisis (<20%)
224
Causes of hypokalemia
Wound drainage, NPO status, excess sweating, diuretics, water intox, abnormal loss from kidney or gi Tract (vomit or diarrhea)
225
Used for big operative procedures
Totally knocks the patient out
Assess ABC's during
General anesthesia
226
2nd lines of defense
Respiratory balance
227
What is Naloxone used for?
Antidote for opioids
228
What are renal/urinary age related changes?
Decreased blood flow to the kidneys
Reduced ability to execrate waste
Decline in glomerular filtration rate
Nocturia common
229
What is isotonic?
Neutral- 0.9% saline and lactate ringers
230
What is calcium chloride?
replacement of calium in defiency state
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Monitor ABC's after surgery-- what is A?
listen to lungs, HOB 30-35 degrees up, head of pt midline, if needed head tilt chin lift, no pillow under legs.
232
What is the job of the Scrub nurse?
Keeps sterile field
Hands on with surgeon
Gives tools to surgeon
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Alkalosis characteristics
Tachycardia, normal to low BP, increased neuro activity, decreased respiratory effort
234
Blood Transfusion Reactions: Hemolytic Transfusion Reaction
Increased anxiety, low back pain, hypotension, tachycardia, fever and chills, chest pain, tachypnea, hemoglobinuria
**This may have immediate onset
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Can a UAP take the patients first vitals after surgery?
No- it's a baseline assessment so an RN must do it
236
Types of local anesthesia
Novocain, Creams
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What is SCIP Inf-4: ?
Cardiac surgery patients with controlled 6am postoperative Blood Glucose
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S/S of malignant hyperthermia
tachycardia, muscle rigidity, fever development, seizure
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Why is a salt substitute dangerous for Hyperkalemia pt's?
It has a K+ in it
240
Types of PCA pumps
Basal rate and demand rate
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What is Evisceration?
Organs fall out
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What are respiratory age related changes?
Reduced vital capacity
Loss of lung elasticity
Decreased oxygenation of blood
243
Why should a pt ambulate post op?
Prevent DVT, eliminate painful gas and increase GI motility
244
What can cause a sickle cell crisis?
Stress
Dehydration
And cold weather
245
Blood pH
7.35-7.45
246
IV infusion for exacerbated sickle cell disease pt
>250 ml/Hr for first 4 hours then 125ml/hr after
247
Common side effects of opioids
Nausea, vomiting, constipation, sedation, respiratory depression
248
Hydrogen Ions regulate Acid Base Balances. Acidosis would show what with hydrogen ions?
An excess
249
Monitor ABC's after surgery-- what is B?
Resp rate, pulse ox, auscultate the lungs, SPO2 >95% or pts regular baseline
250
What is hypocalcemia?
Low calcium levels in blood
251
What are cardio age related changes?
Decreased cardiac output
Increased Blood Pressure
Decreased peripheral circulation
252
Which patients are at high risk of under treatment for pain?
Those with cognitive problems
253
What is anemia?
Reduction in RBC, Hbg/Hct
A clinical sign, NOT a diagnosis
254
What can you NOT delegate?
EAT
E: evaluate
A: assess
T: teaching
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What are core measures?
Evidence based practice set by joint commission
