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Nursing 112 > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

Three phases of inflammation

A

First: vascular and cellular
Second: exudate production
Third: reparative

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2
Q

Focused health history- inflammation

A

Possible irritants: physical (trauma, heat/cold, radiation), chemical (acid, alkalis, poisons, gases), microorganisms (bacteria, fungi, parasites, viruses)

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3
Q

Five signs of inflammation

A
  1. Erythema
  2. Edema
  3. Heat
  4. Pain
  5. Loss of Function
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4
Q

Diagnostic tests- inflammation

A
  1. Erythrocyte Sedimentation Rate (ESR/SED): 0-20

2. C-Reactive Protein (CRP): <1 mg/dL or <10 mg/L; measures response to antibiotic/antiinflammmatory meds.

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5
Q

NSAID’s

A

inhibit the COX enzyme; reduce swelling, pain, and stiffness in joints

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6
Q

COX-1 Inhibitors (1st gen)

A

Loss of stomach lining, prevents blood clots, decreases fever,

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7
Q

COX-2 Inhibitors (2nd gen)

A

Reduces pain and inflammation, Do not disturb stomach lining

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8
Q

Ibuprofen (Motrin/Advil)

A

COX-1 inhibitor; produces analgesic, anti-inflammatory, reduces fever SE: N&V, dyspepsia, dizziness, rash, heartburn

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9
Q

Celecoxib (Celebrex)

A

COX-2 inhibitor; reduces pain and inflammation, used for osteoarthritis and rheumatoid arthritis SE: diarrhea, dyspepsia, headache, URTI, GI discomfort, abdominal pain, peripheral edema (Do not use in pt with existing cardiac issues

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10
Q

Ketorolac (Toradol)

A

NSAID; intraocular anti-inflammatory; inhibits prostaglandin synthesis, reduces prostaglandin levels in aqueous humor, reduces pain SE: headache, nausea, abdominal cramps, dyspepsia

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11
Q

Corticosteroids

A

Controls inflammation by suppressing components of the inflammatory process at site of injury; also used to prevent transplant rejection; administered once a day in large dose

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12
Q

Prednisone (Deltasone)

A

prevents/suppresses immune reactions and decreases tissue response in inflammatory process SE: hyperglycemia, masks infection signals, edema, weight gain, thin skin, bruising, heartburn, diaphoresis, mood swings, delayed wound healing

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13
Q

Perioperative Nursing Practice

A

Encompasses care in all phases

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14
Q

Preoperative Focused Assessment: Older Adults

A

increased risk for complications, Anesthesia may increase confusion or dementia, skin assessment, breath sounds, coughing

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15
Q

Preoperative Focussed Assessment: Children

A

Maintaining temperature 97-100, talk at their level, involve parents, use correct terms they understand, role play, scary stuff last

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16
Q

Preoperative Focussed Assessment: Drugs/Substance abuse

A

pulmonary complications increased in smokers, alcohol and drugs alter response to anesthesia and pain meds, Antihypertensive, Tricyclic antidepressants, NSAIDS increase risk of complications

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17
Q

Preoperative Focused Assessment: History

A

decreased immunity, diabetes, pulmonary disease, cardiac disease, hemodynamic instability, multi-systm disease, coagulation defect, anemia, dehydration, infection, hypertension, hypotension. Family history: malignant hyperthermia, cancer, bleeding disorder

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18
Q

Cardiopulmonary Preoperative Assessment

A

V/S, Report: Hypo/hypertension, HR < 60 or >120, irregular heart beat, chest pain, ShOB, dyspnea, tachypnea, SpO2 <94%

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19
Q

Preoperative Nutritional Assessment

A

assess for malnutrition, need vitamins and protein before and after procedure

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20
Q

Preoperative Patient Medication Review

A

NSAIS’s, Aspirin, and Anticoagulants may be stopped 7-10 days prior to surgery, pt may be started on a a heparin drip to prevent bleeding during surgery.

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21
Q

Preoperative Physical Assessment

A

Head to toe including ROM, LOC, skin integrity; provides baseline for after surgery

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22
Q

Pre-surgical Screening Tests

A
  1. Chest Xray: preexisting cardiac/pulmonary issues
  2. EKG: establishes baseline for new or existing cardiac issues
  3. CBC: Indicates need for blood transfusion, fix any current blood issues before surgery
  4. Electrolyte level: indicate need for electrolyte replacement during/prior to surgery
  5. UA: indicate current drug levels, urine concentration
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23
Q

Preoperative Medications

A
  • given in holding area
  • give any ordered meds
  • facilitates admin of anesthesia or reduces risks of it
  • insulin may not be given prior to surgery; anticoags d/c 5-7 days prior to surgery
  • antianxiety, antiemetic, antibiotics may be given prophylactically
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24
Q

Nursing Diagnosis PreOp

A

Deficient knowledge related to unfamiliarity with surgical procedures
Anxiety related to new or unknown experiences

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25
Q

Planning/Outcomes PreOp

A
  • Pt must be informed and know what to expect during surgery
  • Pt has manageable anxiety prior to surgery
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26
Q

Caring Interventions PreOp

A

DO NOT OVERWHELM

  • focus on teaching
  • explore their level of knowledge and understanding
  • provide info on informed consent, dietary restrictions (NPO), preps before surgery, exercises after surgery, plans for pain management
  • teach limitations, eating, working after surgery
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27
Q

Day of Surgery

A
  • Client teaching complete
  • Informed consent signed
  • Adhered to NPO restriction
  • In surgical gown
  • ID bands are on
  • No jewelry, dentures, contact lenses, nail polish
  • voiding prior to transfer
  • Preop meds are given
  • V/S taken
  • Preop lab work complete
  • Skin has been prepped
  • Pt history reviewed
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28
Q

Surgical Classifications: urgent

A

Surgery needs to be done in 24-48 hours

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29
Q

Surgical Classifications: emergency

A

Surgery needs to be done immediately

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30
Q

DOR: Major

A

Prodecure or greater risk, longer and more extensive

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31
Q

DOR: Minor

A

Procedure w/o significant risk, often done without local anesthesia

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32
Q

DOR: Diagnostic

A

Performed to determine the origin and cause of disorder or cell type for cancer

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33
Q

DOR: Curative

A

Performed to resolve a health problem by repairing or removing the cause

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34
Q

DOR: Restorative

A

Performed to improve a pt functional ability

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35
Q

DOR: Palliative

A

Performed to relieve symptoms of a disease process; does not cure

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36
Q

DOR: Cosmetic

A

Performed to alter or enhance personal appearance

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37
Q

Informed Consent

A
  • Valid for 30 days after signing
  • Signed prior to any sedation
  • Voluntary and informed (Physician job to explain surgery, risks, alternative therapies, outcome)
  • Protects pt, surgeon, hospital, and employees
  • Four conditions: Adequate disclosure, sufficient comprehension, voluntary, competent
  • RN clarifies what surgeon has already said
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38
Q

Circulating Nurse

A

Coordinates, oversees, and involved in pt nursing care in the OR. set up the OR, positions pt with pads, safety straps, warming blankets, provides comfort and reassurance, tests equipment, protect pt privacy, monitor traffic in OR, maintain sterile field in OR, communicates to family members, documents care, drains, count of all materials, communicates with PACU

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39
Q

Scrub Nurse

A

Sets up sterile table, drapes pt, hands sterile supplies and equipment, counts sponges, sharps, and instruments

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40
Q

Time Out

A

Surgical Team ensures: Pt name, DOB, surgical consent form, kind of surgery, location, side, correct position of pt, drug allergies, antibiotics given

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41
Q

General Anesthesia

A

Reversible loss of consciousness induced by inhibiting CNS, causes analgesia and amnesia, loss of muscle tone/reflexes, no sensory perception to consciousness, increased risk of cardiac/pulmonary problems

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42
Q

General Anesthesia: Inhalation

A

Most controllable method, pulmonary ventilation reversal, used in combination with other agents for prolonged procedures, limited muscle relaxant, posted nausea and shivering common

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43
Q

Nitrous Oxide

A

General inhaled anesthetic, Anxiolytic, analgesic, euphoric; rapid acting, rapid reversal, non depressant, nontoxic inhalation analgesic to supplement other anesthetics; SE: blurred vision, confusion, drowsiness, faintness, lightheaded, sweating, weakness

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44
Q

Isoflurane (Forane)

A

nonflammable liquid administered by a vaporizer. general inhaled anesthetic; SE: shivering, nausea, vomiting, ileum

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45
Q

General Anesthesia: IV

A

rapid and pleasant induction, low incidence of posts N/V, must be metabolized and excreted from body for reversal, contraindicated in liver or kidney disease, increased cardiac and respiratory depression

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46
Q

Propofol (Diprivan)

A

rapid acting general anesthetic/sedative hypnotic; inhibits sympathetic vasoconstrictor nerve activity, decreases vascular resistance, produces hypnosis rapidly; SE: involuntary muscle movements, apnea, hypotension, N/V, cardio depression, delirium, euphoria, resp. depression

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47
Q

Midazolam (Versed)

A

Schedule IV, benzodiazepine, sedative, anxiolytic; enhances action of GABA, produces anxiolytic. hypnotic, anticonvulsant, muscle relaxant, amnestic effects; SE: decreased resp. rate, O2 desat, hiccups, arrhythmias, hypotension, unresponsiveness, agitation, confusion
monitor RR, O2 sat during administration, monitor VS
Don’t use with COPD or heart failure

48
Q

Fentanyl (Subsys)

A

opiod, narcotic, agonist, analgesic; reduces stimuli from sensory nerves, inhibits ascending pain paths, alters pain perception, increases pain threshold; SE: drowsiness, N/V, confusion, blurred vision, chills, ortho. hypotension, constipation, dysuria
Establish baseline BP, RR; assist with ambulation, encourage turn, cough, deep breathe Q2h, monitor vitals

49
Q

Regional Anesthesia

A

gag and cough reflex stays intact, allows participation by patient, no control of agent after admin, increased nervous system stimulation, only for short procedures. injected around nerves at site of numbing

50
Q

Bupivacaine (Marcaine)

A

local infiltrate, nerve block, epidural, spinal; SE: cardiac arrest, hypotension, bradycardia, palpitations, seizures, restlessness, anxiety, dizziness, N/V, blurred vision, tinnitus, apnea

51
Q

Lidocaine (Xylocaine)

A

Amide anesthetic, anti arrhythmic, anesthetic; inhibits conduction of nerve impulses, causes temporary loss of feeling; SE: flushing, redness, red or purple spots on skin, swelling at site of application, warm skin

52
Q

Conscious Sedation

A

patient is still able to respond, but will not feel any of the procedures
EKG monitoring

53
Q

Balanced Anesthesia

A

Combination of drugs that are frequently used in anesthesia. Includes: hypnotic given night before, premeditation given with an opioid, benzodiazepine given one hour before surgery to decrease secretions
Decreases anesthetics needed, deceases N/V, minimizes disturbance of organ function, decreases pain

54
Q

Sedative Hypnotics (SH)

A

commonly used for sleep disorders, mildest form is sedation, increasing dose has a hypnotic effect, very high doses may achieve anesthetic effect.

55
Q

Secobarbital Sodium (Seconal)

A

Barbiturates, SH; short acting used for sedation preop; SE: “hangover”, REM rebound, dependence, tolerance, depression, resp. depression, hypersensitivity; monitor VS

56
Q

Temazepam (Restoril)

A

SH, Schedule IV Benzodiazepines; enhances action of GABA, CNS depression, induces sleep; SE: drowsiness, sedation rebound insomnia, dizziness, confusion, euphoria, asthenia (loss of strength), anorexia, diarrhea; assess VS before admin, bed rails up, assess mental status and sleep patterns

57
Q

Zalpidem Tartrate (Ambien)

A

Nonbenzodiazepine, SH; enhances action of GABA, induces sleep with fewer awakenings, improves sleep quality; SE: headache, dizziness, nausea, diarrhea, muscle pain, sleep walking; assess VS, mental status, sleep patterns, raise bed rails,

58
Q

Antiemetic

A

prevents or relieves nausea and vomiting

59
Q

Phenothiazine

A

tranquilizing drugs with antipsychotic actions

60
Q

Promethazine (Phenergan)

A

Phenothiazine, Antihistamine, Antiemetic, SH; Diminishes vestibular stimulation, depresses labyrinthine function, prevents and relieves N/V; SE: drowsiness, dry mouth nose and throat, urinary retention, thick bronchial secretions, flushing, epigastric distress, visual and hearing disturbances, wheezing, paresthesia, diaphoresis, chills, disorientation, hypotension, confusion; assess for allergy symptoms, BP, pulse, dehydration, LOC, F&E balance

61
Q

Anticholinergics

A

Decrease GI motility and secretion

62
Q

Scopolamine (Transderm-Scop)

A

Anticholinergic, Antinausea, Antiemetic; reduces excitability of labyrinthine receptors, prevents motion-induced N/V; SE: dry mouth, drowsiness, blurred vision, dizziness, restlessness, hallucinations, confusion, difficulty urinating, rash

63
Q

Ondansteron HCL (Zofran)

A

Antinausea, antiemetic; blocks serotonin, prevents N/V; SE: anxiety, dizziness, drowsiness, headache, fatigue, constipation, diarrhea, hypoxia, urinary retention, abdominal pain, dry mouth (xerostomia), fever, paresthesia, asthenia

64
Q

Metoclopramide HCL (Reglan)

A

Dopamine receptor antagonist, GI emptying adjunct, peristaltic stimulant, antiemetic; stimulates motility of upper GI, deceases reflex into esophagus, accelerate gastric emptying, relieves N/V; SE: drowsiness, restlessness, fatigue, lethargy, dizziness, anxiety, headache, insomnia, breast tenderness, altered menstruation, constipation, rash, dry mouth

65
Q

Aldrete Score

A

Assess transition from surgery to recovery; Score must be at least 8/10.
Assess activity, respirations, consciousness, circulation, and color.

66
Q

PostOp Respiratory Assessment

A

adequate hydration, turn cough deep breathe, O2 PRN, incentive spirometer, stimulate pt whenO2 drops

67
Q

PostOp Cardiovascular Function

A

VS Q4h, assess skin color, assess hematocrit level, activity tolerance, early ambulation, positioning

68
Q

PostOp Fluid and Electrolytes

A

IV fluid and rate, adequate hydration, GI drainage, renal function lab,

69
Q

PostOp Nutrition/Elimination

A

bowel sounds, NPO, NG tube, encourage fluids, assess fluid tolerance, progress diet slowly, record BM, assess output

70
Q

Morphine Sulfate

A

Narcotic Agonist, Opiate analgesic; alters pain perception and emotional response to pain: SE: rash, RR depression, bradycardia, constipation, sedation, deceased BP, diaphoresis, facial flushing, dizziness, drowsiness, N/V; recumbent position before giving drug, assess VS, pain, hold if RR <12.

71
Q

Transdermal Opioid Analgesics

A

Provides continuous pain control for chronic pain, more potent than morphine

72
Q

PCA/PCEA

A

improves pain relief, ability to titrate dose, decreases delay and dependency, earlier activity postop, decreased anxiety

73
Q

Demand Dose

A

dose administered each time pt hits button

74
Q

Lockout

A

temporary hold on medication until its time for next dose

75
Q

One Hour Limit

A

amount of medication the pt can receive at one time

76
Q

Basal Rate

A

Amount of continuous medication running in addition to demand dose

77
Q

Bolus Dose

A

Amount that may be given at one time for unmanaged pain

78
Q

Loading Dose

A

initial dose given to help with pain

79
Q

PCA Report to MD

A

uncontrolled pain, hypotension, excessive somnolence, confusion, O2 <93, RR <10, uncontrolled N/V, urinary retention

80
Q

PCA Adverse Reactions

A

initiate emergency support, stop PCA (do not clear or turn off) notify MD, administer narcan as ordered, notify risk management, document

81
Q

Acetaminophen (Tylenol)

A

Central analgesic, non-narcotic, antipyretic; lowers fever, reduces pain

82
Q

Sumatriptan (Imitrex)

A

Antimigraine; produces vasoconstrictive effect on cranial blood vessels, relieve migraine headache; SE: tingling, nasal discomfort, flushing, asthenia, visual disturbances

83
Q

Naloxone (Narcan)

A

narcotic antagonist, antidote; displaces opioid-occupied receptor sites at CNS, reduces opioid induced sleep/sedation, increases RR, raises BP to normal; maintain clear airway, monitor VS

84
Q

Increased Potassium level (>5.0)

A

irritability, diarrhea, ECG changes, muscle twitches, cramps, paresthesia, anxiety, deceased BP, dysrhythmias, abdominal cramping

85
Q

Decreased Potassium level (<3.5)

A

weakness, decreased reflexes, dysrhythmias, ECG changes, fatigue, cramps, alkalosis, shallow RR, irritability, confusion, drowsiness, lethargy, thready pulse, N/V

86
Q

Heparin

A 
prevents formation of blood clots and prolongs clotting time; SE: Spontaneous bleeding, vasospasms, ecchymosis, hypersensitivity
PT: 11-13.5 sec
PTT: 60-70 sec
INR:0.8-1.1
APPT:30-45 sec
87
Q

Enoxaparin Sodium (Lovenox)

A

Low-molecular weight heparin; produces anticoagulation, does not influence PT, aPPT significantly; SE: Nausea, peripheral edema, monitor for bleeding

88
Q

Warfarin (Coumadin)

A

Anticoagulant; interferes with synthesis of vitamin K clotting factors, prevents further formation of formed blood clot, prevents new clot formation; SE: GI distress

89
Q

ABO-Incompatible Transfusion Reaction

A

Received blood they have antibodies to

90
Q

Rh Negative exposure to Rh postive blood

A

does not have rh antibodies naturally, will get them from the Rh+ transfusion

91
Q

Human Leukocyte Antigen

A

tissue is comparable between donor and recipient

92
Q

PRBC

A

Packed Red Blood Cell; prevents fluid overload

93
Q

Fresh-Frozen Plasma`

A

Receives if there are any fluid issues

94
Q

Cryoprecipitate

A

receives if there is a coagulation problem

95
Q

Albumin

A

given if there has been a significant loss of blood

96
Q

Allergic Reaction to Transfusion

A

may occur up to 24 hours, may administer antihistamine, facial flushing and hives or rash are mild symptoms
STOP TRANSFUSION FOR SEVERE SYMPTOMS (wheezing, decreased BP)

97
Q

Bacterial Contamination Blood Transfusion

A

abdominal cramping, vomiting, diarrhea, fever, chills,

STOP TRANSFUSION

98
Q

Febrile Transfusion Reaction

A

30 minutes into- 6 hours after, fever, chills, tight chest, flushed face, flank pain, headache, increased HR, anxiety, tachypnea
STOP TRANSFUSION

99
Q

Hemolytic Transfusion Reactions

A

hemoglobulinuria, chest pain, apprehension, low back pain, chills, fever, tachycardia, decreased BP, Increased RR, bleeding at site
STOP TRANSFUSION

100
Q

Fluid Overload Transfusion

A

cardiac and pulmonary problems, dyspnea, tachycardia, increased BP, periedema, JVD, anxious, crackles
STOP TRANSFUSION

101
Q

Blood Transfusions

A

18-20 ga needle, adjust flow if no reaction occurs, if reaction occurs stop transfusion and record VS

102
Q

Dehiscence

A

Seperation or splitting of surgical wound

103
Q

Evisceration

A

Extrusion of viscera or intestine through a surgical wound

Sterile 4x4 with NS on top, then ABD pad, notify physician

104
Q

Urinary Retention

A

unable to void 8-10 hours postop, less than 30ml an hour

palpate bladder, have patient ambulate

105
Q

Paralytic Illeus

A

decreased bowel sounds, no stool or flatus, N/V, abdominal distention, abdominal tenderness
Provide ice chips, then clear fluids, then regular diet

106
Q

Wound Infection

A

redness, purulent drainage, fever, tachycardia, leukocytosis,
Assess drainage if able, mark on dressing the drainage area, reinforce surgical dressing

107
Q

Pulmonary Embolism

A

chest pain, dyspnea, tachypnea, tachycardia, increased anxiety, diaphoresis, decreased LOC, decreased BP, blood gas changes
May develop days after surgery

108
Q

Hypovolemic Shock

A

decreased urine output, deceased BP, weak pulse, cool, clammy, restless, increased bleeding, increased thirst, decreased CVP

109
Q

Pneumonia

A

rapid respiration, shallow respiration, fever, wet lung sounds, asymmetrical chest movement, tachycardia, hypoxia, productive cough, leukocytosis

110
Q

Atelectasis

A

dyspnea, tachypnea, decreased breath sounds, asymmetrical chest movement, tachycardia, increased restlessness

111
Q

DVT

A

prevention is best treatment; use SCD, ambulation, exercise, anticoagulants

112
Q

Gastric Dilation

A

N/V, abdominal distention, treated with NG tube and wall suction

113
Q

Appendicitis

A

RLQ pain, males are higher risk, youth increases risk, begins as dull, steady pain, progresses over 4-6 hours and localizes to RLQ, low grade fever, nausea, anorexia,

114
Q

MAP

A

2DBP + SBP/3
Ideal: 70-90
50 or less: perfusion issue
105 and greater: vasoconstriction/ hypertension

115
Q

Critical Care Drug Calculation

A

dose (mcg) X weight (kg) X 60 (min) X fluid volume / mg X 1000

Nursing 112 (2 decks)

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