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Med Surg > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Endocrine changes with aging

A 
Decreased ADH
Gonal tissues decrease
Decreased glucose tolerance
Hypothyroidism 
Pancreas slows
Acuity decreases
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2
Q

What is vitiligo a sign of

A

Adrenal dysfunction

Autoimmune destruction of melanocytes

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3
Q

What is striae a sign of

A

ACTH excess = Cushings

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4
Q

What could hirsuitism be a sign of

A

Excess adrenal cortical hormones
Excess testosterone
Increased levels of insulin

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5
Q

What are the 3 endocrine pancreas hormones

A

Insulin
Glucagon
Somatostatin

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6
Q

Somatostatin

A

Inhibits glucagon, insulin, GH, gastric and GI peptides

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7
Q

When does endogenous insulin kick in

A

10 mins after meals

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8
Q

DM diagnostics

A
  • 2 fasting blood glucose tests of greater than 126 w/ no food or drink 8+ hours prior
  • oral glucose tolerance tests - 200 at 2 hour point after nPO and balance diet for 3 days before
  • glycosylated hemoglobin assay over 6.5 (pre diabetes = 5.7%-6.4%)
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9
Q

Signs of DM type 1

A 
Hyperglycemia
Polyuria
Polydipsia 
Polyphagia
Rapid weight loss
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10
Q

Complications of type 1

A

DKA
Will have kussmal respirations to blow of CO2
Breath will be fruity

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11
Q

How does insulin impact potassium

A

Drives potassium into cells with glucose

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12
Q

Acute complications of type 2

A

HHS or HHNK (hyperglycemic hyperosomolar ketotic syndrome)

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13
Q

What can contribute to type 2?

A

Genetic defect r/t beta cell function or insulin
Disease of exocrine pancreas
Drug or chemical induced (ex: steroids, thiazide diuretics)
Metabolic syndrome
Genetic disorders

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14
Q

Macro complications of uncontrolled hyperglycemia

A

Angina
HTN
Stroke

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15
Q

Micro complications of uncontrolled hyperglycemia

A 
Retinopathy
Diabetic neuropathy
Neprhopathy = renal failure
Erectile dysfunction
Increased risk for orthostatic hypotension
Increased risk for syncope
Gastroparesis

***Earlier onset than general populations

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16
Q

What is the pre meal/pre prandial goal for diabetics

A

90-130

Normal = 70-100

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17
Q

Novolog

A

Rapid insulin
Onset = .25 hours
Peak = 1-3 hours
Duration = 3-4 hours

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18
Q

Humalog

A

Rapid
Onset = .25
Peak = .5-1.5 hours
Duration = 3-4

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19
Q

Humulin R (regular insulin)

A

Short acting
Onset = .5
Peak = 2-4
Duration = 6-7

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20
Q

NPH (humulin N)

A

Intermediate acting
Onset = 1.5
Peak = 4-12
Duration = 24

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21
Q

Lente

A

Intermediate
Onset = 2.5
Peak = 7-15
Duration = 22 hours

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22
Q

Glargine Lantas

A 
Long acting
Don’t mix!
Onset =1 hour
No peak
Duration = 24 hours
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23
Q

Combo

A

70% human NPH & 30% regular
Onset = .5
Peak = 2-12
Duration = 24 hours

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24
Q

Where is insulin absorbed the fastest

A

Abdomen —> deltoid —> thigh

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25
Q

Injection depth for insulin

A

90 degrees

45 degrees for people with less SQ tissue

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26
Q

When do you inject insulin

A

Rapid/short acting: 10-15 mins before meal to mimic endogenous insulin
Lantus: at night time

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27
Q

Mixing insulins

A

Draw rapid (clear) first

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28
Q

Other insulin administrations

A

Continuous SQ infusion (most costly)
Implanted insulin pumps
Injection devices
New technologies - inhaled or transdermal

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29
Q

S/s of hypoglycemia

A 
Cool, clammy skin
Not dehydrated
Diaphoretic
No changes in respirations
Anxious, nervous, confusion, coma
Weakness, visual changes
Tachycardia, palpitations
Glucose is less than 70
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30
Q

What is mild hypoglycemia

A

Glucose <60

Hungry, irritable, shaky headache, fully conscious

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31
Q

Treatment for mild hypoglycemia

A

1/2 cup of fruit juice or 8oz of milk
4 cubes of sugar or 6 saltines
1 TB of honey

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32
Q

Moderate hypoglycemia

A

Glucose <40

Cool, clammy, pale, tachycardic, tachypneic, drowsy

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33
Q

How to treat moderate hypoglycemic

A

15-30 gm CHO

Feed patient

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34
Q

Severe hypoglycemia

A

Less than 20

Unconscious, can’t swallow

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35
Q

How to treat severe hypoglycemia

A

IM glucagon, MR

Transport to ER

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36
Q

hyperglycemia signs

A

Hot and dry
Dehydrated
Not diaphoretic
Rapid, deep (KussMaul) breaths - trying to blow off acidosis
Variable LOC
s/s of acidosis: abdominal cramps, N/V, orthostatic hypotension, tachycardia
Glucose > 250

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37
Q

treatment for IDDM

A 
Mild: insulin as per order
Severe: transport to ER
Assess ABCs
Hospitalize
Heart monitor
Insulin drip
Hourly lab values
IV hydration
Potassium replacement
Monitor serum glucose
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38
Q

how to store insulin

A

Insulin should be kept cool but not necessarily refrigerated and can’t be heated
Don’t shake the vial - should roll instead
Replace every 28 days

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39
Q

diet therapy for diabetics

A

Limit fats and cholesterol - increased risk for CVD disease already
Protein - 15-20% of calories if they don’t have renal issues
Carbs - 45-60% of calories
Fats - very restrictive
Fiber - improves carb metabolism
Sweeteners - some are okay
Alcohol - if in control of diet, can have with meal

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40
Q

if glucose is not controlled, what does exercise do to blood glucose

A

increases blood glucose

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41
Q

pre exercise checks for diabetics

A

Need supportive shoes that do not bind feet in anyway
Need to inspect feet before exercise
Can’t exercise outside in extreme heat or cold
Type 1: need to carry simple sugar snack in case blood glucose drops out
Guidelines for exercise are based on blood glucose levels
Should check blood glucose levels before exercising
Should be b/w 80 - 250
Shouldn’t exercise within 1 hour of taking insulin or during peak time → could increase risk for hypoglycemia

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42
Q

Parlodel

A

Dopamine agonist

Inhibits GH and prolactin

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43
Q

Somavert

A

GH receptor blocker

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44
Q

Transsphenoidal hypophysectomy

A

for hyperpituitarism
Minimally invasive
Drill through the sinuses into the brain
Clip away and part of pituitary tissue

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45
Q

Postop teaching for Transsphenoidal hypophysectomy

A

Avoid cough, valsalva, sneeze, blowing nose, brushing teeth and bending over after surgery

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46
Q

what does a yellow ring on dressing mean

A

CSF may be leaking

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47
Q

interventions for diabetic foot injuries

A 
Cleanse and inspect feet daily
Wear properly fitting shoes
Avoid walking barefoot
Trim toenails properly
Report non healing breaks in the skin
Change shoes midday
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48
Q

wound care for diabetics

A

Skin breaks down very easily, difficult to heal
Need to maintain moist wound environment
Early debridement if they have any necrotic tissue
Elimination of pressure on an infected area
Apply growth factors to wounds

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49
Q

s/s of neuropathy

A

Tingling, numbness in extremities

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50
Q

interventions for neuropathy

A

Maintain normal glucose levels →
Anticonvulsants (gabapetin and pregabalin)
Antidepressants
Capsaicin cream

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51
Q

how often should diabetics have their kidneys evaluated

A

yearly

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52
Q

side effects of drug therapy for hyper gH

A 
GI upset
Headache
Orthostatic hypotension
Leakage of CSF
Should seek care if they have dizziness or leaky watery nasal discharge
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53
Q

causes of adrenal cortex hypofunction

A 
Autoimmune
TB
Cancer
Hemorrhage**
Postpartum pituitary necrosis
Drugs and toxins
Sudden cessation of steroid therapy
Sepsis
Radiation to abdomen
Tumors 
Adrenalectomy
Shock
AIDs
Radiation to brain
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54
Q

manifestations of addison’s disease

A 
Decreased body hair and pigment changes
Hypoglycemia d/t ↓ cortisol
Hyponatremia d/t lack of aldosterone
Hyperkalemia d/t lack of aldosterone
Wide mood swings, forgetful
Muscle weakness, fatigue, salt cravings, weight loss, vitiligo, anemic, BP is low
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55
Q

replacing cortisol and aldosterone

A

Hydrocortisone for cortisol

Florinef - fludrocortisone - for aldosterone

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56
Q

what triggers addisonian crisis

A

Triggered by life threatening stressful event

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57
Q

s/s of addisonian crisis

A 
Profound swings in status
Severe N/V and diarrhea
Profound hypotension and possible shock d/t dehydration
Pain in back, legs and abdomen
Can lose consciousness
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58
Q

causes of cushing’s

A

Endogenous: ACTH secreting tumors or hyperplasia
Exogenous: steroids for another condition

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59
Q

s/s of cushing’s

A

Changes in fat, carb and mineral metabolism
Hirsutism
High sodium levels b/c of high aldosterone
Altered deposition of body fat, Truncal distribution of fat
Buffalo hump
Striae
Hyperglycemia (high levels of cortisol), hypertension (high levels of aldosterone)
Thin arms and legs, muscle wasting, weakness
Risk for pathologic fractures
Acne (androgen excess)
Cortisol degrades collagen in excess

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60
Q

nonsurgical mgmt for cushings

A

Drug therapy for temporary relief

  • Mitotane (adrenal cytotoxic)
  • Aminoglutethimide, metyrapone (↓ production of cortisol)

Radiation therapy

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61
Q

when can you give surgery for someone with cushing’s

A

Limited to hypersecretory tumor

Adrenalectomy - adrenal tumor - one or both
Hypophysectomy

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62
Q

why are post op cushing’s patients at risk for GI bleeding

A

Cortisol inhibits mucus of lining of GI tract

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63
Q

treatment for pheochromocytoma

A

adrenalectomy

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64
Q

what inhibits conversion of T4 to T3 peripherally

A

stress, starvation, certain dyes, beta blockers, corticosteroids, amiodarone

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65
Q

acute Thyroiditis

A

usually d/t bacterial infection → can cause hypo or hyper thryoid

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66
Q

subacute thyroiditis

A

granulomatous - tagged by viral infection → can cause hypo, hyper or euthryoid function

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67
Q

chronic thyroiditis

A

Hashimoto’s disease - most common, autoimmune with hypo function

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68
Q

symptoms of thyroiditis

A

Dysphagia

Painless enlargement of thyroid gland

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69
Q

mgmt of thyroiditis

A

Nonsurgical: supplement if needed if hypo to decrease TSH being released and decrease goiter in size (levothyroxine)
Surgical: subtotal thyroidectomy if needed

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70
Q

thyrotoxicosis

A

hyperthyroidism

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71
Q

symptoms of Graves

A 
goiter 
exophthalmos, 
pretibial myxedema (dry, waxy swelling anterior lower legs), 
heat intolerant, 
high BP, 
chest pain
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72
Q

nursing considerations for graves

A 
Careful monitoring of VS with temps
Reduce stimulation - reduce lights, keep room cool
Comfort - room temp, cool baths, linens
Watch for changes in status
Medications as ordered
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73
Q

drug therapy for hyperthyroidism

A

Thioamides (PTU) blocks thyroid hormone production

Prevents iodine binding

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74
Q

thyroidectomy post op concerns

A 
Hemorrhage
Resp distress
Hypocalcemia and tetany d/t parathyroid injury
Laryngeal nerve damage
Thyroid storm or thyroid crisis
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75
Q

thyroidectomy post op care

A 
Monitor VS frequently
Assess level of discomfort/position
Support neck
Semi-fowler’s position
Humidified air
Hemorrhage - first 24 hours post surgery
Resp distress - laryngeal stridor
Laryngeal nerve damage- assess
Monitor lab values
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76
Q

What triggers a thyroid storm?

A

Preexisting hyperthyroid condition + infection, trauma, DKA, pregnancy, vigorous palpation of goiter

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77
Q

symptoms of thyroid storm

A 
VS spike - very elevated
N/V/D, abdominal cramping, seizures, coma
Fever
Systolic HTN
Tachycardia
anxiety/agitation/tremors
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78
Q

interventions for thyroid storm

A

Stabilize patient, IV hydration, actually cool but prevent shivering (will ↑ metabolism)
-Precedex - sedative hypnotic, prevents them from shivering
Sodium iodide solution - is radioactive
Control fever

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79
Q

causes of hypothryoidism

A

Lithium can cause low thyroid hormone
Low TSH from AP
Used to have hyperthyroid or nodules on thyroid and they were removed
Overtreated with radioactive iodine
Thyroid slows down with age
Mucinous edema: metabolites collects in cells, mucous increases, cellular edema, organ changes

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80
Q

key features of hypothyroidism

A 
Dry, coarse brittle hair
Poor wound healing
Dyspnea with decreased respirations
Bradycardia
Hypotension
Decreased activity intolerance
Goiter
Apathy , Depression, Withdrawal
Decreased libido
Weight gain
Facial puffiness
Cold intolerance
Muscle aches/pains
constipation
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81
Q

interventions for decreased CO d/t hypothyroidism

A

Monitor status
Monitor for inadequate tissue oxygenation
Monitor for changes in mental status
Monitor fluid status and heart rate
Administer oxygen or mechanical ventilation as appropriate
Evaluate end organ perfusion

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82
Q

interventions for ineffective breathing pattern r/t hypothyroidism

A

Observe and record rate and depth of respirations
Auscultate the lungs
Assess for resp distress
Assess client receiving sedation for respiratory adequacy

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83
Q

myexedma coma

A

Life threatening emergency
Already have hypothyroidism
Usually triggered by acute illness, surgery, chemo, stopping thyroid hormone, use of sedatives/opiates

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84
Q

s/s of myxedema coma

A 
Coma
Resp failure
Hypotension
Hyponatremia
Hypothermia
Hypoglycemia
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85
Q

normal Ca levels

A

8.5-10 mg/dl

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86
Q

symptoms of hyperPTH

A 
Hypercalcemia and hypophosphatemia
Kidney stones
Risk for bony fractures
Nausea, vomiting, diarrhea
Weight loss
Confusion
Psychosis
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87
Q

nonsurgical mgmt of hyper PTH

A

diuretics to flush out calcium

Phosphates inhibit bone resorption
Calcitonin decreases release of calcium from bone
Calcium chelators - binds calcium

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88
Q

post op care for parathyroidectomy

A

Observe for resp distress
Swelling of neck
Compression of trachea
Keep emergency tracheostomy equipment at bedside
Prevent injury - may have significant bone loss

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89
Q

Chvostek’s sign

A

tapping of face anterior to ear below zygoma on one side

If it twitches → indicates hypocalcemia

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90
Q

Trousseau’s sign

A

use BP cuff
Elevate BP until over systolic BP level → when you can’t hear it → leave it elevated for 1-4 minutes

If pt is hypocalcemic, hand and wrist will spasm

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91
Q

causes of hypoPTH

A

Iatrogenic: result of surgical parathyroidectomy
Idiopathic: autoimmune
Hypomagnesemia → seen in serious alcoholics and malabsorption syndromes

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92
Q

hypoPTH interventions

A

Correct hypocalcemia w/ NaCl 10% solution IVPB
calcitriol/rocaltrol
Hypomagnesemia: Treat with mag sulfate
Check with Chovsteks and Trousseau’s signs

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93
Q

GI changes with aging

A

stomach atrophy
Large intestine: ↓ peristalsis, ↓ gastric emptying
Exocrine pancreas: distension and dilation
Liver: decreased size and number of hepatic cells
Gallbladder: decreases bile synthesis, Decreased fat digestion

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94
Q

cullen’s sign

A

bluish, discoloration surrounding umbilicus

Can be d/t intraperitoneal hemorrhage or after ruptured ectopic pregnacy

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95
Q

volvolus

A

Loop of bowel twists on itself → obstructs bowel

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96
Q

Intussusception

A

part of bowel slips into adjacent piece → stricture on bowel
Usually in ileocecal area
Common in little kids

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97
Q

ileus

A

loss of GI motility, silent bowel

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98
Q

grey turners’s sign

A

a bruising on flank area

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99
Q

when would amylase and lipase be elevated

A

Elevated in acute pancreatitis (autodigestion of pancreatic tissues)

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100
Q

What condition is Esophagogastroduodenoscopy for?

A

GERD

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101
Q

What does a Endoscopic retrograde cholangiopancreatography look at?

A

liver, gallbladder, bile ducts and pancreas

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102
Q

endoscopy nursing interventions

A 
Patient undergoes moderate sedation
Amnestic, analgesic, anticholinergic, antiemetic
Nasal cannula with CO2 monitor
Liquid diet
Take out dentures
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103
Q

stomatitis

A

oral cavity

inflammatory process, single or multiple lesions, infectious or noninfectious, painful, bleed easily

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104
Q

stomatitis nursing interventions

A 
bland diet, mouth rinses, medications as rx’d (swish/spit or swish/swallow), frequent sips of cool water
Do not use alcohol based mouthwashes
Peroxide / bicarb solution → spit out
Antifungals
Viscous lidocaine
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105
Q

GERD

A

Gastric contents reflux into esophagus through lower esophageal sphincter

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106
Q

GERD symptoms

A 
Dyspepsia
Regurgitation
Odynophagia - painful swallowing
Dysphagia
Hypersalivation
Belching
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107
Q

consequences of GERD

A

Esophageal erosion
Acute inflammation
Aspiration pneumonia: Gastric acids can spill over into upper tracheal bronchial tree

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108
Q

if you have GERD, how should you sleep

A

Head of the bed up 6-8 in

Sleep on left side - promotes gastric emptying, encourages ileus to relax

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109
Q

goals of GERD drug therapy

A

Inhibit gastric secretion
Accelerate gastric emptying
Protect gastric mucosa

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110
Q

drug therapy for GERD

A

Antacids increase pH of stomach contents (For occasional gerd)
Histamine receptor antagonists (Less effective than PPIs)
Proton pump inhibitors = Number 1 choice “Zoles”

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111
Q

type 1 hernia

A

Sliding hiatal hernia
Widening of hiatal hernia
Herniate of fundus above diaphragm into chest cavity
most common

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112
Q

sliding hernia s/s

A

Symptoms of GERD - heartburn, chest pain, regurgitation, belching, dysphagia

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113
Q

type 2 hernia

A

paraesophageal rolling hiatal hernia - outpouching

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114
Q

rolling hernia s/s

A

Usually due to preexisting anatomic defect (from birth or multiple esophageal surgeries)
Feel extremely full after eating, breathless
Lying down makes it worse
At risk for volvulus, obstruction and strangulation of bowel and potential for developing slow GI bleeds

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115
Q

acute gastritis

A

often d/t exposure to gastric irritant - can be healed
Common cause: infectious, traumatic injury, or NSAIDs
NSAIDs stop production of prostaglandins (pain, help mucous that protects GI tract)

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116
Q

chronic gastritis

A

patchy, diffuse inflammatory process, walls and lining of stomach thin and atrophy
Can involve antibodies or be secondary to other disorders
Atrophic gastritis in older patients: predisposing factor to gastric cancers

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117
Q

acute gastritis s/s

A 
Rapid onset of abdominal pain
Anorexia
N/V 
Bloating
hematemesis/GI hemorrhage
Melanotic stool
Intravascular depletion and shock
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118
Q

chronic gastritis s/s

A

Vague complaints of epigastric pain which can be relieved by food
Anorexia
N/V
Intolerance of spicy or fatty foods
Pernicious anemia d/t loss of intrinsic factor
*might not have any symptoms!

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119
Q

drug therapy for gastritis

A 
Pain relief
H2 receptor antagonists
Antacids
Mucosal barrier fortifier
PPI
Vitamin B12 for anemia
Antibiotic therapy for H. pylori and other infections
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120
Q

peptic ulcer disease s/s

A 
Dyspepsia
Epigastric tenderness midline
Sharp, burning or gnawing pain
Sensation of fullness, pressure hunger
May develop pyloric stenosis: vomiting, bloating, etc.
121
Q

gastric ulcer

A

Backwash of acid because of dysfunctional pyloric valve
Normal or decreased acid secretion → deep penetrating ulcers in the stomach
Grow to associate eating with pain: Pain onset 30-60 mins after eating
Malnourished appearance
Hematemesis is common

122
Q

duodenal ulcer

A 
Hypersecretion of gastric acids
H. pylori 
Well nourished
Pain onset is 1.5 - 3 hours after eating
Pain temporarily relieved by food
Commonly melanotic stools
123
Q

how to eradicate h. pylori infection

A

PPI and 2 antibiotics = triple therapy

124
Q

signs of hernia perforation

A

GI tract will stop moving

Patients will position themselves in knee chest position

125
Q

dumping syndrome

A

need to decrease volume of food and how often they eat and amount of carbs they intake
Food is going to pass out rapidly into duodenum → food is hyperosmolar → N/V, bloating, diaphoresis, get dizzy, cramping, rapid cramping and diarrhea
Tx: low carbs, smaller meals, no sugars, do not drink with dinner or meals

126
Q

vagotomy

A

cut vagus nerve tract to GI to decrease stimulation to decrease acid production

127
Q

diet therapy for ulcers

A

Neutralize acid and reduce hypermotility - no beans, no alcohol, no acidic foods, no tobacco
Bland, nonirritating diet just during acute episodes
Avoid bedtime snacks
Avoid alcohol and tobacco

128
Q

stress ulcers

A

Acute gastric lesions that occur after an acute medical crisis or trauma
Associated with burn injuries, sepsis, respiratory failure, surgery, critical illness
Results In acute gastric bleeding/hemorrhage
Mortality rate of >50%
Nursing concern: prevention!
PPI can be for stress ulcer prevention

129
Q

antacids

A

Most widely used preps
2 hours after meals
Can interfere with certain drugs with anticonvulsants, antifungals and antibiotics
Magnesium or aluminum hydroxide

130
Q

mucosal barrier fortifiers

A

Protecting coating protects against acids

AE: constipation

131
Q

manning criteria for IBS

A

Changes in stool frequency and consistency
Abdominal pain relieved with defecation
Pain Relieved by falling asleep
Pain More common in left lower quadrant
Abdominal distension:Visibility distended b/c they haven’t completely emptied bowel
Presence of mucus stool

132
Q

IBS

A

Characterized by chronic diarrhea and constipation, abdominal pain, cramping and bloating
Onset: young adulthood, lifelong process
Coexisting with stress, anxiety/depression
Familial predisposition
Unknown cause

133
Q

diet therapy for IBS

A

Avoid upsetting foods
Limit caffeine, alcohol, sorbitol, eggs, wheat and fructose
Encourage patients to have high fiber diet and bulk diet
Gluten free diet if they have gluten sensitivity
Get them to establish normal elimination pattern
8-10 glasses of liquid per day

134
Q

hernia

A

segment of bowel protrudes through weakness in abdominal muscle

135
Q

direct hernia

A

if it protrudes out through abdominal wall

136
Q

indirect hernia

A

loop of bowel through inguinal ring

137
Q

inguinal hernia

A

congenital, mostly male children

138
Q

other types of hernias

A

Umbilical hernia

Incisional hernia

139
Q

reducible hernia

A

when lying down, herniated site will reduce down and retract

140
Q

t/f: Irreducible or strangulated hernia is an emergency

A

True

141
Q

nursing interventions hernia

A

Make sure there are bowel sounds
Don’t cough or bear down post op, no lifting
Inguinal repair - elevate scrotum on ice pack to prevent swelling
Make sure they void before leaving hospital

142
Q

surgeries for hernia

A

Laparoscopic
Minimally invasive inguinal hernia repair
Open herniorrhaphy - more common with abdominal or ventral hernia,
Hernioplasty - lay down mesh to stop it from popping through

143
Q

mechanical intestinal obstructions

A

Adhesion
Hernia
Mass
Stricture

144
Q

paralytic ileus

A

Neuromuscular disturbance
Post general surgery - brief period of time when GI motility stops
Spinal injury

145
Q

s/s of mechanical bowel obstruction

A 
Sporadic mid abdominal pain and cramping
Vomiting
Obstipation (complete obstruction) vs. diarrhea
Abdominal distension
Borborygmi vs. absent bowel sounds
Abdominal tenderness
146
Q

s/s of nonmechanical bowel obstruction

A 
Constant diffuse discomfort “colicky”
Vomiting
Obstipation
Abdominal distension
Decreased or absent bowel sounds
147
Q

placing NG tube

A

Have patient sit upright
Have glass of water with straw
Lubricant on the tube - non petroleum based
Chucks across chest, basin for vomiting
Measure nose to ear to end of xiphoid process
Choose whatever nare has better airflow
Go into nare gently and when you get to back of nare you twist and gently push pressure to make the curve → go further and ask them to start swallowing (each time they take a sip, push a bit) → secure
confirm with Xray

148
Q

nursing care NG tube

A 
Check status of skin everyday
Oral care
HOB should be 30 degrees all the time
Document drainage, amount, color
Might need to do ph test trips 
Gastric ph should be b/w 4-6
Tube feedings → don't check ph for at least an hour
Need to flush tubes every 3-4 hours with pure water
149
Q

disimpaction

A

digitally dig out fecal material from anus
Need to be careful with older adults → vagal reflex → PSNS activity → can lower heart rate
Put older patients on cardiac monitoring during

150
Q

oil enema

A

helps fecal bolus soften and move

151
Q

polyps

A
  • small growths in intestine
  • attached to inner surface of GI tract mucosa
  • can be familial adenomatous polyposis → risk factor for colorectal cancer
  • not uncommon to have some when older
  • usually asymptomatic
152
Q

s/s of polyps (if symptomatic)

A
  • gross rectal bleeding or clots
  • can form obstruction
  • can put person at risk for intraception - bowel turning onto itself
153
Q

hemorrhoids

A
  • unnaturally swollen or distended veins
  • often due to increased abdominal pressure: pregnancy, people chronically constipated and straining, prolonged sitting, prolonged standing, weight lifters
154
Q

internal hemorrhoids

A

Originate Above anal sphincter

Can become enlarged and prolapse through sphincter

155
Q

external hemorrhoids

A

Originate below anal sphincter

156
Q

nonsurgical mgmt for hemorrhoids

A 
Prevent constipation 
Topical anesthetic - prep H
Sitz bath 4x per day, tucks wipes
High fiber diet/supplements
Increase fluid intake
157
Q

post op hemorrhoidectomy concerns

A

Pain
Swelling
Prolapse
bleeding/thrombosis
First bowel mvmt might be uncomfortable
Return if they have increasing bleeding, passing clots, temp over 100.5 F
Priority: keep perianal area clean -surgical site is exposed to fecal contamination
Can use bath but don’t put anything in bath other than soap and water
Ice pack
No specific diet

158
Q

rebound tenderness

A

appendicitis

-s/s: rebound tenderness - press on McBurney’s point halfway between iliac crest and umbilicus

159
Q

appendicits and perforation

A

rare in early phases, more common after 24 hours → risk for peritonitis

160
Q

peritonitis

A

acute inflammation of visceral/parietal peritoneum and endothelial lining of abdominal cavity or peritoneum

161
Q

primary peritonitis

A

more rare
Rare, blood borne
Infectious process
Peritoneum becomes colonized with bacteria/fungus

162
Q

secondary peritonitis

A

Acute abdominal disorder
Maybe from rupture ulcer or appendix
Renal failure → peritoneal dialysis - can get infection through port

163
Q

s/s of peritonitis

A

Peristalsis comes to a halt, bowel movement stops
Peritoneal cavity should be sterile
Abdominal pain
Tender to palpation
Guarding from pain
Rigid, boardlike abdomen d/t pain
Can become septic with high fever and chills
Tachycardia, dehydration b/c of fluid shifting
Shock → low urine output, N/V
Irritation of gastric enzymes → irritation and inflammation of diaphragm → shallow breathing
Can become septic quickly

164
Q

how to diagnose peritonitis

A 
CBC 
Physical exam
KUB - kidney, ureters, bladder - exam of these areas, X ray, looking for free air in peritoneal cavity which would indicate perforation in bowel somewhere
White count is high
Sonogram → can cause more pain
165
Q

peritonitis exploratory laparotomy

A

Will put red catheter into abdomen
Bathe peritoneal cavity with antibiotic solution during
Leave red catheter in → post op will order irrigation of peritoneal cavity with antibiotic solution after

166
Q

gastroenteritis

A 
Acute diarrheal illness
Common in travelers to areas with poor sanitation or poor handwashing
Bacterial, viral, or parasitic in nature
Fecal oral transmission
Associated with small bowel only
Large bowel = dysentery
Increased motility of bowel
167
Q

s/s of gastroenteritis

A 
Increase in the frequency and water content of stools
nausea/Vomiting
Can last up to 10 full days
Rapid fluid shifting
Myalgia - muscle aches
Headaches
Dehydration
Hyperactive bowel sounds
Malaise - feeling not well
168
Q

diet therapy for gastroenteritis

A

No caffeine, alcohol
Drink sports drinks for electrolytes
Clear liquids after vomiting subsides and progress

169
Q

drug therapy for gastroenteritis

A

Do not give antidiarrheals
If they need to slow down diarrhea, might recommend imodium (OTC antidiarrheal)
May end up on antibiotics

170
Q

crohn’s disease

A

Genetic predisposition
Disease of colon, small bowel or both
Transmural bowel involvement- one end of bowel to the other and all layers of bowel involved
Skip lesions
Usually begins in terminal ileum with patch involvement through all layers of the bowel
15-40 years old
5-6 soft loose stools per day, rarely bloody

171
Q

complications with crohn’s

A

anemia
Hemorrhage less common
Fistulas b/w bowel and skin, bowel and bowel, bowel and bladder more common than UC
Bowel cancer is more rare
Severe nutritional deficiencies
Rare cancer of small bowel and colon can develop

172
Q

physical assessment of crohn’s pt

A

Can have history of frequent bladder infections or vaginal infections
Could be d/t fistulas to bladder
Perinanal fissures/ulcerations
Steatorrhea - stools have high fat content
Weight loss is common, worse malabsorption

173
Q

ulcerative colitis

A 
Begins in rectum and proceeds in continuous manner toward cecum
Thickening of colon wall
15-25 y/o and 55-65 y/o
10-20 liquid blood stools per day and mucus in stools
Sudden need to defecate
Pain is better with bowel movement
Remissions and flares
Autoimmune like component
174
Q

ulcerative colitis complications

A 
anemia
Hemorrhage/Perforation
Abscesses in bowel lining
Fistulas often b/w bowel and bladder
Colorectal cancer
Toxic megacolon - enlarged colon, abdominal distension, fever, abdominal pain, can go into shock
Can treat with colectomy
Nutritional deficiencies
Gallstones
175
Q

manifestations of UC

A 
Colic, lower abdomen pain
Mucus bloody diarrhea
Tenesmus - uncontrolled straining for bowel mvmt
Low grade fever
Abdominal distension
Risk for bowel obstruction
176
Q

lab studies of UC

A 
Hypoalbumin
Hyponatremia
Hypochloremic
Hypokalemic
Anemia
Dehydration 
WBC count elevated if actively infected or abscesses have formed in ulcerated areas of colon
Positive indicators of inflammation - elevated C reactive protein and ESR
177
Q

goals of UC therapy

A

↓ frequency of stools
Reduce symptoms
Promote GI healing
↓ Inflammatory response

178
Q

UC nursing interventions

A

Record color, volume, frequency of stools
Is & Os
Encourage patient to keep diary of eating and stools
Identify causes or what’s contributing to diarrhea
Should make themselves NPO if really bad
Eliminate gas producing or spicy foods
Eliminate by trial anything that includes lactose
High protein, high calorie diet
Low fiber diet
Antidiarrheal medications (carefully w/ observation)
Monitor skin
Use warm cloth
Record weight regularly
Rest bowel
Might be put on NPO or TPN
CAMS

179
Q

Proctocolectomy w/ permanent ileostomy

A

Removal of rectum and colon and permanent closure of anus

for UC

180
Q

Kock’s pouch

A

made with loop of ileum: permanent continent ileostomy after proctocolectomy procedure
Continent means its not constantly draining

181
Q

ilial pouch with anal anastomosis:

A

entire colon and rectum are removed, internal pouch is created to collect fecal material and pt can defecate normally

182
Q

ostomy care

A

Brand new ostomy = beefy red
If not new - a mucous colored pink
Stoma should never be blue or purple → worried about blood flow to stoma

183
Q

how to diagnose crohns

A

colonoscopy

184
Q

drug therapy for UC

A

Aminosalicylate compounds
Corticosteroids (more in Crohn’s exacerbations)
Hydrocortisone rectal foam
Immunosuppressives
Antidiarrheals conservatively
Antibacterials if fistulas develop in Crohn’s
Remicaid (more Crohn’s) - immunomodulator, ↓ inflammation

185
Q

diverticulosis

A

pouch like herniations in wall of intestine (diverticula) → asymptomatic
Most common in large colon
Food can collect in outpouchings and rupture
Detect on colonoscopy

186
Q

diverticulitis

A

acute inflammation of diverticula, resulting from perforation of diverticula and local abscess formation

187
Q

how to diagnose diverticulitis

A

CT

188
Q

nonsurgical mgmt of diverticulitis

A 
Broad spectrum antibiotics
Pain meds
Avoid laxatives b/c bowel is weak
No enemas
IV fluids to correct dehydration
IV antibiotics 
Don’t bend/strain b/c bowel is weak
Rest
NPO if going to surgery
Analgesics
Anticholinergics - inhibit PSNS → slows down motility of bowel
189
Q

s/s of diverticulitis

A 
Abdominal pain
Distended
Fever 
LLQ pain
May have general peritonitis s/s
Labs reflect infection - elevated WBC
190
Q

anal fissures

A

Generally treated nonsurgically
Associated w/ chronic constipation
Keep area clean, use topical anti inflammatories

191
Q

anal absess

A

Usually d/t obstructed glands in anorectal area or profoundly hair in perianal or perineal area

192
Q

anal abscess treatment

A

OR procedure: incision and drainage
Heal by secondary intention: has to be left open and heal from inside out
Abscess is opened → cleaned out → packed if deep or just heals

193
Q

anal issues teaching

A 
High fiber diet
Regular bowel habits
Perineal hygiene
No enemas
No laxatives
194
Q

fistulotomy

A

open tract where abscess extended
Heals by secondary intention
Takes longer to heal than abscess

195
Q

hep A&E

A

fecal oral

196
Q

hep B & C

A

B&C = blood borne

197
Q

hepatitis manifestations

A 
Abdominal pain
Changes in skin or eye color (yellow)
Arthralgia
Myalgia
Diarrhea or constipation
Changes in color of urine or stool
Fever
Lethargy
Malaise
N/V
peruritis
198
Q

hepatitis education

A

No medications unless prescribed and approved by provider
No alcohol
Rest
Small meals
No sexual intercourse until antibody tests are negative
Disease prevention (mostly A&E)

199
Q

s/s of Cholecystitis

A 
Episodic or vague upper abdominal pain
Can radiate to right shoulder
Pain elicited by large meal or high fat meal
Anorexia
N/V
Flatulence or eructation
Abdominal fullness
Fever
Clay colored stools
Dark urine
200
Q

Choledocholithiaisis:

A

stones in common bile duct

201
Q

management of cholecystitis

A 
Diet therapy:
Low fat w/ vitamin supplementation
Drug therapy:
Opiate pain control acutely
antispasmodic
Surgically if needed = laparoscopic
202
Q

high fiber diets

A

30g or more of fiber
↑ whole grains
Fresh fruits and veggies
↑ legumes

203
Q

low fiber diets

A 
< 10 g of fiber daily
Indicated for diarrhea d/t inflammatory disease or diverticulitis
Avoid GI stimulants
Limited fruits and veggies
No whole gains
Milk is avoided
No nuts, seeds, coconut
204
Q

diet therapy for acid problems

A

feed less frequently, 3 meals per day

205
Q

diet therapy for motility issues

A

feed more frequently, small meals

206
Q

renal system changes with aging

A

Reduced RBF
Thickening of glomerular and tubular basement membranes → reduced filtration ability
↓ GFR
↓ tubule length
↓ thirst mechanism → at risk for hyponatremia, risk for dehydration
Nocturia - can’t concentrate urine

207
Q

bladder changes with aging

A

Changes in detrusor muscle elasticity and ↓ bladder capacity
Detrusor muscle keeps urine in bladder
↓ muscle tone of urinary sphincters
Enlarged prostate → ↑ urinary retention, difficulty initiating stream (micturition) → more at risk for UTIs
Decreased muscle tone in urinary sphincters
Women have shorter urethra than men

208
Q

aniuria

A

urine output of less than 100 ml in 24 hours

Normal urinary output for adult: 30 ml / hour

209
Q

azotemia

A

syndrome that results from increased BUN & creatinine together

210
Q

oliguria

A

decreased urine output, less than 400 mL / 24 hours

211
Q

polyuria

A

increased urine output, more than 2000 mL in 24 hours

212
Q

uremia

A

manifestations of renal failure

Electrolyte changes

213
Q

normal urine specific gravity

A

1.000 - 1.030 = normal range
Higher = more concentrated
1.000 = water

214
Q

Leukocyte Esterase (LCEs) -

A

enzymes found in WBCs

Indicator for infection

215
Q

collection and handling urine samples

A

Small amount of RBCs and WBCs - not uncommon
If not immediately tested -
Bacteria will multiply
Avoid by putting on ice!

216
Q

normal serum creatinine

A

0.2-1.0 mg/dl

Should not rise until 50% of renal function is compromised

217
Q

BUN Normal

A

8 - 20 mg/dl

Indication of renal excretion of urea nitrogen, by product of liver metabolism

218
Q

when would BUN rise

A

dehydration, infection, steroid therapy, and injury to tissues

219
Q

creatinine clearance

A

Indicator of renal function
More involved test
Calculated by lab and involves timed urine (24 hour urine collection = composite urine)
Want to know age, gender, blood levels

220
Q

urine samples for men

A 
Wash hands
1 Cleansing wipe end of penis
Sample cup 
First few drops → into toilet
Catch mid stream urine
Don't want last few drops either
221
Q

urine samples for women

A 
Wash hands
3 cleaning wipes 
Front to back on labia on one side, then the other, and then down the middle
Sit on toilet 
First few drops → into toilet
Catch mid stream urine
Don't want last few drops either
222
Q

CT scans and diabetics

A

metformin → if they have iodinated contrast → at risk of lactic acidosis
Need to hold oral agent for 24 hours before CT scan and 48 hours after scan OR can get contrast induced nephropathy
Put on sliding scale insulin instead

223
Q

cystoscopy/cystography/VCUG

A

Done to diagnose bladder or urethral trauma
Done to see why frequent UTIs
Remove tumor in urinary tract
Examine enlarged prostate

224
Q

process for cystoscopy/VCUG

A

Ask patient to void
Catheter
Sterile saline → fill bladder
Get pictures
VCUG - have person stand, remove saline, and watch how bladder contracts to empty
Shows if there are problems with motion of bladder wall

225
Q

when you remove foley after cystoscopy/VCUG…

A

When you remove foley, first void may sting - not uncommon

Should not sting after that - need to call provider

226
Q

cystitis

A

can be d/t

  • infection
  • Usually d/t infection
  • e.coli ascending urethra into bladder
  • Can also be virus, fungus or parasites
  • Catheter related infections are common

most common cause of sepsis

227
Q

how to diagnose cystitis

A

Urinalysis with culture and sensitivity

228
Q

interstitial cystitis

A

Unknown cause
Doesn’t have infectious variety but have all the symptoms
Could be allergic response

229
Q

cystitis drug therapy

A 
If infectious → antibiotics 
Long term antibiotics for chronic, recurring infections
Antifungal agents
Analgesics
Antispasmodics for bladder spasm
Not a surgical problem in most cases
230
Q

Urethritis

A

inflammation or urethra that causes s/s of UTIs

Etiology determines tx

231
Q

urethral stricture

A

Narrowing of urethra
Causes obstruction of outflow of urine → can lead to urine stasis and UTI
Can develop overflow incontinence
Surgical tx: urethroplasty - repair urethra

232
Q

causes of incontinence

A

Drugs and disease
Depression
Retaining continence requires energy! Can become not important to depressed pts.
Cognition required to know that there is a time and place and way to void
Inadequate resources - financials or physical limitations
May not be able to afford diapers/pull ups
May not be able to ambulate to bathroom or afford products to help ambulate
Visual problems, mobility problems

233
Q

stress incontinence

A

Due to weakening of the bladder neck, often associated with childbirth

234
Q

s/s of stress incontinence

A

Incontinence when sneezing, coughing, laughing, exercising

Small amounts leaked

235
Q

stress incontinence interventions

A

Want them to keep a diary of incontinence
Pelvic floor exercises = Kegels
Spacing fluid during the day
Topical estrogen therapy for postmenopausal therapy
Reconstructive surgery
Loop of bowel prolapse that is pressing on uterus or bladder prolapse
Implanted sacral nerve stimulator - reminder to kegel
Tens units

236
Q

urge incontience

A

Loss of urine r/t strong need/desire to urinate and inability to suppress signal for same
“Overactive bladder” / unstable bladder
Large amounts of urine b/c they suppress need to void for so long
May be secondary to Parkinsons, MS, stroke

237
Q

urge incontience interventions

A

Behavioral interventions
Diet therapy - stay away from caffeine, alcohol, stimulants
Drugs - anticholinergics for smooth muscle relaxation, antihistamines, etc.
Bladder training
Pelvic floor exercise
Interval training
Space fluid intake, and limit fluid after dinner

238
Q

overflow (reflex) incontinence

A

Detrusor muscles fail to contract so bladder over extends
“Underactive bladder”/ acontractile bladder
Doesn’t contract as it should to empty all urine
Can be associated with meds
Diabetes, spinal cord injuries, MS, BPH, uterine prolapse
Constant dribbling of urine to avoid bladder rupture

239
Q

interventions for overflow incontinence

A

Intermittent catheterization (maybe for spinal injury)
Surgery if outflow is obstructed (like BPH)
Meds - depends on cause
BPH - flomax

240
Q

functional incontinence

A

Caused by factors other than urinary tract issues like
Loss of cognitive function
See this in Alzhemiers and other dementias but never assume dementia is the reason (could be BPH)

241
Q

interventions for functional incontinence

A 
Treat any reversible causes first
Skin protection
Urine containment
Caregiver would need the urinary training - i.e. walk patient to bathroom, etc.
Condom caths at night, Diapers for women
Intermittent catheterization
242
Q

Urolithiasis

A

Presence of calculi (stones) in urinary tract
Majority of stones are made of calcium but not all (some can be bacterial)
Can have pressure build up behind stone and form outflow obstruction
50% of stones go on to form another stone in the future
Crystals can damage lining of urinary tract

243
Q

Urolithiasis s/s

A

sudden onset of extreme pain
Hematuria
Occult - color, dip (would come back + for blood)
Oliguria
Ureteral spasm
N/V secondary to pain
Pallor and diaphoresis
Potential for shock d/t nearby SNS nerves
Potential for hydroureter &/or hydronephrosis = obstructive stone
Stone that isn’t moving - doesn’t usually cause pain

244
Q

urolithiasis mgmt

A

Lab assessment - chemistries, hematology, UA
Elevated WBC - infectious process
KUB x ray can see stones
CT scan w/o contrast
IV access for hydration = controversial
Can make pressure behind stone if there is hydroureter or hydronephrosis
Pain mgmt: Opiates, injectable NSAIDs (toradol), antispasmodics
Complementary and alternative therapies: Heat → dilation
Walking promotes passage of stone!

245
Q

Shock wave lithotripsy (SWL) w/ stents = fluoroscopic procedure

A

Under moderate sedation
IV
Cardiac monitoring
Aim a shock wave at location of the stone and blast it with sound/shock wave so they can pass it

246
Q

other surgeries for urolithiasis

A

Retrograde ureteroscopy
May use laser to break stone up
Bruising may appear over area

247
Q

pt teaching for urolithiasis

A

Strain urine
stay hydrated
antibiotics

248
Q

AD PCKD

A

AD - more common
Manifests later in life
Few nephrons have cysts until pt reaches adulthood

249
Q

AR PCKD

A

100% of nephrons are involved from time they are born

Children usually die early in childhood

250
Q

PCKD s/s

A

Pain
Chronic - all the time because of cysts, pressure, discomfort
Acute - when cysts rupture, sharp pain over flank, pain is worse
Distended abdomen - enlarged kidneys press on bowel constipation
Hematuria/cloudy urine
Kidney stones are common
Nocturia & proteinuria
Nocturia = early sign
Proteinuria = once glomerulus is damaged
HTN b/c of renal ischemia
Edema b/c of high sodium levels (d/t renal ischemia)
N/V, anorexia
Pruritus (itching)

251
Q

mgmt of PCKD

A

Can needle aspirate through back to cyst
ASA and NSAIDs are not encouraged!
Antibiotics if indicated for infection
Constipation: put on stool softener
HTN and renal failure
Fluid therapy - stay hydrated (Would not push fluid in renal failure)
Drug therapy: BP medications - Measure and record BP
Diet therapy: increase fiber, decrease Na+

252
Q

PCKD teaching

A

Take temp if feel ill
See MD for unremitting headache or visual changes (could be cyst elsewhere)
Call MD for foul smelling urine = sign of infection

253
Q

Hydronephrosis, hydorturerer and urethral stricture

A

Results in outflow obstruction

Diagnosis by CT or ultrasound

254
Q

causes of Hydronephrosis, hydorturerer and urethral stricture

A 
Tumors
Stones
Trauma to renal system
Congenital defects
Scar tissue
Radiation therapy for urological cancers
255
Q

interventions for Hydronephrosis, hydroureter and urethral stricture

A

Catheterization as needed
Double voiding
Partial stricture or obstruction - relax and double void
Monitor bladder distension - gentle palpation
Bladder scan
Post void catheterization vs. bladder scan for post op
Nephrostomy tube

256
Q

nephrostomy tube care

A

If huge stone is obstructing - undergo fluoroscopy and drain ureter → reroute urine to decrease pressure
NPO before
Clotting studies or correct if not normal before procedure
Pain control before procedure
Moderate sedation plus local for procedure
If there is foley - you need to check both because both kidneys will route
Prone position/ fluoroscopic guidance of catheter
Follow up care
Bloody urine expected for 24 hours
Recurrence of pain may mean nephrostomy tube could have been displaced
Check urine output and report to provider

257
Q

acute pyelonephritis

A

Bacterial infection of the kidney
Can be primary of urinary tract
Or can be obstruction
Usually a bladder infection that has ascended!

258
Q

s/s of acute pyelonephritis

A 
Fever, chills, tachycardia and tachypnea
Flank or back pain
Abdominal discomfort
Significant N/V
May not be able to take PO antibiotics
May have urgency, frequency, nocturia
General malaise or fatigue
dehydration
259
Q

Causes of chronic pyelonephritis (4 things)

A

numerous episodes of acute pyelo in the past
Stones
Neurogenic impairment of voiding
Kinked ureter

260
Q

s/s of chronic pyelonephritis

A

HTN
Very dilute urine/nocturia - can’t concentrate
Abnormal lab values: hyponatremia, hyperkalemia, acidosis

261
Q

tx for chronic pyelonephritis

A

Urinary diversion surgery
Unkink ureter via surgery
Antibiotic but might be long term

262
Q

diabetic nephropathy

A

Leading cause of end stage renal disease

Microvascular complication of type 1 or type 2

263
Q

what is the first sign of diabetic nephropathy?

A

albuminuria

264
Q

tx for diabetic nephropathy

A

Avoid nephrotoxic agents
Avoid dehydration
Might need to reassess insulin requirements
Kidneys metabolize and excrete insulin
If kidneys are failing, insulin will clear slower → will be at risk for hypoglycemia

265
Q

reasons for surgery

A 
diagnostic
curative
restorative
palliative
cosmetic
266
Q

types of surgeries

A

Elective - planned, non acute problem (cataracts, hernia repair)
Urgent - prompt but not emergent
Emergent - immediate intervention

267
Q

simple surgery

A

only part of body involved is removed

268
Q

radical surgery

A

remove more tissue than just body part involved (i.e. lymph nodes, regional tissues)

269
Q

nurses’s focus for surgeries

A 
keep patient calm and comfortable
Labs to draw before
Patients belongings
Consent for surgery? armband?
Pre-op teaching
head to toe assessment
270
Q

informed consent roles

A

Nurse to verify that they know what they’re going in for

Physician’s responsibility

271
Q

questions to ask patient

A

Tell me about the procedure you’re going to have today
Last time you ate or drank?
Allergies?
Do you use any OTC meds or herbal supplements?
Have you had any issues with pain control in past?
Chronic pain?
Take any meds this morning? Which ones?
Who is here with you?

272
Q

periop medications

A

Need to know if they should take or not
Cardiac and respiratory meds, anticonvulsants, HTN → usually they take them
If they didn’t take them at home- make sure they get them before OR
No non steroidals or anything that interferes with clotting

273
Q

general anesthesia

A

reversible loss of consciousness induced by inhibiting neuronal impulses in the CNS
Can involve as single agent or a combo
Inhalation or IV or both

274
Q

side effects of gen anesthesia

A
  • agitation
  • N/V
  • altered sensory or motor mobility
  • shivering
275
Q

complications of gen anesthesia

A

overdose (if renal or hepatic function is decreased)

  • unrecognized hypoventilation → intubate one bronchus by accident
  • intubation complications
  • Malignant Hyperthermia (AD trait) -
276
Q

malignant hyperthermia

A

Skeletal muscle’s calcium level rises as response to the anesthetic drugs → skeletal muscle metabolism increases → serum Ca and K+ rises
Results in: acidosis, dysrhythmias, hyperthermia

277
Q

s/s of malignant hyperthermia

A

Tachycardia, dysrhythmias, muscle rigidity of jaw and upper chest, hypotension, tachypnea, mottling, cyanosis, myoglobinuria
Rise in CO2, drop in O2

278
Q

how to treat malignant hyperthermia

A

dantrolene (muscle relaxant) and others (NS, insulin in D50 (concentrated sugar) - will cause uptake of glucose and K+, D50 makes it so glucose doesn’t bottom out, sodium bicarbonate, CaCl)

279
Q

local anesthesia

A

brief disruption of sensory nerve impulse transmission from specific body area or region

  • local infiltration or delivered topically
  • pt. is conscious
280
Q

regional anesthesia

A

blocks peripheral nerves in a specific body region

Regional examples: field block (dental), nerve block (limb or chronic pain), spinal block (abdominal hip or knee surgery), epidural block (vaginal, anal, rectal, perineal surgery)

281
Q

complications of local anesthesia

A
  • anaphylaxis
  • incorrect delivery
  • systemic absorption
  • OD
  • local complications
282
Q

moderate sedation

A

conscious

  • IV delivery of sedative, hypnotic or opioid drug
  • diminished LOC
  • patent airway, can respond to verbal commands
  • Short acting amnesia
  • medications for pain with an amnestic: Diazepam, midazolam, meperidine, fentanyl, alfentanil, morphine sulfate
283
Q

pre procedural pause

A

All health care members in the team pause and ask the following questions and state/confirm out loud:

Patient Name and DOB
Procedure being performed - includes site of procedure
Physician performing procedure

284
Q

circulating nurse role

A 
Coordinate OR
Flow
Set up
Positioning
Assist anesthesia
Sponge and instrument counts - documentation
4x4s = sponges
Flows from room to room/units to ensure progress, needs, breaks, etc.
285
Q

scrub nurse role

A

Set ups sterile field - draping, instruments, maintains count

286
Q

number 1 concern in OR

A

pt safety

287
Q

handoff b/w circulating nurse and PACU nurse

A 
Procedure performed
History	
Blood loss (EBL)
Procedure l length
Procedure complications
BP stable?
Cardiac regularities?
Medications (including anesthesia)
288
Q

immediate post op concerns

A 
Pneumonia
Shock
Cardiac arrest
Resp arrest
DVT
GI bleeding
289
Q

immediate pacu priorities

A

Assess and support airway
HR and rhythm
Perfusion - cap refill, pulse ox

290
Q

second priority in PACU

A

VS
Neurological assessment
Transfer to monitors

291
Q

within several minutes of getting to PACU…

A 
Complete report quick review of operative record
EBL
Last pain meds
Updated status since report
Evaluate surgical dressing
292
Q

how often do you do VS in PACU

A

Vital signs q 15 minutes x4 (1 hour), q30 x4 (2 hours), q1 hour x4 (4 hours)
7 hours total

293
Q

post op GI

A

General anesthesia makes GI come to a halt
Can take up 72 hours for GI tract to return to normal
Listen for bowel sounds

294
Q

dehiscence and how to treat

A

wound separation
Apply a sterile non adherent (telfa) dressing or a moist dressing (sterile saline) to the site
Notify surgeon
Position patient with knees slightly bent
Tell patient not to cough or strain

295
Q

evisceration

A

most serious complication of dehiscence

Occurs with abdominal incisions → wound completely separates with protrusion of the viscera through the incision area

296
Q

evisceration treatment

A

Stay with patient, call for help
Call surgeon or rapid response team
Put patient in low fowlers, knees slightly bent and keep exposed viscera moist, cover the abdominal contents, contact provider
Do not attempt to reinsert the protruding viscera
Watch for shock, reassure patient
Document

297
Q

risk factors for impaired wound healing

A

Diabetics
Obesity → longer OR time, more anesthesia, more intraoperative blood loss
More SQ tissue, decreased regional perfusion, decreased O2 tension → impairs healing
Can be associated with other comorbidities
Steroids → lowered inflammatory response
Poor nutrition - underweight
Lengthy surgery - longer length increases the risk
Multiple blood transfusions → higher risk for for post op infection
TRIM - transfusion associated immunological modification
Multiple invasive lines and catheters
Other comorbidities
Mechanical ventilation post surgery

298
Q

is a low grade fever normal after surgery?

A

yes

Med Surg (2 decks)

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