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Med Surg 1 > Final > Flashcards

Final Flashcards

1
Q

Who’s at greatest risk for hyponatremia?

A

people with increased sodium excretion (diuretics, vomiting, wound drainage, kidney disease), inadequate sodium intake, and those with dilution of serum sodium (excessive hypotonic fluids, kidney disease, freshwater drowning, SIADH, hyperglycemia, heart failure)

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2
Q

Who’s at greatest risk for hyperkalemia?

A

excessive K intake (rapid infusion of K IV solutions), decreased K excretion ( retaining diuretics, kidney disease, adrenal insufficiency), and movement of K from ICF to ECF (tissue damage, acidosis, hyperuricemia, and hypercatabolism)

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3
Q

What 4 functions does Na do?

A
  • Nerve impulse transmission
  • Skeletal muscle and cardiac contraction
  • Maintain electrical balance: slower depolarization
  • Determine osmolality of ECF
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4
Q

What are the 3 functions of K?

A
  • Determine osmolarity of ICF
  • Generate action potentials, and depolarization
  • Regulate protein synthesis and regulating glucose use and storage
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5
Q

What are the ECG changes in hyperkalemia?

A

peaked T waves, flat P waves, widened QRS complexes, and prolonged PR intervals

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6
Q

What are the 4 functions of Ca?

A
  • Bone and tooth strength
  • Blood clotting
  • Neuromuscular conduction via Na/K pump
  • Cardiac contractions
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7
Q

What are the 3 functions of phosphorous?

A
  • Formation of bone and teeth (most in bones)
  • Activating vitamins and enzymes, forming ATP
  • Assist in cell growth and metabolism
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8
Q

What are the 4 functions of magnesium?

A
  • Assist in skeletal/cardiac muscle contraction
  • Participate in CHO, protein, liquids, Vit B12 metabolism
  • Facilitate ATP formation
  • Contribute in vasodilation of peripheral arteries
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9
Q

What are the 3 functions of chloride?

A
  • Active component of renal physiology (goes with Na)
  • Balance acid-base (decreased Cl causes renal retention of bicarb –>metabolic alkalosis)
  • Form gastric acid HCl
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10
Q

Which electrolytes are positively charged?

A

Na, K, Ca, Mg,

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11
Q

Which electrolytes are negatively charged?

A

Phosphorous, Chloride

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12
Q

Why does blood pH change?

A

because CO2 mixed with H20=carbonic acid

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13
Q

Which organ controls bicarbonate?

A

kidneys

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14
Q

Carbohydrate metabolism forms…

A

CO2

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15
Q

Protein breakdown forms…

A

sulfuric acid

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16
Q

Fat breakdown forms…

A

fatty acids and ketoacids

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17
Q

Incomplete breakdown of glucose (occurs when cells metabolize anaerobically) forms…

A

lactic acid

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18
Q

Why do electrolyte imbalances occur with abnormal ABGs?

A

because H either goes into or out of the cell to compensate
Alkalosis: decreased K (H moves out of cell into ECF and K moves into ICF)
Acidosis: increased K (H moves into ICF so K goes out into ECF)

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19
Q

Increased hydrogen ions leads to…

A

increased acid, lower pH

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20
Q

Decreased hydrogen concentration, what are you expecting?

A

alkalosis

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21
Q

What is Colloidal Osmotic Pressure?

A

a pulling pressure, so increased protein = increased water

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22
Q

Colloid IV solutions pull fluid from… to…

A

from the interstitial compartments into the vascular compartment (used to increase vascular fluid rapidly, like with a hemorrhage or severe hypovolemia)

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23
Q

Which fluids can you give centrally?

A

fluids and medications with a pH value less than 5 and more than 9 and with osmolarity more than 600 mOsm/L are best in central circulation (if used peripherally it can damage blood cells and the endothelial lining o the veins)

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24
Q

Which pressure changes occur when a pt is given a hypertonic solution?

A

osmotic pressure increases, causing water to go into the vessels DOUBLE CHECK!

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25
Q

What is hydrostatic pressure?

A

the force that pushes water outward from a confined space

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26
Q

What are the 3 factors that influence hydrostatic pressure?

A
  • Blood volume
  • Force of contraction (of the heart on arteries)
  • Resistance of blood vessels
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27
Q

At the arterial end of a capillary bed, hydrostatic pressure is … resulting in…
At the venous end of a capillary bed, hydrostatic pressure is… resulting in…

A

greater than the interstitial fluid resulting in fluid flowing into the interstitial space
decreased, less than the interstitial fluid which results in fluid flowing into the vessel

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28
Q

Blood travels from the body to the vena cava, to the right atrium, to the right ventricle, through the _______, to the lungs, through the _______, to the left atrium, to the left ventricle, to the aorta

A

pulmonary artery, pulmonary vein

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29
Q

What does the QRS represent?

A

the time it takes for the impulse to travel from the AV node, down the bundle of His, through the left and right bundle branches, and down the Purkinje fibers
-ventricle contraction (depolarization)

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30
Q

What does the PR represent?

A

the time it takes for the impulse to travel from the SA node to the AV node.
-Atrial contraction (depolarization)

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31
Q

What does the T wave represent?

A

ventricle repolarization

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32
Q

What is the role of surfactant? What happens without it?

A

(a fatty protein) reduces surface tension in the alveoli

atelectasis occurs if no surfactant

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33
Q

What’s the difference between asthma and COPD?

A

Asthma is reversible (intermittent reversible airflow obstruction and wheezing), COPD is irreversible (asthma and chronic bronchitis)

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34
Q

What is asthma?

A

airway obstruction that occurs from inflammation and airway hyper-responsiveness that leads to bronchoconstriction

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35
Q

Understand antibiotics & the importance of teaching

A

to prevent antibiotic resistant diseases

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36
Q

How does antibiotic therapy increase the risk for infection?

A

antibiotic therapy may increase the growth of microbes within biofilms, change normal protective flora, providing opportunity for pathogenic bacterial overgrowth and colonization

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37
Q

Pain can lead to which ABG change?

A 
respiratory alkalosis (breathing fast, breathing off all of the CO2-->alkalosis)
or respiratory acidosis (abdominal pain) CO2 retention b/c you’re not breathing deeply b/c it hurts so bad,
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38
Q

Who’s at greatest risk for dehydration?

A

older adults (b/c their thirst mechanism doesn’t work as well and they are composed of less H2O b/c they have less muscle)

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39
Q

What does an increased plasma osmotic pressure do?

A

causes fluid to go into the blood vessel

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40
Q

What does decreased osmotic pressure do?

A

causes edema

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41
Q

What s/s will u see w heart failure?

A

right: dependent edema, jugular venous distention, abdominal distention, hepatomegaly, splenomegaly, anorexia, nausea, weight gain, nocturnal diuresis, swelling of fingers and hands, increased or decreased BP
left: pulmonary congestion, dyspnea, tachypnea, crackles, cough, paroxysmal nocturnal dyspnea, increased or decreased BP
dyspnea, fluid retention

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42
Q

Risk factors for cardiovascular disease/heart failure? (15)

A

Smoking, diabetes, hypertension, CAD, cardiomyopathy, substance use, valvular disease, congenital defects, cardiac infections, dysrhythmias, family history, obesity, severe lung disease, hyperthyroidism, sleep apnea

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43
Q

How does diabetes affect the cardiovascular system?

A

Cardiovascular disease: diastolic dysfunction–> HF, MI

  • causes both diastolic and systolic heart failure
  • pts with DM are also usually obese, have hypertension, dyslipidemia, and sedentary lifestyle
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44
Q

What are the 3 macrovascular (large blood vessels) complication of diabetes? (6)

A

atherosclerosis (increases CVD, CAD, PVD risk), angina, PAD, MI, stroke, TIA (percursor to stroke)

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45
Q

Risk factors for peripheral vascular disease?

• What causes it?

A

hypertension and cigarette smoking

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46
Q

What are the pt preparations for cardiac catheterization?

A

tests: chest x-ray, CBC, coagulation studies, and 12 lead , electrolytes, BUN, creatinine (before and after) ECG, vitals, pulses, auscultate heart and lungs
Ask: allergies to iodine?
Give: antihistamine or steroid if needed, mild sedative,
hydration and acetylcysteine pre and post study help minimize contrast induced renal toxicity,

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47
Q

What do u need to know w a Pt that gets something w iodine in it?

A

are you allergic to shellfish?

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48
Q

What are important assessments after Pt comes out of cardiac catheterization?

A

bed rest, keep site straight, check VS, pressure on site, check for bleeding or hematoma, check peripheral/pedal pulses skin temperature and color

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49
Q

When/why would a diabetic pt have hypokalemia?

o Potassium on Insulin

A

-Hypokalemia: when you pee out too much after giving insulin,

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50
Q

What is potassium’s effect on digoxin?

A

Hypokalemia increases the risk for digoxin toxicity and ventricular dysrhythmias

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51
Q

How does using insulin and glucose decrease K (nursing intervention for hyperkalemia)?

A

causes K into the cell (ICF) from ECF

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52
Q

What do beta adrenergic blockers do? Used for?

A

block the sympathetic nervous system, decrease cardiac output, HR, and BP, decrease oxygen demands

used for: hypertension, angina, dysrhythmias, migraine headache (prophylaxis), MI (prevention), glaucoma, heart failure (HF)

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53
Q

What do ACE inhibitors do? Used for?

A

prevent peripheral vasoconstriction by blocking conversion of angiotensin I to angiotensin II

-treat hypertension and heart failure and to protect kidney function in patients with diabetes mellitus.
(doesn’t let you hold onto water, like a diuretic)

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54
Q

What is the RAAS system?

A

regulates BP, increases BP by retaining water and sodium
-renin converts angiotensinogen to angiotensin I; angiotensin I is converted to angiotensin II (in lungs); angiotensin II stimulates release of aldosterone (which promotes water and sodium retention by the kidneys therefore increasing blood volume and BP

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55
Q

Renin converts ______ to ________. Angiotensin I is converted to ______ in the lungs which stimulates the release of _______

A

angiotensinogen to angiotensin I,
angiotensin I converts to angiotensin II
angiotensin II releases aldosterone

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56
Q

What lab values that indicate myocardial infarction?

A

no single ideal test to diagnose MI

-most common: troponins T and I, CK-MB, and myoglobin

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57
Q

What is CK-MB?

A

creatine kinase-MB,the most specific marker for MI but doesn’t peak until about 24hours after the onset of pain

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58
Q

CK vs CKMB?

A

CK: enzyme specific to cells of the brain, myocardium, and skeletal muscle , indicates tissue necrosis or injury
CKMB: CK found in myocardial muscle, most specific for MI

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59
Q

Normal value for troponin?

A

cardiac troponin T 0.03 ng/mL

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60
Q

When someone is receiving insulin, what do you want to monitor?

A

blood glucose, HbA1c levels, monitor K! and look for s/s of DKA (not enough insulin so body can’t use glucose so it breaks down protein–>ketones–>metabolic acidosis)

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61
Q

Why is checking weights important in heart failure pts?

A

lets you know how much extra fluid your body is holding on to.
Sudden weight gain may mean that fluid is building up in your body because your heart failure is getting worse
-heart tries to compensate for poor pumping by holding onto Na and water

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62
Q

Important assessments for Pt w Diabetes

A

sensation, foot care, peripheral pulses, check for hypertension and hyperlipidemia, changes in renal function, eye function

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63
Q

What are the P’s of diabetes?

A

polyuria, polydipsia, and polyphagia

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64
Q

s/s of diabetes

A

polyuria, polydipsia, polyphagia, hyperglycemia, weight loss, blurred vision, slow wound healing, vaginal infections, weakness, parethesias, inadequate circulation to the feet, signs of accelerated atherosclerosis

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65
Q

What are the s/s of gout?

A

(mimics RA) pain, inflammation of joints (usually toes first), tophi (hard, white under skin)

  • usually big toe, then next toe, etc
  • leg first than hand (distal to proximal)
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66
Q

What is the management for gout?

A

acute: NSAIDs and oralColchicine (4-7 days)
chronic: Allopurinol and Probenecid: reduces production of uric acid in blood stream
-Fluid intake: 64 oz/day, citrus fruit/juice, milk
Diet: strict low-purine diet, no organ meats, shellfish, and oily fish with bones (sardine)
Avoid alcohol, Aspirin, stress

67
Q

What is the pt teaching for gout?

A

DO: drink fluids (citrus, juices, milk), ear low purine diet, learn triggers,
AVOID: excessive alcohol intake, starvation/fasting diets, diuretics and aspirin, stress,

68
Q

What are the hip precautions?

A
  • Vital signs, I&O, deep breathing & coughing, & use of incentive spirometer.
  • Monitor neurovascular: extremity for color, temperature, capillary refill, distal pulses, edema, sensation, motor function, & pain.
  • Log roll, abductor pillow
  • Dressing and drain
  • Mobilize ASAP
69
Q

How to stabilize a spine, how to align a spine?

A
  • Log Roll, don’t let spine twist to either side, lie supine with pillow under the neck and slightly flex the knees
  • If u suspect unstable vertebrae, definitely put Pt in spinal precaution
  • Spinal cord injury: immobilize on spinal backboard (head in neutral position), prevent head flexion, rotation, or extension, don’t sit the pt
70
Q

Complications of bone fractures? (5)

A

Fat embolism, compartment syndrome, infection and osteomyelitis, avascular necrosis, and pulmonary embolism

71
Q

Osteoporosis

A

reduced Ca intake, more likely to have bone fracture, more prominent in females bc of reduced estrogen, we ensure regular exercise, good diet in Ca and vit D

72
Q

How can you prevent osteoporosis?

A

build strong bone as a young person,decrease modifiable risk factors, eat Ca, dairy products, dark green leafy vegetables, adequate vitamin D, limit carbonated drinks, weight bearing exercise (walking)
- avoid alcohol, coffee ,and cigarettes

73
Q

What is osteopenia?

A

decreased bone density (bone loss, low bone mass), severe osteopenia is called osteoporosis

74
Q

Who is high risk for Osteoporosis?

A

smokers, early menopause, excessive use of alcohol, family history, female, age, insufficient intake of Ca, sedentary lifestlye, thin/small frame, white or asian

75
Q

What does COAL stand for (in terms of cane use)?

A

Cane Opposite Affected Leg

move cane at the same time as the affected leg) (no more than 30 degrees of flexion of the elbow

76
Q

Wandering Wilma’s Always Late?

A

Walker With Affected Leg
(put all for point of the walker flat on the floor before putting weight on the hand pieces. Pt moves walker forward, then weaker foot, then unaffected foot)

77
Q

What are the s/s that indicate GERD? (5)

A

heartburn, epigastric pain, dyspepsia, nausea/regurgitation, pain and difficulty swallowing, hypersalivation

78
Q

Teaching for Pt with GERD?

A

Avoid triggers (peppermint, coffee, chocolate, fatty foods, alcohol, smoking), ear low fat high fiber, don’t drink anything 2 hours before bed, elevate head of the bed 6-8 inch blocks, avoid anticholinergics (delay stomach emptying) and NSAIDS, take antacids, H2 receptor antagonists or PPIs

79
Q

What are the 5 causes of GERD?

A 
Incompetent LES
Pyloric stenosis
Hiatal hernia
Delayed emptying
Motility problems
80
Q

• Fecal impaction? Renal diet? Liver Failure?

A

sdf

81
Q

What are the main two differences in gastric and duodenal ulcers?

A

in gastric ulcers: pain 1-2 hours after meals, more common in females, hematemesis is more common
-in duodenal ulcers: pain is relieved by food, more common in males, melena is more common

82
Q

What are the emergency s/s of peptic ulcers? (3)

A
  • hematemesis, melena,
  • Perforation of the ulcer (sudden, sharp pain –> peritonitis) can lead to septicemia and hypovolemia shock, peristalsis diminishes and paralytic ileus develops
  • or symptoms of obstruction (bloating, n/v)
83
Q

What is the diet therapy for PUD?

A

avoid: caffeine, coffe (caf and de-caf), alcohol, tobcacco

- bland, nonirritating diet is recommended during symptomatic phase-eat 6 smaller meals

84
Q

What shouldn’t you give to liver failure pts?

A

carbs/starches

85
Q

What shouldn’t you give to kidney failure pts?

A

protein

86
Q

How can you prevent fecal impaction in the older adult?

A

high fiber diet, plenty of fluids, don’t routinely use laxatives,exercise, warm beverages/prune juice, wake metamucil (bulk-forming products) for fiber

87
Q

o Strokes – recognize diff strokes

• Nursing responsibilities

A

jhg

88
Q

What are the 3 types of strokes?

A

ischemic (embolic or thrombotic stroke), hemorrhagic stroke, or TIA

89
Q

What is an ischemic stroke?

A

blocked blood flow to the brain, 80% all strokes

90
Q

What is a hemorrhagic stroke? s/s?

A

abrupts, daytime, sudden, stupor or coma, could have seizures, no TIA precipitation, severe neuro deficits, possibly permanent effects

91
Q

What is a TIA? S/s?

A

brief disruption of blood flow, temporary neurologic dysfunction, symptoms resolve within an hour or <24 hr, precursor for stroke, can be a result of plaque, or unstable plaque, or a spasm (from stress perhaps)

92
Q

s/s of embolic stroke?

A

Abrupts, daytime, sudden, awake, no seizures, no TIA precipitation, expressive aphasia, paralysis, and a rapid recovery

93
Q

s/s of thrombotic stroke?

A

intermittent, daytime, gradual, awake, no seizures, TIA precipitation, headache, speech, visual, confusion, weeks months or permanent to recover

94
Q

What are the top 2 risk factors for stroke?

A

HTN and DM (both cause endothelial damage)

95
Q

What are the nursing considerations with stroke pts?

A

DVT prophylaxis
Aspiration: precaution, swallow screening, speech therapist
Mobilization: PT
Communication: speech therapist
Incontinent: bowel/bladder training
Sensory: vision, memory, simple instruction
Paralysis: unilateral neglect

96
Q

What is the management of a stroke?

A

CAB!

  • BP (don’t want it too low or too high)
  • correct hypo/hyperglycemia
  • Nomothermia
  • FLuid resuscitation
  • Imagine
  • Eval for thrombolytic therapy
97
Q

These symptoms are most consistent with which type of stroke?

  • sudden onset of facial or extremity paresis
  • sudden onset of facial or extremity paresis
  • Sudden visual deficit
A

ischemic stroke

98
Q

These symptoms are most consistent with which type of stroke?

  • Decreased LOC
  • HA, n/v (increased ICP)
A

bleed (hemorrhagic) or seizure

99
Q

How does an aneurism appear? s/s

A

sudden onset of severe headache (aneurysm rupture)

100
Q

What is diagnostic surgery?

A

to determine origin/cause

101
Q

What is curative surgery?

A

to remove the cause

102
Q

What is restorative surgery?

A

to improve function

103
Q

What is palliative surgery?

A

to relieve signs/symptoms, make pt more comfortable

104
Q

What are the post-op nursing priorities?

A

DVT prevention, I&O, mobility, IS, TCDB, Leg exercises (look up in the book!)

105
Q

What is isotonic dehydration? causes? (3)

A

water and electrolytes are lost in equal proportions (hypovolemia)

  • inadequate intake of fluids and solutes
  • fluid shifts between compartments
  • excessive losses of isotonic body fluids
106
Q

What is hypertonic dehydration? causes? (7)

A

water loss exceeds electrolyte loss
-excessive perspiration, hyperventilation, ketoacidosis, prolonged fevers, diarrhea, early-stage kidney disease, and diabetes insipidus

107
Q

What is hypotonic dehydration? causes? (4)

A

electrolyte loss exceeds water loss

-chronic illness, excessive fluid replacement (hypotonic), kidney disease, and chronic malnutrition

108
Q

Who is at risk for hypernatremia? What causes it? (4)

A
  • decreased sodium excretion
  • Increased sodium intake
  • decreased water intake (NPO, fasting)
  • Increased water loss (infection, fever, diarrhea, etc)
109
Q

What are the differences in s/s of hyper and hyponatremia?

A

Hyper: spontaneous muscle twitches until skeletal muscle weakness, extreme thirst, decreased UO, increased urinary specific gravity
Hypo: shallow, ineffective respiratory movement due to skeletal muscle weakness, HA, confusion, seizures, coma, hyperactive BS, nausea, diarrhea, increased UO, decreased urinary specific gravity

110
Q

Who is at risk for hypokalemia? What causes it?

A

-actual total body potassium loss (diurects,vomiting, etc)
-inadequate K intake
-movement of K from ECF to ICF
dilution of K (water intoxication)

111
Q

What are the differences in s/s of hyper and hypokalemia?

A

Hyper: decreased BP, muscle twitches, cramps, that turn into profound weakness, hyperactive BS, diarrhea, peaked T waves
Hypo: orthostatic hypotension, diminished breath sounds, anxiety, confusion, coma, diminished DTR, hypoactive/absent BS, n/v/constipation, paralytic ileus, ST depression (flat or inverted T wave)

112
Q

What are the differences in s/s of hyper and hypocalcemia?

A

Hyper: increased HR then brady, increased BP, ineffective RR due to muscle weakness, disorientation, lethargy, coma, renal calculi, hypoactive BS, nausea, constipation, shortened ST and widened T wave
Hypo: decreased HR and BP, twitches, cramps, seizures, Trousseau and Chvostek, hyperactive DTR, hyperactive BS, cramping, diarrhea, prolonged ST, prolonged QT

113
Q

Hyper or Hypomagnesemia?

tachycardia, hypertension, twitches, positive Trousseau’s and Chvostek’s, irritability, confusion

A

hypomagnesmia

114
Q

What are the normals for pH? CO2? and HCO3?

A

pH: 7.35-7.45 (7.40)
CO2: 35-45 (40)
HCO3: 22-26 (24)

115
Q

What effect do these solutions have? 0.9% NS, D5W/1/4 NS, LR

A

isotonic solutions, increase ECF

116
Q

What effect do these solutions have? D5W, 1/2NS, 1/4NS, 1/3 NS,

A

Hypotonic, increases ICF (water flows from ECF into cells)

117
Q

What effect do these solutions have? 3%NS, 5%NS, D10W, D5W/NS, D5W/1/2NS, D5LR

A

Hypertonic, increase ECF (from cells into ECF)

118
Q

What effect do these solutions have? Dextran and albumin

A

colloid, pulls fluid from ICF into vascular compartment (increases vascular volume rapidly like in hemorrhage or severe hypovolemia)

119
Q

What respiratory problem is this?
Infection of pulmonary tissue (alveoli and bronchioles), edema, decreased gas exchange, increased exudate, diminished breath sounds, fecer

A

pneumonia

120
Q

What respiratory problem is this?
Abnormal permanent enlargement of air spaces with destruction of alveolar walls, loss of elasticity of alveolar sacs, restricts air flow in and out (primarily out) leading to an increased CO2 level

A

emphysema

121
Q

What respiratory problem is this?
Inflammation os the bronchi and bronchioles caused by exposure to irritants, irritant triggers inflammation, vasodilation, mucosal edema, congestion, and bronchospasm, affects only the airways not the alveoli

A

Chronic bronchitis

122
Q

What constitutes and open airway? What are you going to listen for?

A

Open, clear, and aligned

-crackles

123
Q

S/s of hypertrophic heart (ventricle)?

Would the apical pulse be in the same spot?

A

(dyspnea on exertion, syncope, dizziness, and palpitations)

High pressure (wall stress) in the ventricle heightens myocardial oxygen consumption, a situation that promotes further hypertrophy and
activates neurohormonal systems
-Reduction in ejection fraction
-Reduced ventricular performance
-Morbidity and mortality

-probably not

124
Q

Nursing diagnoses for HF pt?

A

Impaired gas exchange

then decreased cardiac output

125
Q

CABG, what’s important to assess after?

A

HR, rhythm, pulmonary and arterial pressures (BP), neuro status, I&O (drains, chest tubes, etc), fluid and electrolytes, temperature, monitor for signs of cardiac tamponade, and pain

126
Q

What ECG finding(s) would indicate a heart attack/cardiac arrest?

A

either ST elevation (STEMI), T-wave inversion, or non-ST elevation (abnormal Q wave may be present)
-Days later, ST and T wave return to normal

127
Q

Treadmill test: what are you looking for in your pt?

A

ischemia and infarction (ECG changes)

128
Q

What is the normal time frame of a PR interval?

A

0.12-0.20 seconds

3-5 small boxes

129
Q

What is the normal time frame of QRS?

A

0.04-0.10

1-2 1/2 boxes

130
Q

What is the normal time frame of QT?

A

~0.36

131
Q

What is a normal T wave look like?

A

Upright well rounded and less than ½ the height of the QRS complex

132
Q

Why do diabetics experience polyuria?

A

results from an osmotic diuresis caused by excess glucose in the urine

133
Q

Why do diabetics experience polydipsia?

A

Due to polyuria, the body loses sodium, chloride, potassium, and water (dehydration occurs) so thirst occurs

134
Q

Why do diabetics experience polyphagia?

A

because the cells receive no glucose, cell starvation triggers excessive eating

135
Q

Once you have diabetes what does it increase risk for?

A

CV disease, CVA, kidney disease, reduced vision/eye problems, neuropathy, nephropathy, ED

136
Q

What are the microvascular complications of diabetes?

A

Retinopathy & Nephropathy

137
Q

What causes diabetes?

A

type I: insulin deficiency (too little or no insulin), autoimmune, usually congenital
Type II: relative lack of insulin or resistance to the action of insulin (too little or wrong insulin)

138
Q

Total knee precautions?

A

Knee should be maintained in neutral position, ice, CPM, avoid weight bearing

139
Q

What are the safety precautions for a pt with osteoporosis?

A

identify and correct home hazards, ensure unobstructed walkways, use side rails to prevent falls, use cane or walker, use firm mattress, move pt gently, assist with ambulation if unsteady, ROM exercises, avoid alcohol and coffee

140
Q

Risk factors for GERD and PUD?

A

GERD: alcoholism, smoking, high-fat diets, obesity, older adult, men
PUD: smoking, older adult, NSAIDs, additional chronic diseases, cocaine use, chemo, radiation, and genetic predisposition

141
Q

How do the NSAIDs effect the stomach?

A

2 levels, topical and systemically, prostaglandin inhibitor (prostaglandin increase blood flow to tissue/perfusion)

142
Q

Define these surgeries:
Simple:
Radical:
Minimally invasive:

A

Simple: affected area
Radical: beyond inv area
Minimally invasive: endoscopic

143
Q

What’s the difference between urgent and emergent surgeries?

A

Urgent: 24-48h not plan
Emergent: stat life threat

144
Q

Why do we do preoperative assessments?

A

because after post-op and before discharge, you compare the post-op assessment and vitals to the baseline
Full assessment!
ESTABLISH A BASELINE!

145
Q

What is the nurses role in informed consent?

A

to witness, that’s it!
-Nurse can back it up, but it’s not their responsibility. If the pt doesn’t understand, the surgeon comes back (not the nurse), and the pt must understand

146
Q

Who is in the sterile field in surgery?

A

scrub nurse, surgeon, and all assistants

-Anesthesiologist/CRNA, circulating nurse, holding area nurse, etc are not in the sterile field

147
Q

What is the purpose of the PACU? (3)

A
  • Ongoing evaluation
  • Stabilizing
  • Anticipate, prevent, and treat complications
148
Q

What are you going to monitor in the PACU?

A

full assessment, airway, stable VS and temp, no bleeding, return of gag, cough, and swallow reflexes, ability to take liquids, UO, ECG, pulses, neuro, wet or dry, BS, everything

149
Q

What are the 4 complications of general anesthesia?

A

1) Malignant hyperthermia
2) Overdose
3) Unrecognized hypoventilation
4) Intubation complications

150
Q

What is malignant hyperthermia? Treatment?

A

genetic, increase Ca & increase muscle metabolism –> increased K, acidosis (increased CO2), increased temp (>111’F), dysrhythmia
-dantrolene

151
Q

What are the s/s of malignant hyperthermia?

A

rise in end-tidal CO2!

also sinus tachycardia, high temperature (late sign)

152
Q

What is the emergency care for a pt with malignant hyperthermia?

A

stop anesthetics, intubate, 100% oxygen at highest rate, stop surgery, ABGs,cooling techniques, NG and rectal tube, foley, iced IV fluids, correct ABG and electrolytes if possible

153
Q

What are the local/regional anesthesia emergency s/s?

A 
CNS stimulation (restlessness, excitement, incoherent speech, headache, blurred vision, metallic taste, tremors, seizures, inc HR, RR, BP) 
CNS and cardiac depression
154
Q

What are the risk factors for surgery? (7)

A 
Age
Nutrition
Fluid and electrolyte imbalance
Infectious disease
Obesity
Pregnancy
Chronic illness
155
Q

What are the complications from surgery? (3)

A

pressure ulcers, blood loss, infection, and hypoventilation

156
Q

When is BNP released?

A

released in response to atrial and ventricular stretch; it serves as a marker for heart failure (promote vasodilation and diuresis due to fluid overload in heart failure)

157
Q

Where is BNP mainly excreted from?

A

ventricular myocardium

158
Q

How do the goals of end of life care change? (4 goals)

A
  • Needs and preferences met
  • Control of symptoms of distress
  • Promote meaningful interactions with family
  • Facilitate a peaceful death
159
Q

What are the 3 criteria for the definition of death?

A
  • Lack of heart beat
  • Absence of spontaneous respiration
  • Irreversible brain dysfunction
160
Q

What is the philosophy of palliative care?

A
  • provide compassionate and supportive approach to pts and families with life-threatening illnesses
  • Not hasten or postpone death
  • provide relief of symptoms, increase function independent, emotional and spiritual support to improve quality of life
  • focus on caring interventions and symptom management for diseases that no longer respond to treatment
161
Q

What is the philosophy of hospice?

A
  • facilitates quality of life and a “good” death for clients (<6 months to live)
  • provides support and care for pts in last phases of incurable diseases
162
Q

s/s of someone approaching death? (8)

A 
Coolness of extremities
Increased sleeping
Decreased fluid and food intake
Incontinence
Congestion and gurgling
Breathing pattern change
Disorientation
Restlessness
163
Q

What can you do for a dying pt? if they need pain control or are having difficulty breathing

A

admin. pain meds, elevate head of the bed or position pt on side if difficulty breathing, admin oxygen, suction as needed
- oral care, antiemetics, provide support and privacy

Med Surg 1 (5 decks)

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