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Med Surg > Med Surg Exam 1 > Flashcards

Med Surg Exam 1 Flashcards

1
Q

What does PACU stand for?

A

Post Anesthesia Care Unit

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2
Q

What happens during phase I in PACU

A

-immediate recovery
-intensive nursing care ( lots of assessing)
-pt transitions to an inpatient nursing unit or phase II

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3
Q

What happen during phase II in PACU

A

-pt is prepared to transfer to an inpatient nursing unit, an extended care setting, or discharge

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4
Q

What is the nurses job in the PACU

A

-provide care for the pt until pt has recovered from effects of anesthesia
- return to cognitive baseline
- clear airway
- controlled nausea and vomiting
- stable V/S
- asses LOC, cardiac, respiratory, wound and pain
- check drainage tubes, monitor lines, IV fluids, and
meds
- give report if being admitted

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5
Q

True or false: The primary nursing goal in the immediate postoperative period is maintenance of pulmonary function and prevention of larygospasm

A

false: The primary nursing goal in the immediate postoperative period is maintenance of pulmonary function and prevention of hypoxemia and hypercapnia

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6
Q

What 4 things should be included in an assessment of a hospitalized post op pt?

A

-respiratory
-pain
-mental status/LOC
-general discomfort

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7
Q

What are some indicators of hypovolemic shock/hemorrhage?

A

-pallor
-cool, moist skin
-rapid respirations
-cyanosis
-rapid, weak, thready pulse
-decreasing pulse pressure
-low BP
-concentrated urine

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8
Q

True or False: The nurse should intervene at the patient’s first report of nausea to control the problem rather than wait for it to progress to vomiting.

A

True, vomiting can lead to aspirating so it is very important to keep that risk at a minimal

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9
Q

Which of the following occurs during the inflammatory stage of wound healing?

A

blood clot forms

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10
Q

What is the purpose of post op dressings?

A

-proving a healing environment
-absorb drainage
-spring or immobilise
-protect
-promote homeostasis
-promote patient’s physical and mental comfort

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11
Q

What are some problems that can arise post-op

A

-pulmonary infection / hypoxia
-DVT/PE
-hematoma/hemorrhage
-infection
-wound dehiscence or evisceration

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12
Q

Who are the members of the surgical team?

A

-pt
-anaesthesiologist
-surgeon
-nurses
-surgical techs
-RNs

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13
Q

True or false: The circulating nurse is responsible for monitoring the surgical team.

A

true

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14
Q

What are some intraoperative complications?

A

-anesthesia awareness
-nausea, vomiting
-anaphylaxis
-hypoxia
-hypothermia
-malignant hyperthermia
-infection

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15
Q

True or False: The most frequent early sign for a pt at risk for malignant hyperthermia subsequent to general anesthesia is bradycardia

A

FALSE, the most frequent sign for a pt at risk for malignant hyperthermia subsequent to general, is TACHYCARDIA

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16
Q

What can be worn in the unrestricted zone of the OR?

A

-street clothes

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17
Q

What can be worn in the semi restricted zone of the OR?

A

scrub clothes and cap

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18
Q

What can be worn in the restricted zone of the OR?

A

scrub clothes, shoe covers, caps, masks

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19
Q

Where are gowns considered sterile?

A

in front from chest level of sterile field , sleeves from 2 inches above the elbow to the cuff.

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20
Q

Through which route are inhaled general anaesthetics primarily eliminated?

A

lungs

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21
Q

What is homeostasis?

A

-where the body fights to maintain homeostasis. This means to maintain a set temp, HR, RR etc.)

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22
Q

What is intracellular fluid?

A

fluid inside the cells

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23
Q

What is extracellular fluid?

A

fluid outside the cells

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24
Q

What are the major cation electrolytes?

A

-sodium
-potassium
-calcium
-magnesium
-hydrogen ions

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25
Q

What are the major anion electrolytes?

A

-chloride
-bicarb
-phosphate
-sulfate

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26
Q

What is osmosis?

A

the diffusion of water caused by fluid and solute concentration gradients

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27
Q

what is hydrostatic pressure?

A

pressure that is exerted on walls of blood vessels

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28
Q

what is osmotic pressure?

A

pressure that is exerted by protein in plasma

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29
Q

What is diffusion

A

solutes move form area of higher concentration to one of lower concentration

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30
Q

What is filtration

A

movement of water

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31
Q

What are ways the body gains fluid and electrolytes?

A

drinking and eating

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32
Q

What are ways that the body looses fluid and electrolytes?

A

-kidneys - urine
-skin loss- sweating
-lungs -300ml every day
-GI tract

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33
Q

Fluid volume deficit =

A

hypovolemia

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34
Q

Fluid volume excess= hypervolemia

A

hypervolemia

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35
Q

What is the number 1 way to manage Fluid volume DEFICIT

A

ORAL PO FLUIDS

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36
Q

What are some ways you could know someone has FVD

A

-high HR
-Low BP
-poor skin turgor
-low wt
-dry oral mucosa
-low UOP
-fever
-flat neck veins
-confusion due to lack of fluids to brain
-thirst
- low central venous pressure - <2
-orthostatic hypotension

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37
Q

What is the nurses job when your pt is in FVD

A

-get daily wt (if pt looses 3 or more lbs in 24 hours its bad)
-encourage PO fluids
-put pt on fall precautions
-strict I&O
-monitor VS if SBP is less than 100 or HR is less than 60
-hold diuretics

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38
Q

How do you know someone has pulmonary edema

A

-crackles
-increased WOB
-pitting edema
-orthopnea
-postive JVD
-high BP
-gain wt

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39
Q

What lab values would be off if pt is in FVE

A

-H&H low
-creatnine off
BUN off
electrolyte imbalance

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40
Q

What is something to remember when you are correcting a sodium imbalance

A

NEVER correct sodium more than 12meq in 24 hours

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41
Q

What does hyperkalemia do to T-waves

A

makes them tall

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42
Q

Normal PH

A

7.35-7.45
Less than 7.35= acidic
More than 7.45 =alkalosis

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43
Q

Normal PACO2

A

35-45

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44
Q

HCO3

A

22-26

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45
Q

PAO2

A

80-100

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46
Q

What do you administer for Malignant hyperthermia

A

Dantrolene

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47
Q

Sodium level

A

135-145

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48
Q

Chloride level

A

98-106

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49
Q

Potassium level

A

3.5-5.0

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50
Q

Calcium level

A

8.8-10.5

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51
Q

Phosphorus

A

2.5-4.5

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52
Q

Magnesium

A

1.8-3.6

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53
Q

Which fluids are isotonic?

A

NS 0.9% (normal saline 0.9%)
LR (lactated ringers)
D5W (5% dextrose in water)

54
Q

Which fluids are Hypotonic

A

0.45% NS (0.45% normal saline)
D25 45% NS (2.5% dextrose in 0.45% saline)

55
Q

Which fluids are hypertonic

A

D10W (10% dextrose in water)
D50W (50% dextrose in water)
D5NS (5% dextrose in 0.9% normal saline)
D5W in 0.45% NaCl (5% dextrose in 0.45% saline)
D5LR (5% dextrose in lactated ringers)

56
Q

What are the indications for a isotonic solution

A

-vascular system defect
-these fluids are used to increase fluid volume after blood loss or dehyrdration

57
Q

What is Normal saline used for? And when should you use caution?

A

useful for
-IV hydration
-maintenance fluids
-hypovolemia
-hyponatremia
-hypotension
-sepsis
-shock

Caution with
-CHF
-ESRD
-SIADH
-large quantities

58
Q

What is Lactated ringers used for? When should you avoid?

A

Useful for
-dehydration
-maintenance fluids
-ongoing fluid losses
-sepsis
-pancreatitis
-burns
-surgical pts

Avoid with
-renal failure
-liver failure
-hyperkalemia
-hypercalcemia
-blood transfusions

59
Q

What do isotonic solution do inside the body?

A

prevents fluid shifts between compartments
-keeps the fluids in the intravascular area and intestinal cavity

60
Q

What are hypotonic solutions indicated for?

A

-intracellular dehydration

61
Q

Where do hypotonic fluids shift the fluid?

A

shifts fluid from the ECF to the ICF

62
Q

What are the indications for hypertonic fluids?

A

-only when serum osmolality is critically low

63
Q

Where do hypertonic fluids shift the fluid?

A

shift fluids from ICF to ECF

64
Q

What populations should you avoid giving any hypotonic solution to?

A

infants or head injury pts
can cause cerebral edema

65
Q

What are some safety things to remember when giving hypertonic fluids ?

A

GO SLOW

66
Q

What is the antidote for opiods?

A

naloxone (narcan)

67
Q

At what point will naloxone be indicated?

A

pts is having respiratory distress

68
Q

What is the antidote for benzodiazepines (versed, alazopram)

A

flumazenil

69
Q

What is something you should be sure to have BEFORE administering neuromuscular drugs?

A

be sure to have a airway because these drugs will relax the diaphram

70
Q

How much fluid will the JP drain hold?

A

100cc

71
Q

How much will the hemovac drain hold?

A

500cc

72
Q

What is a LMA? Who can put those in?

A

Laryngeal mask airway (does not go past the trachea)
nurse can put in

73
Q

What must be normal before discharging pt from PACU

A

-aldrete score of 8 to 10
-stable VS
-no evidence or minimal bleeding
-pt can gag, swallow, cough
-minimal N/V
-urine output >30ml/hr

74
Q

How would you know someone is bleeding internally

A

-tachycardic
-low BP
-cool and clammy

75
Q

What are the 4 steps if your pt is having a would complication

A

1.lay pt is low fowlers
2.lie still
3. cover with sterile saline
4.call provider

76
Q

What is the joint commission surgical universal protocol

A

-conduct a pre-procedure verification process
-make the procedure site
-perform a time out

77
Q

General Anesthesia

A

-given through IV
-pt is fully asleep
-must think about airway, 02 etc, since they are unconscious

78
Q

Local Anesthesia

A

-only administers to a local site
-pt is awake
-LOC is normal

79
Q

Reginal Anesthesia

A

-epidural or spinal
-lay the pt flat post surgical because they can develop a spinal headache.
-Pt might get a blood patch if it does not resolve on its own

80
Q

What is an example drug of a sedative?

A

barbiturates

81
Q

Malignant hyperthermia

A

-RARE LIFE THREATENING
-genetic (ask before surgery of family Hx)
-increased co2 levels and decreased O2 levels
-tachycardia appears first followed by dysrrythmias, muscle rigidity, hypotension, MOTTLING, cyanosis
-high temp (as high as 111.12) is a late sign

82
Q

What do you give for malignant hyperthermia

A

-dantrolene
-ice cold IV bags
-cooling blankets

83
Q

Which is the only solution that can be given with blood products >

A

isotonic

84
Q

What solutions are colloids

A

D5W or D in NS

85
Q

What is something you should notify the provider about the BP post op

A

if it is below SBP 90 or if it drops 5mmhg in 15 min or less

86
Q

What are some potassium rich food?

A

-bananas
-dried fruits
-spinach
-avacado
-potatoes

87
Q

If a pt has no urine output, can you give potassium>

A

NO
no p=no K

88
Q

How much potassium can you give in a push in an hour?

A

10meq/hr

89
Q

What should you think when you thing sodium imbalance

A

neuro

90
Q

How fast can you correct sodium imbalance?

A

12meq/24 hours
NO MORE THAN THAT
can cause cerebral edema

91
Q

How much ccs should you allow your pt to have if they are on a fluid restriction diet?

A

2000cc

92
Q

What electrolyte is inverse to phosphorus?

A

Calcium
If Ca is high, Ph is low
vice versa

93
Q

What kind of problem is sodium imbalance typically?

A

water problem

94
Q

S/S Hyponatremia

A

-SEIZURES
-headache
-wt gain
-edema
-muscle cramps/twitching
-confusion
-lethargy

95
Q

Interventions for hyponatremia

A

-sodium replacement
-restrict oral fluid intake
-daily wt
I&O
-NO HYPERTONIC SOLUTIONS= cerbral edema

96
Q

What is the number 1 clinical symptom for hypernatremia?

A

THRIST

97
Q

S/S hypernatremia

A

-lethargy
-restlessness
-irratibility
-seizures
-fever
-hallucinations
-thirst

98
Q

Interventions for hypernatremia

A

-Initiate SEIZURE precautions
-IV infusion of hypotonic or isotonic solutions
Sodium restriction diet

99
Q

What does hypokalaemia predispose a pt for?

A

digitalis toxicity

100
Q

How much Potassium can you give in a central line per hour?

A

20meq per hour

101
Q

What do you think when you hear potassium imbalance?

A

heart

102
Q

What should you note about giving oral Potassium>?

A

it is recommended
CAN NOT crush or chew

103
Q

What diuretic spares Potassium?

A

aldactone

104
Q

What should you keep your pt on 24/7 when having a potassium imbalance?

A

telemetry and frequent EKG

105
Q

What are risk factors for Hypokalaemia?

A

-V/D
-wound drainage
-NG suction
* if the body is losing fluids, its losing K+

106
Q

What are S/S of hypokalaemia

A

-dysrrythmias
flat or inverted T-waves

107
Q

What is the MOST important electrolyte imbalance

A

HYPERKALEMIA

108
Q

What type of pt is at the highest risk for hyperkalemia

A

kidney failure pts

109
Q

What will you see on an EKG of a pt with hyperkalemia

A

Tall t-waves

110
Q

What are risk factors for hyperkalemia

A

-renal failure
-adrenal insufficiency
-acidosis
-excessive K+ intake
-potassium sparing diuretics
-ACE inhibitors

111
Q

S/S of hyperkalemia

A

-muscle twitching and parathesia (early)
-muscle weakness (late)
-tall t waves

112
Q

interventions for hyperkalemia

A

-initiate dialysis
-kayexelate (makes pt shit it out)
-50% glucose in insulin (will buy time but not fix the problem)
-calcium glucontate (atagozies effects of k+, but does not get rid of it)

113
Q

S/S for hypocalcemia

A

-tetany, cramps
-parasthesia
-+ Trousseau and Chovosteks
-seizures

114
Q

Interventions for hypocalcemia

A

-seizure precautions
-IV calcium replacement
-vitamin D therapy
-calcium supplements
- admin IV Ca slowly

115
Q

What are some risk factors for Hypercalcemia

A

-hyperparathyroidism
-malignant disease
-vitamin D excess

116
Q

S/S hypercalcemia

A

-muscle weakness
-dysrrythmias
-lethargy/coma
-deep bone pain

117
Q

Interventions for Hypercalcemia

A

-dialysis
-cardiac monitoring
-glucocorticosteriods (calcium channel blockers)

118
Q

S/S for hypomagnesemia

A

-trousseau and chvosteks can be present
-hyperreflexia
-nausea/vomiting
CHECK DTRs
HYPERREFLEXES
remember magnesium acts as a sedative, so if its low, then you will be restless and hyper

119
Q

S/S of hypermagnesemia

A

-HYPOreflexes
-too much magnesium can “sedate” the pt to much, so you must watch for things like:
Low BP
bradypnea
cardiac arrest
DTRs
coma

120
Q

Interventions for hypermagnesemia

A

-IV fluids: LR
-IV calcium gluconate
-loop diuretics
- DTRs

121
Q

What lab do you check for electrolytes?

A

CMP/BMP

122
Q

What lab do you check for PH?

A

ABG

123
Q

What should you do before you check an ABG?

A

Alans test to check for radial perfusion

124
Q

If the pt is bleeding and needs more volume what do you give

A

BLOOD

125
Q

What all is in the pre OP exam?

A

what brought them here
review of systems
comprehensive assessment

126
Q

What effect does corticosteroids have on surgery

A

delay healing / Sudden CV collapse

127
Q

What effect does insulin have on surgery

A

not eating in surgery, sugar could drop

128
Q

What effect does anticoagulants have on surgery

A

bleeding

129
Q

What effect does thyroid/hormone meds have on surgery

A

high tolerance f

130
Q

Main nursing intervention for intraoperative care?

A

MAINTAIN AIRWAY

131
Q

What degree should you keep the HOB when maintaining an airway?

A

15-30

Med Surg (2 decks)

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