Med surg test 2 Flashcards
perioperative
preop, intraop, and postop
Reasons for Surgery: restorative
improve the patient’s ability to function
Surgery can be canceled if the patient does not
follow instructions
even though the patient should be NPO before surgery, which drugs are usually allowed with a sip of water
Cardiac disease
Respiratory disease
Seizures
Hypertension
who obtains signed consent before sedation and/or surgery
surgeon
before surgery, the nurse is not responsible for
explaining lots of details to the patient
An anxiety Intervention used before surgery
distraction
Preoperative Teaching includes 5 things
Coughing and deep-breathing Extremity exercises Ambulation Pain control Equipment
Before surgery: if malnourished may defer surgery and give tpn and high
carbohydrate
protein
vitamin c
Med history:
H
Heart disease, renal disease, respiratory disease (copd, asthma),allergies
Med history:
A
allergies to anything-fish, chemicals, latex (avocado, banana, carrot, melons, tomato)
Med history:
B
bleeding tendencies-asa, coumadin, herbal meds (ginkoba, garlic), vitamin e
Med history:
C
cortisone or steroid use
Med history:
D
diabetes
Med history:
E
history of emboli
Deep Breathing: have patient sit in what position
semi fowlers
Deep Breathing: have patient place his hands
on his abdomen, to feel if the air is flowing
Deep Breathing: have the patient inhale through his
nose until the abdomen distends
Deep Breathing: have the client exhale through pursed lips while
contracting the abdomen
Deep Breathing: client should DB every
hour on the day of surgery
Surgery positions: hernia, mastectomy, bowel surgery
Dorsal recumbent (supine)
Surgery positions: surgery of lower intestines
Trendelenberg
Surgery positions: gyn surgery
Lithotomy
Surgery positions: kidney, chest or hip surgery
Lateral
Surgery positions: some types of neurosurgery/craniotomy
Prone
Regional anesthesia includes:
spinal, epidural, or caudal
Avoiding wrong site surgery: Ask the patient to mark the surgical site with a
permanent marker
For GB surgery; was the __ __ __ explored
common bile duct
preferred patient position in the PACU is
lateral sims
watch for ___ after extubation
laryngospasms
PACU: stay at bedside until the
gag reflex returns
What to do in case of shock-
4 things
o2,
raise legs above the level of heart,
increase iv fluids unless contraindicatied,
notify anesthesia and surgeon
. Pt must have a minimum temperature of __ before they are discharged form pacu.
96.8
The stress response to surgery stimulates the secretion of __ and aldosterone, which cause fluid retention
ADH
Until the stress of surgery subsides, urine volume decreases regardless of
fluid intake
Discharge from the PACU: SaO2 must be greater than
90%
Hypoxia is SaO2 below
90%
evisceration- what do you do?
3 things
return the pt to bed,
do not try to return organs to abd,
cover wound with sterile dressings moistened with normal saline
PACU: if in the first 2 days the temperature is above 100.4, suspect that the problem is
respiratory
PACU: if after 3 days the temperature is above 100.4, suspect that the problem is
wound infection,
urinary infection,
resp infection,
phlebitis
Highest incidence of hypoxemia occurs on the __ postoperative day
2nd
Orthopaedic-joint replacement (hip)- unique complications:
peroneal nerve palsy,
leg length discrepancy,
peripheral neuropathies.
Knee surgery- unique complications:
tibial nerve palsy,
poor wound healing
NG Tube is inserted during surgery to promote GI __
rest (also lets the lower GI tract rest)
In addition to regular pain meds, an adjuvant may be added such as
tricyclic antidepressants like elavil
what is the gauge size needed for a blood transfusion
18 to 20
One of the symptoms indicating that you should stop the blood infusion
back pain
What do you do after having to stop a blood infusion
blood and urine sample
insensible water loss adds up to ___ ml per day
900
What volume of urine requires escalation
less than 500 ml per day
In dehydration, the urine SG will be greater than
1.030
Isotonic fluids
NS
Ringers Lactate
Hypotonic fluids
D5W (after infusing for a while)
0.45 NS
Hypertonic fluids
D5RL
D5/.45NS
Very hypertonic fluids
50% dextrose
3% NaCl
too much lactate can cause
alkalosis
EFV, pulse rate
increased
EFV, pulse pressure
decreased
EFV, respiratory rate
increased
EFV, quality of respiration
shallow
EFV, breath sounds
crackles
EFV, skin
pale and cool
EFV, GI
increased motility
EFV, liver
enlarged
EFV, skeletal muscles
weakened
EFV outcome: Bun, na, h and h, osmolality approaching normal levels in
48 to 72 hours
EFV intervention (besides obvious ones)
Mobilize fluid (moving around)
ACE inhibitors can cause retention of
potassium
broadly speaking, Na is usually associated with
neuro
Biggest reasons that a dehydrated patient is at risk for falls
Orth hyp
AMS
People at high risk for fluid imbalance
Renal pts Acute heart failure (aka CHF) Elderly Babies Ppl working outside in the heat
Mg is married to
Na
Calcium has a relationship with
phosphorus
ESRD has elevated ___ (an electrolyte)
phosphorus
Because ESRD has elevated phosphorus, they can get
osteoporosis (because the phosphorus draws up and binds to calcium)
Na foods
canned vegetables and vegetable juices.
Olives, pickles, sauerkraut and other pickled vegetables.
Packaged mixes, such as scalloped or au gratin potatoes, frozen hash browns and Tater Tots.
Commercially prepared pasta and tomato sauces and salsa.
Which electrolyte can cause dig tox
LOW k
DFV, pulse
increased
DFV, BP
decreased
DFV, SaO2
decrease
DFV, pulse pressure
narrow (decrease)
DFV, first step is to give
O2
DFV, BUN
increase
DFV, position
semi fowler and elevate legs
What do you look for in patient with dig tox
Do you see halos?
N/V?
decreased HR?
DFV, what kind of IV
NS (which is isotonic)
Ringers lactate is for someone
coming out of surgery, someone with burns
D5W
rare, but maybe be used for someone with hypernatremia
0.45 NS can be used for
DKA
3% NaCl
For severe hyponatremia
Very dangerous
Most dangerous IV fluid
3% NaCl
Hemoglobin to hematocrit ratio
1 globin to 3 crit
osmolality range
270 to 290
2 major problems of potassium imbalance
respiratory depression (muscle weakness) Dsrythmia
2 major problems of sodium imbalance
AMS
Seizure
Lymph range
20% to 30%
A serious complication of infusing IV too fast
cardiac arrest
Best criteria for urine
greater than .5 ml/kg/hr in 24 hours
Compazine
anti-emetic
don’t give to older adults
FVE goals (2 of them)
lose 1 pound per day
BS clear w/i 1 hour
Lasix complication
ototoxicity
couple precautions for ESRD
limit fluids to 1 liter per day
Limited amount of eggs because they have phosphorus
Who might have hypo-magnesium
alcoholics
nutrition deficiency
Co2 range
35 to 45
HCO3 range
22 to 26
Base excess range
-2 to +2
Constricted pupils can indicate
opiod OD
Insulin shock
Acidosis, neuro
drowsy, disorientation, dizziness, headache, coma
Acidosis, CV
dec bp,
VF,
arrhythmias,
warm flushed skin
metabolic Acidosis
N/v
diarrhea
abd pain
Acidosis, breathing pattern
Deep, rapid ventilations
Respiratory Acidosis complication
Seizure
Alkalosis, Neuro
lethargy,
dizziness,
confusion
Alkalosis, CV
tachy,
arrhythmia,
low bp
Respiratory Alkalosis, GI
N/V
epigastiric pain
Metabolic Alkalosis, GI complication
anorexia
Respiratory Alkalosis, muscles
Tetany, numbness, tingling, hyper-reflexia, seizures
metabolic Alkalosis, muscles
tremors, hypertonic, muscle cramps, tetany, tingling, seizures
Respiratory Alkalosis, breathing pattern
hyperventillation
metabolic Alkalosis, breathing pattern
hypoventilation (compensatory mech)
What do you treat with paper bag breathing
alkalosis
Major problem in DKA
dehydration (fix with NS)
Who might have metabolic acidosis with partial compensation
leukemia
When looking at AB imbalances, what’s the clue that it’s an acute problem
no compensation
Mild to moderate DVF is
2-5% loss of body weight
how long should it take to correct mild to moderate fluid deficits
8 to 24 hours
a patient with DFV should call the doctor if they’re sick for more than
24 hours
EFV, HR
increase
EVF, respiratory findings
Sob
doe
moist crackles
3 main complications of EVF
Pulmonary edema
HF
Skin breakdown
Fluid volume excess could be r/t __, __, or ___ failure
heart, renal, liver failure
In EVF, Bun, na, h and h, osmolality approaching normal levels within
48 to 72 hours
salt substitutes are high in
K
EVF, if they gain more than __ pounds, call the doctor
3
EVF, if they have increased ____ call the doctor
fatigue
EVF, nursing dx could be ___ ___ ___ related to na and water retention
Ineffective airway clearance
major sodium functions
nerve impulse
regulate acid/base
Increased ___ causes increase in osmolality leading to thirst and release of ADH
Na
Low Na+ causes the kidneys to excrete h2o by __ inhibition
ADH
Hyponatremia, neuro
AMS
Hyponatremia, Neuromuscular
General muscle weakness (if very weak diaphragm may be imacted)
Diminished deep tendon reflexes
Hyponatremia, GI
Increased motility, nausea, diarrhea
the cardiac symptoms of hyponatremia depend on
whether or not there’s EFV DFV
Hyponatremia can be r/t
burns loop diuretic hypoaldosterone npo status SIADH HF
Hyponatremia goal having to do with BM
1-2 BM/day within 1 day
Hyponatremia goal, no s___
seizures
Hyponatremia: Never give more than 3 __ ___ ___ without notifying the md
tap water enemas
Use __ to irrigate gastric tube
NS
Hypernatremia: Neurological
Altered cerebral function
Seizures (both w too much and too little)
Lethargy, stuporous
Hypernatremia: Neuromuscular
Muscle twitching and irregular contractions
Severe-muscle weakness-paralysis
Hypernatremia: cardiac
Decreased cardiac contractility (slow movement of Ca+ into the cells)
Hypernatremia: BP and HR
??
Hypernatremia: Normal levels of Na within ___ days
Mild-correction in 8-24 hours
Severe-2-3 days
Hypernatremia: meds
furosemide, bumetanide (both diuretics)
Hypokalemia: assessment of meds
Diuretics, beta agonists, antagonists K supplements Digoxin
Hypokalemia: Resp
Changes due to muscle weakness
Assess rate, effort, O2
Hypokalemia: GI
decreased peristalsis
Hypokalemia: Neuro
AMS
Lethargy
Hypokalemia can be related to
diarrhea Vomiting Cushings Steroids NPO TPN
Never give K via
IVP
rate of KCL infusion
5-10 meq/hr
Hyperkalemia: Neuromusc
Muscle twitching,
paresthesia,
flaccid paralysis
Hyperkalemia: GI
Increased motility
High serum K+ decreased the difference between intra and extracellular K (charge)
and ______s excitability
INCREASEs. This means that the cells respond to just a little stimuli.
ALL cells in the body.
Phosphorus range
3 to 4.5
Phosphorus is needed for rigidity of ___
bones
Phosphorus __ ___ balance
Acid-base balance
Phosphorus role in metabolism of
CHO and fats
Phosphorus promotes __ and __ activity
nerve and muscle
Phosphorus releases __ from ___
O2 from hemoglobin
Calcium range Framework bone and teeth Blood clotting Transmission of nerve Strengthens capillary membranes Skeletal & card muscle contraction
9 to 10.5
Calcium, 3 of the roles are
blood clotting
nerve transmission
muscle contraction
Calcium strengthens ___ membranes
capillary
Hypocalcemia can be caused by ___ intolerance
lactose
Hypocalcemia: malabsorption of calcium can be caused by
celiac
crohn’s
bowel resection
Hypocalcemia: neuromusc
paresthesias muscle twitching leg cramps tingling Chvostek and Trousseau
Hypocalcemia: GI
Increased peristalsis
Hypocalcemia: skeletal
osteoporosis
Hypocalcemia: keep the room
quiet, decreases excitement
Hypocalcemia: ___ precautions
seizure precautions
Hypercalcemia: causes
Kidney failure Use of thiazide diuretics Hyperparathyroidism Malignancy Hyperthyroidism Immobility Steroids dehydration
Hypercalcemia: Cardiac
Very serious!
Increased HR and BP
Increased risk for blood clots
Hypercalcemia: major impact area
muscles
DVT s/s
Swelling in the affected leg.
Pain in your leg. The pain often starts in your calf and can feel like cramping or a soreness.
Hypercalcemia: Neuromusc
Severe muscle weakness,
decreased DTR,
altered LOC,
psychiatric problems
Hypercalcemia: GI
Decreased motility
Constipated
Hypercalcemia: GU
Polyuria
Calculi
Hypercalcemia is treated with what IVF
NS
Hypercalcemia and diuretics?
Thiazide no
Furosemide yes
Hypercalcemia: can be treated with calcium binders like
plicamycin, penicillamine
Hypercalcemia: can be prevented with
biphosphates
Hypercalcemia: 2 procedures that are appropriate for the treatment
dialysis
Cardiac monitoring
Hypercalcemia: what electrolyte increases calcium secretion
NA
calcium and phosphorus relationship
inverse
Magnesium range
1.5 to 2.5
Magnesium: involved in ___ reactions
enzyme
Magnesium: Helps the process of ___, contributing to cardiovascular regulation
vasodilation
Magnesium: found in what what kingdom
plants (other stuff to)
Magnesium: ___ ___ stabilizer
Excitable membrane stabilizer
Hypomagnesmia: drugs that cause it
diruretics,
aminoglycoside,
cisplatin,
cyclosporine
Hypomagnesmia: caused by something related to stool
Steatorrhea
Hypomagnesmia: ___ ingestion
ethanol
Hypomagnesmia: neuromusc
Hyperactive DTR, numbness and tingling, painful muscle contractions
May occur w low Ca+
Muscle weakness
Hypomagnesmia: neuro
Psychological depression and confusion
Hypomagnesmia: GI
reduced motility
Hypomagnesemia: when treating with IV Mg, every hour assess for __ and __
DTR and BP
Hypomagnesemia: when treating with IV Mg, the person’s face may flush. What do you do
slow down infusion rate
Hypomagnesemia: administer prescribed oral agents such as mg oxide
tabs or ___
antacid
Hypomagnesemia: check for ___ toxicity
digitalis
Hypomagnesemia: iv replacement with mgso4 for severe deficits at a rate no faster than
___ mg/min
150
Hypermagnesemia: can be caused by excess intake of
antacids or laxatives
Hypermagnesemia: all s/s
flushing,
increased perspiration,
muscular weakness,
DTR
n/v,
hypotension,
dysrhythmias,
resp compromise
Hypermagnesemia: monitor their LOC for
sedation
Hypermagnesemia: monitor VS for
hypotension
ABG: abnormal ph and a change in one blood parameter
Uncompensated
ABG: change in ph, and abnormal parameter associated with primary
disorder
Compensated
ABG: ph is normal parameters may still be abnormal
Fully compensated
ABG: ph is abnormal may have improved toward normal
range, all 3 values are abnormal
Partially compensated
ABG: all parameters return to normal. Primary disorder is rectified
corrected
In addition to Troponin and Creatine Kinase increases, the other s/s of MI
ST elevation
hypokalemia: EKG
ST depression, U wave, flat T
hypokalemia: pulse
Weak thready pulse,
slow to rapid,
irregular
hypokalemia: safety risk
Orthostatic hypotension
Hyperkalemia: HR
decreased
Hyperkalemia: EKG
prolonged pr intervals,
tall T waves,
Hyperkalemia: BP
decreased
Hyperkalemia: cardiac complications
VF
ectopic beats,
complete heart block,
Hypocalcemia: HR
HR fast or slow,
Hypocalcemia: pulse quality
weak thready pulse,
Hypocalcemia: BP
decreased
Hypocalcemia: EKG
prolonged st and qt intervals
