Med surg test 2 Flashcards
1
Q
perioperative
A
preop, intraop, and postop
2
Q
Reasons for Surgery: restorative
A
improve the patient’s ability to function
3
Q
Surgery can be canceled if the patient does not
A
follow instructions
4
Q
even though the patient should be NPO before surgery, which drugs are usually allowed with a sip of water
A
Cardiac disease
Respiratory disease
Seizures
Hypertension
5
Q
who obtains signed consent before sedation and/or surgery
A
surgeon
6
Q
before surgery, the nurse is not responsible for
A
explaining lots of details to the patient
7
Q
An anxiety Intervention used before surgery
A
distraction
8
Q
Preoperative Teaching includes 5 things
A
Coughing and deep-breathing Extremity exercises Ambulation Pain control Equipment
9
Q
Before surgery: if malnourished may defer surgery and give tpn and high
A
carbohydrate
protein
vitamin c
10
Q
Med history:
H
A
Heart disease, renal disease, respiratory disease (copd, asthma),allergies
11
Q
Med history:
A
A
allergies to anything-fish, chemicals, latex (avocado, banana, carrot, melons, tomato)
12
Q
Med history:
B
A
bleeding tendencies-asa, coumadin, herbal meds (ginkoba, garlic), vitamin e
13
Q
Med history:
C
A
cortisone or steroid use
14
Q
Med history:
D
A
diabetes
15
Q
Med history:
E
A
history of emboli
16
Q
Deep Breathing: have patient sit in what position
A
semi fowlers
17
Q
Deep Breathing: have patient place his hands
A
on his abdomen, to feel if the air is flowing
18
Q
Deep Breathing: have the patient inhale through his
A
nose until the abdomen distends
19
Q
Deep Breathing: have the client exhale through pursed lips while
A
contracting the abdomen
20
Q
Deep Breathing: client should DB every
A
hour on the day of surgery
21
Q
Surgery positions: hernia, mastectomy, bowel surgery
A
Dorsal recumbent (supine)
22
Q
Surgery positions: surgery of lower intestines
A
Trendelenberg
23
Q
Surgery positions: gyn surgery
A
Lithotomy
24
Q
Surgery positions: kidney, chest or hip surgery
A
Lateral
25
Surgery positions: some types of neurosurgery/craniotomy
Prone
26
Regional anesthesia includes:
spinal, epidural, or caudal
27
Avoiding wrong site surgery: Ask the patient to mark the surgical site with a
permanent marker
28
For GB surgery; was the __ __ __ explored
common bile duct
29
preferred patient position in the PACU is
lateral sims
30
watch for ___ after extubation
laryngospasms
31
PACU: stay at bedside until the
gag reflex returns
32
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
33
. Pt must have a minimum temperature of __ before they are discharged form pacu.
96.8
34
The stress response to surgery stimulates the secretion of __ and aldosterone, which cause fluid retention
ADH
35
Until the stress of surgery subsides, urine volume decreases regardless of
fluid intake
36
Discharge from the PACU: SaO2 must be greater than
90%
37
Hypoxia is SaO2 below
90%
38
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
39
PACU: if in the first 2 days the temperature is above 100.4, suspect that the problem is
respiratory
40
PACU: if after 3 days the temperature is above 100.4, suspect that the problem is
wound infection,
urinary infection,
resp infection,
phlebitis
41
Highest incidence of hypoxemia occurs on the __ postoperative day
2nd
42
Orthopaedic-joint replacement (hip)- unique complications:
peroneal nerve palsy,
leg length discrepancy,
peripheral neuropathies.
43
Knee surgery- unique complications:
tibial nerve palsy,
| poor wound healing
44
NG Tube is inserted during surgery to promote GI __
rest (also lets the lower GI tract rest)
45
In addition to regular pain meds, an adjuvant may be added such as
tricyclic antidepressants like elavil
46
what is the gauge size needed for a blood transfusion
18 to 20
47
One of the symptoms indicating that you should stop the blood infusion
back pain
48
What do you do after having to stop a blood infusion
blood and urine sample
49
insensible water loss adds up to ___ ml per day
900
50
What volume of urine requires escalation
less than 500 ml per day
51
In dehydration, the urine SG will be greater than
1.030
52
Isotonic fluids
NS
| Ringers Lactate
53
Hypotonic fluids
D5W (after infusing for a while)
| 0.45 NS
54
Hypertonic fluids
D5RL
| D5/.45NS
55
Very hypertonic fluids
50% dextrose
| 3% NaCl
56
too much lactate can cause
alkalosis
57
EFV, pulse rate
increased
58
EFV, pulse pressure
decreased
59
EFV, respiratory rate
increased
60
EFV, quality of respiration
shallow
61
EFV, breath sounds
crackles
62
EFV, skin
pale and cool
63
EFV, GI
increased motility
64
EFV, liver
enlarged
65
EFV, skeletal muscles
weakened
66
EFV outcome: Bun, na, h and h, osmolality approaching normal levels in
48 to 72 hours
67
EFV intervention (besides obvious ones)
Mobilize fluid (moving around)
68
ACE inhibitors can cause retention of
potassium
69
broadly speaking, Na is usually associated with
neuro
70
Biggest reasons that a dehydrated patient is at risk for falls
Orth hyp
| AMS
71
People at high risk for fluid imbalance
```
Renal pts
Acute heart failure (aka CHF)
Elderly
Babies
Ppl working outside in the heat
```
72
Mg is married to
Na
73
Calcium has a relationship with
phosphorus
74
ESRD has elevated ___ (an electrolyte)
phosphorus
75
Because ESRD has elevated phosphorus, they can get
osteoporosis (because the phosphorus draws up and binds to calcium)
76
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.
77
Which electrolyte can cause dig tox
LOW k
78
DFV, pulse
increased
79
DFV, BP
decreased
80
DFV, SaO2
decrease
81
DFV, pulse pressure
narrow (decrease)
82
DFV, first step is to give
O2
83
DFV, BUN
increase
84
DFV, position
semi fowler and elevate legs
85
What do you look for in patient with dig tox
Do you see halos?
N/V?
decreased HR?
86
DFV, what kind of IV
NS (which is isotonic)
87
Ringers lactate is for someone
coming out of surgery, someone with burns
88
D5W
rare, but maybe be used for someone with hypernatremia
89
0.45 NS can be used for
DKA
90
3% NaCl
For severe hyponatremia
Very dangerous
91
Most dangerous IV fluid
3% NaCl
92
Hemoglobin to hematocrit ratio
1 globin to 3 crit
93
osmolality range
270 to 290
94
2 major problems of potassium imbalance
```
respiratory depression (muscle weakness)
Dsrythmia
```
95
2 major problems of sodium imbalance
AMS
| Seizure
96
Lymph range
20% to 30%
97
A serious complication of infusing IV too fast
cardiac arrest
98
Best criteria for urine
greater than .5 ml/kg/hr in 24 hours
99
Compazine
anti-emetic
don't give to older adults
100
FVE goals (2 of them)
lose 1 pound per day
| BS clear w/i 1 hour
101
Lasix complication
ototoxicity
102
couple precautions for ESRD
limit fluids to 1 liter per day
| Limited amount of eggs because they have phosphorus
103
Who might have hypo-magnesium
alcoholics
| nutrition deficiency
104
Co2 range
35 to 45
105
HCO3 range
22 to 26
106
Base excess range
-2 to +2
107
Constricted pupils can indicate
opiod OD
| Insulin shock
108
Acidosis, neuro
```
drowsy,
disorientation,
dizziness,
headache,
coma
```
109
Acidosis, CV
dec bp,
VF,
arrhythmias,
warm flushed skin
110
metabolic Acidosis
N/v
diarrhea
abd pain
111
Acidosis, breathing pattern
Deep, rapid ventilations
112
Respiratory Acidosis complication
Seizure
113
Alkalosis, Neuro
lethargy,
dizziness,
confusion
114
Alkalosis, CV
tachy,
arrhythmia,
low bp
115
Respiratory Alkalosis, GI
N/V
| epigastiric pain
116
Metabolic Alkalosis, GI complication
anorexia
117
Respiratory Alkalosis, muscles
```
Tetany,
numbness,
tingling,
hyper-reflexia,
seizures
```
118
metabolic Alkalosis, muscles
```
tremors,
hypertonic,
muscle cramps,
tetany,
tingling,
seizures
```
119
Respiratory Alkalosis, breathing pattern
hyperventillation
120
metabolic Alkalosis, breathing pattern
hypoventilation (compensatory mech)
121
What do you treat with paper bag breathing
alkalosis
122
Major problem in DKA
dehydration (fix with NS)
123
Who might have metabolic acidosis with partial compensation
leukemia
124
When looking at AB imbalances, what's the clue that it's an acute problem
no compensation
125
Mild to moderate DVF is
2-5% loss of body weight
126
how long should it take to correct mild to moderate fluid deficits
8 to 24 hours
127
a patient with DFV should call the doctor if they're sick for more than
24 hours
128
EFV, HR
increase
129
EVF, respiratory findings
Sob
doe
moist crackles
130
3 main complications of EVF
Pulmonary edema
HF
Skin breakdown
131
Fluid volume excess could be r/t __, __, or ___ failure
heart, renal, liver failure
132
In EVF, Bun, na, h and h, osmolality approaching normal levels within
48 to 72 hours
133
salt substitutes are high in
K
134
EVF, if they gain more than __ pounds, call the doctor
3
135
EVF, if they have increased ____ call the doctor
fatigue
136
EVF, nursing dx could be ___ ___ ___ related to na and water retention
Ineffective airway clearance
137
major sodium functions
nerve impulse
| regulate acid/base
138
Increased ___ causes increase in osmolality leading to thirst and release of ADH
Na
139
Low Na+ causes the kidneys to excrete h2o by __ inhibition
ADH
140
Hyponatremia, neuro
AMS
141
Hyponatremia, Neuromuscular
General muscle weakness (if very weak diaphragm may be imacted)
Diminished deep tendon reflexes
142
Hyponatremia, GI
Increased motility, nausea, diarrhea
143
the cardiac symptoms of hyponatremia depend on
whether or not there's EFV DFV
144
Hyponatremia can be r/t
```
burns
loop diuretic
hypoaldosterone
npo status
SIADH
HF
```
145
Hyponatremia goal having to do with BM
1-2 BM/day within 1 day
146
Hyponatremia goal, no s___
seizures
147
Hyponatremia: Never give more than 3 __ ___ ___ without notifying the md
tap water enemas
148
Use __ to irrigate gastric tube
NS
149
Hypernatremia: Neurological
Altered cerebral function
Seizures (both w too much and too little)
Lethargy, stuporous
150
Hypernatremia: Neuromuscular
Muscle twitching and irregular contractions
Severe-muscle weakness-paralysis
151
Hypernatremia: cardiac
Decreased cardiac contractility (slow movement of Ca+ into the cells)
152
Hypernatremia: BP and HR
??
153
Hypernatremia: Normal levels of Na within ___ days
Mild-correction in 8-24 hours
| Severe-2-3 days
154
Hypernatremia: meds
furosemide, bumetanide (both diuretics)
155
Hypokalemia: assessment of meds
```
Diuretics,
beta agonists,
antagonists
K supplements
Digoxin
```
156
Hypokalemia: Resp
Changes due to muscle weakness
Assess rate, effort, O2
157
Hypokalemia: GI
decreased peristalsis
158
Hypokalemia: Neuro
AMS
Lethargy
159
Hypokalemia can be related to
```
diarrhea
Vomiting
Cushings
Steroids
NPO
TPN
```
160
Never give K via
IVP
161
rate of KCL infusion
5-10 meq/hr
162
Hyperkalemia: Neuromusc
Muscle twitching,
paresthesia,
flaccid paralysis
163
Hyperkalemia: GI
Increased motility
164
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.
165
Phosphorus range
3 to 4.5
166
Phosphorus is needed for rigidity of ___
bones
167
Phosphorus __ ___ balance
Acid-base balance
168
Phosphorus role in metabolism of
CHO and fats
169
Phosphorus promotes __ and __ activity
nerve and muscle
170
Phosphorus releases __ from ___
O2 from hemoglobin
171
```
Calcium range
Framework bone and teeth
Blood clotting
Transmission of nerve
Strengthens capillary membranes
Skeletal & card muscle contraction
```
9 to 10.5
172
Calcium, 3 of the roles are
blood clotting
nerve transmission
muscle contraction
173
Calcium strengthens ___ membranes
capillary
174
Hypocalcemia can be caused by ___ intolerance
lactose
175
Hypocalcemia: malabsorption of calcium can be caused by
celiac
crohn's
bowel resection
176
Hypocalcemia: neuromusc
```
paresthesias
muscle twitching
leg cramps
tingling
Chvostek and Trousseau
```
177
Hypocalcemia: GI
Increased peristalsis
178
Hypocalcemia: skeletal
osteoporosis
179
Hypocalcemia: keep the room
quiet, decreases excitement
180
Hypocalcemia: ___ precautions
seizure precautions
181
Hypercalcemia: causes
```
Kidney failure
Use of thiazide diuretics
Hyperparathyroidism
Malignancy
Hyperthyroidism
Immobility
Steroids
dehydration
```
182
Hypercalcemia: Cardiac
Very serious!
Increased HR and BP
Increased risk for blood clots
183
Hypercalcemia: major impact area
muscles
184
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.
185
Hypercalcemia: Neuromusc
Severe muscle weakness,
decreased DTR,
altered LOC,
psychiatric problems
186
Hypercalcemia: GI
Decreased motility
Constipated
187
Hypercalcemia: GU
Polyuria
Calculi
188
Hypercalcemia is treated with what IVF
NS
189
Hypercalcemia and diuretics?
Thiazide no
Furosemide yes
190
Hypercalcemia: can be treated with calcium binders like
plicamycin, penicillamine
191
Hypercalcemia: can be prevented with
biphosphates
192
Hypercalcemia: 2 procedures that are appropriate for the treatment
dialysis
Cardiac monitoring
193
Hypercalcemia: what electrolyte increases calcium secretion
NA
194
calcium and phosphorus relationship
inverse
195
Magnesium range
1.5 to 2.5
196
Magnesium: involved in ___ reactions
enzyme
197
Magnesium: Helps the process of ___, contributing to cardiovascular regulation
vasodilation
198
Magnesium: found in what what kingdom
plants (other stuff to)
199
Magnesium: ___ ___ stabilizer
Excitable membrane stabilizer
200
Hypomagnesmia: drugs that cause it
diruretics,
aminoglycoside,
cisplatin,
cyclosporine
201
Hypomagnesmia: caused by something related to stool
Steatorrhea
202
Hypomagnesmia: ___ ingestion
ethanol
203
Hypomagnesmia: neuromusc
Hyperactive DTR, numbness and tingling, painful muscle contractions
May occur w low Ca+
Muscle weakness
204
Hypomagnesmia: neuro
Psychological depression and confusion
205
Hypomagnesmia: GI
reduced motility
206
Hypomagnesemia: when treating with IV Mg, every hour assess for __ and __
DTR and BP
207
Hypomagnesemia: when treating with IV Mg, the person's face may flush. What do you do
slow down infusion rate
208
Hypomagnesemia: administer prescribed oral agents such as mg oxide
tabs or ___
antacid
209
Hypomagnesemia: check for ___ toxicity
digitalis
210
Hypomagnesemia: iv replacement with mgso4 for severe deficits at a rate no faster than
___ mg/min
150
211
Hypermagnesemia: can be caused by excess intake of
antacids or laxatives
212
Hypermagnesemia: all s/s
flushing,
increased perspiration,
muscular weakness,
DTR
n/v,
hypotension,
dysrhythmias,
resp compromise
213
Hypermagnesemia: monitor their LOC for
sedation
214
Hypermagnesemia: monitor VS for
hypotension
215
ABG: abnormal ph and a change in one blood parameter
Uncompensated
216
ABG: change in ph, and abnormal parameter associated with primary
disorder
Compensated
217
ABG: ph is normal parameters may still be abnormal
Fully compensated
218
ABG: ph is abnormal may have improved toward normal
| range, all 3 values are abnormal
Partially compensated
219
ABG: all parameters return to normal. Primary disorder is rectified
corrected
220
In addition to Troponin and Creatine Kinase increases, the other s/s of MI
ST elevation
221
hypokalemia: EKG
ST depression, U wave, flat T
222
hypokalemia: pulse
Weak thready pulse,
slow to rapid,
irregular
223
hypokalemia: safety risk
Orthostatic hypotension
224
Hyperkalemia: HR
decreased
225
Hyperkalemia: EKG
prolonged pr intervals,
tall T waves,
226
Hyperkalemia: BP
decreased
227
Hyperkalemia: cardiac complications
VF
ectopic beats,
complete heart block,
228
Hypocalcemia: HR
HR fast or slow,
229
Hypocalcemia: pulse quality
weak thready pulse,
230
Hypocalcemia: BP
decreased
231
Hypocalcemia: EKG
prolonged st and qt intervals
