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
