Unit 1 Exam Flashcards
How do you prioritize different patient scenarios?
ABCs
Maslow’s
How can you prevent aspiration if a patient is having nausea and vomiting?
Turn their head to the side
What situation would you call the doctor before completing an assessment?
Evisceration
RBC
What is the normal range?
Female 4.2 - 5.4
Male – 4.7 – 6.1
WBC
What is the normal range?
5,000 – 10,000/〖mm〗^3
H&H
What is the normal range?
Hematocrit
Female – 37% - 47%
Male – 42% - 52%
Hemoglobin
Female – 12 -16 g/dL
Male – 14 – 18 g/dL
K+
What is the normal range?
3.5 – 5 mEq/dL
Na+
What is the normal range?
135 – 145 mEq/dL
What could cause an RBC abnormal ?
High lvl -Dehydration, cigarette smoking, congenital heart disease, pulmonary fibrosis, renal cell carcinoma, polycythemia vera
Low lvl -Bleeding, anemia, malnutrition, overhydration, hemolysis, erythropoietin deficiency, leukemia, multiple myeloma, porphyria, thalassemia, sickle cell anemia
What could cause an WBC abnormal ?
high lvl: Infections, cigarette smoking, leukemia, inflammatory diseases, tissue damage, severe physical or mental stress
low lvl: Autoimmune disorders, bone marrow deficiencies, viral diseases, liver problems, spleen problems, severe bacterial infections, radiation therapy
What could cause an abnormal Hct?
High Level: Dehydration, hypoxia, cigarette smoking, polycythemia vera, tumors, erythropoietin abuse, lung diseases, blood doping, erythrocytosis, cor pulmonale
Low Level: Overhydration, nutritional deficiencies, blood loss, bone marrow suppression, leukemia, lead poisoning, Hodgkin’s lymphoma, chemotherapy treatment
What could cause an abnormal Hgb?
High Level: Dehydration, cigarette smoking, polycythemia vera, tumors, erythropoietin abuse, lung diseases, blood doping.
Low Level: Nutritional deficiencies, blood loss, renal problems, sickle cell anemia, bone marrow suppression, leukemia, lead poisoning, Hodgkin’s lymphoma.
What could cause an abnormal K+?
High Level: Infection, dehydration, Addison’s disease, injury to tissue, diabetes, acute or chronic kidney failure, hypoaldosteronism
Low Level: Anorexia nervosa, malnutrition, diarrhea, vomiting, poorly managed diabetes, hyperaldosteronism
What are implications of having an K+?
Hyperkalemia
• Monitor for arrhythmias, irritability, paresthesias, anxiety, and GI symptoms such as nausea and intestinal colic.
• Avoid potassium-saving diuretics, potassium supplements, or salt substitutes in patients with high renal insufficiency.
What could cause an abnormal Na+?
High Level: Cushing syndrome, diabetes insipidus, excessive fluid loss, malnutrition, dehydration
Low Level: Addison’s disease, renal diseases, cirrhosis, heart failure, ketonuria
What are implications of having an Na+?
Hyponatremia Monitor fluid losses and gains.
Monitor for GI symptoms (anorexia, nausea, vomiting, abdominal cramping) and CNS symptoms (lethargy, confusion, muscle twitching, seizures), and check urine specific gravity.
• Avoid giving large water supplements to patients receiving isotonic tube feedings.
• Take seizure precautions when hyponatremia is severe.
What are implications of having an Na+?
Hypernatremia
• Monitor fluid losses and gains, and check urine specific gravity.
• Monitor for excessive thirst, elevated body temperature, and changes in behavior such as restlessness, lethargy, and disorientation.
• Give sufficient water with tube feedings to keep serum Na+ and BUN at normal limits.
What are the 3 primary requirements that must be meet with informed consent
Adequate disclosure
Demonstrate sufficient comprehension
Voluntary
What is adequate disclosure?
This is our patient education. The patient must be given adequate information including the risks and benefits, what can happen if the procedure is done, what can happen if it is not done, etc…
What order of assessments are crucial post-surgery?
Airway/Breathing
Cardio-(AP, BP & peripheral vascular status)
What is pulse pressure?
the difference between the systolic and diastolic B/P - a narrowing pulse pressure can indicate hypoxemia or hypovolemia, the patient can be becoming shocky.
What are some red flags to consider post op?
B/P 25% higher or lower, a 15-20 point difference in AP or the development of bradycardia/tachycardia. Look for trends either up or down.
What are signs of hypovolemic shock?
AP increases while the B/P decreases.
What are the classifications of surgery based on urgency?
Purpose, risk factors and urgency
Surgery is classified as minor and major based on?
Risk
What anesthesia does not cause narcosis, but results in analgesia and reflex loss
Regional
A patient scheduled for a colonoscopy would most likely receive which type of anesthesia?
Conscious sedation
What are the nurse’s responsibilities in regard to obtaining the patient’s informed consent?
- Ensure is signed before pre-op meds given.
- Often witnesses signature.
- Answer questions.
- Contact MD PRN based on patient questions/concerns.
What measures can the nurse take to allay the patient’s anxiety related to an upcoming surgery?
o Answer questions o Good patient education o Therapeutic communication o Listen o Nonpharm measures – distraction, imagery, music o Meds – anti-anxiety as indicated
What is the purpose of Restorative surgery?
Improves the patient’s functional ability
What is the purpose of curative surgery?
Resolves a health problem by repairing or removing the cause
What is the purpose of diagnostic surgery?
Determines the origin or cause of a disorder
What is the purpose of palliative surgery?
Relieves symptoms of a disease but does not cure it
determine the category of Cleft palate/cleft lip repair surgery.
cosmetic
determine the category of a Hysterectomy surgery.
curative
determine the category of Repair of traumatic punctured lung surgery.
curative
determine the category of a Colostomy surgery.
palliative
determine the category of a Total joint replacement
restorative
determine the category of a Appendectomy
curative
Determine if the surgery is elective, urgent or emergent in a 22 year old scheduled for appendectomy?
emergent
Determine if the surgery is elective, urgent or emergent in a 77 year old scheduled for total knee replacement?
elective
Determine if the surgery is elective, urgent or emergent in a 55 year old scheduled for colon resection due to small bowel obstruction?
urgent
What transcultural considerations should the nurse recognize when preparing patients for surgery?
- Language barriers – intrepretor, materials in language patient can read
- Ask about specific cultural requests – ie: no blood transfusions
What are the advantages of a PCA?
o Better pain control
o Use less narcotics
o Do not have to wait for nurse
o Time savings for nurse
What measures can the nurse implement to help a new postoperative patient void?
- Increase fluids if able
- Position changes – up to void
- Run water
- Flush toilet
- Water over perineum
During the postoperative period, what are three signs or symptoms are called to the surgeon immediately?
- Resp complications
- Cardiac complications
- Wound dehiscence
Which medical conditions increase the risk of post-operative wound infections?
Obesity
• Diabetes
• Steroids
• any disorder that decreases immune function
What is malignant hyperthermia?
• Genetic metabolic disease - rare
• Rxn to inhalation anesthesia
• Hyperthermia with rigidity of skeletal muscles - life threatening
• S&S: temp, tachypnea, tachycardia, muscle contractions
It usually occurs about 10 to 20 minutes after surgery begins, but it can occur up to 24 hours after surgery.
What are the signs and symptoms of malignant hyperthermia?
• Hyperthermia with rigidity of skeletal muscles - life threatening
• S&S: temp, tachypnea, tachycardia, muscle contractions
It usually occurs about 10 to 20 minutes after surgery begins, but it can occur up to 24 hours after surgery.
What emergent interventions are implemented if malignant hyperthermia develops?
Emergent measures are implemented such as giving 100% O2 and regaining fluid and
electrolyte balance. The medication dantrolene sodium is given to inhibits muscular pathology.
What are the manifestations of pneumonia and how can pneumonia be prevented?
Fever, chills, chest pain, difficulty breathing, SOB, productive cough, crackles in lungs, wheezes
Use of IS, C & DB, early ambulation, good pain control
Epidural anesthesia
Injection of anesthetic agent into the epidural space, the spinal cord is never entered.
Epidural anesthesia – used surgeries lower 1⁄2 body =hip, perineum. legs
Nerve block
Injection of anesthetic agent into or around a nerve or group of nerves, results in blocked sensation and motor impulse transmission.
Nerve block limb surgery, for chronic pain