Unit 1- test Flashcards
3 inpatient surgical procedures
- ) emergent- Immediately
- ) urgent- schedule ASAP
- ) elective
outpatient surgical procedures
- most often elective
- not acute
- Ex: cataract removal, hernia repair
pre-operative period Rn role
- begins when pt scheduled for surgery
- physical/mental assessment
- blood donations
- informed consent (signing)
- teaching
- discharge planning
pre-operative teaching
•pain control •breathing/spirometer •ROM •anti-embolism •diet •invasive devices •anti-anxiety *demonstrate and then have pt state understanding and demonstrate
intra-operative period Rn role
- monitor for resp. depression
- maintain body temp
- equipment count
biggest concern of opioids/sedatives
•respiratory depression
*reverse w/ Narcan
hypothermia during surgery
•increases chance of surgical/wound infection
•alters metabolism of meds
*why need to give pt warm blanket
malignant hyperthermia
•life-threatening complication of exposure anesthetics •tachycardia/pnea •elevated body temp •muscle rigidity •skin mottling •cyanosis •myobloinuria (muscle protein in urine) •rise in tidal CO2 and decrease in O2 sat *tx w/ cold IV and Dantrolene
post-operative Rn role
- evaluate/stabilize pt
- prevent complications (ABC priority)
- determine readiness for discharge (ambulate/fluids/VS)
post-op complications
- airway obstruction
- hypoxia (day 2)
- hypovolemic schock (massive loss circulating blood)
- paralytic ileus
- wound dehiscence or evisceration
- DVT
general anesthesia
•reversible loss of consciousness induced by inhibiting neuronal impulses in CNS
•causes analgesia, amnesia, unconsciousness, and loss of reflexes/tone
•used for major surgery or requiring major muscle rlx
*usually balanced- inhaled, IV, & adjuncts
local anesthesia
- loss of sensation w/o loss of consciousness
- motor fxn may/may not be affected
- topical, local infiltration, or regional
- often supplemented w/ sedative, opioid analgesics, hypnotics
- risk for aspiration low b/c cough/gag reflex intact
regional anesthesia
- blocks multiple peripheral nerves in specific body region
- field
- nerve
- spinal
- epidural
moderate (conscious) sedation
- IV delivery of sedative, hypnotic, opioid drugs to reduce LOC for minor procedures w/o pt having discomfort
- pt responds to verbal stimuli, retains reflexes, and is easily aroused
- pt maintains airway
- often used for burn debridement
major components of body fluid
1.) intracellular (ICF)- ⅔
2.) extracellular (ECF)- ⅓
•ECF includes intravascular and interstitial
•fluid can move b/t
hypotonic ECF
- osmolarity of less than 270 mOsm/L
- fluid into cells (lyse)
- 0.5% NS
hypertonic ECF
- osmolarity of greater than 300 mOsm/L
- fluid out of cells (crenation)
- 1.5% NS or 3% NS
isotonic ECF
- osmolarity of 270-300 mOsm/L
* 0.9% NS
major causes of fluid/electrolyte imbalances
- renal/GI/cardiac dysfunction/losses
- hemorrhage
- third spacing (ascites/burns)
- intake
- fever
- hormones
aldosterone
•excreted by the cortex of the adrenal gland in response to low Na+ levels
•prevents sodium and water loss
*RETAIN fluid (FVD)
anti-diuretic hormone (ADH)
•Produced in the posterior pituitary
•acts on kidneys to make kidneys reabsorb more water so that the body retains more fluid
*RETAIN fluid (FVD)
natriuretic peptides (NPs)
•released in response to barorecptors in the heart or vascular system detecting increased blood volume
*LOSE fluid (FVE)
renin-angiotension system
- in response to low BP, blood volume, blood O2, and blood osmolarity kidneys excrete renin
- renin activates angiotension I, which is converted to angiotension II (active form) by ACE
3 fxns of angiotension II
- vasoconstrictor
- causes nephrons to contract, decreasing UOP
- causes kidneys to release aldosterone
an ACE inhibitor would be classified as…
- diuretic
- lowers BP b/c blocks production of angiotension II
- commonly used for mild HTN
fluid-volume deficit (FVD)
- hypovolemia and dehydration
- tachy/thready
- increased hemoconcentration
- hyperthermia, hyPOtension, confusion, oliguria
- increased serum osm, Hct, Hgb, urine specific gravity
- HYPERNATREMIA
- tx w/ fluid (PO pref.)
hypovolemia vs/ dehydration
•hypovolemia is fluid and electrolyte loss, while dehydration is just fluid loss
hypovolemic shock
- decreased oxygen to organ/pressure to organ
- complication of FVD
- tx w/ O2, fluids, vasoconstrictors (increase central flow first)
hemoconcentration
•decrease in the volume of plasma in relation to # of RBCs
•increase in concentration of circulating RBCs
•increases in Hct, Hgb, electrolytes, and urine specific gravity
*expected in endurance athletes
fluid volume excess (FVE)
- hypervolemia or over-hydration
- tachy/bounding
- weight gain/crackles/edema
- hyPERtension
- decreased hemoconcentration, Hgb, Hct, serum osm
- HYPONATREMIA
- tx w/ Na+, diuretics, O2
expected serum Na+ levels
- 135-145 mEq/L
* imbalances cause NEURO problems (influences conduction rates)
hypernatremia
- Na+ > 145 mEq/L
- due to increased Na+ or excessive water loss
- hypertonic serum (crenation)
- dehydration
- tx w/ hypo/iso IV
hyponatremia
- Na+ < 135 mEq/L
- due to decreased Na+ or excessive water concentration in relation to sodium
- hypotonic serum (lyse)
- over-hydration
- tx w/ hyper IV, ACE inhibitors, diuretics
expected K+ levels
- 3.5-5.0 mEq/L
* imbalances cause CARDIAC problems
hyperkalemia
- K+ > 5.0 mEq/L
- due to increased K+ intake, K+ out of cells (diabetes/tumor lysis), salt sub.
- EKG shows peaked T waves
- tx w/ decreased K+ intake, Kayexalate (K+ in stool), diuretics
hypokalemia
•K+ < 3.5 mEq •results from decreased intake, movement of K+ into cells (insulin high), Lasix (furosimide) cause K+ loss *key s/s is fluttering chest •EKG shows inverted T waves •tx w/ PO K+ (never bolus)
expected Ca2+ levels
- 9.0-10.5 mg/dL
* imbalances cause SKELETAL MUSCLE problems
hypocalcemia
- Ca2+ < 9.0 mg/dL
- bradycardia, hypotension, hyper bowel
- muscle cramps (SPASMS)
- risk of seizure/fall
- Trousseau’s sign- wrist spasm with BP cuff
- Chvostek’s sign- cheek muscle twitch when tap
hypercalcemia
•Ca2+ > 10.5 mg/dL •lethargy, paresthesia b/c less sensitive to normal stimuli •mscl WEAKNESS •causes faster clotting time *high risk for DVT
expected phosphorus level
- 3.0-4.5 mg/dL
* imbalances cause SKELETAL MUSCLE problems
hyphosphatemia
- phos < 3.0 mg/dL
- same as HYPERCALCEMIA
- muscle weakness
hyperphasphatemia
- phos > 4.5 mg/dL
- same as HYPOCALCEMIA
- muscle spasms
phosphorus food sources
- fish
- chicken
- beef
- pork
- organ meats
- nuts
- whole grains
expected Mg2+ levels
- 1.3-2.1 mEq/L
* abnormalities involve DTRs
hypomagnesemia
- Mg2+ < 1.3 mEq
- HYPERACTIVE DTRs
- occurs in conjunction w/ hypocalcemia (spasm)
- tetany, seizure, psychoses
hypermagnesemia
•Mg2+ > 2.1 mEq/L •HYPOACTIVE DTRs •occurs in conjunction w/ hypercalcemia (weakness) •coma, bradycardia, hypotension *use of laxatives poses major risk
use of laxatives risk
- hypermagnesemia
* hypokalemia
normal Hgb values
•m: 14-18 g/dL
•f: 12-16 g/dL
*hemochromatosis- too much Hgb
normal Hct values
•m: 50-57 ml/dL (50-54%)
•f: 37-48 ml/dL (37-48%)
*% of packed RBC/dL of blood
