x Peri-Op (IV, Fluids) Flashcards
1
Q
Drop Factor?
A
size of drop.
Macro Drip - 10gtts/min
Micro Drip - 60gtts/min
Blood tubing - 15gtts/min
2
Q
If IV rate is 80ml/hr or slower, using what size tubing?
A
Micro Drip tubing
3
Q
If IV rate is 81ml/hr and UP, use
A
Macro Drip tubing
4
Q
1L = ?ml
A
1000ml
5
Q
IV RATE formula
A
ml / hr
6
Q
DRIP RATE formula
A
RATE/Time (minutes) x GTT factor/1 = gtts/min
7
Q
READ p107 - 114 (Burke)
A
and chpt 7,9,10,12,13
8
Q
debridement
A
Removal of necrotic tissue
Chemical - collagenase
mechanical - wet to dry dressing
9
Q
Types of Anesthesia
A
Topical
Local
Regional
Epidural
10
Q
Topical Anesthesia
A
spray or paste of lidocaine to numb skin
11
Q
Local Anesthesia
A
inject lidocaine into subq and underlying tissue as well as the skin
12
Q
Regional Anesthesia
A
Lidocaine injection into a nerve plexus to numb a region or limb
13
Q
Epidural Anesthesia
A
Lidocaine injection into spinal region between vertebrae to numb areas called dermatomes (on dura mater)
Spinal goes right into spinal column and last longer.
14
Q
how does Lidocaine work?
A
Sodium Channel Blocker - strips impulse of pain going to brain
15
Q
why do patients shiver after anesthesia?
A
muscle tone and movement generate heat. Anesthesia paralyzes the muscles. The body will shiver because muscles were not generating any heat.
16
Q
Complications of blood transfusions
A
- Transfusion reaction/Allergic Reaction (hives, itching, swelling)
- Bacteremia/Sepsis (sudden chills, back ache, fever)
- In too rapidly, Hypervolemia (fluid overload)
- Blood is citrated to prevent clotting? Treated w NaCitrate or citric acid
17
Q
What blood product would hemophiliacs need?
A
Cryoprecipitate (fibrinogen & multiple clotting factors)
Cryoprecipitate is a source of fibrinogen. Fibrinogen is vital to blood clotting. It is usually used in the treatment of patients with reduced levels of, or poorly functioning, fibrinogen with clinical bleeding, an invasive procedure or trauma.
18
Q
How long can you hand an IV before changing? Bag Tubing TPN tubing IV site
A
Bag - 24hrs
Tubing - 3 days
TPN tubing - 24 hrs
IV site - 3 days
(no IV on side of mastectomy, fistula)
19
Q
PIC line
A
Peripherally Inserted Catheter
tip ends near aorta
Always X-ray to confirm placement
20
Q
How long do blood bags last?
A
3 months
21
Q
READ p 107 - 114, 321, 480
A
.
22
Q
check glucose when?
p. 200
A
ac + hs (before meals, hour of sleep)
23
Q
Debulking
A
removing large peices of cancer to de-bulk tumor.
not therapeutic, merely Palliative (only for comfort)
24
Q
Palliative
A
not going to heal, but only to increase comfort
25
Who obtains Consent?
person performing procedure. Nurse can sign as a witness
26
Presumed Consent
99% of people want to live. Surgeon can make life saving decision if patient is not able and there is no family available.
27
Incentive Spirometer
suck air out. Exercise deep breathing
28
in stress, what is released in body, what are effects to blood
Epinephrine - vital signs affected
Cortisol - decrease immune response
BOTH raise blood sugar
29
Extravesation (signs, symptoms, treat)
passage or escape into tissue of antineoplastic chemotherapeutic drugs.
Signs and symptoms may be sudden onset of localized pain at an injection site, sudden redness or extreme pallor at an injection site, or loss of blood return in an IV needle. Tissue slough and necrosis may occur if the condition is severe.
Nursing responsibilities include maintaining the patient IV line, elevating the affected area, applying ice packs, and notifying the physician of the need for antidote
29
Infiltration (signs, symptoms, treat)
1. the movement of a needle or cannula from within a vessel into the surrounding tissue.
symptoms are a slowed flow of fluids, swelling, pallor, coolness of the skin, and discomfort in the area
Treatment
30
Thrombophlebitis (signs, symptoms, treat)
inflammation of a vein located just below the skin’s surface. The inflammation is due to a blood clot.
Causes
This condition may occur after injury to the vein. Or it may occur after having an intravenous (IV) line or catheter. If you have a high risk of this condition, you may develop it for no apparent reason.
```
Symptoms
Skin redness, inflammation, tenderness, or pain along a vein just below the skin
Warmth of the area
Limb pain
Hardening of the vein
```
Treatment
- Goals:reduce pain and inflammation and prevent complications.
- Wear support stockings, if your leg is affected
- Keep the affected leg or arm raised above heart level
- Apply a warm compress to the area
- remove IV line
Medicines that may be prescribed include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation
Painkillers
If deeper clots (deep vein thrombosis) are also present, your provider may prescribe medicines to thin your blood. These medicines are called anticoagulants. Antibiotics are prescribed if you have an infection.
Surgical removal (phlebectomy), stripping, or sclerotherapy of the affected vein are occasionally needed to treat large varicose veins or to prevent further episodes of thrombophlebitis in high-risk patients.
31
When choosing an IV site, where do you start?
Distal
32
PICC line vs Central Line vs Implanted Ports
PICC line goes in through Central Line to top of aorta. Xray to check.
Central/Implanted ports?
Both are central lines
PICC up to 1 yr
Port over a year
33
Issue w IV in anticubital?
Can bend arm
34
How does Insulin affect BS?
Lowers it
35
How does glucagon affect BS?
Raises
36
TPN
Total parenteral nutrition
37
what is the only instance an LPN can work with a main line?
Dialysis unit
38
Lactated Ringers
isotonic sulations (same concentration as Plasma)
38
Sepsis
Infection of blood
Symptoms: shaking, backache, chills
39
Crystalloid
Solutes dissolved in water
40
Isotonic
normal saline (NS), plasma, D5W (dextrose 5% in H20), Ringers solution
41
Hypotonic
fewer dissolved solids that plasma, 0.45% NaCL, 5% Dextrose
42
Hypertonic
more concentrated than body fluid. D10W, 20% Dextrose
43
Packed cells
RBC , plasma removed
44
Fresh Frozen plasma
used by hemophiliacs. manage coagulapathies, Vit K, ANTIDOTE for warfarin
45
Albumin
Main protein in blood. If not enough protein, fluid leaks into tissue (Kwarshiorkor Edema)
46
In an emergency, we don't have to cross match what blood products?
Fresh Frozen Plasm, Albumin, Platelets. Only necessary in packed RBC or regular blood.
47
Blood subsitutes
emulsion
PFCs (per flouro carbons)
HBOC (Hemoglobin based Oxygen carriers)
48
How high should IV bag be placed for gravity infusion?
18 - 24" above infusion site
49
what is the problem with Anticubital IV?
can't bend arm.
50
Glucagon vs Glycogen
Glucagon causes the liver to convert stored glycogen into glucose, which is released into the bloodstream. High blood glucose levels stimulate the release of insulin. Insulin allows glucose to be taken up and used by insulin-dependent tissues.
51
Aplastic Anemia
body stops making RBC.
treatment: stem cell or marrow transplant
52
Wounds:
| Primary, Secondary, Tertiary
PRIMARY: Wound edges approximated
SECONDARY: would allowed to close from bottom up
TERTIARY: Initially had primary, abscess formed and had to reopen and left to heal secondarily.
53
Elders at risk for
- post/op ICU dementia
- wound healing
- renal/hepatic functions- clear meds
- may not get fever -infection
54
Obese at risk for
- UP pneumonia
- dehiscence of wound
- thrombophlebitis
55
Dehiscence
Wound pops open. Cover w saline gauze and call doc
56
Evisceration
Organs etc come out of open wound
57
When choosing IV sites
Start distal and slowly move proximal
58
Problem w antecubital IV
Can't bend arm
59
Patient on TPN at risk for
Hyperglycemia
60
Have patient cough/deep breathe because
Prevent post op Pneumonia
| Expand lungs and increase deep breathing
61
Treatment of DVT to prevent pulmonary embolus
- TED hose
- ankle/leg exercises
- SCD (Venodyne Boots) Sequential Compression Device (change in pressure to promote circulation)
63
If therapy is painful, can you pre-medicate patient?
Yes
- physical therapy
- ambulated
- dressing changes
- painful re positioning
64
Who obtains Informed Consent?
| What is nurse role?
- Person performing procedure
- Nurse as a witness only.
protects nurse, physician, facility
65
Perioperative nursing care
period immediately before, during and after surgery
66
Inpatient surgery
admission to hospital
67
Ambulatory (outpatient) surgery
local or general anesthesia but allowed to return home without assistance.
in physicians office, free standing ambulatory surgery center, or in hospital suites
68
Patient has right to refuse up to ??? before surgery
20min
69
Types of surgery
```
Diagnostic
Ablative
Constructive
Reconstructive
Palliative (comfort only, no healing)
Transplant
```
70
Malnutrition surgical risk factors
UP rise for adverse outcome
| UP risk for impaired wound healing, infection, sepsis
71
Dehydration/Elec Balance surgical risk factor
UP risk for thrombophlebitis
UP risk for clotting
UP risk for cardio instability/dysrhytmia/heart failure
72
Cardiovascular disorders surgical risk factor
UP risk for cardio instability
HYPOVOLEMIC shock (insuff blood flow to organs)
HYPOTENSION
DVT (cramping in calves, hurts when dorsaflex)
venous thrombosis
pulmonary embolism (does NOT make lung sounds)
stroke
fluid volume overload
edema(peripheral)
lung sounds
73
Alcoholism surgical risk factor
-DTs (hallucinations) (Delerium Tremens)
(treat w Benzodiazapene)
-seizures
74
Universal Protocol
to reduce wrong site, wrong procedure, wrong person
1. procedure verification
2. Mark area (while pnt awake)
3. "Time Out" to ensure right client, right site, right procedure
75
PTT test
PTT: Partial thromboplastin time
| coagulation
76
PT test
PT: Prothrombin Time
| coagulation
77
Diagnostic Tests
- CBC: complete blood count
- Serum Electrolytes
- Coagulation: PT & PTT
- Urinalysis: to rule out UTI/pregnancy
- Chest Xray: baseline for size/shape, condition of heart/lungs
- ECG: Electrocardiogram (for those undergoing general anestesia, older than 40, or history of cardiovascular disease. Identify cardiac status
- Blood glucose levels (esp diabetic ptn)
78
During Skin Prep, any moles, warts, rashes, lesions within surgical site are recorded and put back in place after surgery.
.
79
Who pay attention to I&O during surgery
circulating nurse
80
Splinting is used when ?
To prevent injury or splitting of stitches etc after surgery in abdominal area.
Holding pillow against stomach when coughing
80
Splinting is used when ?
To prevent injury or splitting of stitches etc after surgery in abdominal area.
81
No coughing after what surgeries?
Neuro Surgery
Eye
Hernia
82
Coughing encouraged why?
To prevent post-op pneumonia
83
CPM
Continuous Passive Motion
Machine that moved your joints for you. I.e let after knee surgery
84
PACU
Post Anestesia Care Unit
85
Malignant Hyperthermia
Idiosyncratic reaction to Anestesia
Potentially fatal rise in body temp
Genetic
86
The Surgical Team
Surgeon
Surgical Assistant (physician, RN, PA, or trained LPN)
Anesthesiologist
CRNA( cert RN anesthetist, administered Anestesia and responsible for clients well being)
Circulating Nurse (coordinates and manages activities)
Scrub Nurse (handles tools)
87
Stages of General Anestesia
Induction : drug administered, airway checked, skin prep
Maintenance: surgical incision and almost to end of procedure
Emergence: client awakened, tube removed
89
Conscious Sedation drug and rescue med
Analgesic and amnesiac effect
Opioids: morphine sulfate, fentanyl (sublimaze)
Sedative: Diazepam (valium), Midazolam (versed)
Reversal Med: Naloxone hydrochloride (Narcan), Flumazenil (romazicon)
90
How long is the surgical scrub?
5-10min
91
anything body part removed from patient goes where?
the lab for testing
92
any question asking which symptom is most concerning always go with ....
respiratory
93
Wound Healing: Primary Intention
edges are approximated (staples/sutures), heals quickly, little scarring
94
Secondary Intention
large, gaping, irregular. would allowed to heal on its own from bottom up
95
Tertiary Intention
Initially Secondary itention then got infected
96
3 phases of wound healing
Inflammatory
Proliferative
Remodeling
97
Exudite
wound drainage
98
Types of wound drainage
Serous - clear, yellow serum (thin, yellow)
Sanguineous - serum and RBC (thick reddish)
Purulent - Pus (WBC, tissue debris, bacteria)
99
Wound Drainage Devices
Penrose Tube - rubber tube (gravity)
Jackson Pratt - grenade looking (light suction)
Hemovac - cylinder with springs (heavy suction)
Wet-Dry (Negative Pressure)? - black foam taped onto wound.
100
Atelectasis
incomplete expansion of collapse of lung tissue
prevent w early ambulation and spriometer
101
Homan's Sign
pain in calves on Dorsiflextion of food. (indicates DVT)
102
Signs of Pulmonary Embolism
```
dyspnea
sudden chest pain
diaphoresis (sweating)
anxiety
restlessness
rapid respiration and pulse
dysrythmia
cough
cyanosis
NO LUNG SOUNDS
```
103
Signs Hemmorage
restlessness, anxiety
| UP heart rate, same BP
104
NSAID
Non steroidal anti-inflammatory drug
class of drugs that provides analgesic (pain-killing) and antipyretic (fever-reducing) effects, and, in higher doses, anti-inflammatory effects.
Ibuprofen, Aspirin, Diclofenac, Naproxen, Meloxicam, Celecoxib, Indometacin, Ketorolac, Ketoprofen, Nimesulide, Etoricoxib, Piroxicam, Nabumetone, Mefenamic acid, Loxoprofen, Salicylic acid, Diclofenac sodium, Carprofen, Naproxen sodium, Aceclofenac, Etodolac, Flurbiprofen, Sulindac, Phenylbutazone, Dexketoprofen, Oxaprozin, Lornoxicam, Tenoxicam, Diclofenac/Misoprostol, Benzydamine, Flunixin, Diflunisal, Dexibuprofen, Valdecoxib, Etofenamate, Tiaprofenic acid, Phenazone, Felbinac, Salsalate, Deracoxib, Nepafenac, Diclofenac potassium, Bromfenac, Tolfenamic acid, Fenoprofen, Tolmetin, Lumiracoxib, Fenbufen, Diclofenac epolamine, Suprofen
105
For wound healing, what diet is encouraged?
protein and vit C
106
After major surgery, how often do you assess patient?
every 15min (first hour)
if stable, every 30 min (for 2 hrs)
then every hour (for 4 hrs)
107
what drug given to build up blood before a surgery
Erythropoetin
| Epogen
108
Autolugus Donor
Donating your own blood in advance of your surgery
109
Cell saver
using blood suctioned from surgery. it's washed and given back to you.
110
Who is most at risk for Pneumonia
Elderly
| pts under General Anestesia
111
PCA
Patient controlled analgesic
112
most common post op infection
staph aureus
113
Teratogenic
any drug causing birth defects
114
Anticholinergic
- Dry out secretions
- causes difficulty swallowing d/t dry mouth
- affects peristaltic action of esophogus
block the action of the neurotransmitter acetylcholine in the brain. They are used to treat diseases like asthma, incontinence, gastrointestinal cramps, and muscular spasms. They are also prescribed for depression and sleep disorders. The drugs help to block involuntary movements of the muscles associated with these diseases. They also balance the production of dopamine and acetylcholine in the body. Anticholinergics can also be used to treat certain types of toxic poisoning, and are sometimes used as an aid to anesthesia.
DRY up secretions
115
Perfusion
blood coming out of vessel into area
116
Eschemia
blood leaving area
117
Venous stasis
pooling of blood
118
Penrose tube
gravity drainage
119
Who cannot be on immunosuppressants
HIV, cancer, hep
120
Signs of someone losing blood (lacking O2)
restlessness
| tachycardia
121
Who can sign a consent form?
sober adult (over 18)
emancipated minor
married minor
in emergency, next of kin
122
Bovie Cautery
seal blood vessels not cut.
123
How do they know you need an apendectomy
Rebound tenderness @ McBurney's point
124
Toradol
one of strongest NSAIDs. good weaning drug for opiates
125
If receiving transplant, must take suppressants. What are the times when you don't need suppressants?
- transplant from an identical twin
| - Cornea transplant
126
Paralytic Illeus
all bowel movement ceases
auscultate for bowel sounds
4min per quadrant
127
Gall bladder surgery diet
avoid concentrated fats
| miss out on fat soluble vits (ADEK)
128
Steatorhea
fluffy, fatty stool
129
Laproscopic surgery
- less invasive
- easier recovery
- open surgery
- insufflate belly w CO2 gas. (after surgery, trapped gas can cause pain)
130
PACU
Post Anestesia Care Unit
ptn monitered q15min
nurse ratio: adult 1:2, pedi 1:1
131
Post Op, 1st surgical dressing changed by ?
surgeon
132
Warming Blankets
Bear Hugger (blows hot air)
133
How would the nurse treat an evisceration?
- place saline soaked guaze. don't press, just place on it.
- call Dr STAT
134
After what surgeries should you NOT encourage coughing
Gluacoma, Cataract, (eye), hernia
135
after hip replacement surgery, what do you restrict
- adduction
| - 90* flexion, legs should be straight (sit/stand on high stool)
136
How do you monitor drainage of wound
-draw circle around drainage and check to see if it spreads
137
Post Op Pneumonia
-hypostasis of secretions
138
Adhesion
when tissues stick together during healing
an abnormal union of membranous surfaces due to inflammation or injury
140
Perioperative: Phases or Surgery
PRE-OPERATIVE: perform tests, attempt to limit preoperational anxiety and may include the preoperative fasting.
INTRA-OPERATIVE: begins when the patient is transferred to the operating room bed and ends with the transfer of a patient to the postanesthesia care unit (PACU). During this period the patient is monitored, anesthetized, prepped, and draped, and the operation is performed. Nursing activities during this period focus on safety, infection prevention, and physiological response to anesthesia. Radiation therapy and blood salvage may also be performed during this time. AND COUNTING SUPPLIES
POST-OPERATIVE: The postoperative period begins after the transfer to the PACU (Post Anesthesia Care Unit) and terminates with the resolution of the surgical sequelae. It is quite common for this period to end outside of the care of the surgical team. It is uncommon to provide extended care past the discharge of the patient from the PACU.
