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Nursing, LPN, Year 1 > x Peri-Op (IV, Fluids) > Flashcards

x Peri-Op (IV, Fluids) Flashcards

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1
Q

Drop Factor?

A

size of drop.
Macro Drip - 10gtts/min
Micro Drip - 60gtts/min
Blood tubing - 15gtts/min

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2
Q

If IV rate is 80ml/hr or slower, using what size tubing?

A

Micro Drip tubing

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3
Q

If IV rate is 81ml/hr and UP, use

A

Macro Drip tubing

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4
Q

1L = ?ml

A

1000ml

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5
Q

IV RATE formula

A

ml / hr

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6
Q

DRIP RATE formula

A

RATE/Time (minutes) x GTT factor/1 = gtts/min

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7
Q

READ p107 - 114 (Burke)

A

and chpt 7,9,10,12,13

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8
Q

debridement

A

Removal of necrotic tissue

Chemical - collagenase
mechanical - wet to dry dressing

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9
Q

Types of Anesthesia

A

Topical
Local
Regional
Epidural

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10
Q

Topical Anesthesia

A

spray or paste of lidocaine to numb skin

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11
Q

Local Anesthesia

A

inject lidocaine into subq and underlying tissue as well as the skin

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12
Q

Regional Anesthesia

A

Lidocaine injection into a nerve plexus to numb a region or limb

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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.

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14
Q

how does Lidocaine work?

A

Sodium Channel Blocker - strips impulse of pain going to brain

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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.

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16
Q

Complications of blood transfusions

A
  1. Transfusion reaction/Allergic Reaction (hives, itching, swelling)
  2. Bacteremia/Sepsis (sudden chills, back ache, fever)
  3. In too rapidly, Hypervolemia (fluid overload)
  4. Blood is citrated to prevent clotting? Treated w NaCitrate or citric acid
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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.

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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)

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19
Q

PIC line

A

Peripherally Inserted Catheter

tip ends near aorta

Always X-ray to confirm placement

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20
Q

How long do blood bags last?

A

3 months

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21
Q

READ p 107 - 114, 321, 480

A

.

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22
Q

check glucose when?

p. 200

A

ac + hs (before meals, hour of sleep)

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23
Q

Debulking

A

removing large peices of cancer to de-bulk tumor.

not therapeutic, merely Palliative (only for comfort)

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24
Q

Palliative

A

not going to heal, but only to increase comfort

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25
Q

Who obtains Consent?

A

person performing procedure. Nurse can sign as a witness

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26
Q

Presumed Consent

A

99% of people want to live. Surgeon can make life saving decision if patient is not able and there is no family available.

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27
Q

Incentive Spirometer

A

suck air out. Exercise deep breathing

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28
Q

in stress, what is released in body, what are effects to blood

A

Epinephrine - vital signs affected
Cortisol - decrease immune response
BOTH raise blood sugar

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29
Q

Extravesation (signs, symptoms, treat)

A

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

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29
Q

Infiltration (signs, symptoms, treat)

A
  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

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30
Q

Thrombophlebitis (signs, symptoms, treat)

A

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.

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31
Q

When choosing an IV site, where do you start?

A

Distal

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32
Q

PICC line vs Central Line vs Implanted Ports

A

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

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33
Q

Issue w IV in anticubital?

A

Can bend arm

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34
Q

How does Insulin affect BS?

A

Lowers it

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35
Q

How does glucagon affect BS?

A

Raises

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36
Q

TPN

A

Total parenteral nutrition

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37
Q

what is the only instance an LPN can work with a main line?

A

Dialysis unit

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38
Q

Lactated Ringers

A

isotonic sulations (same concentration as Plasma)

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38
Q

Sepsis

A

Infection of blood

Symptoms: shaking, backache, chills

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39
Q

Crystalloid

A

Solutes dissolved in water

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40
Q

Isotonic

A

normal saline (NS), plasma, D5W (dextrose 5% in H20), Ringers solution

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41
Q

Hypotonic

A

fewer dissolved solids that plasma, 0.45% NaCL, 5% Dextrose

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42
Q

Hypertonic

A

more concentrated than body fluid. D10W, 20% Dextrose

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43
Q

Packed cells

A

RBC , plasma removed

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44
Q

Fresh Frozen plasma

A

used by hemophiliacs. manage coagulapathies, Vit K, ANTIDOTE for warfarin

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45
Q

Albumin

A

Main protein in blood. If not enough protein, fluid leaks into tissue (Kwarshiorkor Edema)

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46
Q

In an emergency, we don’t have to cross match what blood products?

A

Fresh Frozen Plasm, Albumin, Platelets. Only necessary in packed RBC or regular blood.

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47
Q

Blood subsitutes

A

emulsion
PFCs (per flouro carbons)
HBOC (Hemoglobin based Oxygen carriers)

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48
Q

How high should IV bag be placed for gravity infusion?

A

18 - 24” above infusion site

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49
Q

what is the problem with Anticubital IV?

A

can’t bend arm.

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50
Q

Glucagon vs Glycogen

A

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.

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51
Q

Aplastic Anemia

A

body stops making RBC.

treatment: stem cell or marrow transplant

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52
Q

Wounds:

Primary, Secondary, Tertiary

A

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.

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53
Q

Elders at risk for

A
  • post/op ICU dementia
  • wound healing
  • renal/hepatic functions- clear meds
  • may not get fever -infection
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54
Q

Obese at risk for

A
  • UP pneumonia
  • dehiscence of wound
  • thrombophlebitis
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55
Q

Dehiscence

A

Wound pops open. Cover w saline gauze and call doc

56
Q

Evisceration

A

Organs etc come out of open wound

57
Q

When choosing IV sites

A

Start distal and slowly move proximal

58
Q

Problem w antecubital IV

A

Can’t bend arm

59
Q

Patient on TPN at risk for

A

Hyperglycemia

60
Q

Have patient cough/deep breathe because

A

Prevent post op Pneumonia

Expand lungs and increase deep breathing

61
Q

Treatment of DVT to prevent pulmonary embolus

A
  • TED hose
  • ankle/leg exercises
  • SCD (Venodyne Boots) Sequential Compression Device (change in pressure to promote circulation)
63
Q

If therapy is painful, can you pre-medicate patient?

A

Yes

  • physical therapy
  • ambulated
  • dressing changes
  • painful re positioning
64
Q

Who obtains Informed Consent?

What is nurse role?

A
  • Person performing procedure
  • Nurse as a witness only.

protects nurse, physician, facility

65
Q

Perioperative nursing care

A

period immediately before, during and after surgery

66
Q

Inpatient surgery

A

admission to hospital

67
Q

Ambulatory (outpatient) surgery

A

local or general anesthesia but allowed to return home without assistance.

in physicians office, free standing ambulatory surgery center, or in hospital suites

68
Q

Patient has right to refuse up to ??? before surgery

A

20min

69
Q

Types of surgery

A 
Diagnostic
Ablative
Constructive
Reconstructive
Palliative (comfort only, no healing)
Transplant
70
Q

Malnutrition surgical risk factors

A

UP rise for adverse outcome

UP risk for impaired wound healing, infection, sepsis

71
Q

Dehydration/Elec Balance surgical risk factor

A

UP risk for thrombophlebitis
UP risk for clotting
UP risk for cardio instability/dysrhytmia/heart failure

72
Q

Cardiovascular disorders surgical risk factor

A

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
Q

Alcoholism surgical risk factor

A

-DTs (hallucinations) (Delerium Tremens)
(treat w Benzodiazapene)
-seizures

74
Q

Universal Protocol

A

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
Q

PTT test

A

PTT: Partial thromboplastin time

coagulation

76
Q

PT test

A

PT: Prothrombin Time

coagulation

77
Q

Diagnostic Tests

A
  • 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
Q

During Skin Prep, any moles, warts, rashes, lesions within surgical site are recorded and put back in place after surgery.

A

.

79
Q

Who pay attention to I&O during surgery

A

circulating nurse

80
Q

Splinting is used when ?

A

To prevent injury or splitting of stitches etc after surgery in abdominal area.

Holding pillow against stomach when coughing

80
Q

Splinting is used when ?

A

To prevent injury or splitting of stitches etc after surgery in abdominal area.

81
Q

No coughing after what surgeries?

A

Neuro Surgery
Eye
Hernia

82
Q

Coughing encouraged why?

A

To prevent post-op pneumonia

83
Q

CPM

A

Continuous Passive Motion

Machine that moved your joints for you. I.e let after knee surgery

84
Q

PACU

A

Post Anestesia Care Unit

85
Q

Malignant Hyperthermia

A

Idiosyncratic reaction to Anestesia

Potentially fatal rise in body temp

Genetic

86
Q

The Surgical Team

A

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
Q

Stages of General Anestesia

A

Induction : drug administered, airway checked, skin prep

Maintenance: surgical incision and almost to end of procedure

Emergence: client awakened, tube removed

89
Q

Conscious Sedation drug and rescue med

A

Analgesic and amnesiac effect
Opioids: morphine sulfate, fentanyl (sublimaze)
Sedative: Diazepam (valium), Midazolam (versed)

Reversal Med: Naloxone hydrochloride (Narcan), Flumazenil (romazicon)

90
Q

How long is the surgical scrub?

A

5-10min

91
Q

anything body part removed from patient goes where?

A

the lab for testing

92
Q

any question asking which symptom is most concerning always go with ….

A

respiratory

93
Q

Wound Healing: Primary Intention

A

edges are approximated (staples/sutures), heals quickly, little scarring

94
Q

Secondary Intention

A

large, gaping, irregular. would allowed to heal on its own from bottom up

95
Q

Tertiary Intention

A

Initially Secondary itention then got infected

96
Q

3 phases of wound healing

A

Inflammatory
Proliferative
Remodeling

97
Q

Exudite

A

wound drainage

98
Q

Types of wound drainage

A

Serous - clear, yellow serum (thin, yellow)
Sanguineous - serum and RBC (thick reddish)
Purulent - Pus (WBC, tissue debris, bacteria)

99
Q

Wound Drainage Devices

A

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
Q

Atelectasis

A

incomplete expansion of collapse of lung tissue

prevent w early ambulation and spriometer

101
Q

Homan’s Sign

A

pain in calves on Dorsiflextion of food. (indicates DVT)

102
Q

Signs of Pulmonary Embolism

A 
dyspnea
sudden chest pain
diaphoresis (sweating)
anxiety
restlessness
rapid respiration and pulse
dysrythmia
cough
cyanosis
NO LUNG SOUNDS
103
Q

Signs Hemmorage

A

restlessness, anxiety

UP heart rate, same BP

104
Q

NSAID

A

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
Q

For wound healing, what diet is encouraged?

A

protein and vit C

106
Q

After major surgery, how often do you assess patient?

A

every 15min (first hour)
if stable, every 30 min (for 2 hrs)
then every hour (for 4 hrs)

107
Q

what drug given to build up blood before a surgery

A

Erythropoetin

Epogen

108
Q

Autolugus Donor

A

Donating your own blood in advance of your surgery

109
Q

Cell saver

A

using blood suctioned from surgery. it’s washed and given back to you.

110
Q

Who is most at risk for Pneumonia

A

Elderly

pts under General Anestesia

111
Q

PCA

A

Patient controlled analgesic

112
Q

most common post op infection

A

staph aureus

113
Q

Teratogenic

A

any drug causing birth defects

114
Q

Anticholinergic

A
  • 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
Q

Perfusion

A

blood coming out of vessel into area

116
Q

Eschemia

A

blood leaving area

117
Q

Venous stasis

A

pooling of blood

118
Q

Penrose tube

A

gravity drainage

119
Q

Who cannot be on immunosuppressants

A

HIV, cancer, hep

120
Q

Signs of someone losing blood (lacking O2)

A

restlessness

tachycardia

121
Q

Who can sign a consent form?

A

sober adult (over 18)
emancipated minor
married minor
in emergency, next of kin

122
Q

Bovie Cautery

A

seal blood vessels not cut.

123
Q

How do they know you need an apendectomy

A

Rebound tenderness @ McBurney’s point

124
Q

Toradol

A

one of strongest NSAIDs. good weaning drug for opiates

125
Q

If receiving transplant, must take suppressants. What are the times when you don’t need suppressants?

A
  • transplant from an identical twin

- Cornea transplant

126
Q

Paralytic Illeus

A

all bowel movement ceases

auscultate for bowel sounds
4min per quadrant

127
Q

Gall bladder surgery diet

A

avoid concentrated fats

miss out on fat soluble vits (ADEK)

128
Q

Steatorhea

A

fluffy, fatty stool

129
Q

Laproscopic surgery

A
  • less invasive
  • easier recovery
  • open surgery
  • insufflate belly w CO2 gas. (after surgery, trapped gas can cause pain)
130
Q

PACU

A

Post Anestesia Care Unit

ptn monitered q15min
nurse ratio: adult 1:2, pedi 1:1

131
Q

Post Op, 1st surgical dressing changed by ?

A

surgeon

132
Q

Warming Blankets

A

Bear Hugger (blows hot air)

133
Q

How would the nurse treat an evisceration?

A
  • place saline soaked guaze. don’t press, just place on it.
  • call Dr STAT
134
Q

After what surgeries should you NOT encourage coughing

A

Gluacoma, Cataract, (eye), hernia

135
Q

after hip replacement surgery, what do you restrict

A
  • adduction

- 90* flexion, legs should be straight (sit/stand on high stool)

136
Q

How do you monitor drainage of wound

A

-draw circle around drainage and check to see if it spreads

137
Q

Post Op Pneumonia

A

-hypostasis of secretions

138
Q

Adhesion

A

when tissues stick together during healing

an abnormal union of membranous surfaces due to inflammation or injury

140
Q

Perioperative: Phases or Surgery

A

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.

Nursing, LPN, Year 1 (44 decks)

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