Exam 1 Flashcards
(115 cards)
1
Q
Three phases of inflammation
A
First: vascular and cellular
Second: exudate production
Third: reparative
2
Q
Focused health history- inflammation
A
Possible irritants: physical (trauma, heat/cold, radiation), chemical (acid, alkalis, poisons, gases), microorganisms (bacteria, fungi, parasites, viruses)
3
Q
Five signs of inflammation
A
- Erythema
- Edema
- Heat
- Pain
- Loss of Function
4
Q
Diagnostic tests- inflammation
A
- Erythrocyte Sedimentation Rate (ESR/SED): 0-20
2. C-Reactive Protein (CRP): <1 mg/dL or <10 mg/L; measures response to antibiotic/antiinflammmatory meds.
5
Q
NSAID’s
A
inhibit the COX enzyme; reduce swelling, pain, and stiffness in joints
6
Q
COX-1 Inhibitors (1st gen)
A
Loss of stomach lining, prevents blood clots, decreases fever,
7
Q
COX-2 Inhibitors (2nd gen)
A
Reduces pain and inflammation, Do not disturb stomach lining
8
Q
Ibuprofen (Motrin/Advil)
A
COX-1 inhibitor; produces analgesic, anti-inflammatory, reduces fever SE: N&V, dyspepsia, dizziness, rash, heartburn
9
Q
Celecoxib (Celebrex)
A
COX-2 inhibitor; reduces pain and inflammation, used for osteoarthritis and rheumatoid arthritis SE: diarrhea, dyspepsia, headache, URTI, GI discomfort, abdominal pain, peripheral edema (Do not use in pt with existing cardiac issues
10
Q
Ketorolac (Toradol)
A
NSAID; intraocular anti-inflammatory; inhibits prostaglandin synthesis, reduces prostaglandin levels in aqueous humor, reduces pain SE: headache, nausea, abdominal cramps, dyspepsia
11
Q
Corticosteroids
A
Controls inflammation by suppressing components of the inflammatory process at site of injury; also used to prevent transplant rejection; administered once a day in large dose
12
Q
Prednisone (Deltasone)
A
prevents/suppresses immune reactions and decreases tissue response in inflammatory process SE: hyperglycemia, masks infection signals, edema, weight gain, thin skin, bruising, heartburn, diaphoresis, mood swings, delayed wound healing
13
Q
Perioperative Nursing Practice
A
Encompasses care in all phases
14
Q
Preoperative Focused Assessment: Older Adults
A
increased risk for complications, Anesthesia may increase confusion or dementia, skin assessment, breath sounds, coughing
15
Q
Preoperative Focussed Assessment: Children
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Maintaining temperature 97-100, talk at their level, involve parents, use correct terms they understand, role play, scary stuff last
16
Q
Preoperative Focussed Assessment: Drugs/Substance abuse
A
pulmonary complications increased in smokers, alcohol and drugs alter response to anesthesia and pain meds, Antihypertensive, Tricyclic antidepressants, NSAIDS increase risk of complications
17
Q
Preoperative Focused Assessment: History
A
decreased immunity, diabetes, pulmonary disease, cardiac disease, hemodynamic instability, multi-systm disease, coagulation defect, anemia, dehydration, infection, hypertension, hypotension. Family history: malignant hyperthermia, cancer, bleeding disorder
18
Q
Cardiopulmonary Preoperative Assessment
A
V/S, Report: Hypo/hypertension, HR < 60 or >120, irregular heart beat, chest pain, ShOB, dyspnea, tachypnea, SpO2 <94%
19
Q
Preoperative Nutritional Assessment
A
assess for malnutrition, need vitamins and protein before and after procedure
20
Q
Preoperative Patient Medication Review
A
NSAIS’s, Aspirin, and Anticoagulants may be stopped 7-10 days prior to surgery, pt may be started on a a heparin drip to prevent bleeding during surgery.
21
Q
Preoperative Physical Assessment
A
Head to toe including ROM, LOC, skin integrity; provides baseline for after surgery
22
Q
Pre-surgical Screening Tests
A
- Chest Xray: preexisting cardiac/pulmonary issues
- EKG: establishes baseline for new or existing cardiac issues
- CBC: Indicates need for blood transfusion, fix any current blood issues before surgery
- Electrolyte level: indicate need for electrolyte replacement during/prior to surgery
- UA: indicate current drug levels, urine concentration
23
Q
Preoperative Medications
A
- given in holding area
- give any ordered meds
- facilitates admin of anesthesia or reduces risks of it
- insulin may not be given prior to surgery; anticoags d/c 5-7 days prior to surgery
- antianxiety, antiemetic, antibiotics may be given prophylactically
24
Q
Nursing Diagnosis PreOp
A
Deficient knowledge related to unfamiliarity with surgical procedures
Anxiety related to new or unknown experiences
25
Planning/Outcomes PreOp
- Pt must be informed and know what to expect during surgery
- Pt has manageable anxiety prior to surgery
26
Caring Interventions PreOp
DO NOT OVERWHELM
- focus on teaching
- explore their level of knowledge and understanding
- provide info on informed consent, dietary restrictions (NPO), preps before surgery, exercises after surgery, plans for pain management
- teach limitations, eating, working after surgery
27
Day of Surgery
- Client teaching complete
- Informed consent signed
- Adhered to NPO restriction
- In surgical gown
- ID bands are on
- No jewelry, dentures, contact lenses, nail polish
- voiding prior to transfer
- Preop meds are given
- V/S taken
- Preop lab work complete
- Skin has been prepped
- Pt history reviewed
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Surgical Classifications: urgent
Surgery needs to be done in 24-48 hours
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Surgical Classifications: emergency
Surgery needs to be done immediately
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DOR: Major
Prodecure or greater risk, longer and more extensive
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DOR: Minor
Procedure w/o significant risk, often done without local anesthesia
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DOR: Diagnostic
Performed to determine the origin and cause of disorder or cell type for cancer
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DOR: Curative
Performed to resolve a health problem by repairing or removing the cause
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DOR: Restorative
Performed to improve a pt functional ability
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DOR: Palliative
Performed to relieve symptoms of a disease process; does not cure
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DOR: Cosmetic
Performed to alter or enhance personal appearance
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Informed Consent
- Valid for 30 days after signing
- Signed prior to any sedation
- Voluntary and informed (Physician job to explain surgery, risks, alternative therapies, outcome)
- Protects pt, surgeon, hospital, and employees
- Four conditions: Adequate disclosure, sufficient comprehension, voluntary, competent
- RN clarifies what surgeon has already said
38
Circulating Nurse
Coordinates, oversees, and involved in pt nursing care in the OR. set up the OR, positions pt with pads, safety straps, warming blankets, provides comfort and reassurance, tests equipment, protect pt privacy, monitor traffic in OR, maintain sterile field in OR, communicates to family members, documents care, drains, count of all materials, communicates with PACU
39
Scrub Nurse
Sets up sterile table, drapes pt, hands sterile supplies and equipment, counts sponges, sharps, and instruments
40
Time Out
Surgical Team ensures: Pt name, DOB, surgical consent form, kind of surgery, location, side, correct position of pt, drug allergies, antibiotics given
41
General Anesthesia
Reversible loss of consciousness induced by inhibiting CNS, causes analgesia and amnesia, loss of muscle tone/reflexes, no sensory perception to consciousness, increased risk of cardiac/pulmonary problems
42
General Anesthesia: Inhalation
Most controllable method, pulmonary ventilation reversal, used in combination with other agents for prolonged procedures, limited muscle relaxant, posted nausea and shivering common
43
Nitrous Oxide
General inhaled anesthetic, Anxiolytic, analgesic, euphoric; rapid acting, rapid reversal, non depressant, nontoxic inhalation analgesic to supplement other anesthetics; SE: blurred vision, confusion, drowsiness, faintness, lightheaded, sweating, weakness
44
Isoflurane (Forane)
nonflammable liquid administered by a vaporizer. general inhaled anesthetic; SE: shivering, nausea, vomiting, ileum
45
General Anesthesia: IV
rapid and pleasant induction, low incidence of posts N/V, must be metabolized and excreted from body for reversal, contraindicated in liver or kidney disease, increased cardiac and respiratory depression
46
Propofol (Diprivan)
rapid acting general anesthetic/sedative hypnotic; inhibits sympathetic vasoconstrictor nerve activity, decreases vascular resistance, produces hypnosis rapidly; SE: involuntary muscle movements, apnea, hypotension, N/V, cardio depression, delirium, euphoria, resp. depression
47
Midazolam (Versed)
Schedule IV, benzodiazepine, sedative, anxiolytic; enhances action of GABA, produces anxiolytic. hypnotic, anticonvulsant, muscle relaxant, amnestic effects; SE: decreased resp. rate, O2 desat, hiccups, arrhythmias, hypotension, unresponsiveness, agitation, confusion
monitor RR, O2 sat during administration, monitor VS
Don't use with COPD or heart failure
48
Fentanyl (Subsys)
opiod, narcotic, agonist, analgesic; reduces stimuli from sensory nerves, inhibits ascending pain paths, alters pain perception, increases pain threshold; SE: drowsiness, N/V, confusion, blurred vision, chills, ortho. hypotension, constipation, dysuria
Establish baseline BP, RR; assist with ambulation, encourage turn, cough, deep breathe Q2h, monitor vitals
49
Regional Anesthesia
gag and cough reflex stays intact, allows participation by patient, no control of agent after admin, increased nervous system stimulation, only for short procedures. injected around nerves at site of numbing
50
Bupivacaine (Marcaine)
local infiltrate, nerve block, epidural, spinal; SE: cardiac arrest, hypotension, bradycardia, palpitations, seizures, restlessness, anxiety, dizziness, N/V, blurred vision, tinnitus, apnea
51
Lidocaine (Xylocaine)
Amide anesthetic, anti arrhythmic, anesthetic; inhibits conduction of nerve impulses, causes temporary loss of feeling; SE: flushing, redness, red or purple spots on skin, swelling at site of application, warm skin
52
Conscious Sedation
patient is still able to respond, but will not feel any of the procedures
EKG monitoring
53
Balanced Anesthesia
Combination of drugs that are frequently used in anesthesia. Includes: hypnotic given night before, premeditation given with an opioid, benzodiazepine given one hour before surgery to decrease secretions
Decreases anesthetics needed, deceases N/V, minimizes disturbance of organ function, decreases pain
54
Sedative Hypnotics (SH)
commonly used for sleep disorders, mildest form is sedation, increasing dose has a hypnotic effect, very high doses may achieve anesthetic effect.
55
Secobarbital Sodium (Seconal)
Barbiturates, SH; short acting used for sedation preop; SE: "hangover", REM rebound, dependence, tolerance, depression, resp. depression, hypersensitivity; monitor VS
56
Temazepam (Restoril)
SH, Schedule IV Benzodiazepines; enhances action of GABA, CNS depression, induces sleep; SE: drowsiness, sedation rebound insomnia, dizziness, confusion, euphoria, asthenia (loss of strength), anorexia, diarrhea; assess VS before admin, bed rails up, assess mental status and sleep patterns
57
Zalpidem Tartrate (Ambien)
Nonbenzodiazepine, SH; enhances action of GABA, induces sleep with fewer awakenings, improves sleep quality; SE: headache, dizziness, nausea, diarrhea, muscle pain, sleep walking; assess VS, mental status, sleep patterns, raise bed rails,
58
Antiemetic
prevents or relieves nausea and vomiting
59
Phenothiazine
tranquilizing drugs with antipsychotic actions
60
Promethazine (Phenergan)
Phenothiazine, Antihistamine, Antiemetic, SH; Diminishes vestibular stimulation, depresses labyrinthine function, prevents and relieves N/V; SE: drowsiness, dry mouth nose and throat, urinary retention, thick bronchial secretions, flushing, epigastric distress, visual and hearing disturbances, wheezing, paresthesia, diaphoresis, chills, disorientation, hypotension, confusion; assess for allergy symptoms, BP, pulse, dehydration, LOC, F&E balance
61
Anticholinergics
Decrease GI motility and secretion
62
Scopolamine (Transderm-Scop)
Anticholinergic, Antinausea, Antiemetic; reduces excitability of labyrinthine receptors, prevents motion-induced N/V; SE: dry mouth, drowsiness, blurred vision, dizziness, restlessness, hallucinations, confusion, difficulty urinating, rash
63
Ondansteron HCL (Zofran)
Antinausea, antiemetic; blocks serotonin, prevents N/V; SE: anxiety, dizziness, drowsiness, headache, fatigue, constipation, diarrhea, hypoxia, urinary retention, abdominal pain, dry mouth (xerostomia), fever, paresthesia, asthenia
64
Metoclopramide HCL (Reglan)
Dopamine receptor antagonist, GI emptying adjunct, peristaltic stimulant, antiemetic; stimulates motility of upper GI, deceases reflex into esophagus, accelerate gastric emptying, relieves N/V; SE: drowsiness, restlessness, fatigue, lethargy, dizziness, anxiety, headache, insomnia, breast tenderness, altered menstruation, constipation, rash, dry mouth
65
Aldrete Score
Assess transition from surgery to recovery; Score must be at least 8/10.
Assess activity, respirations, consciousness, circulation, and color.
66
PostOp Respiratory Assessment
adequate hydration, turn cough deep breathe, O2 PRN, incentive spirometer, stimulate pt whenO2 drops
67
PostOp Cardiovascular Function
VS Q4h, assess skin color, assess hematocrit level, activity tolerance, early ambulation, positioning
68
PostOp Fluid and Electrolytes
IV fluid and rate, adequate hydration, GI drainage, renal function lab,
69
PostOp Nutrition/Elimination
bowel sounds, NPO, NG tube, encourage fluids, assess fluid tolerance, progress diet slowly, record BM, assess output
70
Morphine Sulfate
Narcotic Agonist, Opiate analgesic; alters pain perception and emotional response to pain: SE: rash, RR depression, bradycardia, constipation, sedation, deceased BP, diaphoresis, facial flushing, dizziness, drowsiness, N/V; recumbent position before giving drug, assess VS, pain, hold if RR <12.
71
Transdermal Opioid Analgesics
Provides continuous pain control for chronic pain, more potent than morphine
72
PCA/PCEA
improves pain relief, ability to titrate dose, decreases delay and dependency, earlier activity postop, decreased anxiety
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Demand Dose
dose administered each time pt hits button
74
Lockout
temporary hold on medication until its time for next dose
75
One Hour Limit
amount of medication the pt can receive at one time
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Basal Rate
Amount of continuous medication running in addition to demand dose
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Bolus Dose
Amount that may be given at one time for unmanaged pain
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Loading Dose
initial dose given to help with pain
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PCA Report to MD
uncontrolled pain, hypotension, excessive somnolence, confusion, O2 <93, RR <10, uncontrolled N/V, urinary retention
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PCA Adverse Reactions
initiate emergency support, stop PCA (do not clear or turn off) notify MD, administer narcan as ordered, notify risk management, document
81
Acetaminophen (Tylenol)
Central analgesic, non-narcotic, antipyretic; lowers fever, reduces pain
82
Sumatriptan (Imitrex)
Antimigraine; produces vasoconstrictive effect on cranial blood vessels, relieve migraine headache; SE: tingling, nasal discomfort, flushing, asthenia, visual disturbances
83
Naloxone (Narcan)
narcotic antagonist, antidote; displaces opioid-occupied receptor sites at CNS, reduces opioid induced sleep/sedation, increases RR, raises BP to normal; maintain clear airway, monitor VS
84
Increased Potassium level (>5.0)
irritability, diarrhea, ECG changes, muscle twitches, cramps, paresthesia, anxiety, deceased BP, dysrhythmias, abdominal cramping
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Decreased Potassium level (<3.5)
weakness, decreased reflexes, dysrhythmias, ECG changes, fatigue, cramps, alkalosis, shallow RR, irritability, confusion, drowsiness, lethargy, thready pulse, N/V
86
Heparin
```
prevents formation of blood clots and prolongs clotting time; SE: Spontaneous bleeding, vasospasms, ecchymosis, hypersensitivity
PT: 11-13.5 sec
PTT: 60-70 sec
INR:0.8-1.1
APPT:30-45 sec
```
87
Enoxaparin Sodium (Lovenox)
Low-molecular weight heparin; produces anticoagulation, does not influence PT, aPPT significantly; SE: Nausea, peripheral edema, monitor for bleeding
88
Warfarin (Coumadin)
Anticoagulant; interferes with synthesis of vitamin K clotting factors, prevents further formation of formed blood clot, prevents new clot formation; SE: GI distress
89
ABO-Incompatible Transfusion Reaction
Received blood they have antibodies to
90
Rh Negative exposure to Rh postive blood
does not have rh antibodies naturally, will get them from the Rh+ transfusion
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Human Leukocyte Antigen
tissue is comparable between donor and recipient
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PRBC
Packed Red Blood Cell; prevents fluid overload
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Fresh-Frozen Plasma`
Receives if there are any fluid issues
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Cryoprecipitate
receives if there is a coagulation problem
95
Albumin
given if there has been a significant loss of blood
96
Allergic Reaction to Transfusion
may occur up to 24 hours, may administer antihistamine, facial flushing and hives or rash are mild symptoms
STOP TRANSFUSION FOR SEVERE SYMPTOMS (wheezing, decreased BP)
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Bacterial Contamination Blood Transfusion
abdominal cramping, vomiting, diarrhea, fever, chills,
| STOP TRANSFUSION
98
Febrile Transfusion Reaction
30 minutes into- 6 hours after, fever, chills, tight chest, flushed face, flank pain, headache, increased HR, anxiety, tachypnea
STOP TRANSFUSION
99
Hemolytic Transfusion Reactions
hemoglobulinuria, chest pain, apprehension, low back pain, chills, fever, tachycardia, decreased BP, Increased RR, bleeding at site
STOP TRANSFUSION
100
Fluid Overload Transfusion
cardiac and pulmonary problems, dyspnea, tachycardia, increased BP, periedema, JVD, anxious, crackles
STOP TRANSFUSION
101
Blood Transfusions
18-20 ga needle, adjust flow if no reaction occurs, if reaction occurs stop transfusion and record VS
102
Dehiscence
Seperation or splitting of surgical wound
103
Evisceration
Extrusion of viscera or intestine through a surgical wound
| Sterile 4x4 with NS on top, then ABD pad, notify physician
104
Urinary Retention
unable to void 8-10 hours postop, less than 30ml an hour
| palpate bladder, have patient ambulate
105
Paralytic Illeus
decreased bowel sounds, no stool or flatus, N/V, abdominal distention, abdominal tenderness
Provide ice chips, then clear fluids, then regular diet
106
Wound Infection
redness, purulent drainage, fever, tachycardia, leukocytosis,
Assess drainage if able, mark on dressing the drainage area, reinforce surgical dressing
107
Pulmonary Embolism
chest pain, dyspnea, tachypnea, tachycardia, increased anxiety, diaphoresis, decreased LOC, decreased BP, blood gas changes
May develop days after surgery
108
Hypovolemic Shock
decreased urine output, deceased BP, weak pulse, cool, clammy, restless, increased bleeding, increased thirst, decreased CVP
109
Pneumonia
rapid respiration, shallow respiration, fever, wet lung sounds, asymmetrical chest movement, tachycardia, hypoxia, productive cough, leukocytosis
110
Atelectasis
dyspnea, tachypnea, decreased breath sounds, asymmetrical chest movement, tachycardia, increased restlessness
111
DVT
prevention is best treatment; use SCD, ambulation, exercise, anticoagulants
112
Gastric Dilation
N/V, abdominal distention, treated with NG tube and wall suction
113
Appendicitis
RLQ pain, males are higher risk, youth increases risk, begins as dull, steady pain, progresses over 4-6 hours and localizes to RLQ, low grade fever, nausea, anorexia,
114
MAP
2DBP + SBP/3
Ideal: 70-90
50 or less: perfusion issue
105 and greater: vasoconstriction/ hypertension
115
Critical Care Drug Calculation
dose (mcg) X weight (kg) X 60 (min) X fluid volume / mg X 1000
