Final Flashcards
1
Q
Who’s at greatest risk for hyponatremia?
A
people with increased sodium excretion (diuretics, vomiting, wound drainage, kidney disease), inadequate sodium intake, and those with dilution of serum sodium (excessive hypotonic fluids, kidney disease, freshwater drowning, SIADH, hyperglycemia, heart failure)
2
Q
Who’s at greatest risk for hyperkalemia?
A
excessive K intake (rapid infusion of K IV solutions), decreased K excretion ( retaining diuretics, kidney disease, adrenal insufficiency), and movement of K from ICF to ECF (tissue damage, acidosis, hyperuricemia, and hypercatabolism)
3
Q
What 4 functions does Na do?
A
- Nerve impulse transmission
- Skeletal muscle and cardiac contraction
- Maintain electrical balance: slower depolarization
- Determine osmolality of ECF
4
Q
What are the 3 functions of K?
A
- Determine osmolarity of ICF
- Generate action potentials, and depolarization
- Regulate protein synthesis and regulating glucose use and storage
5
Q
What are the ECG changes in hyperkalemia?
A
peaked T waves, flat P waves, widened QRS complexes, and prolonged PR intervals
6
Q
What are the 4 functions of Ca?
A
- Bone and tooth strength
- Blood clotting
- Neuromuscular conduction via Na/K pump
- Cardiac contractions
7
Q
What are the 3 functions of phosphorous?
A
- Formation of bone and teeth (most in bones)
- Activating vitamins and enzymes, forming ATP
- Assist in cell growth and metabolism
8
Q
What are the 4 functions of magnesium?
A
- Assist in skeletal/cardiac muscle contraction
- Participate in CHO, protein, liquids, Vit B12 metabolism
- Facilitate ATP formation
- Contribute in vasodilation of peripheral arteries
9
Q
What are the 3 functions of chloride?
A
- Active component of renal physiology (goes with Na)
- Balance acid-base (decreased Cl causes renal retention of bicarb –>metabolic alkalosis)
- Form gastric acid HCl
10
Q
Which electrolytes are positively charged?
A
Na, K, Ca, Mg,
11
Q
Which electrolytes are negatively charged?
A
Phosphorous, Chloride
12
Q
Why does blood pH change?
A
because CO2 mixed with H20=carbonic acid
13
Q
Which organ controls bicarbonate?
A
kidneys
14
Q
Carbohydrate metabolism forms…
A
CO2
15
Q
Protein breakdown forms…
A
sulfuric acid
16
Q
Fat breakdown forms…
A
fatty acids and ketoacids
17
Q
Incomplete breakdown of glucose (occurs when cells metabolize anaerobically) forms…
A
lactic acid
18
Q
Why do electrolyte imbalances occur with abnormal ABGs?
A
because H either goes into or out of the cell to compensate
Alkalosis: decreased K (H moves out of cell into ECF and K moves into ICF)
Acidosis: increased K (H moves into ICF so K goes out into ECF)
19
Q
Increased hydrogen ions leads to…
A
increased acid, lower pH
20
Q
Decreased hydrogen concentration, what are you expecting?
A
alkalosis
21
Q
What is Colloidal Osmotic Pressure?
A
a pulling pressure, so increased protein = increased water
22
Q
Colloid IV solutions pull fluid from… to…
A
from the interstitial compartments into the vascular compartment (used to increase vascular fluid rapidly, like with a hemorrhage or severe hypovolemia)
23
Q
Which fluids can you give centrally?
A
fluids and medications with a pH value less than 5 and more than 9 and with osmolarity more than 600 mOsm/L are best in central circulation (if used peripherally it can damage blood cells and the endothelial lining o the veins)
24
Q
Which pressure changes occur when a pt is given a hypertonic solution?
A
osmotic pressure increases, causing water to go into the vessels DOUBLE CHECK!
25
What is hydrostatic pressure?
the force that pushes water outward from a confined space
26
What are the 3 factors that influence hydrostatic pressure?
- Blood volume
- Force of contraction (of the heart on arteries)
- Resistance of blood vessels
27
At the arterial end of a capillary bed, hydrostatic pressure is ... resulting in...
At the venous end of a capillary bed, hydrostatic pressure is... resulting in...
greater than the interstitial fluid resulting in fluid flowing into the interstitial space
decreased, less than the interstitial fluid which results in fluid flowing into the vessel
28
Blood travels from the body to the vena cava, to the right atrium, to the right ventricle, through the _______, to the lungs, through the _______, to the left atrium, to the left ventricle, to the aorta
pulmonary artery, pulmonary vein
29
What does the QRS represent?
the time it takes for the impulse to travel from the AV node, down the bundle of His, through the left and right bundle branches, and down the Purkinje fibers
-ventricle contraction (depolarization)
30
What does the PR represent?
the time it takes for the impulse to travel from the SA node to the AV node.
-Atrial contraction (depolarization)
31
What does the T wave represent?
ventricle repolarization
32
What is the role of surfactant? What happens without it?
(a fatty protein) reduces surface tension in the alveoli
| atelectasis occurs if no surfactant
33
What's the difference between asthma and COPD?
Asthma is reversible (intermittent reversible airflow obstruction and wheezing), COPD is irreversible (asthma and chronic bronchitis)
34
What is asthma?
airway obstruction that occurs from inflammation and airway hyper-responsiveness that leads to bronchoconstriction
35
Understand antibiotics & the importance of teaching
to prevent antibiotic resistant diseases
36
How does antibiotic therapy increase the risk for infection?
antibiotic therapy may increase the growth of microbes within biofilms, change normal protective flora, providing opportunity for pathogenic bacterial overgrowth and colonization
37
Pain can lead to which ABG change?
```
respiratory alkalosis (breathing fast, breathing off all of the CO2-->alkalosis)
or respiratory acidosis (abdominal pain) CO2 retention b/c you’re not breathing deeply b/c it hurts so bad,
```
38
Who’s at greatest risk for dehydration?
older adults (b/c their thirst mechanism doesn't work as well and they are composed of less H2O b/c they have less muscle)
39
What does an increased plasma osmotic pressure do?
causes fluid to go into the blood vessel
40
What does decreased osmotic pressure do?
causes edema
41
What s/s will u see w heart failure?
right: dependent edema, jugular venous distention, abdominal distention, hepatomegaly, splenomegaly, anorexia, nausea, weight gain, nocturnal diuresis, swelling of fingers and hands, increased or decreased BP
left: pulmonary congestion, dyspnea, tachypnea, crackles, cough, paroxysmal nocturnal dyspnea, increased or decreased BP
dyspnea, fluid retention
42
Risk factors for cardiovascular disease/heart failure? (15)
Smoking, diabetes, hypertension, CAD, cardiomyopathy, substance use, valvular disease, congenital defects, cardiac infections, dysrhythmias, family history, obesity, severe lung disease, hyperthyroidism, sleep apnea
43
How does diabetes affect the cardiovascular system?
Cardiovascular disease: diastolic dysfunction--> HF, MI
- causes both diastolic and systolic heart failure
- pts with DM are also usually obese, have hypertension, dyslipidemia, and sedentary lifestyle
44
What are the 3 macrovascular (large blood vessels) complication of diabetes? (6)
atherosclerosis (increases CVD, CAD, PVD risk), angina, PAD, MI, stroke, TIA (percursor to stroke)
45
Risk factors for peripheral vascular disease?
| • What causes it?
hypertension and cigarette smoking
46
What are the pt preparations for cardiac catheterization?
tests: chest x-ray, CBC, coagulation studies, and 12 lead , electrolytes, BUN, creatinine (before and after) ECG, vitals, pulses, auscultate heart and lungs
Ask: allergies to iodine?
Give: antihistamine or steroid if needed, mild sedative,
hydration and acetylcysteine pre and post study help minimize contrast induced renal toxicity,
47
What do u need to know w a Pt that gets something w iodine in it?
are you allergic to shellfish?
48
What are important assessments after Pt comes out of cardiac catheterization?
bed rest, keep site straight, check VS, pressure on site, check for bleeding or hematoma, check peripheral/pedal pulses skin temperature and color
49
When/why would a diabetic pt have hypokalemia?
| o Potassium on Insulin
-Hypokalemia: when you pee out too much after giving insulin,
50
What is potassium's effect on digoxin?
Hypokalemia increases the risk for digoxin toxicity and ventricular dysrhythmias
51
How does using insulin and glucose decrease K (nursing intervention for hyperkalemia)?
causes K into the cell (ICF) from ECF
52
What do beta adrenergic blockers do? Used for?
block the sympathetic nervous system, decrease cardiac output, HR, and BP, decrease oxygen demands
used for: hypertension, angina, dysrhythmias, migraine headache (prophylaxis), MI (prevention), glaucoma, heart failure (HF)
53
What do ACE inhibitors do? Used for?
prevent peripheral vasoconstriction by blocking conversion of angiotensin I to angiotensin II
-treat hypertension and heart failure and to protect kidney function in patients with diabetes mellitus.
(doesn't let you hold onto water, like a diuretic)
54
What is the RAAS system?
regulates BP, increases BP by retaining water and sodium
-renin converts angiotensinogen to angiotensin I; angiotensin I is converted to angiotensin II (in lungs); angiotensin II stimulates release of aldosterone (which promotes water and sodium retention by the kidneys therefore increasing blood volume and BP
55
Renin converts ______ to ________. Angiotensin I is converted to ______ in the lungs which stimulates the release of _______
angiotensinogen to angiotensin I,
angiotensin I converts to angiotensin II
angiotensin II releases aldosterone
56
What lab values that indicate myocardial infarction?
no single ideal test to diagnose MI
| -most common: troponins T and I, CK-MB, and myoglobin
57
What is CK-MB?
creatine kinase-MB,the most specific marker for MI but doesn't peak until about 24hours after the onset of pain
58
CK vs CKMB?
CK: enzyme specific to cells of the brain, myocardium, and skeletal muscle , indicates tissue necrosis or injury
CKMB: CK found in myocardial muscle, most specific for MI
59
Normal value for troponin?
cardiac troponin T 0.03 ng/mL
60
When someone is receiving insulin, what do you want to monitor?
blood glucose, HbA1c levels, monitor K! and look for s/s of DKA (not enough insulin so body can't use glucose so it breaks down protein-->ketones-->metabolic acidosis)
61
Why is checking weights important in heart failure pts?
lets you know how much extra fluid your body is holding on to.
Sudden weight gain may mean that fluid is building up in your body because your heart failure is getting worse
-heart tries to compensate for poor pumping by holding onto Na and water
62
Important assessments for Pt w Diabetes
sensation, foot care, peripheral pulses, check for hypertension and hyperlipidemia, changes in renal function, eye function
63
What are the P's of diabetes?
polyuria, polydipsia, and polyphagia
64
s/s of diabetes
polyuria, polydipsia, polyphagia, hyperglycemia, weight loss, blurred vision, slow wound healing, vaginal infections, weakness, parethesias, inadequate circulation to the feet, signs of accelerated atherosclerosis
65
What are the s/s of gout?
(mimics RA) pain, inflammation of joints (usually toes first), tophi (hard, white under skin)
- usually big toe, then next toe, etc
- leg first than hand (distal to proximal)
66
What is the management for gout?
acute: NSAIDs and oralColchicine (4-7 days)
chronic: Allopurinol and Probenecid: reduces production of uric acid in blood stream
-Fluid intake: 64 oz/day, citrus fruit/juice, milk
Diet: strict low-purine diet, no organ meats, shellfish, and oily fish with bones (sardine)
Avoid alcohol, Aspirin, stress
67
What is the pt teaching for gout?
DO: drink fluids (citrus, juices, milk), ear low purine diet, learn triggers,
AVOID: excessive alcohol intake, starvation/fasting diets, diuretics and aspirin, stress,
68
What are the hip precautions?
- Vital signs, I&O, deep breathing & coughing, & use of incentive spirometer.
- Monitor neurovascular: extremity for color, temperature, capillary refill, distal pulses, edema, sensation, motor function, & pain.
- Log roll, abductor pillow
- Dressing and drain
- Mobilize ASAP
69
How to stabilize a spine, how to align a spine?
- Log Roll, don’t let spine twist to either side, lie supine with pillow under the neck and slightly flex the knees
- If u suspect unstable vertebrae, definitely put Pt in spinal precaution
- Spinal cord injury: immobilize on spinal backboard (head in neutral position), prevent head flexion, rotation, or extension, don't sit the pt
70
Complications of bone fractures? (5)
Fat embolism, compartment syndrome, infection and osteomyelitis, avascular necrosis, and pulmonary embolism
71
Osteoporosis
reduced Ca intake, more likely to have bone fracture, more prominent in females bc of reduced estrogen, we ensure regular exercise, good diet in Ca and vit D
72
How can you prevent osteoporosis?
build strong bone as a young person,decrease modifiable risk factors, eat Ca, dairy products, dark green leafy vegetables, adequate vitamin D, limit carbonated drinks, weight bearing exercise (walking)
- avoid alcohol, coffee ,and cigarettes
73
What is osteopenia?
decreased bone density (bone loss, low bone mass), severe osteopenia is called osteoporosis
74
Who is high risk for Osteoporosis?
smokers, early menopause, excessive use of alcohol, family history, female, age, insufficient intake of Ca, sedentary lifestlye, thin/small frame, white or asian
75
What does COAL stand for (in terms of cane use)?
Cane Opposite Affected Leg
| move cane at the same time as the affected leg) (no more than 30 degrees of flexion of the elbow
76
Wandering Wilma's Always Late?
Walker With Affected Leg
(put all for point of the walker flat on the floor before putting weight on the hand pieces. Pt moves walker forward, then weaker foot, then unaffected foot)
77
What are the s/s that indicate GERD? (5)
heartburn, epigastric pain, dyspepsia, nausea/regurgitation, pain and difficulty swallowing, hypersalivation
78
Teaching for Pt with GERD?
Avoid triggers (peppermint, coffee, chocolate, fatty foods, alcohol, smoking), ear low fat high fiber, don't drink anything 2 hours before bed, elevate head of the bed 6-8 inch blocks, avoid anticholinergics (delay stomach emptying) and NSAIDS, take antacids, H2 receptor antagonists or PPIs
79
What are the 5 causes of GERD?
```
Incompetent LES
Pyloric stenosis
Hiatal hernia
Delayed emptying
Motility problems
```
80
• Fecal impaction? Renal diet? Liver Failure?
sdf
81
What are the main two differences in gastric and duodenal ulcers?
in gastric ulcers: pain 1-2 hours after meals, more common in females, hematemesis is more common
-in duodenal ulcers: pain is relieved by food, more common in males, melena is more common
82
What are the emergency s/s of peptic ulcers? (3)
- hematemesis, melena,
- Perforation of the ulcer (sudden, sharp pain --> peritonitis) can lead to septicemia and hypovolemia shock, peristalsis diminishes and paralytic ileus develops
- or symptoms of obstruction (bloating, n/v)
83
What is the diet therapy for PUD?
avoid: caffeine, coffe (caf and de-caf), alcohol, tobcacco
| - bland, nonirritating diet is recommended during symptomatic phase-eat 6 smaller meals
84
What shouldn't you give to liver failure pts?
carbs/starches
85
What shouldn't you give to kidney failure pts?
protein
86
How can you prevent fecal impaction in the older adult?
high fiber diet, plenty of fluids, don't routinely use laxatives,exercise, warm beverages/prune juice, wake metamucil (bulk-forming products) for fiber
87
o Strokes – recognize diff strokes
| • Nursing responsibilities
jhg
88
What are the 3 types of strokes?
ischemic (embolic or thrombotic stroke), hemorrhagic stroke, or TIA
89
What is an ischemic stroke?
blocked blood flow to the brain, 80% all strokes
90
What is a hemorrhagic stroke? s/s?
abrupts, daytime, sudden, stupor or coma, could have seizures, no TIA precipitation, severe neuro deficits, possibly permanent effects
91
What is a TIA? S/s?
brief disruption of blood flow, temporary neurologic dysfunction, symptoms resolve within an hour or <24 hr, precursor for stroke, can be a result of plaque, or unstable plaque, or a spasm (from stress perhaps)
92
s/s of embolic stroke?
Abrupts, daytime, sudden, awake, no seizures, no TIA precipitation, expressive aphasia, paralysis, and a rapid recovery
93
s/s of thrombotic stroke?
intermittent, daytime, gradual, awake, no seizures, TIA precipitation, headache, speech, visual, confusion, weeks months or permanent to recover
94
What are the top 2 risk factors for stroke?
HTN and DM (both cause endothelial damage)
95
What are the nursing considerations with stroke pts?
DVT prophylaxis
Aspiration: precaution, swallow screening, speech therapist
Mobilization: PT
Communication: speech therapist
Incontinent: bowel/bladder training
Sensory: vision, memory, simple instruction
Paralysis: unilateral neglect
96
What is the management of a stroke?
CAB!
- BP (don't want it too low or too high)
- correct hypo/hyperglycemia
- Nomothermia
- FLuid resuscitation
- Imagine
- Eval for thrombolytic therapy
97
These symptoms are most consistent with which type of stroke?
- sudden onset of facial or extremity paresis
- sudden onset of facial or extremity paresis
- Sudden visual deficit
ischemic stroke
98
These symptoms are most consistent with which type of stroke?
- Decreased LOC
- HA, n/v (increased ICP)
bleed (hemorrhagic) or seizure
99
How does an aneurism appear? s/s
sudden onset of severe headache (aneurysm rupture)
100
What is diagnostic surgery?
to determine origin/cause
101
What is curative surgery?
to remove the cause
102
What is restorative surgery?
to improve function
103
What is palliative surgery?
to relieve signs/symptoms, make pt more comfortable
104
What are the post-op nursing priorities?
DVT prevention, I&O, mobility, IS, TCDB, Leg exercises (look up in the book!)
105
What is isotonic dehydration? causes? (3)
water and electrolytes are lost in equal proportions (hypovolemia)
- inadequate intake of fluids and solutes
- fluid shifts between compartments
- excessive losses of isotonic body fluids
106
What is hypertonic dehydration? causes? (7)
water loss exceeds electrolyte loss
-excessive perspiration, hyperventilation, ketoacidosis, prolonged fevers, diarrhea, early-stage kidney disease, and diabetes insipidus
107
What is hypotonic dehydration? causes? (4)
electrolyte loss exceeds water loss
| -chronic illness, excessive fluid replacement (hypotonic), kidney disease, and chronic malnutrition
108
Who is at risk for hypernatremia? What causes it? (4)
- decreased sodium excretion
- Increased sodium intake
- decreased water intake (NPO, fasting)
- Increased water loss (infection, fever, diarrhea, etc)
109
What are the differences in s/s of hyper and hyponatremia?
Hyper: spontaneous muscle twitches until skeletal muscle weakness, extreme thirst, decreased UO, increased urinary specific gravity
Hypo: shallow, ineffective respiratory movement due to skeletal muscle weakness, HA, confusion, seizures, coma, hyperactive BS, nausea, diarrhea, increased UO, decreased urinary specific gravity
110
Who is at risk for hypokalemia? What causes it?
-actual total body potassium loss (diurects,vomiting, etc)
-inadequate K intake
-movement of K from ECF to ICF
dilution of K (water intoxication)
111
What are the differences in s/s of hyper and hypokalemia?
Hyper: decreased BP, muscle twitches, cramps, that turn into profound weakness, hyperactive BS, diarrhea, peaked T waves
Hypo: orthostatic hypotension, diminished breath sounds, anxiety, confusion, coma, diminished DTR, hypoactive/absent BS, n/v/constipation, paralytic ileus, ST depression (flat or inverted T wave)
112
What are the differences in s/s of hyper and hypocalcemia?
Hyper: increased HR then brady, increased BP, ineffective RR due to muscle weakness, disorientation, lethargy, coma, renal calculi, hypoactive BS, nausea, constipation, shortened ST and widened T wave
Hypo: decreased HR and BP, twitches, cramps, seizures, Trousseau and Chvostek, hyperactive DTR, hyperactive BS, cramping, diarrhea, prolonged ST, prolonged QT
113
Hyper or Hypomagnesemia?
| tachycardia, hypertension, twitches, positive Trousseau's and Chvostek's, irritability, confusion
hypomagnesmia
114
What are the normals for pH? CO2? and HCO3?
pH: 7.35-7.45 (7.40)
CO2: 35-45 (40)
HCO3: 22-26 (24)
115
What effect do these solutions have? 0.9% NS, D5W/1/4 NS, LR
isotonic solutions, increase ECF
116
What effect do these solutions have? D5W, 1/2NS, 1/4NS, 1/3 NS,
Hypotonic, increases ICF (water flows from ECF into cells)
117
What effect do these solutions have? 3%NS, 5%NS, D10W, D5W/NS, D5W/1/2NS, D5LR
Hypertonic, increase ECF (from cells into ECF)
118
What effect do these solutions have? Dextran and albumin
colloid, pulls fluid from ICF into vascular compartment (increases vascular volume rapidly like in hemorrhage or severe hypovolemia)
119
What respiratory problem is this?
Infection of pulmonary tissue (alveoli and bronchioles), edema, decreased gas exchange, increased exudate, diminished breath sounds, fecer
pneumonia
120
What respiratory problem is this?
Abnormal permanent enlargement of air spaces with destruction of alveolar walls, loss of elasticity of alveolar sacs, restricts air flow in and out (primarily out) leading to an increased CO2 level
emphysema
121
What respiratory problem is this?
Inflammation os the bronchi and bronchioles caused by exposure to irritants, irritant triggers inflammation, vasodilation, mucosal edema, congestion, and bronchospasm, affects only the airways not the alveoli
Chronic bronchitis
122
What constitutes and open airway? What are you going to listen for?
Open, clear, and aligned
| -crackles
123
S/s of hypertrophic heart (ventricle)?
| Would the apical pulse be in the same spot?
(dyspnea on exertion, syncope, dizziness, and palpitations)
```
High pressure (wall stress) in the ventricle heightens myocardial oxygen consumption, a situation that promotes further hypertrophy and
activates neurohormonal systems
-Reduction in ejection fraction
-Reduced ventricular performance
-Morbidity and mortality
```
-probably not
124
Nursing diagnoses for HF pt?
Impaired gas exchange
| then decreased cardiac output
125
CABG, what’s important to assess after?
HR, rhythm, pulmonary and arterial pressures (BP), neuro status, I&O (drains, chest tubes, etc), fluid and electrolytes, temperature, monitor for signs of cardiac tamponade, and pain
126
What ECG finding(s) would indicate a heart attack/cardiac arrest?
either ST elevation (STEMI), T-wave inversion, or non-ST elevation (abnormal Q wave may be present)
-Days later, ST and T wave return to normal
127
Treadmill test: what are you looking for in your pt?
ischemia and infarction (ECG changes)
128
What is the normal time frame of a PR interval?
0.12-0.20 seconds
| 3-5 small boxes
129
What is the normal time frame of QRS?
0.04-0.10
| 1-2 1/2 boxes
130
What is the normal time frame of QT?
~0.36
131
What is a normal T wave look like?
Upright well rounded and less than ½ the height of the QRS complex
132
Why do diabetics experience polyuria?
results from an osmotic diuresis caused by excess glucose in the urine
133
Why do diabetics experience polydipsia?
Due to polyuria, the body loses sodium, chloride, potassium, and water (dehydration occurs) so thirst occurs
134
Why do diabetics experience polyphagia?
because the cells receive no glucose, cell starvation triggers excessive eating
135
Once you have diabetes what does it increase risk for?
CV disease, CVA, kidney disease, reduced vision/eye problems, neuropathy, nephropathy, ED
136
What are the microvascular complications of diabetes?
Retinopathy & Nephropathy
137
What causes diabetes?
type I: insulin deficiency (too little or no insulin), autoimmune, usually congenital
Type II: relative lack of insulin or resistance to the action of insulin (too little or wrong insulin)
138
Total knee precautions?
Knee should be maintained in neutral position, ice, CPM, avoid weight bearing
139
What are the safety precautions for a pt with osteoporosis?
identify and correct home hazards, ensure unobstructed walkways, use side rails to prevent falls, use cane or walker, use firm mattress, move pt gently, assist with ambulation if unsteady, ROM exercises, avoid alcohol and coffee
140
Risk factors for GERD and PUD?
GERD: alcoholism, smoking, high-fat diets, obesity, older adult, men
PUD: smoking, older adult, NSAIDs, additional chronic diseases, cocaine use, chemo, radiation, and genetic predisposition
141
How do the NSAIDs effect the stomach?
2 levels, topical and systemically, prostaglandin inhibitor (prostaglandin increase blood flow to tissue/perfusion)
142
Define these surgeries:
Simple:
Radical:
Minimally invasive:
Simple: affected area
Radical: beyond inv area
Minimally invasive: endoscopic
143
What's the difference between urgent and emergent surgeries?
Urgent: 24-48h not plan
Emergent: stat life threat
144
Why do we do preoperative assessments?
because after post-op and before discharge, you compare the post-op assessment and vitals to the baseline
Full assessment!
ESTABLISH A BASELINE!
145
What is the nurses role in informed consent?
to witness, that’s it!
-Nurse can back it up, but it’s not their responsibility. If the pt doesn’t understand, the surgeon comes back (not the nurse), and the pt must understand
146
Who is in the sterile field in surgery?
scrub nurse, surgeon, and all assistants
| -Anesthesiologist/CRNA, circulating nurse, holding area nurse, etc are not in the sterile field
147
What is the purpose of the PACU? (3)
- Ongoing evaluation
- Stabilizing
- Anticipate, prevent, and treat complications
148
What are you going to monitor in the PACU?
full assessment, airway, stable VS and temp, no bleeding, return of gag, cough, and swallow reflexes, ability to take liquids, UO, ECG, pulses, neuro, wet or dry, BS, everything
149
What are the 4 complications of general anesthesia?
1) Malignant hyperthermia
2) Overdose
3) Unrecognized hypoventilation
4) Intubation complications
150
What is malignant hyperthermia? Treatment?
genetic, increase Ca & increase muscle metabolism --> increased K, acidosis (increased CO2), increased temp (>111’F), dysrhythmia
-dantrolene
151
What are the s/s of malignant hyperthermia?
rise in end-tidal CO2!
| also sinus tachycardia, high temperature (late sign)
152
What is the emergency care for a pt with malignant hyperthermia?
stop anesthetics, intubate, 100% oxygen at highest rate, stop surgery, ABGs,cooling techniques, NG and rectal tube, foley, iced IV fluids, correct ABG and electrolytes if possible
153
What are the local/regional anesthesia emergency s/s?
```
CNS stimulation (restlessness, excitement, incoherent speech, headache, blurred vision, metallic taste, tremors, seizures, inc HR, RR, BP)
CNS and cardiac depression
```
154
What are the risk factors for surgery? (7)
```
Age
Nutrition
Fluid and electrolyte imbalance
Infectious disease
Obesity
Pregnancy
Chronic illness
```
155
What are the complications from surgery? (3)
pressure ulcers, blood loss, infection, and hypoventilation
156
When is BNP released?
released in response to atrial and ventricular stretch; it serves as a marker for heart failure (promote vasodilation and diuresis due to fluid overload in heart failure)
157
Where is BNP mainly excreted from?
ventricular myocardium
158
How do the goals of end of life care change? (4 goals)
- Needs and preferences met
- Control of symptoms of distress
- Promote meaningful interactions with family
- Facilitate a peaceful death
159
What are the 3 criteria for the definition of death?
- Lack of heart beat
- Absence of spontaneous respiration
- Irreversible brain dysfunction
160
What is the philosophy of palliative care?
- provide compassionate and supportive approach to pts and families with life-threatening illnesses
- Not hasten or postpone death
- provide relief of symptoms, increase function independent, emotional and spiritual support to improve quality of life
- focus on caring interventions and symptom management for diseases that no longer respond to treatment
161
What is the philosophy of hospice?
- facilitates quality of life and a "good" death for clients (<6 months to live)
- provides support and care for pts in last phases of incurable diseases
162
s/s of someone approaching death? (8)
```
Coolness of extremities
Increased sleeping
Decreased fluid and food intake
Incontinence
Congestion and gurgling
Breathing pattern change
Disorientation
Restlessness
```
163
What can you do for a dying pt? if they need pain control or are having difficulty breathing
admin. pain meds, elevate head of the bed or position pt on side if difficulty breathing, admin oxygen, suction as needed
- oral care, antiemetics, provide support and privacy
