med surg 1 Flashcards
(392 cards)
1
Q
med srug
A
for hospitalized ADULTS with acute and chronic illnessesPROMOTE HEALTH AND PREVENT ILLNESS The scope of medical-surgical nursing, sometimes called adult health nursing, is to promote health and prevent illness or injury in clients from 18 to 100 years of age or older. The most common practice setting is the acute care hospital.
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Q
RRT
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rapid response team. used before respiratory or cardiact arrest occus. they are on site and available any time.
3
Q
self determination
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Self-determination refers to the idea that clients are autonomous individuals capable of making informed decisions about their care. When the client is not capable of self-determination, the nurse is ethically obligated to protect the client as an advocate in the professional scope of practice.
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justice
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equalitypt that has insure and not insured are treated the same
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benifacence
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Beneficence emphasizes the importance of preventing harm and ensuring the client’s well-being.
6
Q
bedside computers
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The largest application of health care informatics is the growing trend of the use of electronic medical records (EMRs) for documenting interdisciplinary care. Computers may be located at the client’s bedside or in the treatment room for ease of access.
7
Q
interdisciplinary (ID) plan of care for a client. Which health care team members are essential for the client’s daily care regimen
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case meagerhealth care provider
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Q
case menager
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The case manager role includes coordination of acute care and post-discharge community services for the client
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Q
iatrogenic error
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error caused by medical treatemtn
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Q
sentinal event
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unexpected occurrence that causes serious harm or death to a patient
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Q
AHRQ
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best evidence based practive
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Q
inpatient
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pt admitted to the hospital
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outpatient/ambulatory
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goes to the hospital the day of the surgery and returns the same day (same day surgery)
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diagnostic surgery
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performed to determine cause of disorder or cancer (breast biopsy)
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curative surgery
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performed to resolve health problem (appendectomy, cholysistectomy)
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restorative
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performed to improve pt. functional ability (total knee replacement)
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palliative
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performed to relieve symptms but not cure diesease (colostomy)
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urgent surgery
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requires fast acting intervention
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emergent surgery
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immediate intervention
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autologus donation
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blood donation made by same patient just weeks beofre the surgery
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directed blood donation
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pt’s family and friends may donate the blood
22
Q
smoking before surgery
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smoking increases blood level of carboxyhemoglobin which decreases oxygen delivery to organs.cilia decrease and there is retention of mucous secretions which predisposes the pt. to lung infection (pneumonia) and collapse of alvioli (atelectasis)
23
Q
postpone the surgery if
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you find abnormal vitals signs. until problem is solved and vitals are stable postpone surgery and notify surgeon.
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Q
morbidity
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number of serious problems
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mortality
number of deaths
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hypokalemia hyerkalemia
hypokalemia- increases risk of toxticity, slows recovery from anesthesia, increases cardiact irritabilityhyperkalemia- increases risk of dysrithmeas especially with use of anesthesiacorrect any abnormal potassium levels before going to surgery
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responsibility of nurse of consent sign
nurse is responsible to witness and verify the consent sign is signed andclarify what is taught by surgeon and dispel any mythsnurse must not provide detailed info about surgery. surgeon should
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minimun amount of urine in one hour
30ml/ hours less than 20 call physitian
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normal temp
97-100Fanyting above or below call physitian
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anesthesia provider
monitors pt. during surgery by assesing and monitoring levels of anesthesia, pulse ox, ABC, vital signs, i/o
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nurse circulatorCirculating nurses or "circulators" are registered nurses who coordinate, oversee, and are involved in the client's nursing care in the operating room.NOT SCRUBBED IN
sets up OR and ensures supplies are available. once the pt is ready to be moved to the OR the circulating nurse along with OR team transfer the pt into the operating bed. the nurse prositions the pt. and makes sure all bony areas are padded. prepare room, get pt in ORprotects pt provacy and safetyensures surgery team maintains sterile fieldreports finding to surgeon monitors trafic in the roomdocuments careCOUNT OF ALL SHARPS
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scrub nursesSCRUBBED INpasses instruments to surgeon
set up sterile fielddrape pt-hand sterile equiptment to surgeonScrub nurses set up the sterile field, drape the client, and hand sterile supplies, sterile equipment, and instruments to the surgeon and the assistant.
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specialty nurses
may be in charge of one particular type of surgery
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endoscope
tube that allows viewing and manipulation of internal body area
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minimaly invasive surgery
may inject gas into the cavity before the surgery to separate organs and improve visualization.known as INSUFFLATION
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anesthesia1. general2. local3. regional
is to block nerve impulses transmission, suppress reflexes, relax muscles and in some cases achieve controlled levels of unconsciousness
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general anesthesia- pt looses all funcitons, used when MUSCLE RELAXATION is neededcan given IV, inhilation, or balanced anesthesiabalanced anesthesia- combination of IV and inhalation
loos of conciousness induced by inhibiting neuronal impulses in CNS. DEPRESSES CNS and results in ANALGESIA and AMNESIA and UNCONCIOUSNESS. stage 1- anelgesia & sedation, relaxationstage 2- excitement, deleriumstage 3- operative anesthesia, surgical anesthesiastage 4- dangermay cause respiratory problems, some pt may get regional to aviod respiratory problems
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emergence
recovery from anesthesia
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malignent hyperthermia
severe complication from general anesthesia. - increased calcium and potassium levels in muscle cells and increased muscle metabolis leading to acidosis. cardiact dysrhythmias, and high body temp and MYOGLOBINURIA EARLY INDICATION- is the presence of muscle proteins in the urine. rise in carbon dioxide levels and fall in oxygen levels. also sinus tachycardiaLATE INDICATION- extremely elevated temp as high as 111.2 DANTROLENE SODIUM, a skeletal muscle relaxent is the drug of choice for MH
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care of pt. with malignant hyperthermia
stop anesthesiaintubate patient and give 100% o2terminate surgerycooling techniques
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overdose of anesthetic
can occur if pt. metabolism and drug administration is slower than usual. this is most likely to occur in OLDER pt and those with LIVER or KIDNEY problemsaccurate info about pt. heigh weigh and medical history, liver and kidney functions are vital to determine anesthetic type and dosage
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unrecognised hypoventilation
failure to exchange gases and can lead to cardicat arrest and permanent brain damage as well as death.
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local anesthesia
delivered topically (applied to skin or mucous membranes) or can be local infiltration - injected directly to the tissue around the insicionpt. rempains conceous, gag reflex intact, no risk for aspiration
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regional anesthesia
blocks multipe peripheral nerves in a specific body region.it may be used when general anesthesia cant be used because of medical problems. pt. rempains conceous, gag reflex intact, no risk for aspirationex. nervle block, spinal block, epidural
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concious sedation
IV delivery of hypnotic and opioid drugs to reduce level of conciousnes and allow pt to maintain airway and respond to verbal communication. check ABS and VS frequently (midaxolam (versed) most common benzodiapine for concious sedation, may be reersed with flumazenil (reverses respiratory deppression caused by versed)propofol(diprivan)- sedative hypnotic, used in ambulatory settings, causes respiratory depression, NO ANTIDOTE
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levels of concious sedation
0- fully awake1- light sedation2- moderate, slightly aware of sorroundings3- deep sedation, unaware of sorrouding4- general ansethesia, pt is unconcious
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holding area nurse
Holding area nurses manage the client's care before surgery (shes not in the OR but in the holding room)
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herbals
garlic, ginger, ginseng, ginkgo baloba- may cause excessive bleeding post opst. johns wart- prolong effects of anesthesiaechinacea- may cause liver inflamation
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elective surgery- planned ahead of time
emergent surgery- unexpected, urgent
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liver- metabolized meds
kidneys- excrete meds
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rating patients for anesthesia
p1- healthy pt.p2- mild systemic diseasep3- severe systemic diseasep45- not expected to survive without surgeryp6- brain dead
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propholactive antibiotics
60 min before urgery
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muslum, arab, middle eastern
do not remove amulets they wear no pork or alchoholfast in the daytime during ramadan (do not take meds during ramasan)knock before you enterstrong male dominancenurses not seen as health care profestionalspt. only told good news about their dieseasedo not approve abortionlook down on people who are mentally illvery modest
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adjunct TO GENERAL ANESTHESIA
agent added to inhilation agent, such as opioids, benzodiapines,
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opioids
anlegesia and sedationrespiratory depressionreversed with NALOXONE (NARCAN)FENTANYL (SUBLIMAZE)MORPHINE SULPHATESUFENTANIL(SUFENTA)HYDROMORPHONE(DIALUDID)MEPERIDINE (DEMEROL) NOT USED ANYMORE (Treats pain. This medicine is a narcotic pain reliever.)
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BENZODIAPINES
PREMEDICATION FOR AMNESIA, INDUCTION OF ANESTHESIA AND FOR CONCIOUS SEDATIONmidaxolam(versed)- most common benzodiapine, used in ambulatory surgery settings for CONCIOUS sedationdiazepam (valium)lorazepam(ativan)FLUMAZENIL9 romazicon) reverses benzodiapines
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neuromuscular blocking agents
muslce relaxentsfacilitate for intubationOBSERVE AIRWAY CLOSELY
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alergies
iodine or shellfish may indicate pt is alergic to products used to clean the surgical areaif alergic to banana, potatoe, apricot, kiwi pt may be alergic to latex also
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Atropine
pre op medication given to dry up secretions and increase heart rate Atropine-Helps keep your heart rate stable after a heart attack or during surgery. Lowers the amount of body fluids inside your mouth and throat before a surgery. This keeps you from possibly choking on your saliva while you are unconscious.
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stages of anesthesia
induction phase: In the case of general anesthesia the anesthesiologist gives you the medications that make you lose consciousness,maintenance phase: The anesthesiologist ensures that you remain anesthetized until the surgical, diagnostic or other treatment procedure is completed. emergence phase: The anesthesiologist stops giving you the anesthesia medications, allows them to wear off, and/or gives you other medications to reverse their effects, so that you regain consciousness or sensation.
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hydrostatic pressure- pumping of the heart, pushing fluid out of capilaries
water molecules in a confined space constantly press ourward against the confining wallsamount of water in any bofy fluid space determines pressure
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filtration
movement of fluid through a membrane because pf the differences in hydrostatic pressure (equilibrium is reached when fluid leaves one space and enters the other space to make the hydrostatic pressure equal
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edema
when changes in hydrostatic pressure occur such as in pt with CHF. heart is too weak to pump and blood backs up into venous system and venous hydrostatic pressure rises which causes capilary hydrostatic pressure to rise making it higher than that of the interstitial space. because of this excess filtration of fluid goes from capilaries to interstitial tissues causing edema
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diffusion
free movemnt of particles accross a permable membrane from an area of high concentration to area of low concentrationit is importat for the transportation of electrolyes
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some particles are impermeable
even though glucose is higher in ECF than in ICF it can not cross the membrane without the help of insuline. insuline makes the membrane more permeable to glucosethis is called facilitated diffusion
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minimun urine output per day
40-600 ml
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aldosterone
horomne secreted by adrenal cortext when sodium levels in ECF are decreased. it prevents water and sodium loss and acts on the nephrons of the kidneys to reabsorb sodium and water from the urine into the blood
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ADH antidiuretic hormone
produced by the brain and acts on the kidney tubules making them more permeable to water as a result more water is reabsorbed and returened to the blood
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pt with hypertension
are asked to lower their sodium intake because high sodium raises the blood level of sodium causing more water to be retained and blood volume to riose causing a higher blood pressure
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ICF ECF
ICF fluid exists within the cell cytopalm and ECf outside the cell. one third of body volume is ECF and two thirds ICFwhen urinating, vomiting, seating, you are loosing ECF fluid
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renin angiotesin pathway
when kidneys sense a low parameter of water it secretes renin. renin This increases the volume of fluid in the body, which also increases blood pressure, renin-angiotesin pathway is stimulated with shock or stresspt. with hypertension often take ACE inhibitorsif you close angiotesin recepros blood pressure lowers
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weight to fluid
1 L of water = 2.2 lb = 1 kgweight change of 1lb = fluid volume change of about 500 mL
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electrolytes
PSCCMP
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antidiuretic hormone
from pituitary gland regulates osmotic pressure of extracellular fluid by regulating amount of water reabsorbed by kidneys
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types of fluid volume deficits
isotonic dehydration- water and electrolytes lost in equal proportionshypotonic dehydraton- electrolyte loss exceeds water osshypertonic dehydration- water loss exceeds electrolyte loss
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types of fluid volume excess
isotonic overhydration- excessive fliod in ECF hypertonic overhydration- rare, but may be caused by excessive sodium intakehypotonic overhydration- known as water intoxication, excessive fluid moves into ICF and all body fluid compartaments expand
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osmotic pressure
pressure from high to low concentration
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oncotic pressure
pulling fluids from the surrounding tissue into the capillaries
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sodium potasium pump
plays key role in maintaining volume of ICF
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protein is responsible for
vascular and cell wall integrity
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third space
fluid in spaces that arnt part of circulation such as asceitesiso-osmolar fluid shifts into body cavities wherefluid is not available for exchange with plasma volume
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hyperonic saline
3% or 5% saline solution, rarely given only for hyponatermia, watch pt carefuly for seisures
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major ICF electrolite
potassium
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major ECF electrolyte
sodium
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post op patient with small bowel resection is at risk for electrolyte imbalance because of
impaired exchange between anions and cations
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cations (+)
sodiumpotasiumcalciummagnesium
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anions (-)
chloridebicarbonatephosphatesulfate
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hypotonic iv fluids
.45 % .33%and D5W
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metabolic acidosis
hydrogen ions enter the cells and potassium moves to the ECF
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hypocalcemia
trosseaus signs- hand curves in when taking bpchovstek signs- when you tap on their cheek they blink
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lasix (furosemide)
Treats fluid retentionif you have hypercalcemia, you push lasic to get rid of fluid and get rid of the calcium
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solute
substance dissolved in solution
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solvent
liquid that contains a substance in solution
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body fluid
solution that contains both electrolyes and water
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electrolytes
substance that dissociates into ions when dissolved
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high pH- alkeline
low pH- acid
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max infusion rate of potassium chloride is
20mEq. hr
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hypotonic
hypotonicity. in a hypotonic environment, fluid will enter a cell and cause it to swell and burst. the inside of the cell has higher osmotic pressure than the surrounding fluid, so fluid is drawn into the cell.
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hypertonic
: the cell will shrink (crenation) by loss of its fluid to the surrounding hypertonic environment. high osmotic pressure of surrounding fluid pulls fluid out of the cell.
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isotonic
if the concentrations of electrolytes are the same in the cell and surrounding fluid, the situation is balanced (homeostatic). the cell fluid volume remains the same.
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expalin hypo iso hyper
½ ns iv is hypotonic relative to cells. fluid moves from the vascular space into the cells. when a liter of ½ ns is administered intravenously, it will go into the cells and very little will remain in the blood vessel (since it is hypotonic). if you put two isotonic solutions side by side, no fluid shift occurs. a liter of normal saline or ringer’s lactate is limited to the extracellular space and will expand the blood volume.5% dextrose in ns is hypertonic compared to cells; pulls water into the vascular space from the cells or interstitium.
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only flush tubing with
normal 0.9% saline
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fluid colume deficit
dehydration- body looses water and serum sodium levels increasecaused by scites, edema, HYPOTENSION, rapid pulseelevated BUN, serum osmolaroy, hemoglobin & hematocritwater is hypotonic, if IV fluids are needed isotonic fluids are used
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water fluid excess
water intoxication- state in which body retains water and sodium levels decreaseheart failure, renal failure, liver failure, indigenstion of table salt, confusion, crackles, high bp, asltered conciousnesdecresed BUN, hemoglobin, hematocirt, urine osmolarity, and serum osmolaritysodium restricted DIET
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heparin
Heparin-Prevents clots in the blood vessels before or after surgery or during certain medical procedures. Also treats certain blood, heart, and lung disorders and helps diagnose and treat certain bleeding disorders. This medicine is a blood thinner.
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heparin
Zantac-Treats and prevents heartburn with acid indigestion. Also treats stomach ulcers, gastroesophageal reflux disease (GERD), and conditions that cause your stomach to make too much acid (such as Zollinger-Ellison syndrome).
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epinephrine
-Treats severe allergic reactions (including anaphylaxis) in an emergency situation.
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Florinef (Fludrocortisone)-
s a synthetic corticosteroid with moderate glucocorticoid potency and much greater mineralocorticoid potency. the treatment of cerebral salt wasting.
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diazipam (valium)
DIazapam (Valium)- Treats anxiety, muscle spasms, seizures, and other medical conditions. This medicine is a benzodiazepine.
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acetaminophen (tylenol)
Acetaminophen (Tylenol)- Treats minor aches and pain and reduces fever.
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calcitonin (fortical)
Calcitonin (Fortical)- Calcitonin is a 32-amino acid linear polypeptide hormone that is produced in humans primarily by the parafollicular cells of the thyroid, and in many other animals in the ultimobranchial body.
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electrolyes
PRBC-Packed Red Blood Cells-bagged for blood transfusions.0.9 % NSS-Normal SalineD5W-5% dextrose in water- also contains normal saline.Potassium chloride (KCl)- is a metal halide salt composed of potassium and chlorine. Potassium phosphate (Neutra-Phos)- is a generic term for the salts of potassium and phosphate ions Calcium gluconate- is the calcium salt of gluconic acid, an oxidation product of glucose, and contains 9.3% calciumSodium bicarbonate-sodium hydrogen carbonate is the chemical compound with the formula NaHCO3. Sodium bicarbonate is a white solid that is crystalline but often appears as a fine powder. It has a slightly salty, alkaline taste resembling that of washing sodaMagnesium sulfate-Magnesium sulfate is an inorganic salt containing magnesium, sulfur and oxygen, with the formula MgSO4.Phosphorus-Phosphorus is a nonmetallic chemical element with symbol P and atomic number 15. A multivalent pnictogen, phosphorus as a mineral is almost always present in its maximally oxidised state, as inorganic phosphate rocks.
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reverses benzodiapines
Flumazenil (Romazicon)-
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reverses opioids
Naloxone (Narcan)-
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isotonic
same osmolality as ECF and normal plasma- noosmotic pressure created so fluid remains in ECF-used to replace ECF fluid and electrolyte loss and to expans vascular volume0.9 % and LR and 5% dextrose in water D5WUSED TO TREAT DEHYDRATION
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hypotonic
lower osmolarity than normal plasma and ECF-fluid moves from ECF to ICF, water pulled from vessles into cells causing increased cell volume and decreased vascular volume- treats CELLULAR dehydration-should not be used for people with fluid OVERLOAD-should not be used for people with brain injuries because the brain is sensitive nd absorbs much water-frequent monitoring of vitals, concousness, and cerculation.45% 0.225%
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hypertonic
higher osmolarity than normal plasma and ECF- fluid moves from cells into vessels, resulting into increased vascular volume and decreases cell volume(be careful to avoid celular dehydration)(DONT USE WITH PT WITH FLUID VOLUME DEFICIT)3% 5 % saline- used when sodium is low10% dextrose-treats hypoglycemiaD5NS
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hypokalemia (3.5-5)gastric suctionin, vomit, diareah, loop diuretics, steroids, cushing syndromeput on ECK monitor for UWAVES, dysrithmyas, muscle weakness, leg cramps, NV, paresthesiagive iv K
hyperkalemia (3.5-5)rapid administration of IV K, foods, oliguria, multiple blood transfusions, Pseudohyperkalemia- clench fist when get BP, hemolysisput on ekg monitor for TWAVES, NV, paretheses, muscle weaknessglucose insuline, keyexelate, lasyx calcium gluconate to protect heart renal dialysis
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hyponatremia (135-145Odiuretics, diaphoresis, HYPOTONIC tube feedingSEIZURESRESTRICT FLUIDS, give HYPERTONIC saline,
hypernatermia (135-145)DEHYDRATION, diareah, HYPERTONIC feeding, cushing syndromeTHIRST, fever, mental status, SEIZURESgive fluids, HYPOTONIC SALINE, restrict NA
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hypocalcemia (9 - 10.5) (AIRWAY)hypothyrodism, hyperphosphotemia, hypomagnesemia, renal failure, low vit. D numb tingling fingers, CHOVEC- cheek& TRESSOU- hand, DYSRYTHMIAS
hypercalcemia (9-10.5)hyperthyroidism, imobility, tumorspolyuria, DYSRYTHMIAS, cardiact arrestgive CALCITIONIN- calcium is taken to bones and not in serum levels
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hypomagnesemia (1.3-2.1)alchholilsm, ketoacidosis, alkalosis trosseu & chevec, dysrythmias, DIGITALIS TOXTICITY, tachycardia
hypermagnesemua- (1.3-2.1)renal faliure, adrenal insufficency, HYPOREFLEXES, drowsiness, resp. depression, bradycardiacalcium gluconate- to regulate heart
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hypophosphotemua( 3-4.5)refeeding after starvation, alchohol witdrawl, TPNrepiratory depression, muscle weakenss, confusion, bone pain,
hyperphosphotemia (3.0 -4.5)renal failure, excessive phosphate containing lexatives and enemas, chemotherapyshort term- tetany- tingling finger, numness, muscle spasmlong term- phosphoros goes into kidney, joints, arteries, skin
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WBC
4000-11000
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hemoglobin
men 13.2-17.3women 11.7-16
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hematocrit
men 39-50%women 35-47%
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RBC
men 4.3-5.7women 3.8-5.1
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PT time
11-16 sec
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aPTT time
25-35 sec
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cholesterol
less than 200
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HDL
men less than 40women less than 50
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LDL
less than 100
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trigycerides
less than 150
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BUN 6-30
6-30
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creatine
0.6-1.3
135
glucoes
70-100
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hemoglobin
4-6 %
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PSA
0-0.5 womenless than 4 men
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acute pain
results from sudden accidental trauma (fractures, burns, lacerations, after surgery)-serves a biologic puropose, acts as a warning sign by activating SNS causing a physiologic response. -temporary, sudden, easily localized, preemptive anelgesia- pain mx given pre op to reduce amount of pain post op
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chronic pain
persistant pain, gradual onset, poorly localised and hard to describe, SERVES NO BIOLOGIC PURPOSE, -body adapts to the pain and the symptoms such as high BP, RR, P are absent with chronic pain. 1.chronic cancer pain2. chronic non cancer pain
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chronic cancer pain
associalted with cancer or immune deficency disease
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chronic non cancer pain
associated with tissue injury that has healed or non cancer pain (arthritis, back pain,fibromyalgia, neuropathic pain)
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nociceptive pain
viseral or somatic
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viseral pain
arises from organs
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somatic pain
arises from skin and musculosceletal structures
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in the periphery 2 fiber transmit pain stimuli:
A delta fibers- found in skin and muscle- mylenated fibers that carry rapid sharp, pricking and piercing sensations, easily localised (aka. mechanical nociceptors)C fibers- in muscle, periosteum and viscrea- poorly mylenated fibers that conduct thermal, mechanical and chemical impulses, usually produce persistant pain. are dull and achy
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gate control theory n
nerve fibers (A&C) transmit nerve impulses from pheriphery of body. these impulses tracel to the dorsal horn of the spinal cord. when gate is open nerve impulses ascend to the brain, when gate is closed nerve impulses do not get through and are not percived
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endorphines
are morphine like substances and are released when large diameter nerve fibers are stimulated. these fubers close the gate and decrease the pain transmition
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localised pain
pain confined to site of origin
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projected pain
pain along a specific nerve For example, pain in your throat sensed as pain in your ear
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radiating pain
diffused pain around site of origin, it is not well localised
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referred pain
is pain perceived at a location other than the site of the painful stimulus
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pain managment drugs
opioids non opioidsadjuvants
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non opioid analgesics
mild-moderate pain (ex. aspirin & tylenol) optimal dose for these is 650-1000 mg - these drugs have a ceiling affect, which means when dose is > 1000 mg there will be no more analgesic affect, only sideeffects
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NSAIDS (nonsteroidal anti inflamitory drugs)
most non opioid other than TYLENOL are NASAIDS
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NSAIDS
are uswful in the managment of acure inflamation such which causes post op pain*aspirin and other NSAIDS cause GI bleeding and decrease platelet aggregation which may result into bleeding.
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Acetaminophen (tylenon)
non opioid analgesic ( does not have anti infamitory effects therefore does not cause GI bleeding, it is prefered fpr pt with history of peptic ulcer disease)-may cause nephrotoxticity(renal toxticity) and hepatotoxticity(liver roxticity) - no more than 4000mg dailiy, for long tearm use no more than 3600 daily
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opioid analgesics
moderate - severe pain- block release of neurotransmiters to brain
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codine
short acting drug, only opioid with celing effect. converted to morphine after ingestion
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morphine
most common opiod given for acute and chrnoic pain (monotor respirations because it causes resp. depression) also can cause constipation
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side effects of opioids
CONSTIPATION (inhibit peristalsis)NAUSEA&VOMITINGRESPIRATORY DEPRESSION
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opiod antagonist
nalaxone(narcan)has short half life therefore needs to be given more in order to get the entire opioid out of the system
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cold applications
helpful for inflamed areas
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heat
appropriate when an increased blood flow is desired such as for pt with chrnonic arthritis
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NSAIDS
use with caution with older adults because of GI bleeding
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bradycardia after surgery
can indicate an anesthesia effet of hypothermia
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pulse deficit
difference between the apical and pheripheral pulses (could indicate dysrythmias)
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pheripheral vascular assesment
needs to be performed because positioning during surgery could impair peripheral circulation and may contribute to venous thrombosis (DVT)
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compare
pt baseline neurologic assesment with the findings after the surgery
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after pt is alert and stable
he may be discharged from PACU
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pseudoaddiction
Pseudoaddiction is a condition created by the undertreatment of pain. It is characterized by behaviors such as anger and escalating demands for more or different medications.
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physical dependence
Physical dependence occurs in everyone who takes opioids over a period of time. When it is necessary to discontinue opioid analgesia for the client who is opioid dependent, slow tapering (weaning) of the drug dosage lessens or alleviates physical withdrawal symptoms.
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equianelgesia
Equianalgesia refers to the dose and route of administration of one drug that produces about the same degree of analgesia as the given dose and route of another drug. This term is used when switching opioids or routes of opioids.
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preemptive anelgesia
Use of preemptive analgesia is a technique designed to decrease pain in the postoperative period, decrease the requirements for a postoperative analgesic, prevent morbidity, and decrease the hospital stay.
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pca pump
Pruritus (itching) is a common side effect of epidural opioids and is first treated with a small amount of naloxone (Narcan).
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FIRST ASSES
any acute pain because it may be rapid and means somethings wrongrather than chronic pain which is persistant
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general anesthesia depresses voluntary motor function
regional anesthesia alters the motor and sensory function of only parts of the body
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motor and sensory assesment
are very important after epidural or spinal anesthesia. evaluate motor function asking pt to move extremities. the pt. who had epidural aneshtsia remains in PACU until sensory function (feeling) and movement is returned
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kidney system assesment
anesthesia can cause urine retention. urine output may not return untill hours after the surgery.
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pain
reaches its peak at day 2 of surgery when pt. is more awake and active and anesthetic agents have been excreted.
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infection
an indication of infection is an increase in the band cells (immature neutrphils) this is called a left shift or else bandemia
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priority pt. problems after anesthesia
potential for hypoxemiapotential for wound infectionpain
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airway maintanance
after assesing the airway, you may need to insert an oral airway if the pt. does not already have one. the oral airway pulls the tongue forward and holds down to prevent obstruction. -if the pt. had oral surgery and has clenched teeth, a large tongue or an upper airway obstruction you may insery an nasal airway to keep the airway open.
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positioning in PACU
position the pt. in a semi folwers position. if pt. cant have HOB raised turn them to the side or turn head to side to prevent aspiration
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dressing
before the first dressing change, reinforce the dressing if it becomes wet from drainage. (add more dressings)
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dehiscence or eviceration
-ask pt. to bend knees and avoiod coughing-raise HOB 15 - 20 degrees-if eviceration use dressing with sailne, dont let dressing become dry-one Rn stays with pt. as another one gathers equiptment and calls doc-surgeon may perscrive a NG tube to decompress the stomach and relive internal pressure ot to remove stomachs contents if the pt. has been eatting. then pt. goes straight to surgery to close the wound back up in case of eviseration
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pillow support
unless the surgeon perscribes pillow support under knees never put pillows under the knee gatch because it could restrict and increase risk for thrombosis
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priority airway
first asses breathing patternthen asses o2 saturation
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after surgery
IV non-opioid analgesics usually are not given within the first 48 hours after surgery.Correct: IV opioids are given in small doses to provide pain relief but not to mask an anesthetic reaction.
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drainage
Redness and swelling around the incision.Correct: Redness and swelling around the incision indicate an infection. Sanguineous drainage at the suture site Incorrect: Sanguineous drainage at the suture site is normal.
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post op NAUSEA and VOMITING
occurs in about 30% of pt. reciving general anesthesia, they have some sort of GI upset after 24 hours after surgery-pt. may have nausea as the HOB is raised early after surgery. you can reduce this by having the pt. lie in a side lying position before raising HOB slowly
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perstalsis
pt. who are recovering from abdominal surgery often have decreased or no perstalsis at least 24 hours. this can persist for several days for pt. with abdominal surgery. listen for bowel sounds in all quadrants. if NG tube is used you may turn of the suction to prevent mistaking the sound of the suction for bowel sounds. -passing of flatus indicates perstalsis is back
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paralytic ileus
no perstalsis because of anesthesia, abdomen is distended and there is no movement of the intestines.
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salem sump (type of NG tube)- asses drained material every 8 hours
is a double lumen tube with an air vent to keep the tube from grabbing the gastric mucosa. this allows easy drainage of the stomach and prevents mucosal damage. -if it leaks you may inject 30 ml of air to bring stomach sontacs back down. irrigate every 4 hours with 30 ml of normal saline-normal NG drainage is yellowish gree, if red drainage may indicate bleeding.
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serosanguinous drainage
continuing after 5th day alerts the posibility of dehisance
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infection symptoms
redness or swelling, excessive tenderness, pain on palpation, purulent or odeourus drainage may indicate wound infection and needs to be reported to surgeon
196
NG tube
may be inserted during surgery to decompress and drain the stomach, to promote GI rest and to allow the lower GI tract to heal. may also be used to monitor any gastric bleeding and to prevent intestional obstruction.
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oxygen levels
Hemoglobin measures oxygen-carrying capacity PaCO2 indicated carbon dioxide levels in the blood.PaO2 indicates levels of oxygen in the arterial blood; -----> hypoxemiaOxygen saturation measures tissue perfusion.------> hypoxia
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suctioning
The client should be preoxygenated with 100% oxygen for 30 seconds to 3 minutes to prevent hypoxemia. After suctioning, the client should be hyperoxygenated for 1 to 5 minutes, or until the client's baseline heart rate and oxygen saturation are within normal limits.: Repeat suctioning as needed for up to three total suction passes. Additional suctioning will cause or worsen hypoxemia. Suctioning for 30 seconds is too long and can cause or worsen hypoxemia. Never suction longer than 10 to 15 seconds.ONLY SUCTION WHEN YOU REMOVE TUBE
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The client with a new tracheostomy has a soiled dressing. What is the best nursing intervention?
Replace the dressing with sterile, folded 4 × 4 gauze
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LABORED BREATHING
"Do not resuscitate" (DNR) client has a non-rebreather oxygen mask, and breathing appears to be labored. What does the nurse do first? Ensures that the tubing is patent and that oxygen flow is high : Labored breathing and ultimately suffocation can occur if the reservoir bag kinks, or if the oxygen source disconnects or is not set to high flow levels.
201
A client with a tracheostomy is at increased risk for aspiration. Which nursing intervention(s) will reduce this risk
Maintain the client upright for 30 minutes after eating. Correct Provide small, frequent meals. Correct Teach the client to "tuck" the chin down in the forward position to swallow. Correct
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DISLOGED TRACHEOSTEMY TUBE
Direct someone to call the Rapid Response Team while using a resuscitation bag and facemask. Correct: Because a fresh tracheostomy stoma will collapse, the client will lose his airway patency, which will require the nurse to ventilate the client through the mouth and nose while waiting for assistance to re-cannulate the client. Directing someone else to call the Rapid Response Team allows the nurse to provide immediate care required by the client.
203
oxygen in air
21%
204
obtain a perscription for humidifier
for 4L or more of oxygen
205
hypoxic drive
occurs only in the presence of severely elevated PaCo2 with pt. that are used to these leves such as those of COPD. when pt. with low levels of oxygen and high levels of carbon dioxide recieved oxygen theraoy this removes the trigger for breathing casing respiratory depressiongive only up to 1.2.3 L
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oxygen level greater than 50% (causes toxticity)
given continously for more than 24 and 48 hours may damage lungs-symptoms include nonproductive cough, dyspnea, chest pain, GI upset, prolonged oxgen use causes atelectasis
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low flow oxygen delivery
nasal cannulasimple facemaskpartial rebreathernon rebrether mask
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nasal cannula
1-6 L24-40% oxygen (apply non petorleum and water soluble jelly to nostrils)
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simple facemask
5-8 L40-60%
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partial rebreather mask
6-11L60-75%make sure reservoir doesnt kink or twist resulting in deflated bag, this causes decreased oxygen delivery and rebreathing of exhaled air
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non rebreather mask
80-95%closely monitor(pt may require intubation)ensure valves and flaps are intact and functioning with each breath.
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high flow oxygen delivery
ventury maskaerosol mask, face tentt-piece
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ventory mask
4-10L24-50%
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aerosol mask, face tent
24-100% at least 10L
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t piece
24-100%at least 10Ldelive oxygen to pt. with trach
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if skin aroung tracheostomy is puffy and feel a crackling sensation when feeling it
immediatly notify physitian
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suctioning airway
adjust suction at 80-120mmset up sterile fieldpreoxygenate pt. 100% oxygen for 30 sec-3 min to prevent hypoxemianever suction more than 10-15 sec and more than 3 timmesbetween times of suctioning preoxygenate pt.
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PACU
report urine retention less than 30 ml.hr
219
Ondansetron Hydrochloride (Zofran)
nausea/vomiting occur in up to 30% of pt. after general anesthesia. to reduce nausea and vomiting give ZOFRAN its is an antiemetic drug - against N/V
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when pt. is out of surgery you lie them
on their sidewhen they wake up you put them in folwers
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neuromuscular blocking agents
watch airway
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obstruction from pt. tongue
lift head to unblock
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atelectasis
most common cause of postop hypoxemia, may be caused from blockage of secreationgs
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pulmonary edema
cause breathing problems in post op pt. caused by accumilation of fluids in alveoliAKA. left sided heart failure
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if pt. vomits
turn on side so they dont aspirate
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hypoxemia
PaO2 of less than 60 mm
227
internal bleeding signs
low urinary outputchinge in level of concusnesslow BP high P high HR
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pain after surgery
should last 1-2 days- give opioidsgets less and less days after - give tylenon
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parylytic ileus
no bowel sounds after general anestherisa. will return
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feed pt. after surgery when
they have gag reflexbowel soundsand pass gasNPO until bowel sounds are heard
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Flumazenil (Romazicon
benzodiazepine antagonist
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acute urinary retention may occur
returns after 24 hours normal
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wound infection
erythemia- rednessedemadrainageodortempt elevates
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when pt. arrives at PACU
first asses airway
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put on PPE
gownmask gogglesgloves
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take off PPE
gloves gogglesgown mask
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atelextasis
most common cause of post op hypoxemia- results from bronchial obstruction from retained secreations
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bronchospasm
post op complication- wheezing and accesory muscle useresults from increase in bronchial smooth muscle tone with closure of small airways
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hypoventilation
respoiratory problem- poor respiratory muscle tone/ depresion of respiratory drivesign is high CO2 levels
240
hypotension
caused by unreplaced fluid and blood loss, shock, hemmoragetreatment of hypotension begins with oxygen therapydrugs to vasoconstrict vessles
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hypertension
pain, anxiety, bladder distension, respiratory compromisetreatment- give anelgesics, give BP medication,
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emergent delirium
protect lines and make sure pt is safe
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post op abdominal distenscion
encourage pt to pass gasspostition on right sideearly and frequent ambulation gibe bisacodyl (dolucolax) suppositories to move bowels
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it potential for vomition
turn to side and have suction at bedside
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if no urine output
if ordered catheterize 6-8 hours after surgery
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PACU, the patient's blood pressure drops from an admission pressure of 126/82 to 106/78 with a pulse change of 70 to 94. The nurse administers oxygen and then:1. Increases the rate of the IV fluids.
The most common cause of hypotension in the postanesthesia period is unreplaced fluid and blood loss. This situation does not warrant further assessment; the nurse needs to administer IV fluids.
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Hypoventilation
The primary cause of pCO2 level above 45mm Hg is
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trandelenberg position
for postural drainage; the lung segment to be drained should be in the oppermost position.
249
for a pt with DVT
elevation of the effected lef facilitates blood flow by gravity and decreases venous pressure.
250
to give an enema
position pt. in left sims position for enema takes the pathway of the colon
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hyperventilation
very high respirations
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hypoxia
produces wheezing, bradychardia and decreased RR
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A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations?
non-rebreather mask can deliver levels of the fraction of inspired oxygen (FIO2) as high as 100%. Other modes — simple mask, face tent and nasal cannula — deliver lower levels of FIO2.
254
For a male client with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway?
Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the client’s ability to maintain a patent airway, causing a high risk of infection from pooled secretions.
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tidal volume
Tidal volume is the amount of air inspired and expired with each breath. Residual volume is the amount of air remaining in the lungs after forcibly exhaling. Vital capacity is the maximum amount of air that can be moved out of the lungs after maximal inspiration and expiration. Dead-space volume is the amount of air remaining in the upper airways that never reaches the alveoli. In pathologic conditions, dead space may also exist in the lower airways.
256
Nurse Julia is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which of the following interventions will most likely lower the client’s arterial blood oxygen saturation?
Endotracheal suctioning removes secretions as well as gases from the airway and lowers the arterial oxygen saturation (SaO2) level. Coughing and incentive spirometry improves oxygenation and should raise or maintain oxygen saturation. Because of superficial vasoconstriction, using a cooling blanket can lower peripheral oxygen saturation readings, but SaO2 levels wouldn’t be affected.
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black person with cyanosis
inspect mucous membranes not lips
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Nurse Eve formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include:
Conditions that increase oxygen demands include obesity, smoking, exposure to temperature extremes, and stress. A client with chronic bronchitis should drink at least 2,000 ml of fluid daily to thin mucus secretions; restricting fluid intake may be harmful. The nurse should encourage the client to eat a high-protein snack at bedtime because protein digestion produces an amino acid with sedating effects that may ease the insomnia associated with chronic bronchitis. Eating more than three large meals a day may cause fullness, making breathing uncomfortable and difficult; however, it doesn’t increase oxygen demands. To help maintain adequate nutritional intake, the client with chronic bronchitis should eat small, frequent meals (up to six a day).
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asthma unlike COPD
is a chronic disease with intermitten reversible airflow obstruction and wheezing- caused by obstruction of airways1. inflammation 2. hyperresponsiveness that leads to bronchoconstrictioninflammation may trigger hyperresponsivness therefore ppl with asthma have both. -irritants such as cold air, smoke, particles, NSAID and ASPIRIN may trigger innflamation- polutants, excercise and upper resp. illnes may trigger hyperresponsivness
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when asthma is controlled
it is reversible
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GERD
is thought to be a trigger of asthma because the acidic stomach contants trigger hyperresponsiveness
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asthma causes
wheezing, chest tightness, mucous productiin , coughinghypoxia and hypoxemia occur with severe asthma attack, observe nail beds for cyanosis .
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peak flow meter
teach pt. to measure 2 daily , to first establish a personal best in peak flow meater for measuring 2 daily for 2-3 weeks when asthma is well controlled, green zone reading- within 80%yellow zone- within 50-80% - will need a relieve drugs at this point
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control therapy drugs
are used everyday regardless of symptoms
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reliever drugs
are those to stop the attack
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albuterol (proventil, ventolin)
short acting reliver drugcauses bronchodialtaion and relaxes the bronchiolar musckesteach pt. to carry with them at all times-its a bronchodialatro- doesnt have effect on inflamation
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flucasone( flovent)
anti inflamitory, prevents asthma attach (teach pt to perform good mouth care)corticosteroid- anti inflamatory (shouldnt be used as releaver)
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long actiong agonists
need time to buid up an effect,are useful in preventing asthma but not for a rapid attack.
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emphysema
loss of lung elasticity in alveolar walls and hyperinflation of lung-affects alveoliias a result a pt. with emphysema may use accesory musles
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CHRONIC BRONCHITIS
AIRWAY PROBLEM- bronchial walls thicken and obstrcu kairflow inflamation of bronchi caused by irritants
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orthopnea postition
ease breathing, hunched over postiiton for pt. iwith COPD
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advil
is NSAID
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pneumonia
excess of fluid in the lungs resulting from an inflamatory process. the inflamation is triggered by infectious organisms that are inhabiting and irritating the lungs.
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WBC
gets higher. because WBC migrate to the area of infection and cause local capillary leak, edema and exudate
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fibrin and edema in the lunds
stiffen the lungs resulting into less vital capacity. alveolar colapse(atelectasis) and causing hypoxemia
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PPV23 vacine
antigens from the 23 dfferent types of pneumonua organisms. the vacine is usually given once but some belive that older adults and those with chronic health problems could benifit from a second vaccine if more than 5 years have passed from the first vaccination.
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Ventilator bundle
used when caring for pt. with ventilators to prevent VAP1. oral care(asses every 6 hrs, brush teeth every 12 hrs, put pt on side)2.hand hygene3. HOB elevated
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preventing VAP
-perform oral care before intubation-dont wear rings jewerly when providing care-complete oral care every 12 hrs- kepp HOB at 30 elevaated-avoid keeping the pt. supine after feeding
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penumonia signs
flushed cheeks, bright eyeschest painchills, fever (Older adults may not have fever and may have a lower than normal temperature with pneumonia.)dyspneaALL OF THESE CAUSE ANXIETY
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RAPID WEAK PULSE
MAY INDICATE HYPOXEMIA, DEHYDRATION OR SHOCK
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ASCULTATION SOUNDS OF PNEUMONIA
-CRACKLES WHEN FLUID IS IN THE ALVEOLAR AREA- WHEEZING MAY BE HEARD WHEN INFLAMATION IS PRESENT- BRONCHIAL BREATH SOUNDS HEARD OVER ARES OF CONSOLIDATION AND DENSITY-CHEST EXPANSION MAY BE DIMINISHED OR UNEQUAL ON INSPIRATION
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HYPERNATREMIA
OCCURS WITH DEHYDRATION AS A RESULT OF FEVER AND DECREASED FLUID INTAKE(DRINK AT LEAST 2 LITERS 2000 ML OF FLIID A DAY)
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ANTIBIOTICS
GIVEN 5-7 DAYS FOR A PT WITH UNCOMPLICATED cap- GIVEN 21+ DAYS FOR A IMMUNOCMPROMISED PT. WITH HAP
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TEACHING
TEACH PT TO AVOID CROWDSBALANCED DIETSTOP SMOKINGVACCINATION (dont smoke and use nicotine patches because it may cause MI)
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oxygenation
look at level of conciousness (if airway is not clear it may change mental status)
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percusion sounds
Dullness replaces resonance when fluid or solid tissue replaces air-containing lung tissues, such as occurs with pneumonia, pleural effusions, or tumor
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EMPYEMA
Empyema is a collection of pus in the space between the lung and the inner surface of the chest wall (pleural space). DRAIN WITH NEEDLE
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peptic ulcers
mucosal leasions of the stomach or duodenim.
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peptic ulcer disease
results when mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin
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route of H.pylori
fecal oral route-can also be transmited by contaminated endoscopic equiptment-about 1/2 of the would is infected with this but not all get PUD
291
urease
substance secreated by the H.pylori that produces ammonia and creates a more alkaline environent-urease produced by H.pylori breaks down urea into ammonia.
292
gastric ulcers
develop in the antrum of the stomach near acid secreating mucosa, in the lesser curvature of the stomachwhen a break in the mucosal barrier occurs the hydrochloric acis injures the epithelium. without normal functioning of the pyloric sphincter, bile refluxes back up into the stomach then destroy the membrane of the gastric mucosa.
293
gastric ulcers
gastric emptying is often delayed in pts. with gastric ulceration. this causes regurgitation of duodenal contents which worsesns the mucosal injury. decreased blood flow to the gastric mucosa may also cause ulceration to occur.
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conditions favoring the development of gastric ulcers
normal gastric acid secreations and delayed stomach emptying with increased diffusion of gastric acid back into the stomach tissues
295
duodenal ulcers(most common)
occur in the upper portion of the duodenum. in pt. with duodenal ulcers the pH levels (excess acid) are low in the duodenum for long periods of time. also rapid emptying of stomach also delivers a large bolus of acid into the duodenum. -paint usually at nightime after meals
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condition favoring duodenal ulcers
increased stomach emptying and increased secretion of gastric acid.
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stress ulcers
occur from trauma or head injury and sepsisare shallow erosions in the proximal duodenum.-bleeding caused by gastric erosion is the main manifestation of acute stress ulcers-curlings ulcer- associated w/ major burn, trauma, respiratory/renal failure and shock-cushings ulcer- with head or CNS injury
298
BLEEDING
hematamesis- bright red or cofee ground vomittarry or bright red stoolsmelena- occult blood (usually with duodenal ulcers)LOW BP, HIGH THREDY PULSElow hemoglobin and hematocritvertigoconfusion, dizziness, syncope, low urine output
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perforation
abdomen is tender, rigid, and boardlike(peritonitis)pt. assumes knee-chest position to decrease tension on the abdominal muscles. peristalsis diminishes and paralytic ileus occurs. tachycardia and weak pulsenausea and vomiting-restore fluid,PRBC, may need NG tube for decompression
300
pyloric obstruction (gastric outlet obstruction)
obstruction at the pyloric sphincter caused py scarring, edema, inflamation. symptoms- vomiting, nausea, abdominal bloating-scar tissue builds up and obstructs -pain worses through the day as stomach fills and dilates-loud perstalsis, constipation, dilated stomach
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what causes PUD
-h.pylori- produces urease, mediates inflammation -NSAIDS- inhibit prostaglandins that protect the lining of the stomach-corticosteroids- lower the mucoasl cell renewal-coffee- stimulates hydrochlorc acid production
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gastric ulcers- any part of stomachprevalent in womanpeak >50 yrs old-pain 1-2 hrs after meals-pain high in epigastrium
duodenal ulcers- occur at any age and any one (high at 35-45)-caused by increase of HCL acid secreation-pain 2-5 hrs after eatting-midepigastric pain and back pain
303
zollinger ellison tumor in pancreas
tumor of pancreas that increases more gastrin that makes more HCL which causes ulcers
304
3 major complications of PUD
hemmragegastric outlet obstructionperforation
305
(proton pump inhibitors) PPI
-for prolonged period of time the PPI can lead to osteosorotic rlated fractures-PPI's blocks ATPase enzyme which secreates HCL acid
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h receptor antagonists (H2 receptor blockers)
drugs that block the histamine stimulated gastric secreations. INHIBIT GASTRIC ACID SECREATIONS-given as a single dose at bedtime and used for 4-6 weeks in combination with other drugs
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antacids
-increase gastric pH by neutralisin HCL acid-may help heal small duodenal ulcers-take antiacids 2hrs after meals to reduce the hydrogen ion load in the duodenum. antacids are effective 30min-3hrs after ingestion. if taken on empty stomach they are quickly evacuated. -OTHER DRUGS ARE GIVEN 1-2 HRS BEFORE OF AFTER ANTACIDTAKE AFTER MEALS
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-(ALUMINUM HYDROXIDE)
(ANTACID) Aluminum hydroxide is used for the relief of heartburn, sour stomach, and peptic ulcer pain and to promote the healing of peptic ulcers. comes as a capsule, a tablet, and an oral liquid and suspension. The dose and frequency of use depend on the condition being treated. The suspension needs to be shaken well before administration.-watch for constipation
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FOOD ITSELF ACTS AS AN ANACID
BY NEUTRALIZING GASTRIC ACID FOR 30-60 MIN, AN INCREASED RATE OF GASTRIC ACID SECREATION IS CALLED REBOUND MAY FOLLOW.
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TREATING pud NATURAL WAY
BLAND NONIRRITATIND DIETNO BEDTIME SNACKS-the stimulate gastric secreations-eat 6 small meals a day -no alchohol, tabacco, coffee-yoga to reduce stress-herbs such as SLIPPERY ELM, MARSHMELLOW ROOT, QUERCETIN, LICORICE.- heal inflamed tissue and increase blood flow to gastic mucosa
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hypovolemia
shock, decreased blood vloume.-give fluid-blood products may be prescribed to expand blood volume and correct hemoglobin and hematocrit values-for pt. with active bleeding fresh frozen plasma is given if the prothrombin time is 1.5 times higher than the midrange control value. -WHEN BLOOD LOSS EXCEEDS 1L/24H-SHOCK,HYPOTENSION, CHILLS, PALPATATIONS, DIAPHORSES, WEAK THREADY PULSE,
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DIAGNOSTIC STUDIES
-endoscopy- allows for viewing of mucosa, determines degree of ulcer and the biopsy can rule out cancer-rapid urease test- -gastric analysis- NG tube inserted, stomach contents aspirated and anylised for HCL acid
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smokins cessation
smoking promotes acid production and reduced the protective mucus production-delays heling time of ulcers
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antibiotics for hpylori
usually 7-14 days
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high mg- diareag
high aluminum- constipation
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sodium bocarbonate (antacid)
Sodium bicarbonate neutralises stomach acidomeprazole and lansoprazole may be dissolved in a sodium bicarbonate solutions and given through any feeding tube.
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bilroth I (gastroduodenostomy)
surgery when its the removal of distal 2/3 stomach and anastimoses of whats left of stomach to duodenum
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bilrtoh II (gastrojejunostomy)
surgery when its the removal of distal 2/3 stomach and anastimoses of whats left of stomach to jejunum
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dumping syndrome (postop compication)
is a condition where ingested foods bypass the stomach too rapidly and enter the small intestine largely undigested. It happens when the small intestine expands too quickly due to the presence of hyperosmolar contents from the stomach.lowers ability of stomach to control amount of gastric chyme entering the small intestime, large amount of hypertonic fluid enters the intestine and high fluid is drawn into the bowel lumen. (occurs 15-30 min after meal)
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symptoms of dumping syndrome
boborgymos- high bowel soundsweakness, sweating, palpitations, crampslasts no longer than 1 hr
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POSPRANDIAL HYPOGLACEMIA
HIGH BLOOD SUGAR CAUSES AN INCREASE ON INSULINE PRODUCTION WHICH LOWERS THE BLOOD SUGAR RAPIDLY, -results from uncontrolled gastric emptying into small intestine
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dumping syndrome treatment
small frequent meansl 6X a day- withhold fluids at meals, fluids 1hr before or after eating-restrict sugars at meals-moderate protein, carbs and fat-lay down/rest 30 min after mealseat solids-wait....drinkdrink-wait.....eat solids
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with any gastric surgery
do not touch, reposition, drain NG tube-disrupts the internal sutras
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pernecious anemia
when you remove lower portion of stomach intrinsic factor is needed so now you give vitamin B12 show once a month -Intrinsic factor is an important protein that helps your body absorb vitamin B12
325
dumping syndrome diet
no alchohol, no sweet things, no onions, not be allowed to have any mayonnaise and can have whole wheat bread only in very limited amounts, not be allowed to have the buttermilk ranch dressing because it is made from milk products.-Chicken and rice is the only selection suitable for the client who is experiencing dumping syndrome because it contains high protein without the addition of milk or wheat products.
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after perforation
To decrease spillage of duodenal contents into the peritoneum, NG suction should be rapidly initiated. This will minimize the risk for peritonitis.
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thyrotoxicosis (hyperthyroidism)
hypermetabolism, increased CNS activity, stimulate heart increasing HR and stroke volume, diaphoreses, oily silky hair, SOB, rapid RR, tachycardia, palpitations, wight loss, always hyperactive, hot, increased appetite, irritability, increased libido, increased bowel movements, mood swings, muscle weakness, insomina,
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negative nitrogen balance
protein synthesis and degradation are increased but breakdown exceeds buildup causing a loss of body protein,
329
glucose in hyperthyroidism
glucose tolerance is devreased and the pt. has hyperglycemia,
330
graves disease
autoimmune disorder in which antibodies are made and attach to the thyroid stimulating hormone receptors on the thyroid tissue. the thyroid gland responds by increasing the number and size of glandular cells which enlarges the gland forming a goiter and overproduces thyroid hormones.
331
manifestations of hyperthyroidism
goiterexophthalmos-perfusion of eyes- give artificial tears, diuretics may be prescribed to reduce edema in eye. surgical operations only if its needed not for cosmetic purposes. pretibial myxedema- dry, waxy swelling of front surfaces of lower legs.
332
toxic multinodular goiter
multiple thyroid nodules, may be enlarged thyroid tissue or benign tumors. the overproduction of thyroid is milder and the pt. doesnt have exophthalmos or pretibial edema.
333
exogenous hyperthyroidism
caused by excessive use of thyroid replacement hormones.
334
exophthalmos
edema and fatty tussye behind the eye that causes the eye to protrude out.
335
photophobia
sensitivity to light
336
bruits
may be heard with a stethoscope for people with hyperthyroidism
337
cardiovascular problems for ppl with yperthyroidism
increased systolic BP, diastolic deacreased causing a widened pulse pressure. tachycardiadysrhythmias
338
labs for hyperthyroidism
T3 and T4T3RUTSH- thyroid secreating hormone, antibodies to TSH are measured to diagnose graves diseaseif t3 and t4 are up check for HR and dysrythmias
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thyroid scan
RAI radioactive iodine is given by mouth and the uptake of the iodine by the thyroid gland is measured. a normal thyroid gland takes up 5-35% of RAI in 24 hours. if its more than its hyperthyroidism, RAI not given to pregnant women because crosses placenta.
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thyroid storm
uncontrolled hyperthyroidism, with high fever and hypertension. IMMEDIATELY REPORT ANY TEMP CHANGE EVEN BY 1 DEGREE. -reduce stimulatiom, close lights, doors, rest-promote comfort-give antithyroid drugs
341
iodine
may be used for short term therapy. decreases blood flow though the thyroid gland reducing the production of thyroid hormone, improvement usually occurs in 2 weeks but its may be weeks before metabolism return to normal. -this can result into hypothyroidism, monitor pt closely to adust regimen
342
RAI radioactive iodine therapy
thyroid gland picks up the RAI and the cells that produce the thyyroid hormone are destroyed by the radiation. because the thyroid gland strores thyroid hormones the pt. may not have complete releif up to 6-8 weeks after the RAI therapy. additional drugs are needed in the first weeks.-usually given before thyroidectomy
343
total thyroiddectomy
lifelong thyroid hormone replacement
344
thyroidectomy preop care
-get thyroid hormone levels to normal (euthroid)-if pt is not at optimal weight bcuz of weight loss they may need to follow a high carb/protein diet for some weeks before surgey-SUPPORT THE NECK-if stridor or any other respiratory distress call RRT-laryngeal nerve damage- reasure pt. that hornes of voice is usually temporary
345
if parathyroid gland is injured during surgery
results into hypocalcemia and tetany (involuntary contraction of muscles)-pt has tingling around mouth and fingers and chovec and trossous signs-check muscle twiching for calcium deficency
346
hypothyroidism can occur because of
RAI therapy but it can show years later thats why pt. need to be checked up all the time
347
hypothyroidism
when production of thyroid hormones is too low the TSH binds to the thyroid cells and causes the thyroid gland to enlarge forming a goiter altough thyroid production doesnt increase.
348
myxodema
happens in hypothyroidism, when metabolism is low metabolites called glycosaminoglycans build up inside the cell and the buildup of mucous and water happens -tongue and laryn thicken making the voice husky
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myxodema coma
hypothyroidism complication, decreased metabolism causes heart muscles to become flabby resulting into decreaed cardicat outpt and perfusion to the brain causing tissue and organ failure.-causes RESPIRATORY FAILURE what to do-maintain airway, raplace fluid, give synthroid, check temp, warm
350
most cases of hypothyroidism
in the US bceause of overtreatment of RAIworldwide- because no iodine in food and water
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hypothyroidism signs
fat, cold, weak, constipation, decreased libido, temp usually lowe than 97, cardiact and resp function decreased-T3 & T4 decreases-TSH high primarily but can be decreased in pt with secondary hyperthyroidism
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synthroid
lifelong hormone replacement for pt with hypothyroidism and total thyroidectomy. therapy is staret at low doses and gradually increased. increasing too rapidly can cause hypertension and heart failure. if you give too much may cause high pulse and BP, you know synthroid is working when pt has more energy and less tired -when pt needs more sleep and is constipated this means hypothyroidism so dose may need to be increased, if pt. has insomnia and frequent bowel elimination this means hyperthyroidism and dose needs to be decaresd.
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take thyroid hormones
on empty stomach
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after thyroidectomy
support neckno ROMno coughingno hyperextension
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insulin
regulator of metabolism and storage of carbs, fats and proteins-promotes transport of glucose from blood across cell membranes-made in beta cells in the islets of langerhans in pancreasalpha cells-controll glucosebeta cells- controll insulin
356
CRH conterregulatory hormones
glucagon- opposite of insuline, it raises the BS, stimulates glucose production, regulate BS levels when pt. is fasting
357
Type I Diabetes (metabolic keto- acidosis)
-inability of the pancreas to secrete insulin because of destruction of beta cells-body does not make ANY insulinrapid, any agePolyphagia, Polyuria, Polydipsiaunexplained weight loss
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prediabetes
impared fastin glucose levels IFG, impared glucose tolerance IGT-BS not high enought to be diagnosed with diabetes
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prediabetes lab values
IFG 100-125IGT 140-199A1C 5.7-6.4%
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AiC
how much glucose levels are controlled within 3-4 months-long range controll test
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IGT
impared glucose tolerance test, eat certain amount of carbs and 2 hrs later they draw your blood and check the levels
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Type II Diabetes
make SOME insuline, gradual1.insulin resistance2. pancreas doesnt have ability to produce insulin3. no glucose production from liver4.mutations
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syndrome X
big wasit, central obesity, these ppl are more at risk to develop TYPE II diabetes
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type II diabetics dont need treatment
if they loose weight and strict diet controll
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secondary diabetes
caused by other things such as:cushing syndromehyperthyroidismTPN (check 4X a day BS)pancreatitiscystis fibrosiscorticosteroidsdilantinthiazides -resolves when underlying condition is treated
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S&S of type I-poyliuria, polydipsia, polyphagiaweight lossweaknessfatigueketoacidosis
S&S of type IIsame as type Irecurent infectionswounds that dont heal
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gestational diabetes
Gestational diabetes is high blood sugar (diabetes) that starts or is first diagnosed during pregnancy.if infant weighed more than 9 poundsw hen birthed
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diagnosis labs for DIABETES
A1C >6.5%fasting plasma glucose levels >1262hour OGTT >200random or casual plasma glucose levels >200
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long acting insuline (basal)- once a day-injected once a day in bedtime or morningreleased steadily thoughout day-CANT BE MIXED WITH ANY OTHER INSULIN (LANTUS) (LEVEMIR)
short acting insulin- rapid, short acting (bolus) - before meals-rapid- injected 0-15 min before meals, onset of action 15 min (lispro)-short acting- injected 30-45 min before meal, onset of action 30-60 min (regular insulin)
370
ONLY INSULIN THAT CAN BE GIVEN IV
REGULAR INSULIN
371
INSULINE COVERAGE
NPH and regular insulin (in AM and PM) coverage during the day with Regular
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what other meds may cause abnormal BS levels
B adregernic blockers- mask symptoms of hypoglycemiathiazide/loop diuretics- can make hyperglycemia because induces potassium loss
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excercise
increases insulin sensitivity, can lower BSweight loss- decreses insulin resistancereduces LDL
374
snacks
several small carbs snacks can be taken every 30 min during excercise to prevent hypoglycemia-exercise is best after meals-monitor BS levels before and after excercise
375
pancreas transplantation
for pt with type I who have end stage renal disease, had or plan to have a kidney transplantpanceras and kidey transplants are usually done together
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after radiologic procedures with dyes
make patient have plenty of fluids aftwerwards to wash out of system
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diabetic ketoacidosis
type I diabetes get it, body cannot use glucose for energy, and the body starts to break down other body tissue as an alternative energy source. Ketones are the by-product of this process. Ketones are poisonous chemicals which build up and, if left unchecked, and will cause the body to become acidic
378
DKA S&S
lethargy, weaknesspoor skin turgordry mucous membranesorthostatic hypotensionthirstflushed dry skinhyperventilation (body tries to blow off CO2 thats why it goes into metabolic ketoacidosis)-ADMINISTER OXYGEN
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DKA tretment
give regular insulineairwaypotassium to correct hypokalemiafluids to raise BP
380
HHS hyperosmolar hyperglycemic syndrome
type II get it, BS level of >400body doesnt have enough insulin to prevent severe hyperglycemiagive regular insulineairwaypotassium to correct hypokalemiafluids to raise BPsame as DKA but give larger amounts of fluid-check kidney function of BUN
381
hypoglyemia
BS leves <70give fruit juice accompanied with some protein dont give fatty foods because it takes body longer to break down
382
hypoglycemia S&S
confusionirritabiitydiaphoresesseisures, coma, deathweankesshungerbeta blockers block symptoms of hypoglycemia -lolrecheck BS 15 min after tretment
383
if pt is not alreat to swallow
adiminster 1mg of glucagon IM or subQ
384
necrobiosis lipodica diabeticorum
type Ired-yellow leasionsskin becomes shiny. transparent with tiny blood vessles
385
what highers BS
TPNcorticosteroids
386
sick day
take medsdrink fluidscheck BS Q2Hif BS >135 call DRif BS more than 300 check urine for ketones
387
atenolol& propanolol
Treats high blood pressure and angina (chest pain). May also lower the risk of repeated heart attacks. This medicine is a beta blocke
388
hypo/hyperthyroidism
weight daily
389
prednisone
Treats inflammation.This medicine is a steroid.
390
insuline mixing
Pull the plunger down to the correct unit mark for your CLOUDY insulin dose as ordered.Insert the needle into the CLOUDY bottle.Push the plunger down to inject air into the CLOUDY bottle.Withdraw the empty syringe from the bottle. Set the bottle aside.Pull the plunger down to the correct unit mark for the CLEAR insulin dose as ordered.Insert the needle into the CLEAR bottle.Push the plunger down to inject air into the CLEAR bottle.Leave the needle in the bottle. Turn the bottle upside down with the needle in it.Hold the bottle at eye level.Pull the plunger down to the correct unit mark for the CLEAR insulin dose.Look for air bubbles in the syringe.If you see air bubbles in the syringe, push the insulin back into the bottle, and repeat steps 17 and 18.Pull the bottle away from the needle, and set aside the CLEAR bottle.Pick up the CLOUDY bottle of insulin.Turn the CLOUDY bottle upside down and push the needle into the bottle. Be very careful not to move the plunger.Pull the plunger down and withdraw the correct number of units for the CLOUDY insulin.The plunger should now be on the unit mark showing the total units of both the CLEAR and CLOUDY types of insulin. For example, 6 units of CLEAR insulin are already in the syringe. Add 14 units of CLOUDY insulin for a total of 20 units in the syringe.
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recombivax
RECOMBIVAX HB is indicated for vaccination against infection caused by all known subtypes of hepatitis B virus
392
sublingual nitroglycerin
Nitroglycerin is used to prevent angina (chest pain) caused by coronary artery disease. This medicine is also used to relieve an angina attack that is already occurring.
