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Med Surg > Med Surg Exam 1 > Flashcards

Med Surg Exam 1 Flashcards

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1
Q

What does PACU stand for?

A

Post Anesthesia Care Unit

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2
Q

What happens during phase I in PACU

A

-immediate recovery
-intensive nursing care ( lots of assessing)
-pt transitions to an inpatient nursing unit or phase II

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3
Q

What happen during phase II in PACU

A

-pt is prepared to transfer to an inpatient nursing unit, an extended care setting, or discharge

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4
Q

What is the nurses job in the PACU

A

-provide care for the pt until pt has recovered from effects of anesthesia
- return to cognitive baseline
- clear airway
- controlled nausea and vomiting
- stable V/S
- asses LOC, cardiac, respiratory, wound and pain
- check drainage tubes, monitor lines, IV fluids, and
meds
- give report if being admitted

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5
Q

True or false: The primary nursing goal in the immediate postoperative period is maintenance of pulmonary function and prevention of larygospasm

A

false: The primary nursing goal in the immediate postoperative period is maintenance of pulmonary function and prevention of hypoxemia and hypercapnia

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6
Q

What 4 things should be included in an assessment of a hospitalized post op pt?

A

-respiratory
-pain
-mental status/LOC
-general discomfort

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7
Q

What are some indicators of hypovolemic shock/hemorrhage?

A

-pallor
-cool, moist skin
-rapid respirations
-cyanosis
-rapid, weak, thready pulse
-decreasing pulse pressure
-low BP
-concentrated urine

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8
Q

True or False: The nurse should intervene at the patient’s first report of nausea to control the problem rather than wait for it to progress to vomiting.

A

True, vomiting can lead to aspirating so it is very important to keep that risk at a minimal

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9
Q

Which of the following occurs during the inflammatory stage of wound healing?

A

blood clot forms

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10
Q

What is the purpose of post op dressings?

A

-proving a healing environment
-absorb drainage
-spring or immobilise
-protect
-promote homeostasis
-promote patient’s physical and mental comfort

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11
Q

What are some problems that can arise post-op

A

-pulmonary infection / hypoxia
-DVT/PE
-hematoma/hemorrhage
-infection
-wound dehiscence or evisceration

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12
Q

Who are the members of the surgical team?

A

-pt
-anaesthesiologist
-surgeon
-nurses
-surgical techs
-RNs

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13
Q

True or false: The circulating nurse is responsible for monitoring the surgical team.

A

true

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14
Q

What are some intraoperative complications?

A

-anesthesia awareness
-nausea, vomiting
-anaphylaxis
-hypoxia
-hypothermia
-malignant hyperthermia
-infection

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15
Q

True or False: The most frequent early sign for a pt at risk for malignant hyperthermia subsequent to general anesthesia is bradycardia

A

FALSE, the most frequent sign for a pt at risk for malignant hyperthermia subsequent to general, is TACHYCARDIA

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16
Q

What can be worn in the unrestricted zone of the OR?

A

-street clothes

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17
Q

What can be worn in the semi restricted zone of the OR?

A

scrub clothes and cap

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18
Q

What can be worn in the restricted zone of the OR?

A

scrub clothes, shoe covers, caps, masks

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19
Q

Where are gowns considered sterile?

A

in front from chest level of sterile field , sleeves from 2 inches above the elbow to the cuff.

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20
Q

Through which route are inhaled general anaesthetics primarily eliminated?

A

lungs

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21
Q

What is homeostasis?

A

-where the body fights to maintain homeostasis. This means to maintain a set temp, HR, RR etc.)

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22
Q

What is intracellular fluid?

A

fluid inside the cells

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23
Q

What is extracellular fluid?

A

fluid outside the cells

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24
Q

What are the major cation electrolytes?

A

-sodium
-potassium
-calcium
-magnesium
-hydrogen ions

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25
What are the major anion electrolytes?
-chloride -bicarb -phosphate -sulfate
26
What is osmosis?
the diffusion of water caused by fluid and solute concentration gradients
27
what is hydrostatic pressure?
pressure that is exerted on walls of blood vessels
28
what is osmotic pressure?
pressure that is exerted by protein in plasma
29
What is diffusion
solutes move form area of higher concentration to one of lower concentration
30
What is filtration
movement of water
31
What are ways the body gains fluid and electrolytes?
drinking and eating
32
What are ways that the body looses fluid and electrolytes?
-kidneys - urine -skin loss- sweating -lungs -300ml every day -GI tract
33
Fluid volume deficit =
hypovolemia
34
Fluid volume excess= hypervolemia
hypervolemia
35
What is the number 1 way to manage Fluid volume DEFICIT
ORAL PO FLUIDS
36
What are some ways you could know someone has FVD
-high HR -Low BP -poor skin turgor -low wt -dry oral mucosa -low UOP -fever -flat neck veins -confusion due to lack of fluids to brain -thirst - low central venous pressure - <2 -orthostatic hypotension
37
What is the nurses job when your pt is in FVD
-get daily wt (if pt looses 3 or more lbs in 24 hours its bad) -encourage PO fluids -put pt on fall precautions -strict I&O -monitor VS if SBP is less than 100 or HR is less than 60 -hold diuretics
38
How do you know someone has pulmonary edema
-crackles -increased WOB -pitting edema -orthopnea -postive JVD -high BP -gain wt
39
What lab values would be off if pt is in FVE
-H&H low -creatnine off BUN off electrolyte imbalance
40
What is something to remember when you are correcting a sodium imbalance
NEVER correct sodium more than 12meq in 24 hours
41
What does hyperkalemia do to T-waves
makes them tall
42
Normal PH
7.35-7.45 Less than 7.35= acidic More than 7.45 =alkalosis
43
Normal PACO2
35-45
44
HCO3
22-26
45
PAO2
80-100
46
What do you administer for Malignant hyperthermia
Dantrolene
47
Sodium level
135-145
48
Chloride level
98-106
49
Potassium level
3.5-5.0
50
Calcium level
8.8-10.5
51
Phosphorus
2.5-4.5
52
Magnesium
1.8-3.6
53
Which fluids are isotonic?
NS 0.9% (normal saline 0.9%) LR (lactated ringers) D5W (5% dextrose in water)
54
Which fluids are Hypotonic
0.45% NS (0.45% normal saline) D25 45% NS (2.5% dextrose in 0.45% saline)
55
Which fluids are hypertonic
D10W (10% dextrose in water) D50W (50% dextrose in water) D5NS (5% dextrose in 0.9% normal saline) D5W in 0.45% NaCl (5% dextrose in 0.45% saline) D5LR (5% dextrose in lactated ringers)
56
What are the indications for a isotonic solution
-vascular system defect -these fluids are used to increase fluid volume after blood loss or dehyrdration
57
What is Normal saline used for? And when should you use caution?
useful for -IV hydration -maintenance fluids -hypovolemia -hyponatremia -hypotension -sepsis -shock Caution with -CHF -ESRD -SIADH -large quantities
58
What is Lactated ringers used for? When should you avoid?
Useful for -dehydration -maintenance fluids -ongoing fluid losses -sepsis -pancreatitis -burns -surgical pts Avoid with -renal failure -liver failure -hyperkalemia -hypercalcemia -blood transfusions
59
What do isotonic solution do inside the body?
prevents fluid shifts between compartments -keeps the fluids in the intravascular area and intestinal cavity
60
What are hypotonic solutions indicated for?
-intracellular dehydration
61
Where do hypotonic fluids shift the fluid?
shifts fluid from the ECF to the ICF
62
What are the indications for hypertonic fluids?
-only when serum osmolality is critically low
63
Where do hypertonic fluids shift the fluid?
shift fluids from ICF to ECF
64
What populations should you avoid giving any hypotonic solution to?
infants or head injury pts can cause cerebral edema
65
What are some safety things to remember when giving hypertonic fluids ?
GO SLOW
66
What is the antidote for opiods?
naloxone (narcan)
67
At what point will naloxone be indicated?
pts is having respiratory distress
68
What is the antidote for benzodiazepines (versed, alazopram)
flumazenil
69
What is something you should be sure to have BEFORE administering neuromuscular drugs?
be sure to have a airway because these drugs will relax the diaphram
70
How much fluid will the JP drain hold?
100cc
71
How much will the hemovac drain hold?
500cc
72
What is a LMA? Who can put those in?
Laryngeal mask airway (does not go past the trachea) nurse can put in
73
What must be normal before discharging pt from PACU
-aldrete score of 8 to 10 -stable VS -no evidence or minimal bleeding -pt can gag, swallow, cough -minimal N/V -urine output >30ml/hr
74
How would you know someone is bleeding internally
-tachycardic -low BP -cool and clammy
75
What are the 4 steps if your pt is having a would complication
1.lay pt is low fowlers 2.lie still 3. cover with sterile saline 4.call provider
76
What is the joint commission surgical universal protocol
-conduct a pre-procedure verification process -make the procedure site -perform a time out
77
General Anesthesia
-given through IV -pt is fully asleep -must think about airway, 02 etc, since they are unconscious
78
Local Anesthesia
-only administers to a local site -pt is awake -LOC is normal
79
Reginal Anesthesia
-epidural or spinal -lay the pt flat post surgical because they can develop a spinal headache. -Pt might get a blood patch if it does not resolve on its own
80
What is an example drug of a sedative?
barbiturates
81
Malignant hyperthermia
-RARE LIFE THREATENING -genetic (ask before surgery of family Hx) -increased co2 levels and decreased O2 levels -tachycardia appears first followed by dysrrythmias, muscle rigidity, hypotension, MOTTLING, cyanosis -high temp (as high as 111.12) is a late sign
82
What do you give for malignant hyperthermia
-dantrolene -ice cold IV bags -cooling blankets
83
Which is the only solution that can be given with blood products >
isotonic
84
What solutions are colloids
D5W or D in NS
85
What is something you should notify the provider about the BP post op
if it is below SBP 90 or if it drops 5mmhg in 15 min or less
86
What are some potassium rich food?
-bananas -dried fruits -spinach -avacado -potatoes
87
If a pt has no urine output, can you give potassium>
NO no p=no K
88
How much potassium can you give in a push in an hour?
10meq/hr
89
What should you think when you thing sodium imbalance
neuro
90
How fast can you correct sodium imbalance?
12meq/24 hours NO MORE THAN THAT can cause cerebral edema
91
How much ccs should you allow your pt to have if they are on a fluid restriction diet?
2000cc
92
What electrolyte is inverse to phosphorus?
Calcium If Ca is high, Ph is low vice versa
93
What kind of problem is sodium imbalance typically?
water problem
94
S/S Hyponatremia
-SEIZURES -headache -wt gain -edema -muscle cramps/twitching -confusion -lethargy
95
Interventions for hyponatremia
-sodium replacement -restrict oral fluid intake -daily wt I&O -NO HYPERTONIC SOLUTIONS= cerbral edema
96
What is the number 1 clinical symptom for hypernatremia?
THRIST
97
S/S hypernatremia
-lethargy -restlessness -irratibility -seizures -fever -hallucinations -thirst
98
Interventions for hypernatremia
-Initiate SEIZURE precautions -IV infusion of hypotonic or isotonic solutions Sodium restriction diet
99
What does hypokalaemia predispose a pt for?
digitalis toxicity
100
How much Potassium can you give in a central line per hour?
20meq per hour
101
What do you think when you hear potassium imbalance?
heart
102
What should you note about giving oral Potassium>?
it is recommended CAN NOT crush or chew
103
What diuretic spares Potassium?
aldactone
104
What should you keep your pt on 24/7 when having a potassium imbalance?
telemetry and frequent EKG
105
What are risk factors for Hypokalaemia?
-V/D -wound drainage -NG suction * if the body is losing fluids, its losing K+
106
What are S/S of hypokalaemia
-dysrrythmias flat or inverted T-waves
107
What is the MOST important electrolyte imbalance
HYPERKALEMIA
108
What type of pt is at the highest risk for hyperkalemia
kidney failure pts
109
What will you see on an EKG of a pt with hyperkalemia
Tall t-waves
110
What are risk factors for hyperkalemia
-renal failure -adrenal insufficiency -acidosis -excessive K+ intake -potassium sparing diuretics -ACE inhibitors
111
S/S of hyperkalemia
-muscle twitching and parathesia (early) -muscle weakness (late) -tall t waves
112
interventions for hyperkalemia
-initiate dialysis -kayexelate (makes pt shit it out) -50% glucose in insulin (will buy time but not fix the problem) -calcium glucontate (atagozies effects of k+, but does not get rid of it)
113
S/S for hypocalcemia
-tetany, cramps -parasthesia -+ Trousseau and Chovosteks -seizures
114
Interventions for hypocalcemia
-seizure precautions -IV calcium replacement -vitamin D therapy -calcium supplements - admin IV Ca slowly
115
What are some risk factors for Hypercalcemia
-hyperparathyroidism -malignant disease -vitamin D excess
116
S/S hypercalcemia
-muscle weakness -dysrrythmias -lethargy/coma -deep bone pain
117
Interventions for Hypercalcemia
-dialysis -cardiac monitoring -glucocorticosteriods (calcium channel blockers)
118
S/S for hypomagnesemia
-trousseau and chvosteks can be present -hyperreflexia -nausea/vomiting CHECK DTRs HYPERREFLEXES remember magnesium acts as a sedative, so if its low, then you will be restless and hyper
119
S/S of hypermagnesemia
-HYPOreflexes -too much magnesium can "sedate" the pt to much, so you must watch for things like: Low BP bradypnea cardiac arrest DTRs coma
120
Interventions for hypermagnesemia
-IV fluids: LR -IV calcium gluconate -loop diuretics - DTRs
121
What lab do you check for electrolytes?
CMP/BMP
122
What lab do you check for PH?
ABG
123
What should you do before you check an ABG?
Alans test to check for radial perfusion
124
If the pt is bleeding and needs more volume what do you give
BLOOD
125
What all is in the pre OP exam?
what brought them here review of systems comprehensive assessment
126
What effect does corticosteroids have on surgery
delay healing / Sudden CV collapse
127
What effect does insulin have on surgery
not eating in surgery, sugar could drop
128
What effect does anticoagulants have on surgery
bleeding
129
What effect does thyroid/hormone meds have on surgery
high tolerance f
130
Main nursing intervention for intraoperative care?
MAINTAIN AIRWAY
131
What degree should you keep the HOB when maintaining an airway?
15-30

Med Surg (2 decks)

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