Midterm 1 - Pre-Intra-Post Op - N&V - Hyperemesis Gravidarum - PUD- IBD Flashcards Preview

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Flashcards in Midterm 1 - Pre-Intra-Post Op - N&V - Hyperemesis Gravidarum - PUD- IBD Deck (38):
1

Informed Consent: RN's role

Advocate for Pt
Validating consent
Assessing capacity
May ask Pt to sign
May witness Pt signing
Clarifies the Pt's understanding and that they have all the info
Ensure Pt has not had psychoactive meds prior to signing consenting

2

Consent is valid if...

- Given freely - No coercion
- Pt is competent
- Should be in writing, but does not have to be
- Pt should be able to understand (consider lifespan)

3

Consent is required when...

Treatment is/involves:
- Invasive
- Radiation
- Risk
- Sedation

4

Who can sign a consent?

- 19+
- Mentally capable
- Surrogate if not of age or competent
- Emancipated minor
- Emergency-surgeon or physician if life-saving
-Child under the Infant's Act

5

Who can NOT sign a consent?

- Incompetent-not capable
- Not autonomous
- Cognitively impaired, mentally ill, neurologically incapacitated
- Unable to understand (language barrier)

6

Consent assessments

Assess:
-Capacity
-Age
-LOC - teach back
-Cognitive ability

7

Perioperative phases

- PreOperative
-IntraOperative
-PostOperative

8

PreOperative Nursing Assessments

- Physical
- Health Hx (fluid &nutritional status, vitamin & mineral levels, dentition - inutubation is aggressive and you can loose teeth)
- Emotional
- Support Systems (getting to and from Sx)
- Risk Factors
- Previous surgeries
- Meds
- Allergies
- Pain tolerance & hx
- Occupation, literacy & education

9

PreOp Cardiovascular

Pacemaker?
Stent?
HTN?
Coagulation > Warfarin?
PVD?
Cardiac PmHx?

Dx:
- ECG, platelets, coagulation & liver fx (coagulation factors production)

10

PreOp Respiratory

Resp Sounds
Fluid overload
Pulmonary edema
Pneumonia s+s
Comorbidities?
Smoking??? > 4-6 weeks no smoking preop is ideal
> affects wound healing

11

PreOp Neurological

Epilepsy
Depression
Anxiety
Stroke or TIA Hx
Mental Status
Bleeding disorders

12

Nursing Diagnosis related to PreOp

-At risk of infection due to the PreOp findings as evidenced by WBC count
- Actual Anxiety and fear preop due to...
- Knowledge deficit r/t complexity of treatment as evidenced by Pt's lack of knowledge about follow-up care
- Adverse physical response to anesthetics, medications as evidenced by...

13

Sx Risk Factors

- Age (old & young)
- Nutrition, dentition
- Obesity (dehiscence, hypoventilation, might need bigger doses - at risk for OD)
- Immune compromised (HIV/AIDS, chemo, steroids)
- Fluid & electrolyte status - K+!!!! If elevated arrhthmias
- Pregnancy - different meds & fluid status depending on stage
- Illicit drug use
- Smoking - higher risk of clots, infection, poor healing
- Psychiatric/delirium Hx
- Other Meds (insulin, anti-coags, withdrawal)
- Bleeding disorders
- Diabetes
- Heart Disease
- Respiratory disease or infection
- Hepatic disease
- Comorbidities
- Chronic pain

14

IntraOperative Complications

Nausea and vomitting
Anaphylaxis
Hypoxia and respiratory complications
Hypothermia
Malignant Hyperthermia
DIC (disseminated intravascular coagulation)

15

Nursing goals in the intraoperative period?

- Reduce anxiety
- Prevent position injury
- Maintain Pt safety - maintain sterility
- Pt advocate
- Avoid complications

16

IntraOp: How to protect Pt from injury?

- Pt identification
- Correct informed consent
- Verify medical records of health hx
- Allergies
- Monitor physical environment
- Verification and accessibility of blood

17

General Anaesthetics

Drugs that induce a state in which the CNS is altered so that degrees of pain relief, depression of consciousness, skeletal and reflex reduction are produced.

Used for:
- Deep muscle relaxation
- Loss of consciousness during surgery

18

Inhaled anaesthetics

Volatile liquids or gases that are vaporized in O2

19

IV anaesthetics

Used for induction or maintenance of general anaesthesia, amnesia and as an adjunct to inhalation

20

Types of Anaesthesia

General anaesthetics - propofol
Sedatives-hypnotics - barbiturates and benzodiazepines
Narcotics - morphine sulfate, fentanyl and surfentanyl
Neuromuscular Junction Blockers - succinylcholine

21

Benzodiazepines

- Sedative-hypnotic drug
- Anxiolytic
- Ability to depress activity in the CNS (GABA)
- Calming effect in the CNS
- Anticonvulsant
- ETOH withdrawal prevention

22

Antiacids drug interactions

Adsorption - decreases the ability of absorption of other drugs
Chemical - inactivation of other drugs
Increased stomach pH - may increase absorption of basic drugs over acidic drugs
Increased urinary pH- may increase the excretion of acidic drugs and decrease the basic drugs

23

Antidiarrheals types

-Adsorbents - act by coating the GI walls and binding to the causative agent to promote its excretion
- Anticholinergic - slows peristalsis by decreasing the rhythmic contractions and smooth muscle tone
- Probiotics - replenish bacteria and normal flora
- Opiates - decrease bowel motility, increasing the time of transit of food in the GI tract increasing its absorption ( H2O and lytes)

24

Antiemetics types

- Anticholinergic (scopolamine): motion sickness, secretion reduction, N&V
- Antihistamines H1 (dimenhydrinate & diphenhydramine): motion sickness, non productive cough, sedation, rhinitis, allergy, N&V
- Neuroleptic (prochlorperazine): psychotic disorders, N&V (dopamine blocker)
- Prokinetic (metoclopramide): delayed gastric emptying, GERD, N&V
- Serotonin blocker (ondansetran): N&V associated with postop and chemo CA
- Tetrahydrocannaboids (THC): N&V with CA chemo, anorexia and weight loss in AIDS

25

Recovery room nurse’s assessments

Q15min skilled focused assessments
Airway maintenance
Preventing hypoxemia & hypercapnia
Cardiovascular stabilization
Managing acute pain
Controlling nausea & vomiting postop
Relieving anxiety

26

PCA Assessments

Pain level
VS
Sedation?
Respiratory Fx
SE - N&V, pruritus
Insertion site assessm
Bladder Fx
Motor Fx
Sensory Fx

27

PCA: Patient Controlled Analgesia

Effective way to control pain
Increases Pt’s feeling of control
Less dose than IM route
Pt needs to be cognitively aware
Needs a functioning IV
Lock-out system so Pt can not overdose
Only Pt can press button - NOT family
Teaching pre-op is essential

28

PostOp Exercises

- Early ambulation
- Pain management - cautions with sedation or hypotension
- Just don’t ask Pt if exercise was done, do it with them :)
- Refer to pre-op teaching of postop exercises and why

29

Fluid Volume Overload S&S

JVD
Increased BP
Adventitious LS
Extra heart sounds (S3)
Resp distress
Bounding pulse
Peripheral edema
Rapid weight gain

Monitor I&O and VS

30

Complications of N&V

Aspiration
Dehydration
Malnutrition
Disruption of surgical site
Metabolic disturbances
Increased ICP
Stress/Anxiety

31

N&V: Non-Pharmacological Interventions

- Gentle diet
- Ginger, peppermint
- Relaxation, music, distraction
- Cool cloths
- Positioning
- Aromatherapy?

32

Hyperemesis Gravidarum: s+s & complications

Dehydration
Malnutrition (can lead to Wernicke's encephalopathy)
Metabolic disorders (Ketosis)
Stress and extreme fatigue
Fetal Growth Restriction
DVT r/t increased Hematocrit and immobility

33

Hyperemesis Gravidarum Tx

IV Rehydration
- Electrolytes
- B1 (thiamine), B6 (pyridoxine)
- TPN in severe cases, PICC lines used

Medication:
- Antiemetics (promethazine)
- folic acid thiamine, iron
- LMWH (dalteparin)

34

Pediatrics: N and V, Diarrhea

Immature kidneys - less concentrated urine
Infants and children become dehydrated FAST
Dehydration becomes a medical emergency > can lead to kidney failure, cardiac collapse, death

35

Pediatrics: N and V, Diarrhea Assessments

Dry mouth
< urine
Weight loss
Diarrhea: watery? bloody?
Sunken fontanelles in babies
Loss of tears
Sunken eyes
Rapid, deep resps (acidosis)
Cold extremities
Rapid weak pulse
Cyanosis
Loss of skin turgor

36

IBD Management

- Reduce inflammation
- Suppress inappropriate Immune responses
- Rest the bowel (food, diet, Sx intervention)
- Correct fluid and electrolytes
- Nutritional therapy
- Prevent complications - fistulas, ulcerations, toxic megacolon

37

Steroids Side effects

- increased blood glucose
- decrease IR --- >increasing risk of infection
- decreased inflammatory response
- decreased wound healing
- weight gain/facial swelling
- increased risk of ulcers
- electrolyte disorders
- mood disorders

38

Steroids: Nursing considerations

- monitor for potencial hyperglycemia
- give oral steroids with food if possible
- monitor for signs of infection
- Monitor for skin breakdown (poor wound healing)
- Monitor electrolytes
- Monitor for mood or behavioural changes