Midterm 1 - Pre-Intra-Post Op - N&V - Hyperemesis Gravidarum - PUD- IBD Flashcards
(38 cards)
1
Q
Informed Consent: RN’s role
A
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
Q
Consent is valid if…
A
- 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
Q
Consent is required when…
A
Treatment is/involves:
- Invasive
- Radiation
- Risk
- Sedation
4
Q
Who can sign a consent?
A
- 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
Q
Who can NOT sign a consent?
A
- Incompetent-not capable
- Not autonomous
- Cognitively impaired, mentally ill, neurologically incapacitated
- Unable to understand (language barrier)
6
Q
Consent assessments
A
Assess:
- Capacity
- Age
- LOC - teach back
- Cognitive ability
7
Q
Perioperative phases
A
- PreOperative
- IntraOperative
- PostOperative
8
Q
PreOperative Nursing Assessments
A
- 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
Q
PreOp Cardiovascular
A
Pacemaker? Stent? HTN? Coagulation > Warfarin? PVD? Cardiac PmHx?
Dx:
- ECG, platelets, coagulation & liver fx (coagulation factors production)
10
Q
PreOp Respiratory
A
Resp Sounds Fluid overload Pulmonary edema Pneumonia s+s Comorbidities? Smoking??? > 4-6 weeks no smoking preop is ideal > affects wound healing
11
Q
PreOp Neurological
A
Epilepsy Depression Anxiety Stroke or TIA Hx Mental Status Bleeding disorders
12
Q
Nursing Diagnosis related to PreOp
A
- 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
Q
Sx Risk Factors
A
- 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
Q
IntraOperative Complications
A
Nausea and vomitting Anaphylaxis Hypoxia and respiratory complications Hypothermia Malignant Hyperthermia DIC (disseminated intravascular coagulation)
15
Q
Nursing goals in the intraoperative period?
A
- Reduce anxiety
- Prevent position injury
- Maintain Pt safety - maintain sterility
- Pt advocate
- Avoid complications
16
Q
IntraOp: How to protect Pt from injury?
A
- Pt identification
- Correct informed consent
- Verify medical records of health hx
- Allergies
- Monitor physical environment
- Verification and accessibility of blood
17
Q
General Anaesthetics
A
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
Q
Inhaled anaesthetics
A
Volatile liquids or gases that are vaporized in O2
19
Q
IV anaesthetics
A
Used for induction or maintenance of general anaesthesia, amnesia and as an adjunct to inhalation
20
Q
Types of Anaesthesia
A
General anaesthetics - propofol
Sedatives-hypnotics - barbiturates and benzodiazepines
Narcotics - morphine sulfate, fentanyl and surfentanyl
Neuromuscular Junction Blockers - succinylcholine
21
Q
Benzodiazepines
A
- Sedative-hypnotic drug
- Anxiolytic
- Ability to depress activity in the CNS (GABA)
- Calming effect in the CNS
- Anticonvulsant
- ETOH withdrawal prevention
22
Q
Antiacids drug interactions
A
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
Q
Antidiarrheals types
A
- 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
Q
Antiemetics types
A
- 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
