sem 2 exam 2 Flashcards by britt rank

IV where

Used for:
Long Term Therapy
All IV Therapies
Blood Draws
Bad peripheral veins
Large fluid volumes
Total parenteral nutrition (only IV nutritional supplement)

Central Lines

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Potassium (Normal Value: )

3.5-5.0 mEq

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Clinical Manifestations :

Anorexia, N/V
Weakness
Lethargy
Confusion, headache
Muscle cramps/twitching
Seizures
Coma

Hyponatremia

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Type of Anesthesia where

Administration of drugs by inhalation, intravenous, rectal, or oral route

a patient loses all sensation, consciousness, and reflexes, including gag and blink reflexes.

involves major procedures with extensive tissue manipulation

General

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Bowel Diversion

Injuries
Cancer
Perforated Diverticulitis
Fistulas

Colostomy

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same concentraion as plasma

action: fluid stays in the vessels, no gain/ loss of fluids at the cellular level

isotonic

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Classic Signs

Erythema, warmth, edema, drainage, and discomfort

IV site infection

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Pooling of blood into subcutaneous tissues around the venipuncture site.

Hematoma

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Type of Cleansing Enema that

Irritate mucosa
Distends the colon

Soap suds

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Phase of General Anesthesia

—starts when patient emerges from anesthesia and is ready to leave operating room

Emergence

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Nurses signature on informed consent indicates what 2 things

Patient signed without coercion

2. Patient was alert & aware (competent)

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Central Lines _____ side prefereed

Left

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How well are the lungs excreting CO2?

PaCO2

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Catheter “broke” off an tip entered the circulatory system

Rare but deadly.

Pain at site, decreased BP, weak rapid pulse, cyanosis

Severed Catheter

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2 Metabolic Alkalosis causes

Increase of bicarbonate

Loss of metabolic acid

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Restores function lost or reduced as result of congenital anomalies

Constructive

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No BM in 3 days- act on/before day 2

Constipation-

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How well are the kidneys excreting metabolic acids? High: the blood has too few metabolic acids. Low: too many metabolic acids.

HCO3

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Type of Medicated Enema that

Not for stool, but to remove potassium rapidly!

Kayexalate

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Post-Op Stoma Care requires

Low-______ diet first few weeks

fiber

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potassium Less than 3.5 mEq

Hypokalemia

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Clinical Presentation:
Seizures
Headache
Dysrhythmias

Metabolic Alkalosis

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: constipation, too much water reabsorbed, dry stools

Delayed transit times

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Pain at access site with erythema or edema

is a grade __ on the Phlebitis Scale

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type of IV Solution that Uses Intracellular/cellular hydration Fluid management for a patient who is both volume-depleted and hyperosmolar

Hypotonic

Loss of more water than sodium Hypertonic imbalance Water deficit ECV Deficit + Hypernatremia Gastroenteritis (Severe N&V) clinical dehydration

Hypovolemia

No symptoms is a grade __ on the Phlebitis Scale

``` Clinical Manifestations: - + Chvostek’s sign - + Trousseau’s sign Numbness/tingling Muscle twitch Cramping Hyperactive reflexes Tetany Seizures ```

Hypocalcemia

interventions ``` Restrict Na & H2o Promote excretion Strict I&O Daily weight Assessment (including vital sign, respiratory and skin) Raise HOB Skin care: protect edematous tissue Monitor labs Patient teaching ```

HYPERVOLEMIA

Type of Anesthesia where involves loss of sensation at the desired site by inhibiting peripheral nerve conduction commonly used in ambulatory surgery can also be used in addition to general or regional anesthesia patient experiences a loss in pain and touch sensation and motor and autonomic activities

Local anesthesia

Increase in the number of stools and the passage of liquid, uniformed feces Often intestinal cramping Usually a protective response Large amounts of fluids and electrolytes lost places person at risk for complications: Fluid & Electrolyte Imbalances Infants, young children, elderly at greatest risk Skin excoriation and breakdown

Diarrhea

often a symptom of illness/infection

Diarrhea-

Pain at access site with erythema and edema, streak, palpable cord>1 inch in length & purulent drainage is a grade __ on the Phlebitis Scale

Lab Values for ________ - Increased serum osmolality - Increased specific gravity

Hypernatremia

- Excess or trapped gas Can result from slowed motility Gas- can be painful, embarrassing

Flatulence

``` Clinical Presentation: Tachycardia Pulmonary Edema Tachypnea Confusion Coma ```

Metabolic Acidosis

Nuts, beans Canned entrees Frozen bread, meals Smoked/cured/canned meat and poultry are all rich in ______

Sodium

Bowel Diversion Injuries: Gunshot, MVA Familial Polyposis Cancer Inflammatory Diseases Ulcerative colitis Crohn’s Disease

Ileostomy

nursing interventions for patients who are receiving IV potassium: Dilute potassium in an IV bag: NEVER give_____ (can result in cardiac arrest)

IV Push

Spicy foods- increase _______ time

transit

Fluid reservoir is surgically inserted in a subcutaneous pocket(usually upper chest) with catheter via the internal jugular or subclavian vein with the tip resting in the superior vena cava All IV Therapies can be administered through the port Have a low infection rate Has cosmetic advantages Must use non-coring needle to access

Implanted Ports

Calcium (Normal Value: )

9-10.5 mEq

Signs and Symptoms: | Change in Vital Signs, fever, chills, rash, hypotension, shock

Blood Transfusion Reactions

type of IV Solution that Examples: 0.9%NS Lactated Ringers (LR) D5W (note: D5W is the low end of isotonic, this can also be considered hypotonic)

Isotonic

Clinical Manifestations ``` Increased pulse Increased BP Increased RR JVD SOB, crackles, cough, hypoxia (Pulmonary Edema) Increased weight Increased edema Muscle weakness Confusion, lethargy, change in LOC (seizures, coma) ```

HYPERVOLEMIA

Not enough oxygen rich blood circulating - the acid in the blood is not used and builds up

Metabolic Acidosis

Regulates amount of water in the body Helps with electrical signals in the brain, nervous system and muscles

Sodium

—onions, cabbage, beans, cauliflower

Gas-producing foods

high pH | high HCO3

Metabolic Alkalosis

Antibiotic therapy is vigorously initiated if blood cultures verify a __________ condition.

septicemia

Type of Cleansing Enema that Draws water into colon

Hypertonic (Fleet phosphate)

Not enough fiber in the diet Lack of physical activity (especially in the elderly) Some medications – opioids, pain medications Milk , cheese (except in lactose intolerance, allergy) Irritable bowel syndrome Changes in life or routine such as pregnancy, aging, and travel Abuse of laxatives Ignoring the urge to have a bowel movement Dehydration Specific diseases or conditions, such as stroke (most common) Problems with the colon and rectum

Causes of Constipation

Type of Cleansing Enema that Distends the colon Stimulates peristalsis Softens feces

Hypotonic (tap water)

6 Hypocalcemia causes

- Renal failure - Hypoparathyroidism - Malabsorption: ie chronic diarrhea, steatorrhea - Pancreatitis - Alkalosis - Thyroid surgery (parathyroids removed or damaged)

potassium Greater than 5 mEq

Hyperkalemia

causes: | vein has ruptured allowing vesicant to seep into surrounding tissues

Extravasation

Skeletal structure and function (bone and teeth health) Transmitting signals through the body

Calcium

Surgically placed (not PICC) Placement verified by x-ray (Superior Vena Cava) Sterile dressings and technique Flushing and Locking per facility policy Complications include: Central Line Infection, pneumothorax, hemothorax, cardiac perforation,

Central Lines

size of catheter for Most medical/surgical patients, daily use

20-24 gauge

—fruits and vegetables, bran, chocolate, alcohol, coffee

Foods with laxative effect

Not breathing adequately- not exhaling means that you are not getting rid of excess CO2

Respiratory Acidosis

HCO3 normal range

22-26

(not blowing off the CO2).

High: hypoventilation

5 Methods of Emptying the Colon of Feces

``` Cathartics and Laxatives Enemas Rectal suppositories Fecal Management tube system Digital removal of stool ```

Potassium is the main intracellular ion for all cell types. Responsible for action potential of the cells (potassium/sodium ion channel)

Potassium

involves physiological changes that help normalize the pH but do not correct the cause of the problem

compensation

2 Advance Directives

Living wills Durable power of attorney

Blowing off too much CO2 - not enough CO2 in the blood (eventually the body will start to compensate)

Respiratory alkalosis

6 Hyperkalemia interventions

Interventions: - Eliminate parenteral potassium - Kayexalate - Monitor EKG - Administer calcium gluconate to protect the heart - IV loop diuretics - Renal dialysis

Clinical Manifestations: - F: fever/flushed dry skin - R: restless - I: Increased fluid retention - E: Edema - D: Decreased urine output - Seizures - Irritability/hallucinations - Thirst, sticky mucus membranes

Hypernatremia

type of IV Solution that ``` Uses: Correct fluid volume deficit in the vascular system Treatment of vascular dehydration Fever Labor Running ```

Isotonic

Daily Average Fluid Intake Oral ( - ) Foods ( - ) Metabolism ( )

1100 – 1400 mL 800-1100 mL 300 mL

Base Excess normal range

-2 to +2

nursing interventions for patients who are receiving IV potassium: Check renal status: at least ___ml of urine output per day

600

A hematoma around an artery or vein is dangerous because pressure from the expanding hematoma obstructs_________

blood flow.

Relieves or reduces intensity of disease symptoms; does not produce cure

Palliative

Sodium (Normal Value: )

135-145 mEq

Lab Values Decreased HGB & HCT Decreased Na Decreased Serum Osmolality Decreased BUN

Fluid Volume Excess HYPERVOLEMIA

5 Hyponatremia causes

causes: - Diuretics - GI fluid loss - Hypotonic tube feedings - Hypotonic IV fluids - Diaphoresis

less concentrated than plasma action:fluid shifts from plasma into the cells

hypotonic

Daily Average Fluid Output Skin ( - ) Insensible- Lungs ( ) GI ( - ) Urine ( - )

Skin (500 – 600 mL) Insensible- Lungs ( 400 mL) GI (100-200 mL) Urine (1200 – 1500 mL)

Classification of Surgical Procedure where Diagnostic, ablative, palliative, reconstructive, transplantation, constructive

Purpose

FLUID SPACING Abnormal Trapped, cannot be easily exchanged with the ECF ACITES EDEMA (a/w burns, trauma, sepsis)

3rd

Type of Anesthesia where Used on mucous membranes, open skin, wounds, burns

Topical anesthesia

Respiratory alkalosis cause

Deep and Fast Breathing!

Classification of Surgical Procedure where Major Minor

Risk

(blowing off too much CO2).

Low: hyperventilation

``` Clinical presentation: Altered LOC Tachycardia Diaphoresis Headache ```

Respiratory Acidosis

size of catheter for Trauma, large volume at a rapid rate

14-16 gauge

Peripheral Catheter are for what durration

short term

4 Interventions for Hypernatremia

- Restrict sodium intake in diet - Increased water intake - Dietary education: beware of hidden sodium in foods - Seizure precautions-

Age/Developmental considerations Personal Habits/Daily patterns-when, where, how often, position during defecation Food and fluid intake Physical Activity and muscle tone Lifestyle, psychological variables Pathologic conditions (disease, pain, pregnancy) Medications Diagnostic tests Surgery and anesthesia

Variables Influencing Bowel Elimination

2 Metabolic Acidosis causes

Increase of metabolic acids | Loss of bicarbonate

type of IV Solution that Caution (do not use in) Cerebral/peripheral edema

Hypotonic

FLUID SPACING Abnormal Accumulation in the interstitial spaces EDEMA

2nd

nursing interventions for patients who are receiving IV potassium: Patient should receive no more than __mEq/hr

Blood Transfusion Reactions Treatment: give __________, prepare for emergency drugs; save tubing

Normal Saline

5 thing for Promoting Regular Bowel Habits

Timing – after meals and exercise Positioning—commode or toilet vs bedpan- if a bedpan in necessary- make sure you sit the HOB to a 90 degree angle to facility proper positioning of bowel elimination Privacy Nutrition— fluids, fiber, fruits and veggies Exercise Abdominal settings Thigh strengthening

Blood Transfusions 9 step Process

Verify physician order; Obtain Consent Patient must have a type and cross-match blood sample performed Large bore catheter: 18 gauge Administer with 0.9% Normal Saline Baseline vital signs, hold and notify if abnormal Pre-medication may be ordered: Diphenhydramine, Acetaminophen Begin transfusion slowly- watch for reactions Observe closely for first 15 min- Stop immediately if any sign of reaction Blood may not hang longer than 4 hours

Type of Cleansing Enema that Distends the colon Stimulates peristalsis Softens feces

Isotonic (Normal saline)

Acidic (acidosis): too much acid | pH lower than ______

7.35

PaCO2 normal range

34-45

Collection of hardened feces/stool in the rectum Often liquid stool is symptom. Results from unrelieved constipation Ask when the last normal formed bowel movement was

Impaction

Too much bicarbonate - not enough acid

Metabolic Alkalosis

low pH | low HCO3

Metabolic Acidosis

Symptoms: swelling, change in color, sensation, or warmth or mass, that often takes on a bluish coloration.

Hematoma

``` Clinical Manifestations: - Fatigue - Anorexia, N/V - Muscle weakness - Decreased GI motility Dysrhythmia Parasthesia Flat T waves on EKG ```

Hypokalemia

: Balance between fluid intake and absorption, fluid distribution and fluid output

Fluid Homeostasis

6 Hypercalcemia interventions

- Decreased calcium intake (no antacids) - Increased fluid intake - Weight bearing exercises - Tx constipation - Renal dialysis if severe - Give calcitonin to decrease calcium level

6 Hyperkalemia causes

- Hemolyzed serum sample (in lab) - Oliguria - Acidosis - Renal failure - Addison disease - Multiple blood transfusions

Rehydration is most important Skin care-use protectant lotion for all incontinence, especially diarrhea! Protect the skin! Anti-diarrheal meds usually after bacteria is ruled out

Treatment of Diarrhea

type of IV Solution that Caution: Should be used with extreme caution Used cautiously in patients with cardiac and renal failure

Hypertonic

loose stools, diarrhea, less absorption of nutrients, less water reabsorbed

Rapid transit times:

1/3 to 1/2 of food waste is excreted in stool within ___ hours (“normal” transit time)

Pouches and Barrier where | —you take the whole thing off each time you want to throw away the bag

One-piece

—cheese, lean meat, eggs, pasta

Constipating foods

Pain at access site with erythema or edema plus streak formation and palpable cord is a grade __ on the Phlebitis Scale

type of IV Solution that Examples: 3% NS D5W/0.9%NS D5W/LR

Hypertonic

Surgical exploration that allows health care providers to confirm diagnosis; often involves removal of tissue for further diagnostic testing

Diagnostic

—lasts from admission to recovery room to a follow-up evaluation in the clinical setting or home.

Postoperative

size of catheter for Surgical patient, rapid administration of fluids and blood products

18 gauge

Infiltration Score where blanching, cool to touch, edema 1-6 inch

Vein is hard to touch and painful – positive ________

phlebitis

IV where Therapy will continue for 1 month or more Therapy includes administration of a vesicant infusion or long-term antibiotic therapy

Peripherally inserted central catheter (PICC)

Type of Anesthesia where Anesthetic agent injected near a nerve or nerve pathway or around operative site. No sedation. protect a patient's limbs from injury until sensation returns. results in loss of sensation in an area of the body by anesthetizing sensory pathways

Regional

Blood Transfusion Reactions caused by what two things

Blood incompatibility Allergic sensitivity

Classification of Surgical Procedure where Elective, urgent or emergency

Urgency

Causes: puncture of the back wall of the vein, leakage from venipuncture site, too rapid reapplication of tourniquet

Hematoma

Peripherally inserted central catheter (PICC) | Must end up in the ________

superior vena cava

causes Intake Decreased PO intake Decreased Na intake Inability to drink/express thirst Output Diarrhea, vomiting Profuse sweating, drainage Hemorrhage Drugs Diuretics, laxatives Diseases Renal disease Third spacing: burns

Hypovolemia

5 Hypernatremia causes

- Increased salt intake - Hypertonic IV solutions - Decreased renal excretion - Corticosteroids - Water loss

sodium Greater than 145 mEq

Hypernatremia

—extends from admission to surgical department to transfer to recovery room

Intraoperative

type of IV Solution that Examples 0.2% NS 0.45% NS D5W

Hypotonic

``` Potatoes Orange juice Avacados Strawberries Spinach Ish (FISH) Ushroom (mushroom) Melons (cantaloupe) ```

Potassium

interventions Replace fluids!!! Assess, assess, assess! ``` Hypovolemic: Isotonic solution (stays in the vessels to increase BP) ``` Clinical Dehydration: Oral or IV replacement (Hypotonic solution because of hemoconcentration)

Hypovolemia

Signs and Symptoms | Fever, chills, prostration, pain, headache, nausea, and vomiting

Septicemia

Less than 135 mEq of sodium

Hyponatremia

Infiltration Score where blanching, cool to touch, edema >6 inches pitting, Moderate to severe pain, Circulatory impairment

Blood Transfusion Reactions Anaphylactic Reaction is promptly treated with _______,_____________ & _______________

antihistamines, steroids, and epinephrine

nursing interventions for patients who are receiving IV potassium: Make sure there is no more than __mEq in a one liter bag of IV fluids

3 Hypokalemia interventions

Interventions: -Administer potassium supplement PO can have a bad taste and be irritating to the GI tract IV must be well diluted and NEVER given as a bolus - Assess renal status (UOP) prior to giving supplemental potassium - Encourage foods rich in potassium

causes INTAKE Increased fluid intake Rapid isotonic IV fluids Increase consumption of salty foods Output Increased retention of H2O or H2O+ salt Kidney Disease Aldosterone Drugs Corticosteroids Diseases Kidney, heart and liver failure

Fluid Volume Excess HYPERVOLEMIA

Pouches and Barrier where —you can leave the wafer on the skin, and change only the bag

Two piece

A systemic infection occurs from pathogens introduced into the circulating bloodstream.

Septicemia

Hard, dry stool; difficult to eliminate. Low or inactive bowel sounds Excessive straining, bloating, and the sensation of a full bowel. Very common. Over 2 million MD visits/year! Women; adults over 65; during pregnancy Assess for paralytic ileus if patient has had surgery, anesthetic- especially bowel surgery!

Constipation

dilated, engorged veins in lining of rectum Internal or external, painful needing treatment as to not interfere with normal bowel habits

Hemorrhoids

4 Respiratory Acidosis causes

- Insufficient ventilation - Impaired gas exchange - Impaired neuromuscular function - Dysfunction of brainstem respiratory control

type of IV Solution that Uses: Treat intravascular dehydration with interstitial or cellular over-hydration Third spacing

Hypertonic

3 ways Blood Gas is measured?

Arterial Venous Capillary

Type of Enema that - lubricates and softens stool

Oil Retention

Excision or removal of diseased body part

ablative

Erythema at access site with or without edema is a grade __ on the Phlebitis Scale

Accidental administration of a non-vesicant solution into subcutaneous tissues. The severity of the swelling is measured an a standardized scale

Infiltration

Restores function or appearance to traumatized or malfunctioning tissues

Reconstructive/restorative

are pairs of chemicals that work together to maintain normal pH of body fluids. If there are too many free H+ ions, a buffer takes them up so they no longer are free. If there are too few, can release H+ ions to prevent an acid-base imbalance

Buffers

Measure gas exchange and oxygenation. Low: poor oxygenation of the blood

PaO2

Viruses and Bacteria from people or surfaces Clostridium difficle – wash your hands! Can not be removed by hand sanitizers- must use soap and water Medications: Antibiotics Patients receiving enteral nutrition Food Allergies and Intolerances Communicable foodborne pathogens

Diarrhea Causes

Phase of General Anesthesia —from incision to near completion of procedure

Maintenance

Type of Anesthesia where Used for short-term procedures, diagnostic, and therapeutic procedures that do not require complete anesthesia but rather a depressed level of consciousness

Conscious sedation

low pH | high PCO2

Respiratory acidosis

For optimal cell function, the arterial pH of an adult is _______-_______

7.35-7.45

Infiltration of a vesicant medication or solution that causes destruction by chemical injury and/or severe vasoconstriction.

Extravasation

Type of Medicated Enema that before colon surgery

Neomycin

``` Clinical Manifestations: - Muscle weakness - Bradycardia Dysrhythmias Flaccid paralysis Intestinal colic Tall T waves on EKG ``` ``` M-muscles weakness U- urine output decreased R- respiratory failure D- decreased cardiac contractility E- early muscle twitching R- rhythem changes ```

Hyperkalemia

Lentils Beef Almonds Milk, cheese, yogurt are all rich in

Calcium

size of catheter for Small children, Older adults, small vein access

22-24 gauge

clinical manifestations ``` Thready pulse Decreased BP, Increased HR, Increased RR Decreased Cap Refill, cool clammy skin, poor skin turgor Hypoxia Weak, dizzy Decreased Weight Increased thirst Decreased urine output Confusion, changes in LOC, lethargy (seizures, coma) ```

Hypovolemia

Is a measurement of the body’s ability to buffer acid/base balance. Below -2: excessive metabolic acids. Above +2: excessive amounts of bicarbonate

Base Excess

Type of Enema that - to relieve flatus (gas)

Return-flow/Carminative/Cathartics

First sign of IV infection is ____

pain

Lab Values: - Decreased serum osmolality - Decreased urine specific gravity

Hyponatremia

Removal of organs and/or tissues from a person pronounced brain dead for transplantation into another person

Procurement for transplant

Type of Enema that To relieve constipation or impaction, to empty for surgery, to clear out for exams, to establish bowel function during training

Cleansing

when Administering Parenteral Fluids, Monitor site every __ to __ hours or as per policy

1 to 2 hours

Signs and symptoms Statement of “not feeling right” Chills, fever, low back pain, pruritus, Hives/Rash, hypotension, nausea and vomiting, decreased urine output, hematuria, chest pain, dyspnea, shock

Blood Transfusion Reactions

—begins with decision to have surgery, lasts until patient is transferred to operating room

Pre-operative

Alkaline (alkalosis): not enough acid | pH higher than _______

7.45

State of relative constancy in the internal environment of the body; maintained naturally by physiological adaptive mechanisms

homeostasis

6 causes of Hypercalcemia

- Increased calcium intake - Decreased kidney excretion - Prolonged immobilization - Hyperparathyroidism - Decreased calcitonin - Bone disease

calcium Greater than 10.5 mEq

Hypercalcemia

Loss of water and electrolytes OR Isotonic Loss Fluid Volume Deficit decrease in ECF

Hypovolemia

calcium Less than 9 mEq

Hypocalcemia

Inability to control passage of feces/gas from anus Can be neurological in nature

Incontinence

PaO2 normal range

80-100

If the infused blood is not compatible with the patient’s blood type, an acute _____ reaction will occur.

hemolytic

3 Hypocalcemia interventions

- Increased calcium and Vitamin D - Seizure precautions - Quiet environment

4 Hyponatremia interventions

Interventions: - Restrict fluid intake (if that is the cause of the hyponatremia) - Replace sodium - Hypertonic IV fluids (infuse slowly) - Seizure precautions

Reduces length of hospital stay and cuts costs Reduces stress for the patient May require additional teaching and home care services for certain patients Older patients, chronically ill patients, patients with no support system

Ambulatory Surgery

Infiltration Score where blanching, cool to touch, edema > 6 inches, Mild to moderate; numbness

6 cause of Hypokalemia

- Diuretics - Diarrhea - Vomiting - Gastric suction - Steroid administration - Bulemia D- drugs (steroids, diuretics, laxatives) I- inadequate intake (nothing by mouth, anorexic) T- too much (water, base, insulin) C- Cushing syndrome H- heavy fluid loss (suctioning)

Clinical presentation: Numbness Muscle twitches Seizures

Respiratory alkalosis

Large Lumen Catheter surgically placed into a central vein (subclavian or internal jugular)

Central Lines

Fluid Volume Excess

HYPERVOLEMIA

high pH | low PCO2

Respiratory alkalosis

Symptoms: swelling, redness, pain, blisters

Extravasation

8 things on Informed Consent Information

Description of procedure and alternative therapies Underlying disease process and its natural course Name and qualifications of person performing procedure Explanation of risks and how often they occur Explanation that patient has the right to refuse treatment or withdraw consent Voluntary Agreement Legal document with ethical imperatives Person performing surgery obtains consent (usually MD) Nurse Witnesses

Phase of General Anesthesia —from administration of anesthesia to ready for incision

Induction

FLUID SPACING Normal Between ICF & ECF

1st

more concentrated than plasma action: fluid shifts from the cells into the plasma

hypertonic

``` Clinical Manifestations: - Muscle weakness - Constipation - Anorexia, N/V - Dysrhythmias - Neurosis Diminished reflexes Renal calculi (flank pain) ```

Hypercalcemia

Central Lines watch for what 6 things

Watch for: SOB, chest pain, cough, hypotension, tachycardia, anxiety after or during insertion

This results from mechanical irritation (the needle moving in the vein), the low pH of some IV solutions, and highly concentrated additives.

Phlebitis

Blood clotting Muscle contraction

Calcium

lab values ``` Increased Na Increased HGB & HCT Increased serum osmolality Increased BUN Increased urine specific gravity ```

Hypovolemia

Infiltration Score where blanching, cool to touch, edema < 1 inch

Reduces length of hospital stay and cuts costs Reduces stress for the patient May require additional teaching and home care services for certain patients not good for Older patients, chronically ill patients, patients with no support system

Ambulatory Surgery

reflects the electrical activity of the conduction system. monitors the regularity and path of the electrical impulse through the conduction system; however, it does not reflect the muscular work of the heart.

An electrocardiogram (ECG

measures red blood cell count; volume of red blood cells; and concentration of hemoglobin, which reflects patient's capacity to carry O2.

Complete blood count

to determine the type of IV fluids and electrolyte additives to administer before and during surgery.

serum electrolyte levels

Includes a number of tests that are used for screening and are diagnostic for fluid and electrolyte disturbances, urinary tract infection, presence of blood and other metabolic problems

urinalysis

Nurse’s Role in Presurgical Screening Ensure_______are explained to the patient Ensure ______ are recorded in patient records before surgery Ensure that________ are reported

tests results abnormal results

type of Medications such as warfarin (Coumadin) or aspirin alter normal clotting factors and thus increase risk of hemorrhaging. Discontinue at least 48 hours before surgery.

Anticoagulants

type of Medications that enhance action of anesthetic agents. If taken within 2 weeks before surgery, aminoglycosides (gentamicin, neomycin, tobramycin) may cause mild respiratory depression from depressed neuromuscular transmission.

Antibiotics

type of Medications (e.g., beta blockers) can reduce cardiac contractility and impair cardiac conduction during anesthesia.

Antidysrhythmics

type of Medications Long-term use | alters metabolism of anesthetic agents.

Anticonvulsants

type of Medications such as beta blockers and calcium channel blockers interact with anesthetic agents to cause bradycardia, hypotension, and impaired circulation. They inhibit synthesis and storage of norepinephrine in sympathetic nerve endings

Antihypertensives

type of Medications cause adrenal atrophy, reducing the ability of the body to withstand stress. Before and during surgery, dosages are often increased temporarily.

Corticosteroids

type of Medications potentiate electrolyte imbalances (particularly potassium) after surgery.

Diuretics

type of Medications (e.g., ibuprofen) inhibit platelet aggregation and prolong bleeding time, increasing susceptibility to postoperative bleeding.

NSAIDs

is an RN who does not scrub in and uses the nursing process in the management of patient care activities in the OR suite. also manages patient positioning, antimicrobial skin preparation, medications, implants, placement and function of IPC devices, specimens, warming devices, and surgical counts of instruments and dressings

. The circulating nurse

is either an RN or surgical technologist who is often certified (CST). must have a thorough knowledge of each step of a surgical procedure and the ability to anticipate each and every instrument and supply needed by the surgeon

scrub nurse

sem 2 exam 2 Flashcards

(222 cards)