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
Potassium (Normal Value: )
3.5-5.0 mEq
Clinical Manifestations :
- Anorexia, N/V
- Weakness
- Lethargy
- Confusion, headache
- Muscle cramps/twitching
- Seizures
- Coma
Hyponatremia
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
Bowel Diversion
Injuries
Cancer
Perforated Diverticulitis
Fistulas
Colostomy
same concentraion as plasma
action: fluid stays in the vessels, no gain/ loss of fluids at the cellular level
isotonic
Classic Signs
Erythema, warmth, edema, drainage, and discomfort
IV site infection
Pooling of blood into subcutaneous tissues around the venipuncture site.
Hematoma
Type of Cleansing Enema that
Irritate mucosa
Distends the colon
Soap suds
Phase of General Anesthesia
—starts when patient emerges from anesthesia and is ready to leave operating room
Emergence
Nurses signature on informed consent indicates what 2 things
- Patient signed without coercion
2. Patient was alert & aware (competent)
Central Lines _____ side prefereed
Left
How well are the lungs excreting CO2?
PaCO2
Catheter “broke” off an tip entered the circulatory system
Rare but deadly.
Pain at site, decreased BP, weak rapid pulse, cyanosis
Severed Catheter
2 Metabolic Alkalosis causes
Increase of bicarbonate
Loss of metabolic acid
Restores function lost or reduced as result of congenital anomalies
Constructive
No BM in 3 days- act on/before day 2
Constipation-
How well are the kidneys excreting metabolic acids? High: the blood has too few metabolic acids. Low: too many metabolic acids.
HCO3
Type of Medicated Enema that
Not for stool, but to remove potassium rapidly!
Kayexalate
Post-Op Stoma Care requires
Low-______ diet first few weeks
fiber
potassium Less than 3.5 mEq
Hypokalemia
Clinical Presentation:
Seizures
Headache
Dysrhythmias
Metabolic Alkalosis
: constipation, too much water reabsorbed, dry stools
Delayed transit times
Pain at access site with erythema or edema
is a grade __ on the Phlebitis Scale
2
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
0
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
4
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
20
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)
24
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
3
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
2
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
4
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
40
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
1
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
3
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
1
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