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Med-Surg Exam 1
PeriOp, Fluid & Electrolytes, Acid-Base, Diabetes
78
Nursing
Undergraduate 4
05/17/2011

Additional Nursing Flashcards

 


 

Cards

Term
 Common pre-op fears
Definition
Pain, discomfort, the unknown, mutilation, death, anesthesia, disruption of life pattern
Term
Pre-op interview components
Definition

pt and family history

meds

nutrition/herbs

allergies

Term
Pre-op data
Definition

head to toe assessment

know the patient's baseline

ordered lab work

ordered diagnostics

Term
new info that you need to share with Dr/anesthesia
Definition

new dx

new med

new herb

pregnancy

 

Term
what if pre-op pt has URI
Definition

procedure should probably be cancelled

increased risk of larygnospasm, bronchospasm, decrease saO2

Term
what if pre-op pt has hx of dyspnea, coughing, hemoptysis
Definition
bring to the attention of operative team
Term
what if pre-op pt has COPD
Definition
emphasize importance of deep breathing, increased risk of atelectasis and hypoxemia
Term
what if pre-op pt is a smoker
Definition
try to get them to quit 6 wks before surgery, will decrease complications
Term
what if pre-op pt has hx of urinary/renal problems
Definition

tell op team 

f & e imbalances

coagulopathies

infection risk

impaired healing

renal function tests

I&O

Term
what if pre-op pt has arthritis
Definition
ambulate later in the day
Term
pre-op teaching areas
Definition

what to expect

demonstrations (spirometry)

pain management

 

Term
after administering pre op meds....
Definition
don't let the pt get out of bed
Term
preop meds
Definition

sedatives/amnesiacs

anticholinergics

opioids

antiemetics

antibiotics

meds for preexisting conditions

Term
benzodiazepines
Definition

versed, valium, ativan

↓anxiety, induce sedation, amnesia

Term
anticholinergics
Definition

atropine,scopolamine

↓resp & oral secretions, prevent bradycardia

prevent n & v

Term
opioids
Definition

morphine, fentanyl

↓anesthesia requirement, pain

Term
antibiotics
Definition
prevent post-op infection
Term
what abnormal sign is normal post-op
Definition

increase RR

d/t atelectasis

Term

decreased LOC post-op:

normal or abnormal?

Definition
normal, the goal is "arousable"
Term
 post-op positioning of pt
Definition
{image:|}
Term

PACU discharge criteria

Definition
patient awake or arousable
vs stable
no excess bleeding/drainage
no resp depression
O2 sat above 90
report given
Term
Ambulatory surgery discharge criteria
Definition
PACU criteria and:
no IV narcotics in the last 30 min
minimal n&V
voided
able to ambulate
RESPONSIBLE ADULT to accompany pt
discharge instructions given and understood
Term
when pt arrives from surgery...
Definition

take VS

LOC

hook up monitors

observe dressings,drainage

get report

 

Term
do not accept a PACU pt unless...
Definition
they have a gag reflex, are stable, until you have assessed them yourself
Term
what should anesthesia/RN report to you when giving you a PACU pt
Definition
name, procedure, anesthesia used, reversal agents used, fluid loss/replacement, VS, problems, complications, preop condition, comorbidities, vent settings, pain management
Term
postop goals
Definition
airway maintained, protective reflexes, normal spontaneous resp, ABGs normal, no aspiration, HR & BP stable and returning to preop value, body temp WNL, good urine output, normal blood volume, easily arousable, moves purposefully with normal strength
Term
progression of re-establishment of oral intake
Definition
NPO-ice chips-jello-clear liquid-broth
Term
when can oral intake be re-established
Definition
protective reflexes return
Term
when can enteral intake be re-established
Definition
bowel sounds return
Term
when can parenteral intake be re-established
Definition
hemodynamically stable
Term
nsg dx for postop pt
Definition
pain, nausea, risk for infection, ineffective airway clearance, anxiety, constipation
Term
post op PCs
Definition

hemorrhage

thromboembolism

urinary retention

paralytic ileus

hypoxemia

hypoventilation

hypotension

htn

dysrhythmias

hypothermia

malignant hyperthermia

Term
effects of pain
Definition

↑sns, metabolism, O2 demand, stress

↓healing, sleep, cough and deep breathing ability

Term
children may exhibit pain....
Definition
withdrawal, may be irritable
Term
pca monitoring
Definition

pain level,type, ability to be active(determines effectiveness)

resp depression, n&v, LOC, allergy

 

Term
always verify at beginning of shift (pca pump)
Definition

med

basal rate

dose

lockout

Term
PCA side effects
Definition

respiratory depression

n & v

sedation

allergic reaction

Term
epidural assessment
Definition

level of anesthesia

catheter

dressing

 

Term
pt teaching epidural
Definition

how to report pain

HOB up

don't get up without help

assistance to turn

Term
local anesthetic adverse effects
Definition

hypotension (vasodilation)

urine retention

toxicity (absorbed into blood)

Term
pt has resp depression what do you do
Definition

stop or slow drug

narcan

 

Term
sympathetic blockade
Definition

decreased bp

have pt lie with legs up (trendelenburg)

 

Term
geriatric considerations with surgery
Definition
length of surgery (over 2 hrs)
decreased senses (communication)
decreased compliance, alveoli
more energy to breathe
atherosclerosis, decreased heart function, compensatory mechanisms decreased, less blood volume
liver and kidney function lower, meds stick around longer, fluid electrolyte acid base imbalances,
postop delerium normal
fragile skin
Term
oncotic pressure
Definition
protein-liver-kidney-diet
Term
geriatric fluid balance
Definition

decrease kidney=decreased concentration, ability to conserve water,

more loss through skin

decreased intake

 

Term

hypovolemia lab values

 

Definition

increased:BUN,creatinine,

protein,h&h,glucose,

serum osmolality

specific gravity

urine osmolality

 

Term
isotonic solution given for
Definition
maintenance, dehydration
Term
hypervolemia tx
Definition

fluid restriction diuretics

na restriction

Term
hypernatremia manif.
Definition
thirst lethargy agitation seizure coma
Term
hyponatremia manif.
Definition
confusion n&v seizure coma
Term
when is 3% nacl given
Definition

severe hyponatremia

(pt having seizures)

Term
K+ necessary for
Definition

nerve impulses cardiac rhythm skel muscle contraction acid-base

 

Term
hyperkalemia
Definition
K+ sparing diuretics renal failure increased intake tissue destruction acidosis
Term
hyperkalemia manif.
Definition

muscles weak

vfib

impaired cardiac depolarization

quick repolarization

abdom cramping, diarrhea-early indication

Term
tx hyperkalemia
Definition

no oral/parenteral intake

diuretic/kayexalate

IV insulin

 

Term
hypokalemia
Definition

aldosterone

loop diuretics

diarrhea

Mg deficiency

movement into cells

Term
hypokalemia manif.
Definition

lethal v dysrhythmia-inverted t wave, decreased pr interval-ventricles filling

increased dig toxicity

muscle weakness

muscle cell breakdown-myoglobin in urine

decreased gi motility

hyperglycemia

Term
tx hypokalemia
Definition

replacement-never iv push

never give if kidneys arent working

 

Term
hypercalcemia causes
Definition

hyperparathyroid

cancer

Term
hypercalcemia manif.
Definition

lethargy weakness depressed reflexes confusion n&v

bone pain fractures (phosphate)

dehydration

coma

Term
hypercalcemia tx
Definition

aggressive hydration with isotonic

low ca diet

weight bearing exercise

Term
hypocalcemia causes
Definition

decreased intake

chronic renal failure

hypoparathyroid

vit d deficiency

acute pancreatitis

alcoholism

diarrhea

Term
hypocalcemia manif.
Definition

fatigue

depression confusion anxiety

numbness tingling

hyperreflexes

chvostek

trousseau

tetany seizure

Term
hypocalcemia tx
Definition

iv replacement

increased dietary intake

Term
hypermagnesemia cause
Definition

renal insufficiency

uncontrolled dm

addisons

hypothyroid

too many antacids

 

Term

hypermagnesemia

manif.

Definition

loss of dtr

lethargy drowsiness

n&v

cardiac arrest

Term
hypomagnesemia cause
Definition

prolonged fasting/starvation

chronic alcoholism

uncontrolled diabetes

chronic renal disease

Term
hypomagnesemia manif.
Definition

cardiac irritability

confusion

hyperactive dtr

tremor

seizure

Term
D5W
Definition

hypotonic

prevents ketosis

causes edema

 

Term
NS
Definition

isotonic

expands iv volume

risk for fluid overload

compatible with all meds

Term
lactated ringers
Definition

isotonic

most like plasma

don't give to pt with liver problems

Term
D5 1/2 NS
Definition

hypertonic

prevents ketosis

Term

D10W

 

Definition

hypertonic

given to neonates, hypoglycemic, DKA

eats through veins,preferably given through central line

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