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81 Cards in this Set

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We lose approximately ____ cc of fluids from the skin every day.
500-600 cc
What are some age-related changes with respect to drug metabolism?
Slower gastric emptying, delays onset of action.
Increased gastric pH affects ionization and solubility.
Less total body water, decreased lean body mass, higher blood levels.
Decreased hepatic drug metabolism increases the drug half-life.
Decreased renal function, drugs stick around longer.
Acidosis is caused by a ?
pH of below 7.35, caused by metabolic, respiratory or both problems
Describe first intention wound healing?
Primary closure; minimal scar formation.
What is the primary effect of alkalosis?
Serious and life-threatening disturbances in metabolism and in respiration.
What happens with an atelectasis?
The alveoli stick together and there is no transfer of gasses.
What is diffusion?
From a higher to a lower concentration (particles)
What is wound dehiscence?
Partial or total separation of wound layers which can occur 3 to 11 days after surgery.
Osmolarity or osmolality?
Concentration of solutes in body fluid: Osmotic pull of particles.
Describe second intention?
Wound left open to granulate; large scab.
What is the most abundant cation in the ECF?
Sodium!!! KNOW THIS. (NL 135-145 mEq/L.
What are some special considerations in the elderly postoperative patient?
1) Eldelry may have problems from immobility & the common fluid and rate of D51/2 NS with 20 meq KCl@ 125 cc/hr may be too much for the elderly patient with renal compromising to handle.
What is the most abundant cation in the ICF?
Potassium.
What is a possible indication of wound infection postop?
A high temperature after the 3rd postoperative day with increased WBCs, redness and swelling around the incision.
What does the Renin-Angiotensin regulation do?
Affects kidney response, water, sodium retention.
Describe third intention?
Delayed closure.
Hypertonic/hyperosmolar solution causes the fluid to go out of the cells and the cells ___.
Shrink.
If we have a postoperative nursing diagnosis of: At risk for alteration in tissue perfusion related to decreased mobility, what are the three considerations used?
1) Low dose heparin.

2) Leg exercises.

3) TED hose, pneumatic compression devices, foot "cuffs".
What is serum osmolality?
The measurement of osmotically active solutes in serum.
How long does it usually take for bowel sounds to return postoperatively?
24-48h, unless a manipulation
Filtration?
From a higher hydrostatic pressure to lower.
Promethazine (phenergan) is often used for post-op vomiting. However, it has two potential side effects?
1) Can increase awareness of pain if given with narcotics.

2) Can cause hypotension.
What is the primary regulator of fluid loss?
The kidneys (we loss approximately 1500 cc of urine in a day.
Describe several key issues with the elderly postop client?
1) Recovery time.
2) Ability to adapt to changing BP and fluid volume status.
3) Risk for impaired skin integrity and thrombus formation.
4) Risk for atelectasis and pneumonia.
5) Confusion.
6) Wound healing (immune system not as healthy).
7) Discharge planning.
A pH bwelow 7.3 (6.8 is incompatible with life) will cause what?
CNS depression (judgment errors, drowsiness, GI symptoms and abd pain.)
What is a paralytic ileus?
A bowel obstruction due to lack of peristalsis.
A pH above 7.6 will cause what?
Over-excitation of the CNS. Tingling sensation in the fingers and toes, tetany, convulsions and ultimately death.
What can be some of the causes of urine retention postop?
1) Increased aldosterone and ADH 24-48 h postop.

2) Increased osmolality. Decreased blood volume.

3) Narcotics, stress, anesthesia and surgery.
Normal saline is ______.
Isotonic.
-rrhaphy
Suturing or stitching, repair
Hypotonic/hypo-osmolar solution causes the fluid to go _______ the cells and the cells ___.
into; swell
What is an indication of a respiratory infection postop?
Temperature >110 24-48 postop.
Alkalosis is a pH above __
7.45; caused by metabolic, respiratory problems or both.
What is evisceration?
Protrusion of visceral organs through a wound opening.
What does urine specific gravity measure?
The weight of the solution in relation to water.
Normal saline is a _____ solution?

Sterile water is a _____ solution.
NS is istonic.
SW is hypotonic.
The ANF is the same/opposite of the renin-angiotensin system.
opposite
How much blood is lost in the three stages of shock?
#1 (initial): <500 mL
#2 (compensatory) 1000 mL or more
#3 (progressive) 1800-2500 mL
What is osmosis?
Lower to higher solute concentration across a membrane.
Def. induction tx
Therapy given when no alternative treatment exists.
What does aldosterone do?
Helps the body to keep sodium and water.
We have _________ metabolism in the first two stages of shock (initial and compensatory) versus _________ metabolism in the second two stages of shock (Progressive and irreversible)
aerobic; anaerobic
What is differentiation?
How closely a tumor cell looks like the parent cell.
What may indicate a rupture of the ulcer?
Pain, sudden, severe, upper abdominal and shoulder pain. Now at risk for hemorrhaging.
What is grading of tumors?
Classifying tumor cells based on how closely they resemble the parent cell.
Define shock?
Shock is the hypoperfusion of body tissues; the systemic imbalance between oxygen supply and demand. Not enough blood supply to tissue.
What happens in metabolic acidosis?
Excess acids are added or when bicarbonate is lost.
Side effects of chemotherapy include n/v, alopecia, and depressed bone marrow. Why is the depressed bone marrow such a problem?
It leads to anemia, bleeding and infection.
What is a hematocrit?
The % of cells compared to the amount of serum.
What happens in cardiogenic shock?
Decreased cardiac output.
Increased heart rate.
Increased myocardial oxygen consumption.
Decreased coronary perfusion.
Hct goes __ with dehydration and __ with overhydration.
up; down
Def. neoadjuvant.
Used before surgery to shrink tumor. Chemo then surgery.
In normal body metabolism, there is a slight ____ of acid compounds.
Excess.
Hematochezia is?
Blood in the stool
Are changes in the systolic BP a good indicator of initial stages of shock?
No
What does TNM stand for?
T = tumor size (1 to 4; 1=small; 4= very large); n + nodes; M = metastasis.
What does an ABG analysis tell us?
The effectiveness of the lungs and kidneys in maintaining balance.
Quickly (rapidly) dividing cells are the most vulnerable to the effects of chemo. What does this include?
The bone marrow, GI tract lining and hair follicles.
Cardiogenic shock is due to?
Inadequate heart pumping action.
Def. primary tx.
Used first, there is an alternate (but less effective) tx available.
How do you determine mean arterial pressure (MAP)?
Diastolic pressure x 2 + systolic/3

Ex: 120/60
120 + 120/3 = 80

Miniumim 60

The average pressure during a cardic cycle.
PUD is caused by?
90% H. pylori; 10% chronic use of NSAIDs.
What are changes associated with shock?
Decreased arterial pressure.
Decreased tissue perfusion.
Decreased oxygen to cells.
Increased cellular destruction.
Increased waste buildtup.
Eventual organ failure.
All chemotherapeutic agents cause what?
Bone marrow suppression! Decreased RBCs (anemia); Decreased WBCs (Infection); Decreased platelets (bleeding)
Hypovoleimc shock (the most common type) is due to what?
Inadequate blood volume. (Loss of at least 15%.)
How is the iliopsoas muscle test done?
Put patient in supine position; ask pt to do a straight leg raise; apply resistance as pt tries to hold up leg. Increased abdominal, flank or pelvic pain is a positive finding.
What are the most common causes for shock?
Hemorrhage.
Burns.
Vomiting/Diarrhea.
Severe sodium loss.
In a grade 4 tumor, the tumor cells have no resemblance to normal cells and are said to be __________ differentiated.
Poorly.
A pH ranges from 1 to 14. If it is closer to 1, it is more _________; if it closer to 14, it is more __________.
acidic; basic
In a grade 1 tumor it is ______ differentiated and is least malignant.
Well differentiated.
What are the four stages of shock?
Initial; Compensatory; Progressive; and Irreversible.
Def. adjuvant.
Used with another modality.
What does body homeostasis require?
Heart beaing, enough blood, intact vascular system and tissues that can extract and use the delivered oxygen.
How is the obturator muscle test done?
Pt placed in supine position, and using asisted motion, flex at hip and 90 degrees at the knee. Hold the ankle and rotate the leg internally and externally. Reproduced RLQ abdominal or pelvic pain is a positive finding.
Anaphylactic (antigen-antibody)?
Severe vasodilation leading to inadequate blood volume.
How much does the MAP decrease in the first three stages of shock?
#1 (initial) <10 mmHg below normal.
#2 (compensatory) <10-15 mmH
#3 (progressive) <20 mm Hg or more
Septick shock is caused by?
Infaction. Most often gram negative bacteria. Leading cause of death in the ICU.
What is a reliable indicator of the initial stage of shock?
LOC and Pulse.
What is a normal blood pH?
Between 7.35 and 7.45
In illness, there is a lot _____ acid compounds, which may overwhelm homeostasis.
more
What is a pH?
A logarithm of the # of hydrogen ions in a solution. KNOW THIS!!!