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43 Cards in this Set
- Front
- Back
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s&s of shock
& Cx |
decreased b/p; tachycardia; resless; decreased urine;
Cx: loss of blood; anesthesia; dehydration |
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wound dehisence might occur
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5-12 post op
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sanguineous
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bright red
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serosanguineous
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pink
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serous
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straw color or clear
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hypovolemic shock
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inadequate blood volume to maintain o2 & nutrients (decreased blood loss: Hemorrhage, D&V
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cardiogenic shock
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heart fails as pump; (MI, myocarditis) decreased output and perfusion
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obstructive shock
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physical impairment of circulating blood flow (tension pneumothorax, pericardial tampondade, emboli)
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Distributive shock
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excessive dilation of blood vessels; fluid pools. increased cap permeability, plasma leaks (swelling)
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neurogenic shock
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disruption in nervous system affecting vasomotor in medulla
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sodium Na+
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regulates fluid volume, nerve impulse, etc
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potassium K+
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fluid osmolarity and volume, protein synthesis
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urine ph
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4.5-8
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Hemoatocrit
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percent of blood volume of rbc
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bun
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8-20 mg/dl
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albumin
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3.5-5.5
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creatinine
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0.6-1.5 mg/dl
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hyponatremia
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sodium deficit;build up fluid in brain cells
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Fluid volume deficit
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hypotension, increased R & P
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Fluid excess
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hypertension, increased pulse, increased resp
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blood ph
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7.35-7.45
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resp acidosis
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fails to eliminate co2. co2 is retained - rapid heart rate, lethargy, confusion
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resp alkalosis
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low paco2, hyperventilation... excess amts of carbon dioxide is eliminated through lungs.
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metabolic acidosis
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body retains to much acid - starvation, dehydration.
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metabolic alkalosis
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increase in bicarbonate- (suction) tx: isotonic
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iatrogenic infections
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cx by tx given to the pt
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fat sol vitamins
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A D E K
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water sol vita
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b complex, c,
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how much water qd
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2500 ml
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vegans risk for
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anemia and b12 deficiency
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lactovegi
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milk, cheese, other dairy no meat or eggs
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lacto-ovo-vegi
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dairy and eggs but no meat
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General Adaption Syndrome
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1- alarm reaction (fight or flight) 2 - resistance stage (adaption to stressor) 3- exhaustion stage (body no longer defend - death)
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transcultural nursing
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integration of culture into all aspects of nursing care
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Passive or gravity drains –
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Penrose of T Tube – can be used for drainage of stab wounds.
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Active or negative pressure drains –
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Hemovac & Jackson Pratt drains. (used for open wounds w/extensive tissue damage)
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when does gas occur
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2/3 post op day
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1st primary intention
2ndary intention Tetritary |
1 - CLEAN SUTURED - wound edges closed
2- infected wound left open to heal from bottom up 3 - left open to heal then closed |
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3 phases of wound healing
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1- inflammatory 2 - proliferation 3 - maturation
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partial thickness loss heal by
full thickness heal by |
partial - epithealization
full - contaction |
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isotonic solutions
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0.9 sodium chloride or ns
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hypotonic (given for water loss)
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0.45 sodium chloride
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hypertonics
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increase blood volume
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