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113 Cards in this Set
- Front
- Back
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Major Determinant of Health
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Behavior/Lifestyle
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Racial Minorities have increased rates of:
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-Diabetes
-HTN -COPD -Cancer -Stroke |
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Differences in geographic location:
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Can cause health disparities
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Persons of lower income/education/occupational status:
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experience worse health and die at a younger age than the more affluent
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Ageism
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Biases towards the elderly that affect their care
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Age-related physiological Changes:
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Cognitive impairment
Frail Chronically Ill Need someone to advocate FOR them |
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How to eliminate health disparities:
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-Monitor for each INDIVIDUAL response to therapy
-Be a patient advocate regardless of culture/language -Be aware of own biases/prejudices and work to eliminate them -Provide the same standard of care for all patients |
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Early Ambulation Post-op
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#1 preventative action!
-Make sure they have pain managed and then get them moving |
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Benefits of early ambulation
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-Gets blood circulating
-Mobilizes secretions -Keeps muscle strength/tone -Physiological encouragement -GI awakening -Prevents skin breakdown |
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Initial Assessment when patient arrives to PACU
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1. Vital signs/Pain
2. Airway Patency and O2 Saturation 3. ECG monitoring 4. Neurological assessment |
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Also assess when patient arrives to PACU
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-Urinary
-Incision site: condition of the wound and dressing |
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Explain everything in PACU even if you think patient is unconscious
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Because hearing is the first sense to return
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Check vital signs every:
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q. 15 X4, q. 30 X4, 2. hr X4 (7 hours total)
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Proper positioning for Open Airway:
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-LATERAL if unconscious
-SUPINE w/ HOB ELEVATED if conscious |
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Post-op interventions for breathing/oxygenation:
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-Cough
-Deep breathing -Use of incentive spirometer -Splinting -Turn q. 2 hrs |
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Cause of Atelectasis
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Decreased surfactant & mucus plugs the alveoli
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Pneumonia
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bacteria growing in stagnant mucus leads to an infection if secretions are not mobilized
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Elevated temperature 24-48 hours post op
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NOT infection yet! Elevated temp is due to atelectasis
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Early warning signs of decreased airway patency/oxygenation:
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Tachypnea, gasping, apprehension, anxiety, restlessness, tachycardia, thready pulse. Check for mucus present that could be blocking
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Interventions for decreased patency/oxygenation:
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-Ambulate
-Increase fluid intake -Incentive Spirometer -Monitor Vital Signs -Monitor labs/X-rays -Give meds ordered, especially pain meds |
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Complications of fluid overload:
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-Stress response
-Chronic illness such as congestive heart failure or chronic renal failure -Increased CO |
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Complications of fluid deficit:
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-Decreased renal blood flow
-Low CO |
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Causes of fluid retention:
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-CHF, CRF
-IV fluid replacement rate was too fast |
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Causes of fluid deficit:
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-Blood/fluid loss
-Inadequate/slow replacement of fluids -Wound drainage/suctioning/vomiting/bleeding |
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Hypokalemia leads to
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Cardiac arrhythmias
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Decreased BP, rapid HR, cold, clammy pale skin =
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HYPOVOLEMIC SHOCK
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Causes of DVT:
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-Stress response (increases coagulation due to increased platelets
-Inactivity, poor positioning, pressure |
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People who are at greatest risk for DVT:
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-Elderly
-Obese -Smokers -Immobile (post op if you don't get them to ambulate) |
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Signs&symptoms of a DVT:
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-Warm
-Swollen -Red & Painful Calf -Positive Homan's sign (although advised not to do this because it could dislodge it and DVT may lead to pulmonary embolism) |
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Interventions to avoid DVT:
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-TED Hose/SCD
-Ambulation -Positioning -Smoking cessation -Keep weight down |
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Manifestations of a pulmonary embolism:
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Anxiety!
-Tachypnea, dyspnea, tachycardia, chest pain, hemoptysis, hypotension, arrhythmias, heart failure REQUIRES IMMEDIATE TREATMENT |
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Most common post-op manifestations:
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-Dizziness
-Syncope (fainting) Caused by postural hypotension, diminished baroreceptor response |
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Interventions for postural hypotension (post-op):
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-Raise HOB all the way
-Let feet dangle for a few minutes before standing up -Stand them up using gait belt -Stand for a bit before walking -Walk a bit, further every time, keeping in mind the distance it takes to return |
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Check OR report for:
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EBL (Estimated blood loss) to anticipate fluid status and other complications resulting from fluid status
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Post-op neurological effects:
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1. Delirium
2. Postoperative cognitive dysfunction (often due to HYPOXIA among other things) 3. Anxiety (pre and post) 4. Depression 5. Alcohol Withdrawal Delirium |
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Post op anxiety:
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Assure them that there will be adequate pain medication, and no they will not get addicted to it.
Teach about importance of pain management in order to perform other healing strategies |
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ICU Psychosis:
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Can be a completely different person, must be aware of this and teach this to family/visitors, encourage family not to talk about severe situations later with the patient
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Phantom Limb pain:
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Teach patients about this so that they are not criticized or confused later
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Post op GI complications:
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Nausea, emesis, bowel distention
Very important to ambulate! Give some meds if appropriate Monitor I&Os and description of Os |
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Wound healing post op:
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proper nutrition, proper dressing to avoid infection, proper body mechanics to avoid dehiscence, know to expect delayed healing in elderly/diabetes/obese/smokers
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Objective sign of malnourishment:
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Low albumin on lab values
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Pain management
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Medicate before any activity!!
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Patient-Controlled Analgesia
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-Provides immediate analgesia and maintains constant blood level of agent
-Self-administered -Make sure RR is >8/minute -ONLY patient pushes the button -Use pain scale to assess (1-10) |
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Most important nursing interventions post-op:
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-EARLY AMBULATION
-DAILY WEIGHTS -Accurate I&Os -Accurate IV administration (no playing catch-up) -Assess risk for DVTs |
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Patient Teaching upon Discharge
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-Prepare for discharge when patient is admitted, discharge instructions all at the end before leaving is overwhelming and confusing!
-Provide instructions for care of wound/dressings, actions/effects/when to use drugs, diet -Phone numbers what for what reasons to call, where/when to return for follow-up -Answer questions/concerns |
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Causes of hypovolemia
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-Fistula drainage, hemorrhage, diarrhea
-Inadequate intake -plasma-to-interstitial fluid shift |
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Treatment of hypovolemia
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Replace fluid/electrolytes with balanced IV solutions
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Treatment of hypervolemia
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Remove fluid without changing electrolyte composition or ECF osmolality
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Most common med to decrease fluid overload:
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Lasix, or another diuretic (s/e would be potassium deficiency--think for patient if this would be an issue)
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Objective signs of hypervolemia:
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Crackles in lungs, bounding pulse, high BP, weight gain, bulging neck veins,
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Objective signs of hypovolemia:
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Weight loss, weak/thready pulse, hypotension, tachycardia
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What is going on when the patient has hyponatremia
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-Decreased sodium
-Excess fluid (water), fluid retention (monitor lung sounds!) |
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Complications due to hyponatremia:
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-Severe neurologic changes
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Complications due to hypernatremia:
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-Seizures, and coma, leading to brain damage
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Treatment of hypernatremia:
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-Treat underlying cause
-Oral fluids if can swallow, IV fluids (D5W or hypotonic saline) -Diuretics |
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Treatment of hyponatremia
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Fluid replacement with hypertonic solution, but must monitor for fluid retention
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Causes of hyperkalemia:
(MACHINE) |
Meds
Acidosis Cell destruction (burns, crushing) Hyperaldosteranism Intake Nephrons (renal failure) Excretion impaired |
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Clinical manifestations of hyperkalemia:
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-Weak/paralyzed muscles
-V. fib/cardiac arrest -Abdominal craping/diarrhea |
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Signs/symptoms of hyperkalemia: (mr. p and dic)
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Muscle weakness
reflexes paralysis abdominal cramping nausea diarrhea decreased HR irregular pulse cardiac problems |
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Acidosis and hyperkalemia
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Metabolic acidosis: H will go into the cell in exchange for K coming out into the bloodstream, balancing the pH but causing hyperkalemia (if kidneys not working. if they are working properly then they will just excrete excess K).
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Alkalosis and Hypokalemia:
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If pH of blood is too low then H will come out of the cell to balance pH, but in exchange K will go into the cell causing hypokalemia. And vice versa.
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Hyperkalemia interventions:
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-Medications
-Dialysis to increase elimination of K -Kayexalate to eliminate K through stool -Insulin to force K into the cell (monitor blood sugar though) -Administer calcium gluconate IV (to slow depolarization, must watch for signs of hypercalcemia) |
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Causes of hypokalemia:
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-abnormal loss of K
-magnesium deficiency -alkalosis |
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Clinical manifestations of hypokalemia (s&s):
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-CARDIAC IS MOST SERIOUS: arrhythmias and V fib
-Skeletal muscle weakness -Weak respiratory muscles/diaphragm--will manifest as trouble breathing -Flaccid paralysis, absent reflexes -muscle cramps -constipation (decreased GI motility) |
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Treatment of hypokalemia:
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-Potassium supplements (oral or IV)
(do not give too fast and do not exceed 10-20 mEq/hr!) -Potassium in diet |
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Foods high in potassium
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-Dark leafy greens
-White beans -Bananas -Baked potatoes -Dried apricots -squash -yogurt -fish -avocados -mushrooms (anything that grows in the ground) |
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Clinical manifestations of hypercalcemia:
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-Decreased memory
-Confusion/disorientation -Fatigue -Constipation (kidney stones from renal calculi) |
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Causes of hypercalcemia:
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-Hyperthyroidism
-Malignancy (bone tumors secrete calcium) -Vitamin D overdose -Prolonged immobilization -Constipation (stool full of calcium) |
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Interventions for hypercalcemia:
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-Excretion of Ca
-Ambulation -Hydration (isotonic saline, 3000-4000ml/day) -Synthetic calcitonin (reabsorb calcium) |
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Causes of hypocalcemia:
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-Decreased Parathyroid hormone
-Acute pancreatitis -Multiple blood transfusions -Decreased intake |
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Manifestations of hypocalcemia:
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-Paresthesia (numbness/tingling around mouth and extremities)
-Trousseu's or Chvostek's sign -Laryngeal stridor -Dysphagia (difficulty swallowing from lack of calcium in esophageal muscles) |
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Treatment of hypocalcemia:
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-Treat the cause
-Give oral or IV calcium (but never IM to avoid local reactions) -Treat pain/anxiety--prevent hyperventilation-induced respiratory alkalosis |
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Causes of Hyperphosphatemia:
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-ARF or CRF
-Chemo -Excessive ingestion of phosphate OR vitamin D |
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Manifestations of hyperphosphatemia:
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-Calcified deposits in soft tissue (skin, joints, arteries, kidneys, corneas)
-Neuromuscular irritability |
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Vitamin D
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-Messes up calcium/phosphate levels
-Overdose can turn into hypercalcemia or hyperphosphatemia |
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Management of hyperphosphatemia:
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-Identify and treat underlying cause
-Correct hypocalcemic conditions -Limit foods with phosphate (dairy, mushrooms, anything that grows in the ground) -Give adequate fluids |
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Causes of hypophosphatemia:
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-Malnourishment/malabsorption
-Alcohol withdrawal -Use of phosphate-binding antacids -Inadequate replacement during parenteral nutrition |
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Manifestations of hypophosphatemia:
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-CNS depression/confusion
-Muscle weakness, pain -Dysrhythmias -Cardiomyopathy |
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Causes of hypermagnesemia:
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-Increased intake
-Renal failure |
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Manifestations of hypermagnesemia:
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-Weakness, nausea, vomiting
-Impaired breathing -hyPOactive DTRs -hypotension -hypocalcemia (when one is low the other is too) -arrhythmia and asystole (because when there is too much magnesium it acts as a calcium channel blocker causing electrical conduction abnormalities) |
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Management of hypermagnesemia:
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-IV CaCl or calcium gluconate (if you give calcium it will drive magnesium down)
-Fluids to promote urinary excretion |
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Causes of hypomagnesemia:
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-Prolonged fasting or starvation
-Chronic alcoholism (because not getting adequate nutrition) -GI fluid loss -TPN that does not have magnesium -Diuretics |
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Manifestations of hypomagnesemia:
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-Confusion
-Hyperactive DTRs (tremors) -Seizures -Cardiac dysrhythmias |
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Treatment for hypomagnesemia:
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-Oral magnesium tablets
-Increase intake (peanut butter, nuts, bananas, oranges, green vegetables, chocolate) -If severe can give IV or IM |
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S&S of sodium excess:
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-Thirst
-CNS deterioration -Increased interstitial fluid |
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S&S of sodium deficit:
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-CNS deterioration
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S&S of potassium excess:
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-V. fib
-ECG changes -CNS changes |
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S&S of potassium deficit:
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-Bradycardia
-ECG changes -CNS changes |
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S&S of calcium excess:
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-Thirst
-CNS deterioration -Increased interstitial fluid |
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S&S of calcium deficit:
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-Tetany
-Positive Chvostek's/Trousseau's -Muscle twitching -CNS changes -ECG changes |
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S&S of magnesium excess:
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-Loss of deep tendon reflexes (DTRs)
-Depression of CNS -Depression of neuromuscular function |
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S&S of magnesium deficit:
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-Hyperactive DTRs
-CNS changes |
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Orthostatic hypotension = _________ deficit
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Saline
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Hypotonic fluids:
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-More water than electrolytes (but not just water alone because water lyses RBCs)
-D5W (isotonic--hypotonic after metabolization of glucose) -Used to replace water (and treat hypernatremia -Does not provide electrolytes -170 calories |
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Isotonic fluids:
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-Expands only ECF
-0.9% NaCl -No calories |
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Normal saline:
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-expands VASCULAR compartment
-Increases BP-->CO increase -increases risk for fluid overload -make sure its not being infused too rapidly by listening to the lungs |
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Hypertonic Fluids:
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-Expands and raises osmolality of ECF
-Monitor lung sounds, BP, serum sodium -D5 & 1/2 NS - |
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Lactated Ringer's
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-Isotonic
-More similar to plasma -Has K/Ca/PO4/lactate-->is metabolized to HCO3 meaning it can cause alkalosis |
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D10W
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-Hypertonic, very sweet and concentrated
-Provides 340 kcal/L -free water once glucose is metabolized -Make sure body can metabolize extra glucose and can handle extra fluid (test with chem stick) |
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Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
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-Too much ADH in the body--excess water is reabsorbed
-Patient becomes overloaded with fluid, which causes more ADH to be released, which causes more ADH... |
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Causes of SIADH
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-Lung cancer
-Duodenal Cancer -Pancreatic Cancer -Head trauma/surgery -Brain tumor that affects pituitary function |
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How does SIADH affect FEAB?
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-Causes hyponatremia
-Decreased hematocrit -Fluid in lungs -Third spacing of fluid to abdomen/peritoneal space -Think SIADH2O to remember all the fluid excess |
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Treatment of SIADH:
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Eliminate the cause: restrict fluids!
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Treatment for respiratory acidosis:
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-Maintain patent airways with enhanced gas exchange
-Ventilatory support -Assess LOC frequently -Eat a diet low in carbs high in fat |
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Causes of respiratory acidosis:
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-Respiratory depression
-Chest or head trauma (slows your breathing or control of breathing) -Neurological disorders -Airway obstruction -Alveolar disorders -COPD (chronic, gets to point where O2 levels signals breathing) |
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Manifestations of Respiratory Acidosis:
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-Decreased level of consciousness
-Weakness, decreased DTRs -Tachycardia-->increased CO -Ineffective respiratory efforts -Increased potassium in acute respiratory acidosis |
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Causes of respiratory alkalosis:
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-Anxiety
-Hypoxemia -Metabolic triggers -Mechanical ventilation -CNS stimulation |
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Manifestations of respiratory alkalosis:
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-Rapid, deep respirations
-Anxiety, irritability -Tetany, seizures -Paresthesia -muscle cramping, weakness -Tachycardia, may be hypotensive, palpitations -Skin and mucous membranes pale to cyanotic -Decreased potassium, decreased calcium |
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Treatment for respiratory alkalosis
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-Decrease breathing rate (focused breathing, decrease breaths per minute on ventilator, oxygen therapy)
-Anti-anxiety medications -Brown paper bag/washcloth |
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S&S of metabolic acidosis
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-Decreased LOC
-Weakness, decreased DTRs -Tachycardia-->increased CO-->actually leads to decreased CO/BP/dysrhytmia -Kussmaul respirations -Warm flushed skin and mucous membranes -Increased potassium (because of pH buffer exchange) |
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Treatment for metabolic acidosis
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-Hydration
-Correct the cause (treat diarrhea, give insulin, dialysis) -Sodium bicarbonate not routinely given but an option |
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Manifestation of Metabolic Alkalosis:
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-Increased HCO3 with rising CO2
-Altered mental status -Tingling/numbness around mouth, fingers, toes -Shallowed, slow breathing |
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Treatment for metabolic alkalosis:
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-Antiemetic medications
-Monitor electrolytes--replace as needed -Seizure precautions |
