Med Surge - Test 1 P. 21-25

Front 1

Conscious sedation

-IV delivery of what kind of drugs?

Back 1

-IV delivery of sedative, hypnotic, and opioid drugs

Front 2

Conscious sedation

what does this sedation do?

Back 2

reduces the level of consciousness but allows the client to maintain a patent airway and to respond to verbal commands.

Front 3

Conscious sedation

Nursing assessment of what 5 things, how often?

Back 3

of airway,

level of consciousness,

oxygen saturation,

electrocardiographic status,

vital signs








monitored every 15 to 30 minutes.

Front 4

Conscious sedation

who administers the meds?

Back 4

Nurse administers meds but NOT propofol.

Front 5

Conscious sedation

-done for patients with what (4)

Back 5

dislocation,

cardioversion (The conversion of one cardiac rhythm or electrical pattern to another, almost always from an abnormal to a normal one)

EGDs (Esophagogastroduodenoscopy, or EGD for short, is a procedure used by your doctor to gain more information about your esophagus, stomach, and small intestine. Your doctor can look at the insides of these structures by placing an endoscope (a small, bendable tube that acts like a video camera) into your throat.) ,

colonoscopies

Front 6

Understand what malignant hyperthermia is :

Back 6

acute, life threatening complication of certain drugs used for general anesthesia

Front 7

The MH crisis is a biochemical chain reaction response “triggered” by

Back 7

general anesthetics and the paralyzing agent succinylcholine within the skeletal muscles of susceptible individuals.

Front 8

malignant hyperthermia is : susceptibility occurs in what people??

Back 8

inherited with an autosomal dominant inheritance pattern


This means that children and siblings of a patient with MH susceptibility usually have a 50% chance of inheriting a gene defect for MH

Front 9

malignant hyperthermia is :

-link to which agents?

-how can you see if u have the trait for MH

-linked to another specific agent, such as:

Back 9

-usually linked to inhalants

-succinylcholine is a short acting paralytic and it’s usually used or induction to intubation


-muscle biopsy is the only way you can find out if you have MH

Front 10

malignant hyperthermia :


the reaction begins where:

Back 10

reaction begins in skeletal muscle exposed to specific agents, causing increased calcium levels in muscle cells and increased muscle metabolism.

Front 11

malignant hyperthermia :

serum calcium and potassium levels are increased, as is the metabolic rate, leading to (3 things)

Back 11

acidosis,
cardiac dysrhythmias,
high body temperature.

Front 12

-malignant hyperthermia :

susceptible persons have a mutation that results in the presence of

Back 12

abnormal proteins in the muscle cells of their body.

Front 13

malignant hyperthermia :

Exposed to certain anesthetic agents, it causes an abnormal release of what inside the muscle cell.

Back 13

calcium

Front 14

malignant hyperthermia :

Exposed to certain anesthetic agents, it causes an abnormal release of CA+ inside the muscle cell.
•That results in

Back 14

sustained muscle contraction & the abnormal increase in energy utilization and heat production.

Front 15

Exposed to certain anesthetic agents, it causes an abnormal release of CA+ inside the muscle cell.


Results in a sustained muscle contraction & the abnormal increase in energy utilization and heat production.

The muscle cells eventually run out of energy, and die. Then they release:

Back 15

Large amounts of K+ are released into the bloodstream,causing heart rhythm abnormalities.

Front 16

Results in a sustained muscle contraction & the abnormal increase in energy utilization and heat production.


The muscle cells eventually run out of energy, and die.

Then they release large amounts of K+ are released into the bloodstream,causing heart rhythm abnormalities.

The muscle pigment myoglobin is also released and may cause issues:

Back 16

kidney. it becomes toxic. The kidney is occluded and it can’t perform it’s function and goes into kidney failure.

Front 17

malignant hyperthermia, if left untreated can cause:

Back 17

cardiac arrest,
kidney failure,
blood coagulation problems,
internal hemorrhage,
brain injury,
liver failure,

Front 18

malignant hyperthermia

there is a result of calcium from inside the muscle, then what happens?

as the muscle fatigue, they start to die..why do they die?


when the muscle cell dies, it releases K into the blood which also releases what:

Back 18

there is a stained muscle contraction, which produces the heat inside the body (fever)



they are not getting blood cuz they are contracting and they are hypoxic)


myoglobin, which circulates to the kidney and sends the pt into renal failure

Front 19

What drugs are commonly associated with MH?

Back 19

The volatile gaseous inhalation anesthetics are MH triggers:
-sevoflurane
-desflurane
-isoflurane
-halothane
-enflurane
-methoxyflurane
-Also, succinylcholine (Anectine), the depolarizing muscle relaxant

Front 20

General signs and symptoms of MH??

Back 20

tachycardia b/c of the increased body metabolism,

muscle rigidity/contraction (of the jaw and upper chest)
which produces the high fever that may exceed 110°F, and carbon dioxide builds up.

Front 21

other signs and symptoms of MH??

Back 21

hypotension,
tachypenia,
skin mottling,
cyanosis,
myoglobinuria (presence of muscle proteins in the urine)

Front 22

MH
first sign the anesthesiologist notices is what?

Back 22

- an increase in co2 and tachycardia with unknown etiology

Front 23

MH

-Severe complications include: cardiac arrest, brain damage, internal bleeding or failure of other body systems.

Thus, death, primarily due to....

Back 23

a secondary cardiovascular collapse

Front 24

MH:
-brain damage occurs because of

Back 24

the carbon dioxide build up and high temperature (105-111) –cerebral tissue is damaged

Front 25

Malignant hyperthermia: possible treatment with

Back 25

dantrolene sodium,...WHICH IS WHAT??





a skeletal muscle relaxant.

-genetically mediated problem.
-It’s not known if the pt has this.
-It’s a muscle link

Front 26

-what do you do if MH occurs?



-how does flurane have to exit your body?

Back 26

-the anesthesiologist stops the “flurane” injections and they give fresh oxygen.


-The flurane has to be excreted through the lungs, and then we have to give lots of fluid and cool that body. (cooling blankets, ice, ice water in rectum, cool moist blanket

Front 27

MH
-treatment:
what does dantrolene do?

Back 27

stops the process from occurring at the muscles and stops contractions.

Front 28

MH
-how is dantrolene administered?

-who gets the equipment??

Back 28

per kilogram (90-120 lb person ways 6-8 bottles)


the circulating room nurse gets the equipment

Front 29

Post op

-In the postop pt, what does the nurse generally include in the initial assessment when the pt returns to the floor?

Back 29

A-airway (open and accessible?)
B-breathing (look for chest rising, listen to breath sounds, RR rate, sao2, and feel for subcutaneous emphysema ---feels like rice krispies (air trapped in subq layers), lung sounds
C-circulation -HR , BP, capillary refill, color, check IV sites.. Output (circulation of kidney)
D-neuro (disability) -----A, V, P, U A is alert (eyes are open and they are looking at you and answering appropriately), V is verbal.. P is pain, sternal rub to get pt to respond or make a withdraw, and U is unresponsive
E- exposure: lift up gown and look at skin to see if they have injuries returning from OR..looking at dressings, drains, skin interruption
F-farhrenheit- what's their temp….are they warm enough? Do they need blankets?
G- glucose

Front 30

Post op

Additional assessments the nurse does when the pt gets back from the OR

Back 30

•I/O
•Hydration- do not advance diet without bowel sounds or passage of flatus
•IV site/fluid
•Drains
•Integument
–Surgical site, general body,
•Pain –family can’t push button
•Lab- lab work that needs to be reassessed, CBC, LFT

Front 31

Jackson Pratt and Hemovac drains are 2 self contained drainage systems that drain wounds how?

Back 31

directly through a tube via gravity and vacuum

Front 32

Jackson Pratt and Hemovac

-both drains are sutured in place, with a suture that...


what kind of technique is used to empty the reservoir?

Back 32

seals the area when the drain is removed.

use sterile technique to empty reservoir.

Front 33

Jackson Pratt and Hemovac

how often do you drain them?


what do you record?

Back 33

. during every nursing shift or more often if prescribed.


record the amount and color of drainage


after emptying and compressing the reservoir to restore suction, secure the drain to pts gown to prevent pulling and stress on the surgical wound.

Front 34

Jackson Pratt and Hemovac


used in open or closed wounds?


drainage collects where?

Back 34

-used in closed wound drainage systems


- in a collecting vessel by means of compression and re-expansion of the system.

Front 35

JP (Jackson- Pratt tube) :

are like big eggs and they have a flip tip. In order to produce suction you have to squeeze egg and close top…when you open the top what happens:

Back 35

it release negative pressure and you can pour the liquid out

Front 36

- Hemovac seen on (small or large) joints

-done with negative pressure
-The compression of these drains does what to the fluid?

Back 36

large

pulls the fluid out of the space)

Front 37

Hemovac
-used for what 2 kinds or surgery

Back 37

hips or knee surgery

Front 38

Hemovac
--complications can occur from:

Back 38

seroma-serious tumor

Front 39

What does dehiscence mean?


what is it sometimes referred to?

Back 39

the partial or total separation of wound layers. A client who is at risk for poor wound healing


splitting open of a wound

Front 40

dehiscence

-what kind of people are at risk? 3

Back 40

poor nutritional status,

infection,

obesity

Front 41

dehisence

uses what kind of dressing?


what do you instrut the pt to do? (2)

Back 41

a sterile nonadherent or saline dressing.

instruct the pt to bend the knees and avoid coughing.


a wound becomes infected dehiscences by itself or it may be opened by a surgeon through an incision and drainage procedure.

Front 42

if a wound dehiscences , do you leave it open or resuture it up?

Back 42

the wound is left open

Front 43

dehiscence and evisceration
-usually occurs when?

Back 43

- between the 5-10 day post op ,

Front 44

dehiscence

what 5 people are at risk for these:

Back 44

usually with:
obese pts
diabetes,
immune deficiency
people using steroids
malnutrition

Front 45

-what may follow forceful coughing, vomiting, or straining when not splitting the surgical site

Back 45

dehiscence

Front 46

_________often occurs with abdominal surgical wounds after a sudden strain, such as coughing, vomiting, or sitting up in bed

Back 46

Dehiscence

Front 47

Dehiscence
-what do patients often report feeling when this happens?

Back 47

the feeling as though something has popped.

Front 48

When there is an increase in serosanguineous drainage from a wound, the nurse should be alert for the potential for __________

Back 48

dehiscence

Front 49

To prevent dehiscence, what should the nurse do?

Back 49

place a folded thin blanket or pillow over an abdominal wound when the client is coughing. This provides a splint to the area, supporting the healing tissue when coughing increases the intra-abdominal pressure.

Front 50

What does evisceration mean?

Back 50

a wound opening with protrusion of internal organs.

Front 51

With total separation of wound layers, _______(protrusion of visceral organs through a wound opening) may occur.

Back 51

evisceration

Front 52

dehiscence or evisceration

The condition is an emergency that requires surgical repair.

Back 52

evisceration

Front 53

When evisceration occurs, the nurse does what:

Back 53

places sterile towels soaked in sterile saline over the extruding tissues.


-The client should be allowed nothing by mouth (NPO), observed for signs and symptoms of shock, and prepared for emergency surgery.

Front 54

fyi: A fistula is an abnormal passage between two organs or between an organ and the outside of the body.

Back 54

fyi: A fistula is an abnormal passage between two organs or between an organ and the outside of the body.

Front 55

Resp complications post –op

what 2 things should you assess for?

Back 55

- patent airway and adequate gas exchange

Front 56

Resp complications post –op

-monitor pulse oximetry, what should it be?

-when should you call the rapid response team?

Back 56

-greater than 95%

-drop of 10% or more

Front 57

Resp complications post –op

-respirations (what should you all assess to determine the adequacy of air exchange)

Back 57

rate,
pattern,
depth of breathing to determine adequacy of air exchange

Front 58

Resp complications post –op

-respirations (assess rate, pattern, and depth of breathing to determine adequacy of air exchange)


-less than 10 breaths per minute indicate

Back 58

anesthetic or opioid analgesic induced depression

Front 59

Resp complications post –op


-respirations (assess rate, pattern, and depth of breathing to determine adequacy of air exchange)

-rapid, shallow respirations may signal (4 things)

Back 59

shock,
cardiac problems,
increased metabolic rate
pain

Front 60

-listen for lung sounds, symmetry of breath and chest movements


-absent sounds may indicate:

Back 60

decreased lung expansion

Front 61

-atelectasis:
is what

what do you hear while assessing?

Back 61

collapse of alveoli. (p 573),


crackles, decrease breath sounds

Front 62

-what results from excess fluid in lungs resulting from inflammatory process, interstitial spaces??

Back 62

pneumonia-

Front 63

-pulmonary embolism

what is it??

Back 63

- blood clot that is obstructing the pulmonary blood flow-leading to decrease oxygen, hypoxia-possible death

Front 64

-laryngeal edema- swelling in the laryngeal, doing what?

Back 64

cutting air supply off

Front 65

-ventilator dependence- risk for infection increases, why?

Back 65

because the body doesn’t filter the air as it would normally

Front 66

-pulmonary edema-

what is it?


what does it cause?

Back 66

an abnormal build up of fluid in the air sacs of the lungs,




leads to SOB

Front 67

Resp complications post –op

s/s

Back 67

-anxiety
-cough
-difficult breathing
-excessive sweating
-feeling of ‘air hunger’ or ‘drowning’ (if this occurs suddenly, awakening you from sleep and causing you to sit up and catch your breath, its called ‘paroxysmal nocturnal dyspnea)
-grunting or gurgling sounds with breathing
-pale skin
-restlessness
-sob (also when lying down ---orthopnea—you may need to sleep with head proper up or use extra pillows
-wheezing
-pleruitic pain

Front 68

GI problems
-most common reactions after surgery

Back 68

-n/v

Front 69

GI
n/v
-what is a preventative drug?

Back 69

ondansetron ( Zofran ), a serotonin antagonist

Front 70

GI
n/v
-common in a pt with a history of:


-why is it common in an obese person?

Back 70

motion sickness


-because anesthetics are retained by fat cells

Front 71

GI
n/v


what non-pharm thing can you help the pt do to reduce this feeling?

Back 71

-having the pt in a side lying position before raising the head slowly

Front 72

GI
-Paralytic ileus

what is it?

Back 72

Obstruction of the intestine due to paralysis of the intestinal muscles.

Front 73

GI
-Paralytic ileus

5 s/s include

Back 73

absent or few bowel sounds,
distended abdomen,
abdominal discomfort,
vomiting,
no passage of flatus or stool

Front 74

GI
-Paralytic ileus

-intestinal peristalsis, may be delayed because of long anesthesia time. pts with abdominal surgery may have decreased or no peristalsis for how long

Back 74

24 hrs

Front 75

GI
-Paralytic ileus


what happens to the abdominal wall?

WHAT OCCURS?

Back 75

-decreased peristalsis occurs in pts who have a paralytic ileus.


the abdominal wall is distended and there is no movement of intestinal wall, few bowel sounds, discomfort, vomiting, no passage of stool

Front 76

what drugs may reduce peristalsis

Back 76

-opioid analgesics

Front 77

How does the nurse know when to advance a patients diet if the MD writes advance as tolerated.

Back 77

-usually need to hear movement throughout intestinal tract before advancing to higher consistency diets

Front 78

used post op if pt is scheduled for diagnostic test, no more than 24 hours. limit caffeine

Back 78

-clear liquid

Front 79

pts who are lactose intolerant don’t do well on this diet, problem for dysphagia who can’t swallow thin liquids

Back 79

-full liquid:

Front 80

those pts with chewing or swallowing difficulty

Back 80

-mechanical soft

Front 81

usually pts with mild GI issues

Back 81

-soft diet:

Front 82

eggs, tender meats, milk, white breath, rice , strained juices, cooked veggies, cooked or canned fruits
– no nuts, seeds, or skins

Back 82

-low-fiber/residue

Front 83

high fiber: more than ______ day

Back 83

20g

Front 84

-low fat: restricts to less than ___ day

Back 84

50 g

Front 85

-low sodium: restricts for less than ______day

Back 85

2000 mg

Front 86

-low protein: restricts to less than ______ day

Back 86

60 g

Front 87

Listen for bowel sounds and ask if they are passing flatus or stool. After NPO, The patient is usually started on what kind of diet??


then advances to
2)
3)

Back 87

clear liquid diet and then advanced to full liquid diet and then a full solid diet.

Front 88

KNOW WHAT CATEGORIES ARE ON THE FOOD PYRAMID

Back 88

grains:
vegetables:
fruits:
milk:
meats:
oils-

Front 89

FOOD PYRAMID


grains:
vegetables:
fruits:
milk:
meats:
oils-

Back 89

grains: 6 oz
vegetables: 2 ½ cups
fruits: 2 cups


milk: 3 cups
meats: 5 ½ oz
oils- not a food group but you need some in your diet

Front 90

Interventions related to relieve distention and promote peristalsis

Back 90

-suction fluids
-increase physical movement when safe to surgery site
-increase oral intake when safe
-increase fiber intake
-mild use of laxatives if not contraindicated
-enema may be needed
-If necessary a NG tube is put in place during surgery to decompress and drain the stomach, promite GI rest, and allow the lower GI tract to heal