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113 Cards in this Set

  • Front
  • Back
Major Determinant of Health
Racial Minorities have increased rates of:
Differences in geographic location:
Can cause health disparities
Persons of lower income/education/occupational status:
experience worse health and die at a younger age than the more affluent
Biases towards the elderly that affect their care
Age-related physiological Changes:
Cognitive impairment
Chronically Ill
Need someone to advocate FOR them
How to eliminate health disparities:
-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
Early Ambulation Post-op
#1 preventative action!
-Make sure they have pain managed and then get them moving
Benefits of early ambulation
-Gets blood circulating
-Mobilizes secretions
-Keeps muscle strength/tone
-Physiological encouragement
-GI awakening
-Prevents skin breakdown
Initial Assessment when patient arrives to PACU
1. Vital signs/Pain
2. Airway Patency and O2 Saturation
3. ECG monitoring
4. Neurological assessment
Also assess when patient arrives to PACU
-Incision site: condition of the wound and dressing
Explain everything in PACU even if you think patient is unconscious
Because hearing is the first sense to return
Check vital signs every:
q. 15 X4, q. 30 X4, 2. hr X4 (7 hours total)
Proper positioning for Open Airway:
-LATERAL if unconscious
-SUPINE w/ HOB ELEVATED if conscious
Post-op interventions for breathing/oxygenation:
-Deep breathing
-Use of incentive spirometer
-Turn q. 2 hrs
Cause of Atelectasis
Decreased surfactant & mucus plugs the alveoli
bacteria growing in stagnant mucus leads to an infection if secretions are not mobilized
Elevated temperature 24-48 hours post op
NOT infection yet! Elevated temp is due to atelectasis
Early warning signs of decreased airway patency/oxygenation:
Tachypnea, gasping, apprehension, anxiety, restlessness, tachycardia, thready pulse. Check for mucus present that could be blocking
Interventions for decreased patency/oxygenation:
-Increase fluid intake
-Incentive Spirometer
-Monitor Vital Signs
-Monitor labs/X-rays
-Give meds ordered, especially pain meds
Complications of fluid overload:
-Stress response
-Chronic illness such as congestive heart failure or chronic renal failure
-Increased CO
Complications of fluid deficit:
-Decreased renal blood flow
-Low CO
Causes of fluid retention:
-IV fluid replacement rate was too fast
Causes of fluid deficit:
-Blood/fluid loss
-Inadequate/slow replacement of fluids
-Wound drainage/suctioning/vomiting/bleeding
Hypokalemia leads to
Cardiac arrhythmias
Decreased BP, rapid HR, cold, clammy pale skin =
Causes of DVT:
-Stress response (increases coagulation due to increased platelets
-Inactivity, poor positioning, pressure
People who are at greatest risk for DVT:
-Immobile (post op if you don't get them to ambulate)
Signs&symptoms of a DVT:
-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)
Interventions to avoid DVT:
-Smoking cessation
-Keep weight down
Manifestations of a pulmonary embolism:
-Tachypnea, dyspnea, tachycardia, chest pain, hemoptysis, hypotension, arrhythmias, heart failure
Most common post-op manifestations:
-Syncope (fainting)
Caused by postural hypotension, diminished baroreceptor response
Interventions for postural hypotension (post-op):
-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
Check OR report for:
EBL (Estimated blood loss) to anticipate fluid status and other complications resulting from fluid status
Post-op neurological effects:
1. Delirium
2. Postoperative cognitive dysfunction (often due to HYPOXIA among other things)
3. Anxiety (pre and post)
4. Depression
5. Alcohol Withdrawal Delirium
Post op anxiety:
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
ICU Psychosis:
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
Phantom Limb pain:
Teach patients about this so that they are not criticized or confused later
Post op GI complications:
Nausea, emesis, bowel distention

Very important to ambulate! Give some meds if appropriate

Monitor I&Os and description of Os
Wound healing post op:
proper nutrition, proper dressing to avoid infection, proper body mechanics to avoid dehiscence, know to expect delayed healing in elderly/diabetes/obese/smokers
Objective sign of malnourishment:
Low albumin on lab values
Pain management
Medicate before any activity!!
Patient-Controlled Analgesia
-Provides immediate analgesia and maintains constant blood level of agent
-Make sure RR is >8/minute
-ONLY patient pushes the button
-Use pain scale to assess (1-10)
Most important nursing interventions post-op:
-Accurate I&Os
-Accurate IV administration (no playing catch-up)
-Assess risk for DVTs
Patient Teaching upon Discharge
-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
Causes of hypovolemia
-Fistula drainage, hemorrhage, diarrhea
-Inadequate intake
-plasma-to-interstitial fluid shift
Treatment of hypovolemia
Replace fluid/electrolytes with balanced IV solutions
Treatment of hypervolemia
Remove fluid without changing electrolyte composition or ECF osmolality
Most common med to decrease fluid overload:
Lasix, or another diuretic (s/e would be potassium deficiency--think for patient if this would be an issue)
Objective signs of hypervolemia:
Crackles in lungs, bounding pulse, high BP, weight gain, bulging neck veins,
Objective signs of hypovolemia:
Weight loss, weak/thready pulse, hypotension, tachycardia
What is going on when the patient has hyponatremia
-Decreased sodium
-Excess fluid (water), fluid retention (monitor lung sounds!)
Complications due to hyponatremia:
-Severe neurologic changes
Complications due to hypernatremia:
-Seizures, and coma, leading to brain damage
Treatment of hypernatremia:
-Treat underlying cause
-Oral fluids if can swallow, IV fluids (D5W or hypotonic saline)
Treatment of hyponatremia
Fluid replacement with hypertonic solution, but must monitor for fluid retention
Causes of hyperkalemia:
Cell destruction (burns, crushing)
Nephrons (renal failure)
Excretion impaired
Clinical manifestations of hyperkalemia:
-Weak/paralyzed muscles
-V. fib/cardiac arrest
-Abdominal craping/diarrhea
Signs/symptoms of hyperkalemia: (mr. p and dic)
Muscle weakness
abdominal cramping
decreased HR
irregular pulse
cardiac problems
Acidosis and hyperkalemia
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).
Alkalosis and Hypokalemia:
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.
Hyperkalemia interventions:
-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)
Causes of hypokalemia:
-abnormal loss of K
-magnesium deficiency
Clinical manifestations of hypokalemia (s&s):
-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)
Treatment of hypokalemia:
-Potassium supplements (oral or IV)
(do not give too fast and do not exceed 10-20 mEq/hr!)
-Potassium in diet
Foods high in potassium
-Dark leafy greens
-White beans
-Baked potatoes
-Dried apricots
-mushrooms (anything that grows in the ground)
Clinical manifestations of hypercalcemia:
-Decreased memory
(kidney stones from renal calculi)
Causes of hypercalcemia:
-Malignancy (bone tumors secrete calcium)
-Vitamin D overdose
-Prolonged immobilization
-Constipation (stool full of calcium)
Interventions for hypercalcemia:
-Excretion of Ca
-Hydration (isotonic saline, 3000-4000ml/day)
-Synthetic calcitonin (reabsorb calcium)
Causes of hypocalcemia:
-Decreased Parathyroid hormone
-Acute pancreatitis
-Multiple blood transfusions
-Decreased intake
Manifestations of hypocalcemia:
-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)
Treatment of hypocalcemia:
-Treat the cause
-Give oral or IV calcium (but never IM to avoid local reactions)
-Treat pain/anxiety--prevent hyperventilation-induced respiratory alkalosis
Causes of Hyperphosphatemia:
-Excessive ingestion of phosphate OR vitamin D
Manifestations of hyperphosphatemia:
-Calcified deposits in soft tissue (skin, joints, arteries, kidneys, corneas)
-Neuromuscular irritability
Vitamin D
-Messes up calcium/phosphate levels
-Overdose can turn into hypercalcemia or hyperphosphatemia
Management of hyperphosphatemia:
-Identify and treat underlying cause
-Correct hypocalcemic conditions
-Limit foods with phosphate (dairy, mushrooms, anything that grows in the ground)
-Give adequate fluids
Causes of hypophosphatemia:
-Alcohol withdrawal
-Use of phosphate-binding antacids
-Inadequate replacement during parenteral nutrition
Manifestations of hypophosphatemia:
-CNS depression/confusion
-Muscle weakness, pain
Causes of hypermagnesemia:
-Increased intake
-Renal failure
Manifestations of hypermagnesemia:
-Weakness, nausea, vomiting
-Impaired breathing
-hyPOactive DTRs
-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)
Management of hypermagnesemia:
-IV CaCl or calcium gluconate (if you give calcium it will drive magnesium down)
-Fluids to promote urinary excretion
Causes of hypomagnesemia:
-Prolonged fasting or starvation
-Chronic alcoholism (because not getting adequate nutrition)
-GI fluid loss
-TPN that does not have magnesium
Manifestations of hypomagnesemia:
-Hyperactive DTRs (tremors)
-Cardiac dysrhythmias
Treatment for hypomagnesemia:
-Oral magnesium tablets
-Increase intake (peanut butter, nuts, bananas, oranges, green vegetables, chocolate)
-If severe can give IV or IM
S&S of sodium excess:
-CNS deterioration
-Increased interstitial fluid
S&S of sodium deficit:
-CNS deterioration
S&S of potassium excess:
-V. fib
-ECG changes
-CNS changes
S&S of potassium deficit:
-ECG changes
-CNS changes
S&S of calcium excess:
-CNS deterioration
-Increased interstitial fluid
S&S of calcium deficit:
-Positive Chvostek's/Trousseau's
-Muscle twitching
-CNS changes
-ECG changes
S&S of magnesium excess:
-Loss of deep tendon reflexes (DTRs)
-Depression of CNS
-Depression of neuromuscular function
S&S of magnesium deficit:
-Hyperactive DTRs
-CNS changes
Orthostatic hypotension = _________ deficit
Hypotonic fluids:
-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
Isotonic fluids:
-Expands only ECF
-0.9% NaCl
-No calories
Normal saline:
-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
Hypertonic Fluids:
-Expands and raises osmolality of ECF
-Monitor lung sounds, BP, serum sodium
-D5 & 1/2 NS
Lactated Ringer's
-More similar to plasma
-Has K/Ca/PO4/lactate-->is metabolized to HCO3 meaning it can cause alkalosis
-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)
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
-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...
Causes of SIADH
-Lung cancer
-Duodenal Cancer
-Pancreatic Cancer
-Head trauma/surgery
-Brain tumor that affects pituitary function
How does SIADH affect FEAB?
-Causes hyponatremia
-Decreased hematocrit
-Fluid in lungs
-Third spacing of fluid to abdomen/peritoneal space
-Think SIADH2O to remember all the fluid excess
Treatment of SIADH:
Eliminate the cause: restrict fluids!
Treatment for respiratory acidosis:
-Maintain patent airways with enhanced gas exchange
-Ventilatory support
-Assess LOC frequently
-Eat a diet low in carbs high in fat
Causes of respiratory acidosis:
-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)
Manifestations of Respiratory Acidosis:
-Decreased level of consciousness
-Weakness, decreased DTRs
-Tachycardia-->increased CO
-Ineffective respiratory efforts
-Increased potassium in acute respiratory acidosis
Causes of respiratory alkalosis:
-Metabolic triggers
-Mechanical ventilation
-CNS stimulation
Manifestations of respiratory alkalosis:
-Rapid, deep respirations
-Anxiety, irritability
-Tetany, seizures
-muscle cramping, weakness
-Tachycardia, may be hypotensive, palpitations
-Skin and mucous membranes pale to cyanotic
-Decreased potassium, decreased calcium
Treatment for respiratory alkalosis
-Decrease breathing rate (focused breathing, decrease breaths per minute on ventilator, oxygen therapy)
-Anti-anxiety medications
-Brown paper bag/washcloth
S&S of metabolic acidosis
-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)
Treatment for metabolic acidosis
-Correct the cause (treat diarrhea, give insulin, dialysis)
-Sodium bicarbonate not routinely given but an option
Manifestation of Metabolic Alkalosis:
-Increased HCO3 with rising CO2
-Altered mental status
-Tingling/numbness around mouth, fingers, toes
-Shallowed, slow breathing
Treatment for metabolic alkalosis:
-Antiemetic medications
-Monitor electrolytes--replace as needed
-Seizure precautions