Term
| When does pre-op phase begin & end? |
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Definition
| begins in the doctors office when you schedule the surgery & ends when you go into the surgery room. |
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Term
| Why is it so important to take a very full history before surgery on a patient? |
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Definition
| Surgery & General anesthesia are very stressful to the body. We control their breathing & monitor them hemodynamically. All info is based on height & weight, so meds differ drastically. Very important to know ALL CURRENT meds. It's complicated when diabetics are NPO the night before. Definitely need to know PRIOR SURGICAL HISTORY. Know if metal implants? Know if had rxn to surg before (aka MALIGNANT HYPERTHERMIA!) Allergies? Latex or if allergic to shellfish (r/t iodine, which is betadine cleansing agent) |
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Term
| What is the primary goal & responsibility of the nurse for surgery? |
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Definition
| Being the patients advocate. We always want to do what's in the patients best interest. As a nurse we want them to have theknowledge & understanding of surgery. What are the patients support systems? How are they going to rehab? Getting help around? |
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Term
| Pre-op patient needs a full physical assessment. explain... |
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Definition
| Need complete set of baseline vital signs. Also, physically assess around area the surgery is about to be on. |
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Term
| Lab assessments pre-op are important. What does the urinalysis tell us? |
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Definition
| to assess abnormal substances in urine: like proteins, glucose, blood, bacteria (renal disease) |
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Term
| Lab assessments pre-op are important. THe most common are: urinalysis, blood type & crossmatch, complete blood count or hemoglobin level and hematocrit, clotting studies, electrolyte levels, serum creatinine levels and pregnancy tests. If electrolyte imbalance "HYPOKALEMIA" is found... what does this mean is happening and what are the implications for surgery? |
|
Definition
| Means the patient has decreased serum Potassium levels. It increases the risk for toxicity if the client is taking digoxin, slows recovery from anesthesia and increases cardiac irritability. |
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Term
| What would an electrolyte imbalance of "HYPERKALEMIA" mean pre-op surgery? |
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Definition
| HYPERKALEMIA is increased serum potassium levels. It increases the risk for dysrhythmias, especially with the use of anesthesia. (hypo & hypoerkalemia must be corrected before surgery). |
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Term
| When and to who do we report abnormalities found pre=op? |
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Definition
| Have to speak up when you find them (not later!) and you don't need to know exactly what it is... just that it might be abnormal. Report to the surgeon or anesthesia provider. |
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Term
| Factors that increase surgical risk (REMEMBER... this would be abnormals.) |
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Definition
| Older then 65, On Medications like antihypertensives, tricyclic antidepressants, anticoagulants, NSAIDs, Medical History of decreased immunity, diabetes, pulmonary or cardiac disease, hemodynamic instability, multisystem disease, coagulation defect or disorder, anemia, dehydration, infection, hyper or hypotension, ANY chronic diseae. Prior surgical experiences like: less than optimal emotional response, anesthesia reactions or complications, post-op complications. Health Hx of: malnutrition or obesity, med, tabacco, alcohol abuse, altered coping ability. Family hx of: MALIGNANT HYPERTHERMIA, Cancer, Bleeding Disorder. Type of Surg planned is: Neck, Oral, Facial (airway complications), Chest or Abdominal Procedures (Pulmonary complications), Abd Surg (paralytic ileus, DVT). |
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Term
| What 7 med categories are red flags pre-op.... |
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Definition
| Antidysrhythmics (affect tolerance of anesthesia, depress cardiac fx, cause peripheral vasodilation), Antihypertensives (alter clients response to muscle relaxants, may cause hypotensive crisis), Corticosteroids (delays wound healing w/o collagen, increased risk of infection), Anticoagulants (risk of hemorrhage), Antiseizure Meds (seizures injure wound site, meds alter anesthesia), Glaucoma Meds (can cause respiratory & cardiac collapse in surgery), Antidiabetic Agents (insulin needs decrease pre-op because they're on NPO status, post-op insulin needs increase b/c of IV dextrose, insulin fluctuates during healing b/c activity lessens & physical stress is increased). |
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Term
| What kind of things are so important to teach pre-op?? |
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Definition
| Address their fears & anxieties + pain management plans, tell them all about the surgical procedure, the pre-op routine including being NPO by midnight, enemas and blood samples, if it is an invasive procedure tell them about lines, catheters, talk about needing to Cough, Turn & Deep breath (Tell post-op exercizes pre-op), How & when to use incentive spirometer correctly, their lower extremity exercizes, about stocking and pneumatic compression devices, early ambulation, splinting. |
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Term
| Why are diet restrictions pre-op (NPO by midnight) SO important? |
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Definition
| Risk of aspiration from vomiting. Aspiration pneumonia and gastric lungs are VERY dangerous. So, this means no water or toothpaste swallowing, no candy & no gum (gets gastric juices going just the same). |
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Term
| If the patient is asking the nurse about details on surgery... is it okay to give them? |
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Definition
| It is NOT the nurses responsibility to provide detailed info about the surgery. That is the doctor's. It is not in our scope of practice so DO NOT get into this. The nurses job is when you witness their signature on the informed consent that they really are informed about the surgery. It's the nurses job to stand up & say "I don't think Mrs. Jones understands though she signed this." |
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Term
| What are the 5 areas covered in the informed consent? |
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Definition
| 1. Nature & reason for surgery 2. Who will be performing the surgery & everyone who will be present when it goes down (including students) 3. All available options and the risks associated with each option 4. The risks associated with the surgical procedure and its potential outcomes 5. The risks associated with the use of anesthesia. |
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Term
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Definition
| holding the incision area to provide support. Promotes a feeling of security and reduces pain during coughing; use a folded blanket or a pillow as a splint. |
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Term
| Why do we want early ambulation? |
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Definition
| It stimulates intestinal motility, enhances lung expansion, mobilizes secretions, promotes venous return, prevents joint rigidity and relieves pressure. |
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Term
| What is the difference between autologous & direct blood donation? |
|
Definition
| Autologous is when the client donates their own blood, can be up to 5 weeks in advance & the last donation was 72 hours ago (need to be able to replenish their own RBC's). Directed is family or friends donating blood for client's use. Their blood types must be compatible and donor's blood must be acceptable. |
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Term
| What will the red flags of poor circulation, high blood pressure, history of kidney disease, diabetes, thyroid disease and a hysterectomy tell you? |
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Definition
| poor circulation we know they're at risk for a DVT post-op. High blood pressure we know they've had long term stress on their heart. we will need to get an EKG to see if they've had a MI in the past b/c often they're suprised. History of kidney disease goes with the high blood pressure and diabetes. Diabetes tells us they are at an increased risk of POOR WOUND HEALING B/C OF MICROCIRCULATION. We're also worried about blood sugar control. Thyroid Disease: what controls the metabolism in the body. Hysterectomy: took out uterus from abd incision. |
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Term
| The role of the nurse is mainly for ___________, understand procedure, what meds to take and also dietary restrictions. |
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Definition
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|
Term
| Why do we want someone to be NPO? |
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Definition
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|
Term
| THe _______________ nurse gets the labs in order and makes sure the consent form is done. |
|
Definition
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|
Term
| Who are members of a surg team? |
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Definition
| Surgeon, surgical assistant, anesthesiologist, CRNA, holding area nurse, circulating nurse, scrub nurse and maybe a specialty nurse. |
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Term
| What does a circulating nurse do? |
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Definition
| regular nurse who is not scrubbed in (circulating nurse is NOT STERILE). She positions the patient, does prep, watches to make sure asepsis is maintained. Circulating nurse is responsible for safety. If another instrument is needed the circulating nurse will go get it. |
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Term
|
Definition
| The scrub nurse is scrubbed in and IS STERILE. They set up instruments and pass them. The scrub nurse is more hands on in the surgical process (ie setting up sterile fields, drapes the patient) while the circulating nurse is more responsible for procedures going on around the surgery. |
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Term
| To prevent retained items in surgery (leaving an instrument in the belly), the scrub nurse & the circulating nurse ensure what? |
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Definition
| The correct count of surgical instruments, sharps and sponges; performed before the beginning of the procedure, during the procedure as items are added or at the time personnel are relieved from that assignment, and immediately before complete skin closure. |
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Term
| Does the surgical scrub used to wash hands before surgery make hands sterile? |
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Definition
| No, surgical scrub is not sterile, it just reduces microorganisms for the hands, arms and nails. |
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Term
| What 2 routes is general anesthesia administered? |
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Definition
| Inhalation & IV injection |
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Term
| Traffic flow is limited in the OR because we want to limit ____________. |
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Definition
|
|
Term
| ______________ is an induced state of partial or total loss of sensation, occurring with or without loss of consciousness. |
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Definition
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Term
| __________ _____________ results in a REVERSIBLE loss of consciousness. 3 different ways to do this: inhalation, intravenous, and balanced. After they're under they will be intubated - you do not want to be awake for this. |
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Definition
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|
Term
| What 2 ways can Local Anesthetic be delivered? |
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Definition
| Topically (by ointment or spray) and Local Infiltration (injection directly into the tissue around the incision, wound or lesion). |
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Term
| When is Regional Anesthesia used? |
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Definition
| It is used when general anesthesia can't be used d/t medical problems, previous adverse reactions to general anesthesia, preference and choice by the patient. The patient remains conscious and able to follow directions in Regional Anesthesia (also with Local: Topical & Local Infiltration). |
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Term
| What are some types of Regional Anesthesia? |
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Definition
| Field Block, Nerve Block, Spinal Anesthesia, Epidural Anesthesia. Local & regional briefly disrupts sensory nerve impulse transmission from a specific body area or region. Patient stays conscious & is able to follow directions. Gag & cough reflexes stay intact, risk for aspiration is low. Often given with sedatives, opioid analgesics or hypnotics to reduce anxiety and increase comfort. |
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Term
| Who makes the protocol for preventing wrong site, wrong procedure, wrong person surgery? |
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Definition
| JHACO: The Joint Commission, is there for PATIENT SAFETY. |
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Term
| What ways does JCAHO & hospitals do pre-op verification processes? |
|
Definition
| There is a time-out once surgeon gets in the room, a checklist to confirm that appropriate are available: consent form, history & physical, imaging studies. The operative site is marked (every hosp. has own way of doing this): might be a line indicating site of incision, surgeon's initials and/or the word "yes." Final Verifications of corect pt, procedure & site |
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Term
| What is Malignant Hyperthermia? |
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Definition
| It is an acute, life-threatening complication of certain drugs used for general anesthesia. When a certain skeletal muscle is exposed to the agent Calcium, Potassium & Metabolic labels increase. Leads to Acidosis, cardiac dysrhythmias and a high body temperature. |
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|
Term
| What is the earliest sign of malignant hyperthermia? |
|
Definition
|
|
Term
|
Definition
| extremely elevated temperature: 111.2 degrees! Between you will see muscle rigidity in jaw & upper chest, hypotension, tachypnea, skin mottling and cyanosis. |
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|
Term
| What drug would you intervene with during a Malignant Hyperthermia attack? |
|
Definition
| Dantrolene Sodium (a skeletal muscle relaxant) |
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|
Term
| When does post-op nursing begin? |
|
Definition
| begins at the end of surgery and then they are transferred to the PACU, same day surgery unit, or the ICU and continues after the client is discharged from the ambulatory surgery facility or hospital. |
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Term
| A typical PACU nurse characteristics are: |
|
Definition
| registered nurse, requires in-depth knowledge of anesthesia, pharm, pain mgmt, and surg procedures. skilled in assessment and must make decision if emergencies or complications occur. |
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Term
| A typical PACU cubicle includes: |
|
Definition
| oxygen, suction equipment, cardiac monitors, emergency meds, usually one nurse to 2 patients. Sits at the end of the 2 beds and watches both patients. |
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Term
| What is the PACU nurse assessing on their patients? What is the MOST important? |
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Definition
| RESPIRATIONS ARE MOST IMPORTANT, also looking at LOC, temperature, pulse (if they're tachycardic they could be bleeding), blood pressure, looking at surgical area for bleeding. |
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Term
| Respiratory assessment includes making sure they have a _________ airway and adequate ____ _______. |
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Definition
| airway, gas exchange. We know about gas exchange because of pulse ox and making sure the chest is expanding bilaterally. We are assessing breath sounds by ausculating and listening for symmetry. Also listening for snoring or stridor - these are signs of airway obstruction. Also, chest wall checking for accessory muscle use. |
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|
Term
| Our cardiovascular assessment looks at vital signs _____ and compare that to the _________. |
|
Definition
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|
Term
| Other cardiovascular assessments include cardiac monitoring, done with an _______ interpretation, and a peripheral vascular assessment, done by checking pulses where? |
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Definition
| EKG, check distal pulses of bilateral feet |
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|
Term
| Neurologic assessment is for cerebral functioning and looks at the patient's LOC. How do we check for awareness and oreientation? |
|
Definition
Check Awareness by asking the patient to "open their eyes"/"take a deep breath"/"squeeze my hand."
Check for Orientation with "What is your name?"/"Where are you?"/"What day is it?" |
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|
Term
| We assess Motor & Sensory fucntioning by.... |
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Definition
| General motor function is tested by asking a patient to maybe "life their leg." |
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Term
| F & E + Acid-Base Balance looks at: |
|
Definition
| Intake & Output: (must know all in -IV fluids, PO and blood administration. Out-vomiting, urine, NG tube draining, blood loss. Know total from OR + PACU to assess accurately.) Hydration Assessment: look at color & moisture of mucous membranes, turgor, texture & tenting of skin, amt of drainage on dressing and presence of axillary sweat. Intravenous fluids: closely monitor to promote F & E balance. and Acid-Base Balance: affected by respirations, drainage, vomiting... |
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|
Term
| Renal Assessment is imp right after surgery b/c it could retrun or take hours to work. It is imp to inspect, palpate and percuss the lower abdomen for bladder distention. Assess patients with a Foley catheter by looking at the... |
|
Definition
| color, clarity and amount. Report if less then 30 ml/hr. |
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|
Term
| Post-op we do a skin assessment and look for: |
|
Definition
| redness, warmth, swelling, tenderness/pain and drainage. |
|
|
Term
| How do we monitor drainage? |
|
Definition
| We're looking at drainage amount, color, consistency and odor. We monitor drainage progression by outlining with a pen. |
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|
Term
| Reinforcing a dressing means to.. |
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Definition
| add more drainage, don't remove! |
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|
Term
| One of the most common reactions follow surgery is N & V. What drug can be given to help? Patients with motion sickness are more likely to develop n/v after surg. Also, obese patients b/c many anesthetics are retained by fat cells and would thus remain in them longer. |
|
Definition
|
|
Term
| What are the 2 gravity type drains? |
|
Definition
| Penrose (drain with a rubber clip) and a T-Tube (open into cystic duct: draining bile out of it) |
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|
Term
| What are 2 closed suction drains? They're used so less microbes can get in |
|
Definition
| Hemovac (as this fills with blood it expands) and Jackson Pratt (if it's not depressed in some way, it will not suck or work) |
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|
Term
| How do you remove a drain when the patient is going home? |
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Definition
| There may be one suture to snip, but otherwise the drain isn't connected anywhere inside so you just pull. You don't know how long the tube is when you're pulling it. Put a 4 x 4 over the hole & it will heal nicely. |
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Term
| What is dehisence and what should you do? |
|
Definition
| Partial or complete separation of outer wound layers. It is "splitting open." Usually happens a couple days post-op, not immediately. The nurse needs to get sterile saline, a nonadherent dressing and notify the surgeon. |
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Term
| What is evisceration & what should the nurse do? |
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Definition
| This is total separation of all wound layers and protrusion of internal organs. This is a surgical emergency, call the surgeon immediately and stay with the patient! |
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|
Term
| What are physiological signs of acute pain? |
|
Definition
| shallow breathing, increased BP, restlessness, wincing, moaning, crying & sweating. |
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|
Term
| What are the opioids often given in the first 34-48 hours of surgery? |
|
Definition
| meperidine hydrochloride (Demerol), Morphine Sulfate, Oxycodone. |
|
|
Term
| BIggest complication of opioids? |
|
Definition
| Respiratory Depression. There is also hypotension, constipation, N/V.... |
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|
Term
| If the patient has hypotension (BP less then 60) what should you do? |
|
Definition
| have them dangle their feet or stand still for a second. |
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|
Term
| If the patient has N/V what should you have them do? |
|
Definition
| Have them eat crackers with meds and drink water. |
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|
Term
| Opioid Overdose? What drug will you give... |
|
Definition
|
|
Term
| How is pain meds in the PACU usually given? |
|
Definition
| intravenously in small doses. |
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|
Term
| If a post-op patient is in pain their BP will ______, but if they are bleeding their BP will ______. |
|
Definition
| pain=BP rises, bleeding=BP lowers |
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|
Term
| ____________ makes up 55-60% of total body weight. |
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Definition
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|
Term
| _____________ depends on differences in water volume pressing against confining walls (hydrostatic pressure). Substances move from the greater amount of pressure to the lesser. |
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Definition
|
|
Term
| Diffusion is the movement of particles from an area of ___________ concentration to an area of ________ concentration. |
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Definition
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|
Term
| ___________ is the movement of water through selectively permeable membrane. The different concentrations are isotonic, hypertonic & hypotonic. |
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Definition
|
|
Term
| A cell uses energy to move a substance across a cell membrane, what is this called? |
|
Definition
|
|
Term
| What are the 3 factors involved in hormonal regulation? |
|
Definition
| Aldosterone, Antiduretic Hormone (ADH), Natriuretic Peptide (NP) |
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|
Term
| Aldosterone is secreted by the _____________ ____________. |
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Definition
|
|
Term
| What does Aldosterone do? |
|
Definition
| Prevents Sodium loss & regulates water balance. |
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|
Term
| Antidiuretic hormone is produces & stored where? |
|
Definition
| Produced in the brain & stored in the pituitary gland |
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|
Term
| Does the Antidiuretic Hormone (ADH) make the kidney tubules more or less permeable to water? What happens as a result? |
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Definition
| ADH makes the kidney tubules MORE permeable to water. So, more water is reabsorbed and returned to the blood. Decreases urine output. |
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Term
| Natriuetic Peptide is secreted by cells where? Natriuetic Peptides secrete in response to what? |
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Definition
| That line the atria & ventricles of the heart. They're secreted in response to an increased blood volume & blood pressure. They increase the renal excretion of sodium & water. So, more output. |
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Term
| This tonicity has the same concentration as the cells in the body. SO, the cell will remain the same size. What tonicity is this? |
|
Definition
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|
Term
| This tonicity has a higher salt concentration then the cells in the body. The cells will decrease in size in this ___________ solution. |
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Definition
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|
Term
| This tonicity has a lower concentration then the cells in the body. Therefore they increase in size in this ___________ solution. |
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Definition
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|
Term
| Fluid intake that is less then what is needed to meet the bodies needs is ______________. |
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Definition
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|
Term
| If dehydration occurs. Then isotonic would mean fluid & electrolyte loss was equal. If hypertonic then _____ loss is greater. If hypotonic then ___________ loss is greater. |
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Definition
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|
Term
| What manifestations does the body with when dehydrated? |
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Definition
| With deficient fluid volume there is decreased cardiac output, impaired oral mucous membrane and potential for dysrhythmias. |
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Term
| What are some interventions for dehydration? The Mmanagement of dehydration aims to prevent further fluid losses and increase fluid compartment volumes to normal ranges with... |
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Definition
| Oral fluid replacement, IV fluid replacement, oxygen therapy, monitor vital signs, monitor level of consciousness, monitor intake/output, monitor electrolytes, urine specific gravity (concentration of the urine), oral care. |
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Term
| IV fluid replacement is important. If the body is isotonic (fluid & electrolyte loss is equal) then we treat with: |
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Definition
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|
Term
| IV fluid replacement of hypertonic (water loss is greater) will be treated with: |
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Definition
|
|
Term
| IV fluid replacement of hypotonic (electrolye loss greater) is treated with the opposite: |
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Definition
| D10W, 5% Dextrose in 0.9% or 0.45% saline, 5% Dextrose in LR |
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Term
| When the body is overhydrated there is an excess of body fluids. With an Isotonic there is an expansion of the ____ only. |
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Definition
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|
Term
| With overhydration, a hypotonic will have expansion of ____ & ____. |
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Definition
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|
Term
| With overhydration, a hypertonic will have expansion of ____ and contraction of the _____. |
|
Definition
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|
Term
| THe manifestations of overhydration (excessive fluid volume) include: |
|
Definition
| potential for electrolyte imbalances, HTN and pulmonary edema. |
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Term
| What interventions would be recommended for a patient with overhydration? |
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Definition
| Administering diuretics, fluid/volume restrictions, monitor intake/output, monitor urine specific gravity, have controlled IV therapy, look for fluid overload (venous distention, crackles, peripheral edema) and DO DAILY WEIGHs. |
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Term
|
Definition
Electrolytes are also known as ions.
Electrolytes are substances in body fluids that carry an electrical charge.
The various concentration differences in electrolytes maintains membrane excitability to allow nerve impulse transmission. |
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|
Term
| The normal range for Potassium is ___ to ___ mEq/L. |
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Definition
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|
Term
| Potassium is regulated by the _____ pump & __________ function. |
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Definition
| Na+/K+ pump & kidney function. If you can't pee off waste then you'll have a lot of K+ in system. |
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|
Term
| The vital functions of Potassium are: its regulation of ________ use & storage. The maintenance of _______ __________ in excitable membranes (ie your heart). |
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Definition
| glucose, action potentials |
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Term
| Hypokalemia is K+ levels less then 3.5. What happens to cells when hypokalemia occurs? |
|
Definition
| reduces the excitability of cells & results in the cell membrane of all excitable tissues (nerve and muscle) to be less responsive to normal stimuli. |
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Term
| What nursing action is necessary for hypokalemia? |
|
Definition
| Hook up & monitor ECG changes. (Think, if the a.p. in excitable membranes are way reduced then you are worried about the heart most! hook up an ECG!) Usually there is an ST depression with hypokalemia. Called "code stemi." |
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Term
| What interventions are done for hypokalemia (not enough potassium)? |
|
Definition
| Take POTASSIUM SUPPLEMENTS (like Potassium Chloride, Potassium Gluconate, Potassium Citrate), Potassium-sparing diuretics (want ones that increase urint output, but does not increase K+ loss), Do Dietary Management: bananas & leafy greens are a good source of K+. |
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|
Term
| Hyperkalemia is Potassium levels greater then 5. Hyperkalemia is usually found in _____ failure patients. |
|
Definition
|
|
Term
| What happens to the body when there is too much Potassium (aka Hyperkalemia)? |
|
Definition
| get increased cell excitability, results in excitable tissue responding to less intense stimuli. |
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|
Term
| What will you see on the ECG from hyperkalemia? |
|
Definition
| Too much K+ on ECG: if it goes untreated - you'll see tall tented T waves. Often have a complete heart block & will go asystole (means we don't have systolic portion of contraction - that's the contraction part) or may have ventricular fibrillation. We won't be tested on specifics. Know you can never shock asystole. |
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|
Term
| What kind of interventions are done for too much Potassium (Hyperkalemia)? |
|
Definition
| Want to INCREASE POTASSIUM EXCRETION (with Potassium excreting diuretics like Lasix. Cation Exchange Resins like Kayexalate. Dialysis: kidney outside your body basically. Take blood in you, filter it and return blood w/in normal range of K+ for you), IV FLUIDS CONTAINING GLUCOSE & INSULIN, CARDIAC MONITORING, DIETARY MGMT: STAY AWAY FROM BANANAS & LEAFY GREENS. |
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|
Term
| Normal ranges for sodium balance is _____ to _____ mEq/L. |
|
Definition
|
|
Term
| Sodium is regulated by your _________. The vital functions you really have to know are that sodium affects: |
|
Definition
| kidneys. Sodium affects: skeletal muscle contraction, cardiac contractions, nerve impulse transmission. |
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|
Term
| Without having enough sodium in your system (hyponatremia) less then 136 mEq/L, will have: |
|
Definition
| slower membrane depolarization, cellular swelling, remember she said Na+ is a major component of the ECF. |
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|
Term
| The patient will manifest hyponatremia with: |
|
Definition
| personality changes, headaches, having changes in cerebral fx (cerebral edema & increase ICP). |
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|
Term
| What interventions are done with hyponatremia (not enough sodium)? |
|
Definition
| Hypertonic Saline Infusions (3 mL/kg/hr), Osmotic Diuretics, Dietary Mgmt. |
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|
Term
| Hypernatremia is sodium levels higher then 145. Water moves from the ICF to the ECF and causes cellular dehydration. How do excitable tissues respond? |
|
Definition
| Excitable tissues overrespond to stimuli (early) and also fail to respond to stimuli (late). |
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|
Term
| WHat kind of interventions are appropriate for Hypernatremia? |
|
Definition
| Administering Isotonic or Hypotonic Fluids (0.9% Saline or 0.45% saline), Diuretics, Maintain SODIUM RESTRICTIONS. Hypernatremia patients will have special diets from the cafeteria. |
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|
Term
| Normal Calcium levels should range between ___ to ___ mg/dL. Calcium is regulated by the _______________ gland & the _________ gland. |
|
Definition
| 9-10.5 is normal calcium. The parathyroid & thyroid glands regulate calcium. |
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|
Term
| The vital functions of Calcium include: |
|
Definition
| bone strength & densite, activation of enzymes or reactions, skeletal muscle contraction, cardiac muscle contraction, nerve impulse transmission, blood clotting. |
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|
Term
| Hypocalcemia allows for ____________________ to occur more easily and at inappropriate times. |
|
Definition
|
|
Term
| Paresthesia is a common first sign of hypocalcemia (tingling in hands & feet). You will be testing & looking for a positive Trousseau's & Chostek's signs with hypocalcemia. Explain them... |
|
Definition
| Trousseau's: check by putting on a BP cuff pumped past their systolic & leave on for 3-4 minutes. Under the hypoxic conditions, a positive Trousseau's sign when then hand & fingers go into spasms in palmar flexion. To test for Chvostek's sign: tap the face just below and in front of the ear (over the facial nerve) to trigger facial twitching of one side of the mouth, nose & cheek. |
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|
Term
| There will be ECG changes with hypocalcemia. What are they? |
|
Definition
| a prolonged ST interval and a prolonged QT interval. |
|
|
Term
| What kind of interventions are appropriate for a hypocalcemic patient? |
|
Definition
| Medications of Calcium Salts, Dietary Mgmt of Vitamin D, Safety Precautions for: seizures & fractures (do NOT want them to fall!) |
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Term
| Is Hypercalcemia (more then 10.5 mEq/L) life threatening? |
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Definition
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Term
| Hypercalcemia will _____ HR & BP early & then cause _____ HR & BP later. |
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Definition
| Hypercalcemia early causes a raise (tachycardia) and then later causes it to slow to bradycardia, cardiac arrest. |
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Term
| Hypercalcemia causes a potentiation of ______ toxicity. |
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Definition
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Term
| What ECG abnormalities are seen with hypercalcemia? |
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Definition
| Shortened ST and a widened T |
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Term
| Hypercalcemia causes excitable tissue to be ____ sensitive to normal stimuli. (ie the heart, muslce, nerves, and intestinal smooth muscle) |
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Definition
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Term
| What does Hypercalcemia do to the blood? |
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Definition
| Causes excessive blood clotting. Know this... these are test Q's on clotting & hypercalcemia! |
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Term
| If you are at risk for blood clots with hypercalcemia, what happens to the blood with hypocalcemia? |
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Definition
| at risk for hemorrhage, increased bleeding. Takes longer for blood to clot. |
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Term
| What are the interventions done for hypercalcemia? Interventions are aimed at reducing calcium levels through drug therapy & dialysis... |
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Definition
| Give Calcium Chelators (binders), Dialysis, Cardiac Monitoring (ECG, Clotting) |
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Term
| what IV fluid replacement would you use 0.9% saline-NS ? and D5W - 5% dextrose in water ? |
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Definition
| Isotonic (used for surg patients). Lactated Ringers or Ringers Lactate. |
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Term
| IV fluid replacement. Understand that Hypertonic is treated with ___________. and Hypotonic is treated with ____________. |
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Definition
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Term
| What IV Fluid replacement is treated with o.45% saline - 1/2 NS ? |
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Definition
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Term
| What IV fluid replacement is treated with D10W - 10% dextrose in water. 5% dextrose in 0.9% or 0.45% saline. 5% dextrose in LR. |
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Definition
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Term
| Cerumen impaction occurs when earwax becomes wedged in & blocks the canal. It is common in the elderly. Impactions in the ear will reduce their hearing and even decrease their _______ ________. |
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Definition
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Term
| What is very commonly the very last sense to be lost? |
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Definition
| hearing. It is the sense that never sleeps. |
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Term
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Definition
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Term
| We use warm water in a syringe to first try to remove an impaction. Do you force the water out directly on the impaction? |
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Definition
| No, at an angle so the fluid pushes on one side and not directly on the impaction. This will help loosen the impaction instead of forcing it further into the canal. Continue to irrigate with more water & if it does not drain out, wait 10 minutes & repeat. Look for signs of nausea (if they do, stop!) If cerumen can't be removed by irrigating then place mineral oil in ear 3x a day for days to soften dry, impacted cerumen. |
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Term
| When recovering from ear surgery, what should the nurse advise the pt to avoid? |
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Definition
| straining with a BM, drinking water through a straw, air travel, excessive coughing + people with colds, if blowing nose only occlude one side & leave mouth open, don't get head wet or shower for a week, keep ear dry (put cotton ball with vaseline in ear - change daily), avoid moving head rapidly, bouncing or bending backwards. |
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Term
| What do we irrigate ears with? |
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Definition
| Normally it is BODY TEMPERATURE WATER ONLY. Only time oil is used is if there is an insect in there. |
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Term
| Very important to NOT IRRIGATE an ear if there is a ____________ of the ear drum or otitis media. |
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Definition
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Term
| An INFLAMMATION or INFECTION of the external ear canal is called _________ _________. There is redness, swelling, tenderness and discharge. Excessive moisture and trauma. We are always worried about meningitis because close to the brain. |
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Definition
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Term
| The patient has a very red & inflamed tympanic membrane and you see fluid & pus in the ear. They say it was a rapid onset of ear pain, pressure and have diminshed hearing. You are thinking it is very possibly ______ ________ ________. |
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Definition
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Term
| A patient with Acute Otitis Media has ____________ _____ ___________. |
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Definition
| Eustachian tube dysfunction |
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Term
| THe patient you're seeing has an earache or pressure, ear drum rupture or bulging, purulent drainage and hearing loss. Basically, they have a chronic recurrent infection or inflammation of the middle ear. You think this could very possibly be _________ _________ _________. |
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Definition
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Term
| There is an accumulation of fluid in the middle ear that is most often due to EUSTACHIAN TUBE DYSFUNCTION. Commonly due to infections, allergies, adenoids or other obstruction. This is likely _____ _______ _________. |
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Definition
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Term
| This is an outpatient ear surgery procedure where a tube is inserted into the eardrum. It falls out itself after a year. This is usually only performed on pt's with intractable (not easily cured) pain. |
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Definition
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Term
| What activities does a person with myringotomy have to avoid? |
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Definition
| All of the previously mentioned for ear surgery, but especially cannot go swimming or jump on a trampoline. |
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Term
| a TYMPANIC PERFORATION is usually the result of infection, but may be due to trauma or overly aggressive ear cleaning. What do we do for this? How much hearing loss happens? |
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Definition
| Tympanic Perforations usually heals on their own in 1-2 weeks. Hearing loss depends on the size of the opening. |
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Term
| This is a traumatic inflammatory disorder of the middle ear caused by sudden, severe negative pressure. It causes SUDDEN SEVERE PAIN, hyperemia of the ear drum, sometimes with fluid in the middle ear and hearing loss. It usually resolves spontaneously within several hours. This damage from rapid depressurization is called ____________. |
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Definition
| Barotrauma (might be an ascent from underwater or coming down fast from a plane) |
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Term
| This is an acute or chronic infection of the mastoid air cells in the temporal bone due to untreated or poorly treated otitis media. Pain is not relieved by a myringotomy. (this is not seen a lot in the US anymore & is more prevalant in children) What is this called? |
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Definition
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Term
| What are some signs & symptoms of Mastoiditis? What are the tests that will be performed? and finally what is the treatment? |
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Definition
| THE BONE BEHIND THE EAR ISVERY POROUS. S/S=swelling, cellulitis behind the ear, fever, malaise, ottorhea, tender enlarged lymph nodes, otitis media on ear exam, and hearing loss. Tests=CBC, C&S, CT scan, lumbar puncture if intracranial signs exist. Treatment=IV antibiotics & surgical excision of infected bone & tympanoplasty. |
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Term
| What is ringing or noise in the ear audible only to the patient? |
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Definition
| Tinnitus. Often it is noticed most at night, can be whining, roaring or ringing. we want to focus on treatment of underlying cause, mask the noise, and aid with sleep and depression. |
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Term
| If the patient complains of a new onset of tinnitus (ringing) then start looking at their medications sd effects. What common drugs cause tinnitus? |
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Definition
| Aminoglycoside antibiotics (like Gentamyacin), Salycilates (like Aspirin), Propanolol. Be careful to monitor blood levels in known ototoxic drugs like Gentamyacin b/c it can cause permanent hearing loss. |
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Term
| What's the difference between vertigo & dizziness? |
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Definition
| Vertigo feels like the world is moving around you (usually comes with N&V, nystagmus, falls & headaches). Dizziness is an altered feeling of a persons relationship to space (may also be described as feeling faint or light headed). |
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Term
| Benign Paroxysmal Positional Vertigo is incapacitating vertigo associated with changes in position. There is an accumulation of canalith in the inner ear (canalith is calcium carbonate crystals). Rehab for this is to get calcium carbonate crystals back where they're supposed to be. Benign Paroxysmal Positional Vertigo is diagnosed using _____________ ____________. |
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Definition
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Term
| An infection of the labyrinth (the vestibular nerves) is called _____________. The 1st is usually the worst, it can be permanent & they will physical therapy need gait retraining. |
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Definition
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|
Term
| Labyrinthitis is treated with: |
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Definition
| antivirals or antibiotics. Antiemetics and antivertigo meds along with dark, quiet room and bed rest. |
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Term
| __________ Disease is CHRONIC, RECURRENT DISORDER of the inner ear. Dilation of cochlear duct by either over production or decreased reabsorption of endolymph lead to progressive __________ _________ __________. |
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Definition
| Meniere's Disease. leads to sensorineural hearing loss. |
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Term
| Meniere's disease occurs in __________ ___________ that last hours to days of being nauseatingly dizzy. They will want to be in a dark, quiet room. The nursing goal is to keep them safe b/c they're at risk for injury & have sleep distrurbance. Position them lying down with affected ear up. |
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Definition
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Term
| Meniere's Disease requires a STRICT ADHERENCE to a low ______ diet, less then 2 grams/day. We want to give them a _____ wasting diuretics such as Diazide. Treat their nausea + vertigo. Absolutely, NO ____________. |
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Definition
| NO SALT, SODIUM wasting diuretics, NO SMOKING |
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|
Term
| Hearing aids are used for someone with __________ hearing loss. This type of hearing loss results from.... |
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Definition
| conductive - results from any physical obstruction of sound wave transmission (such as foreign body in external ear canal, a retracted or bulging tympanic membrane, or fused bony ossicles) |
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Term
| Hearing aids require an ear exam and audiometry. From the nurse, they require _________ for best use and longevity. usually last 3-5 years and cost from $400-$3,000. |
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Definition
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|
Term
| The patient will always want to have an ____ _____ prior to first purchase. |
|
Definition
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|
Term
| A ________ _________ is an implanted electrical device that is usually only placed in one ear & directly stimulates the auditory nerve. This is a 2-3 hour procedure under general anesthesia. |
|
Definition
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|
Term
| What kind of communication techniques should you facilitate when talking to someone who is hearing impaired? |
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Definition
| stand directly in front of the client, be sure the room is well lit, get their attention before you speak, remove all distracting noises, speak clearly and slowly, keep it simple and ask for feedback (not just a nod). Use lower tones, DO NOT SHOUT. write to clarify. Have them repeat your statements, do not just assume they understood. Rephrase your sentences & repeat the info to aid in understanding. |
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Term
| What age changes are common in the eye? |
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Definition
| pupil shrinks (harder to see in dim light), cornea flattens (increases blurring), eyes appear to be sunken, sclera yellows, lens yellows, hardens & loses elasticity, near point of vision increases, but far point of vision decreases, color perception decreases (can't see green, blue & violet), older people have a NARROWER FIELD OF VISION. |
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Term
| ____________ is inflammation of the eyelid. That causes itching and occasionally red, burning eyes. Causes crusting, scales and exudate to be seen. 2 main types are bacterial and seborrheic. |
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Definition
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Term
| _________ is inward turning of the eyelid, most commonly the lower lid. Caused by trauma, muscle spasms or inflammation. What is the main concern of this??? |
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Definition
| Entropion - main concern is corneal abrasion |
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Term
| _________ is outward turning or drooping of the eyelid, most often the lower lid. Usually caused by aging. What is the main concerns about what this leads to??? |
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Definition
| Ectropion. Main concerns are it leads to: Corneal drying and ulceration. |
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Term
| __________ is a "stye." Comes from glands in the lid becoming infected, and the pores which allow the glandular material to escape become clogged. How do we treat this? |
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Definition
| Hordeolum. With treatment we increase blood flow to the area, so treat with a warm compress 3-4x/day + antibiotic ointment. |
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Term
| ____________ is a "stye" too, but it's an infection of the Zeis gland or the meibomian glands (chalazion glands). You will see a slowly enlarging nodule on the eyelid caused by the inflammation of these glands. |
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Definition
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|
Term
| Keratoconjunctivitis Sicca is ____ _____ syndrome. |
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Definition
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Term
| Keratoconjunctivitis sicca or Dry Eye Syndrome is due to an alteration in tear production, composition or tear distribution. Caused by medications, autoimmune diseases such as RA, lupus or Sjogrens, radiation or chemical burns or nerve damage. Some meds that can cause or make this worse are: |
|
Definition
any anticholinergic drug, oral contraceptices, antihistamines, beta-blockers, phenothiazines, atropine...
Probably don't need to know this exactly, but know the general causes of dry eye syndrome. |
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Term
| Subconjunctival Hemorrhage is usually due to ___________, _________ or straining. It may be a complication of _________ or ____________. |
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Definition
| usually: coughing, sneezing or straining. may be b/c of: HTN or a clotting problem. |
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|
Term
| What do we do for subconjunctival hemorrhages? |
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Definition
| they usually resolve without treatment in 1-2 weeks |
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Term
| _________________ is "pink eye". It's an inflammation or infection of the conjunctiva. S/S are itching, burning, edema, excessive tearing and engorged blood vessels. Really important to teach really good handing washing & do not share towels. |
|
Definition
| Conjunctivitis (can be b/c of allergies/dust, not always infection) |
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Term
| ____________ is the leading cause of preventable blindness. This is a chronic, bilateral conjunctival infection by Chlamydia trachatis. Have edema, entropion, conjunctivitis, tearing, photophobia, corneal scarring. |
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Definition
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Term
| ____________ is an opacity or cloudiness of the lens that interferes with focusing light and being able to form a clear image. This results in what kind of vision? |
|
Definition
| Cataracts. Get blurry, distorted vision. |
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Term
| What are the causes of cataracts? |
|
Definition
| Age (common over 70) Trauma, Toxic EXPOSURE TO CHEMICALS, SUNLIGHT OR MEDICATIONS. Associated with other SYSTEMIC DISEASES and complications of other EYE DISEASES. |
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Term
| to prevent Cataracts wear __________. Does cataracts cause pain/redness? |
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Definition
| sunglasses. There is NO PAIN or REDNESS with cataracts... if there is then they have something else. |
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|
Term
| What does cataracts do to color perception, visual acuity, red reflex? How does the pupil appear and what does cataracts eventually cause? |
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Definition
| BLURS VISION, GET GLARES FROM SUN OR HEADLIGHTS, DECREASED COLOR PERCEPTION, REDUCED VISUAL ACUITY, ABSENCE OF RED REFLEX. pupil appears WHITE & Cataracts leads to.... EVENTUAL BLINDESS. |
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|
Term
| How do we treat cataracts? |
|
Definition
| SURGERY (lens removal & implant is the only cure) - it's a very safe surgery & go home in a couple of hours. See better in a few days, but it actually takes SEVERAL MONTHS (so wait a couple months to get new prescription). A pre-op evaluation & post op education is key to a successful experience. |
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Term
| Post op care for cataracts says we want to call the doctor if which of the following occur? severe eye pain, esp. if have N+V too, purulent drainage, decrease in vision, increase in eye drainage, bleeding or sudden flashes of light... |
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Definition
| ANy & ALL of those ... give Tylenol & avoid Aspirin/Ibuprofen following surgery. |
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|
Term
| What patient instructions will be given to a cataract surgery patient? |
|
Definition
| Need to really avoid activities that increase IOP. So, try not to sneeze, cough, BEND FROM THE WAIST, vomit, have sex, and do NOT carry more then 5-10 lbs. Do not go to the hair dresser and lean head back. NO driving (figure out who is going to drive them home). Sleep on non-op side or back so pressure is decreased. They can gently clean the eye with water on a cotton ball, but do not get water into the eye. wear eye patch when sleeping for a week to a month, lie flat or in low Fowlers. |
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Term
|
Definition
| it's a PROGRESSIVE!!! degeneration of optic nerve fibers associated with an increase in IOP due to an imbalance between production and outflow of aqueous humor or an obstruction of outflow. Early detection is key to stop progressive damage to the optic nerve b/c it can't be reversed. |
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|
Term
| What are symptoms of Glaucoma? |
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Definition
| Increased IOP (Normal is 5-10 mmHg IOP), diminished accomodation, blind spots or decreased peripheral vision, HALOS AROUND LIGHTS, headaches. |
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Term
| There are 2 major types of glaucoma: Primary open-angle & acute or closed angle glaucoma. What is the key differences? |
|
Definition
| Primary Open-Angle is ASYMPTOMATIC in the beginning, is bilateral and is much more common. ACUTE or CLOSED ANGLE GLAUCOMA is a medical EMERGENCY, has a SUDDEN ONSET with impaired vision, SEVERE EYE PAIN, N & V. |
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Term
| Glaucoma assessments use tonometry, opthalmoscope exams and tonography. What do each of these assess? |
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Definition
| Tonometry: measure IOP (normal is 22-32 mmHg), Opthalmoscopic Exam: cupping and atrophy of the optic disc, Tonography: measure outflow of aqueous humor. |
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|
Term
| How does a non-surgical glaucoma treatment work? |
|
Definition
| DRUG THERAPY: it works to decrease IOP by either CONSTRICTING THE PUPIL (CILIARY MUSCLE) or by REDUCING THE PRODUCTION OF AQUEOUS HUMOR. |
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|
Term
| What kind of drugs are used in Glaucoma drug therapy for pupillary constriction? |
|
Definition
| Miotics & Prostaglandin agonists |
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|
Term
| What kind of drugs are used in glaucoma drug therapy for aqueous humor inhibition? |
|
Definition
| Beta blockers and Carbonic Anhydrase Inhibitors |
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|
Term
| When meds are no longer working for Glaucoma then a surgical treatment is recommended. Explain how the laser surgery works for glaucoma... |
|
Definition
| LASER SURGERY: trabeculoplasty, the trabecular meshwork is burned & scared tightening the fibers thus improving outflow. Instruct the patient to bring someone with them. |
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|
Term
| What are the 2 leading causes of blindness? |
|
Definition
|
|
Term
| Hypertensive Retinopathy. How does hypertension lead to blindness? |
|
Definition
| HTN leads to NARROWING OF THE BLOOD VESSELS, leakage of blood and exudate, ischemic areas and retinal detachment. May be precipitated by headaches & vertigo. |
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|
Term
| What is the LEADING CAUSE OF VISUAL DISABILITY AND BLINDNESS AMONG ADULTS IN THE US? |
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Definition
| Diabetes! Diabetic Retinopathy causes damage to the blood vessels of the retina that worsens as blood glucose worsens. It is very imp. for diabetics to get their eyes checked. |
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|
Term
| Diabetic Retinopathy causes microaneurysms and vessel death causing leakage of blood and scarring, retinal iscehmia and macular edema. Capillaries can't carry oxygen and nutrients anymore. Then Proliferative diabetic retinopathy happens in response to _____ new fragile blood vessels grow. The new vessel leaks and they grow onto the retina and iris. Can lead to retinal detachment. |
|
Definition
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|
Term
| How does the laser photocoagulation treatment for diabetic retinopathy work? |
|
Definition
| a high energy laser beam burns and creates small scars, sealing leaks and aneurysms and destroying new vessel networks. |
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|
Term
| How does diabetic retinopathy treatment Vitrectomy work? |
|
Definition
| done to remove large unresolved hemorrhage or scar tissue. Fluid & tissue volume is replaced using a saline solution. |
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|
Term
| Macular Degeneration (losing central vision) can we "wet" or "dry". What is the wet? |
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Definition
| Wet (or exudative) is new blood vessels & exudate that blocks vision. |
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|
Term
| What is the "dry" macular degeneration? |
|
Definition
| Dry is age-related degeneration caused by gradual blockage of retinal capillaries leading to ischemic death of photoreceptors. 90& have dry like this. Dry is more common, but unfortunately less treatable then wet. |
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Term
| Signs of Macular Degeneration are loss of central vision, blurred words when reading print, warped or bent lines on an _________ grid. |
|
Definition
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|
Term
| What risk factors should be reduced to stop macular degeneration? What is the nutritional treatment? |
|
Definition
| STOP SMOKING, treat HTN, treat high cholesterol, Eat a lot cholesterol/low fat diet, protect eyes from UV rays/sun (wear sunglasses). NUTRITIONAL TREATMENT for macular degeneration: deit rich in antioxidant vitamins D & E, Carotinoids: lutein, zeaxanthin, and betacarotin, get Minerals: zinc, selenium, magnesium. |
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|
Term
| Exudative or WET Macular Degeneration can be treated with _______ treatments of seal leaking blood vessel. |
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Definition
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|
Term
| The FDA recently approved the new drug ________ for wet macular degeneration. It is an antibody fragment to Vascular Endothelial Growth Factor (VEGF). It was developed from an anticancer drug called Avastin. |
|
Definition
|
|
Term
| Retinitis Pigmentosa is an INHERITED PROGRESSIVE DEGENERATION of the retinal nerve cells leading to ____________________________ into the sensory areas of the retina. |
|
Definition
| growth of pigmented cells |
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|
Term
| Myopia is ______sightedness where images fall short of the retina. |
|
Definition
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|
Term
| Hyperopia is ___sightedness where images focus behind the retina. |
|
Definition
|
|
Term
| ___________ is when the lens stiffens and it is hard to adjust to close work |
|
Definition
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|
Term
| _______________ is a curve of the cornea is uneven. |
|
Definition
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|
Term
| __________ Disorders are any disorder that alters the clearness or integrity of the cornea. There is pain, decreased vision, photophobia and increased secretions. Goals are to reduce symptoms, restore clarity, and enhance remaining vision. |
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Definition
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|
Term
| Arcus Senilus is an age related change. The iris has decreased ability to dilate and the elderly require more _____ to read. The cornea flattens, ocular muscle strength weakens and ____ production diminishes. |
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Definition
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|
Term
| _______ _________ is age related changes to the eye. |
|
Definition
|
|
Term
|
Definition
| 20/200 or less in the better eye with the best possible correction. |
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|
Term
| In Uveitis/Iritis the ____ is the most common place for inflammation. |
|
Definition
|
|
Term
| Symptoms of Iritis are... |
|
Definition
| unilateral, VERY painful, RED EYE (esp around iris), blurred vision, photophobia, tearing |
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|
Term
| Blunt trauma or a _________ is impact from an object causn sudden compression of the eye. Leads to edema of the eyelid, hemorrhage, corneal edema & hyphema. |
|
Definition
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|
Term
| _______________ hemorrhage is bleeding into the vitreous cavity d/t aging, systemic disease, trauma or it may occur spontaneously. Usually absorbs with no treatment. |
|
Definition
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|
Term
| ___________ is aging in the anterior chamber. Want to protect the eye with a _____ and _________. Elevate the HOB to 30-40 degrees, and avoid anelgesics like aspirin... do not want them to retain blood in this. |
|
Definition
|
|
Term
| Retinal Tear and Detachment is an ___________. What are the symptoms? |
|
Definition
| Emergency. flashes of light, showers of floaters, vision loss "like a curtain", filmy, wavy or cloudy visual defects. |
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|
Term
| Retinal holes tears & detachments are more common in people who are myopic (nearsightedness), older and who have had cataract removal. What is the treatment? |
|
Definition
| Depends on type location and size of detachment. Laser therapy or cryotherapy, intraocular gas, and sclera buckling are usually done as an outpatient. |
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Term
| If the patient has something in their eye irritating them we are worried about corneal abrasion. The evaluation of vision is ALWAYS done when? before or after the object is out? |
|
Definition
| ALWAYS evaluate vision PRIOR to treating the patient. |
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|
Term
| Do we immediately attempt to put an eye back in or remove an object that is protruding? |
|
Definition
| No, DO NOT ATTEMPT TO PUT THE EYE BACK (cover it with sterile saline, place so no stress on optic nerve) DO NOT REMOVE THE OBJECT: it may be holding the eye structures in place! |
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