Term
| What is general anesthia and what are its possible complications? |
|
Definition
Patient is unconscious and paralyzed.
-CNS Depression
-Malignant hyperthermia: acute and life-threatening
-Hypoventilation
-Intubation complications
-Tissue injuries due to positioning |
|
|
Term
|
Definition
-Inherited condition
-R/T inhalation anesthetics and succinylcholine
-Symptoms can occur anytime after administration of triggering agent
-Treatment: Dantrolene sodium |
|
|
Term
|
Definition
-Epidural (spinal is rare)
-Nerve block
-Infusion usually a combination of opioid and local anesthetic
-Chosen when patient is poor risk for general anesthia, when post-op analgesia is desired. |
|
|
Term
| What are some complications of regional anesthia? |
|
Definition
-Systemic delivery or absorption
-Overdose
-Catheter movement
-Nerve damage |
|
|
Term
| What are the post-op nursing implications of regional anesthia? |
|
Definition
-Monitor for appropriate level of analgesia
-Monitor for epidural catheter
-Monitor for complications
-Maintain patient safety |
|
|
Term
| What is moderate sedation? |
|
Definition
-Procedural sedation: endoscopy, ED, bedside
-Reduced level of consciousness - pt. is arousable and can maintain airway (reflexes intact)
-Fast-acting, short-duration meds |
|
|
Term
| What equipment is needed at bedside for moderate sedation? |
|
Definition
-Code cart for airway supplies (Ambu-bag, non-invasive and invasive airway devices)
-Suction
-Cardiac monitor/defibrilator
-BP cuff |
|
|
Term
| Nursing management for conscious sedation |
|
Definition
-Requires extra training for MD & nurse
-Do not leave the bedside if you ar the primary nurse
-Patent IV site
-Monitor VS, airway, and CV status before, durign, and until patient is stable after procedure
-Hold PO until LOC improve and gag reflex is checked (if upper endoscopy) |
|
|
Term
| What are some intraoperative nursing diagnosis? |
|
Definition
-Risk of bleeding
-Risk for infection
-Risk for injury and impaired tissue perfusion
-Risk for respiratory complications |
|
|
Term
| Post-Op Gi assessment and interventions |
|
Definition
-Postoperative N/V common (30% of patients experience N or V after general anesthesia)
-Peristalsis may be delayed up to 24 hours
-Monitor for bowel sounds
-Delay giving solid foods if peristalsis slow to return
-Increase activity as tol
-Treate N/V (watch for aspiration)
-Monitor for ileus |
|
|
Term
| Management of NG tube for GI surgeries |
|
Definition
-Assess drainage every 4 hours: quantity and quality
-Assess NGT is secured properly
-Verify placement each time before inserting anything |
|
|
Term
| What is the neurologic impact of delirium? |
|
Definition
-Not a disease but a symptom: global cerebral function
-Acute
-Transient
-Reversible
-Symptoms: Decreased attention span and fluctuating confusion
-Requires urgent attention |
|
|
Term
|
Definition
Incision closed: heals from outside in
-Dehiscence, evisceration: loss of incisional integrity seen most often between 5th and 10th days after surgery |
|
|
Term
|
Definition
Wound left open after surgery: heals from inside out
-Indications:
-Infected wounds
-Too much internal edema to close wound
-Too much trauma to close wound |
|
|
Term
| Fever in post-op patients |
|
Definition
-Monitor for temp >101.5
-Fever in first 48 hrs
--Usually due to inflammatory response
--Unlikely to ve r/t surgical site infection but watch for malignant hyperthermia
--May be r/t pneumonia or UTI or other nosocomial infection
--Careful assessment and interventions to decrease risk of infection
-Check WBCs
-Remeber that older patients may blunted response to inflammation or infection |
|
|
Term
| What population is most at risk for anesthesia complications? |
|
Definition
| Patients with cardiac problems |
|
|
Term
| What 3 populations are most at risk for pulmonary complications during surgery? |
|
Definition
-Older patients
-Those with chronic respiratory problems
-Smokers |
|
|
Term
| When can autologous blood donations be made? |
|
Definition
| Up to 5 weeks before surgery |
|
|
Term
| What are some alternative options for patients with religious or medical restriction to blood transfusions? |
|
Definition
-Bloodless surgery
-Minimally invasive surgery |
|
|
Term
| What are some indicators of malignant hyperthermia? |
|
Definition
-Tachycardia
-Increased end-tidal carbon dioxide level
-Increased body temp |
|
|
Term
| What are some possible intubation complications? |
|
Definition
-Broken or injured teeth
-Swollen lip
-Vocal cord trauma |
|
|
Term
| When is the highest incidence of hypoxemia after surgery? |
|
Definition
| Occurs on the second postoperative day |
|
|
Term
| About how long does it take clean surgical wounds to heal at skin level? |
|
Definition
|
|
Term
| About how long does complete healing of all tissue layers with in the wound take? |
|
Definition
| May take 6 months to 2 years |
|
|
Term
| What technique should you use during dressing changes? |
|
Definition
|
|
Term
| What steps should you take if dehiscence or evisceration occurs? |
|
Definition
-Remain with the patient
-Have the patient lie flat with knees bent to reduce intra-abdominal pressure
-Apply sterile, nonadherent dressing materials to the wound |
|
|
Term
|
Definition
| Decrease serum potassium level - increase risk for toxicity |
|
|
Term
|
Definition
| Increased serum potassium level - increased risk for dysrythmias |
|
|
Term
|
Definition
Used to assess the level of sedation in a hospitalized patient
-Ranges from 1-6
1. Anxious/Restless
2. Co-operative, oriented, and calm
3. Responsive to commands only
4. Exhibiting brisk response to light glabellar tap or loud noise
5. Exhibiting sluggish response to light glabellar tap or loud noise
6. Unresponsive |
|
|
Term
| How does a nurse know that a patient is ready to transfer from PACU? |
|
Definition
-Has a 9 or 10 on the recovery scale
-Is aware, oriented, alert
-Stable vital signs for 15-30 minutes
-Possess a core body temp not less than 96.8
-Have no acute bleeding |
|
|
Term
| How do you calculate nasogastric tube drainage? |
|
Definition
| Drainage in collection device minus amount of irrigant equals true amount of drainage |
|
|
Term
|
Definition
| Total separation of all wound layers and portrusion of internal organs through the open wound |
|
|
Term
| What are the 5 different categories of surgical procedures? |
|
Definition
1. Diagnostic: performed to determine origin or cause
2. Curative: Performed to resolve a health problem
3. Restorative: Perfromed to improve pt.'s functional ability
4. Palliative: Performed to relieve symptoms of a disease process, but does not cure
5. Cosmetic |
|
|
Term
| Why are dysrhythmias a problem? |
|
Definition
| Because they affect cardiac output |
|
|
Term
|
Definition
| Initiate their own impulse (intrinsic pacemakers, not dependent on neuro) |
|
|
Term
|
Definition
| Ions rapidly shift, depolarization. |
|
|
Term
|
Definition
| Transfer the electrical impulse from the muscle cell to muscle cell |
|
|
Term
|
Definition
| Cardiac muscle continually convert an electrical signmal into mechanical action without rest |
|
|
Term
| If EKG measures electrical activity of the heart, how do we measure mechanical activity? |
|
Definition
|
|
Term
|
Definition
| Usually refers to extra or abnormal beats |
|
|
Term
| What is the order of pacemakers failure in the heart? |
|
Definition
-SA Node (sinus)
-Atrial
-Junctional (AV node)
-Ventricular |
|
|
Term
| Average Stroke Volum (SV) |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are supportive care for symptomatic dysrhythmias? |
|
Definition
-Assess cerebral & CV perfusion
-Give supplemental oxygen
-Check IV access, consider second line
-IVF-NS
-Stat EKG
-Stat labs: BMP, CBC, Coags, CK/Troponin
-RRT |
|
|
Term
|
Definition
-Low BP
-Altered or loss of LOC
-Chest pain
-Heart failure
-Cool and clammy (shock state) |
|
|
Term
| Care for symptomatic bradydysrhythmias |
|
Definition
-Airway, O2, IVF, and get EKG
-Call RRT/code and prepare to give Atropine rapid IV push and/or Pacing |
|
|
Term
| Symptoms of symptomatic tachydysrhythmias |
|
Definition
-Low BP
-Altered or loss of LOC
-Chest pain
-Heart failure
-Cool and clammy
-Anxious |
|
|
Term
| Nursing care for symptomatic tachydysrhythmias |
|
Definition
-Airway, O2, IVF, EKG
-Meds differ if SVT (Adenosine, Diltiazem) vs. VT (Amiodarone)
-Cardioversion if pulse and BP present
-Defib and CPR if no pulse or BP |
|
|
Term
| What area do EKG leads reflect? |
|
Definition
|
|
Term
| Advantages pf "wireless" telemetry |
|
Definition
-Real-time continuous monitoring of rhythm
-Allows immediate identification, assessment and treatment of dysrhythmia
-Does not restrict patient to bed
-Unusual events on telemetry are followed up with 12 lead EKG |
|
|
Term
| Advantages of 12 lead EKG |
|
Definition
-Can measure amplitude (height) as well as time -- dx Myocardial ischemia &/or infarction and what part of the heart is affected.
-Consistent method across all providers which allows good baseline across time
-12 leads reflect more areas of the heart |
|
|
Term
| What is a pathophysiology r/t ST depression and ST elevation? |
|
Definition
Depression: Ischemia
Elevation: Infarction |
|
|
Term
|
Definition
-Primary pacemaker-starts cardiac cycle
-Initiates atrial depolarization and synchronized atrial contraction
-EKG: P wave
-HR: 60-100
-Location in right atrium makes it vulnerable to atrial enlargement or distension |
|
|
Term
|
Definition
-HR > 100
-Start with the assumption that ST is compensatory if HR is 150 or less
-Look for the cause, DO NOT treat rate without knowing cause
-ST>150-pt may become hemodynamically unstable if prolonged or compromised heart |
|
|
Term
| Atrial dsyrhythmias: A. Fib |
|
Definition
-Most common dysrhythmias
-R/t aging, HTN, CAD, HR, damage to right atrium
-Multiple sites send out weak uncoordinated impulses-atria quiver, no coordinated contraction to push blood into ventricles (loos of atrial kick-10%-30%
-Can be chronic underlying lung problem |
|
|
Term
| When someone is on Coumadin what lab do you monitor? |
|
Definition
|
|
Term
|
Definition
-Decreased cardiac output
-Risk for impaired cerebral perfusion: loss of contraction leaves blood sitting in atria->production of multiple small clots-> increased risk of stroke |
|
|
Term
|
Definition
| Calcium channel blocker-see for rate control, slows AV node |
|
|
Term
| A. Fib: Tachy protocol, brady protocol |
|
Definition
Tachy: IV diltiazem, followed by infusion
Brady: Check meds, hold inotropes, BB & CBC; may need permanent pacemaker |
|
|
Term
|
Definition
-Caused by localized irritable spot that rapidly and persistently fires impulses, seen as flutter waves
-AV node does not pass on every one
-See how atria have different rae from ventricles, but al vent impluses originate from atria |
|
|
Term
| Synchronized cardioversion |
|
Definition
-Treatment for a fib and a flutter
-All myocardial cells depolarize at once, allowing a refractory period for SA node to start first
-Done at bedside on telemetry unit or outpatient
-If non-urgent (pt asymptomatic), usually try "chemical" cardioversion first with meds |
|
|
Term
| Why must a patient be anticoagulated before a cardioversion? |
|
Definition
| If not anticoagulated, first strong beats of newly coordinated atria will send shower of clots to the brain . . . pt will have transesophageal echo |
|
|
Term
|
Definition
Depolarizing every cell in your heart at once
-Use if no pulse on patient |
|
|
Term
|
Definition
-Secondary pacemaker
-Normal rate 40-60 bpm
-Only electrical connection between atria and ventricles
-PRI: measures time charge is held in the AV node so ventricles have time to fill
-Normal PRI: 0.12-0.20 sec |
|
|
Term
| Problems with AV blocks and Junctional Rhythms |
|
Definition
-Rate too low:
AV blocks: Impulses blocked to ventricles and vent initiated rate is low
JR: inherent rate is 40-60
-Is patient symptomatic?
Yes: Follow Brady protocol
No: Check cardiac meds |
|
|
Term
|
Definition
Extension of AV node that splits into right and left bundle branches
-QRS: AV node firing & ventricular depolarization, initiating what?
-Normal QRS: < 0.12 sec |
|
|
Term
|
Definition
-Not a dysrhythmia, but abnormal conduction pattern in the ventricles.
-One BB is damaged (usually due to MI) and does not conduct impulses
-Normal fast conduction in one ventricle but delayed cell-to-cell transmission in other |
|
|
Term
|
Definition
-Ventricular origin of rhythm
-Ectopic vent site takes over pacing
-R/t electrolyte imbalance (esp K+ and Mg++), hypoxia, ischemia, infarction, idiopathic
-"Downward displacement of pacemaker"-bad sign |
|
|
Term
|
Definition
-If slow, the vent rhythm is usually called an "escape" rhythm: no rhythm initiated by SA or AV node, so ventricular site starts its own rhythm (to escape death)
-<40 we do not treat with antiarrhythmics |
|
|
Term
|
Definition
-Vent rate >100
-Treatment based on symptoms: with pulse or pulseless
-Pulse: tachy protocol if symptomatic
-No pulse: CODE
-AMIODARONE IV bolus, and then infusion x 18 hours |
|
|
Term
|
Definition
-No synchronized electrical activity in ventricles
-NO CARDIAC OUTPUT
-Loss of consciousness within seconds
-Code! Requires immediate CPR and defib |
|
|
Term
|
Definition
-No cardiac electrical activity, no cardiac output
-Code!
-ACLS does not recommend defibrillation for asystole
-Defib Resets the electrical system-no electrical activity to reset in asystole |
|
|
Term
|
Definition
Call a code and start CPR
-V tach
-V fib
-Asystole |
|
|
Term
|
Definition
-Not necessarily a problem
-Check for new onset, increased frequency, oxygenation, labs (especially lytes).
-Watch for new onset or increased frequency-might indicate precipitating condition that could cause heart dysrhythmias
-PAC-A. Fib
-PVCs-V. Tach |
|
|
Term
|
Definition
-Indications: chronically or intermittenly low rate that does not meet metabolic demands (low cardiac output)
-3rd degree heart block, slow a. fib, post-ablation
-No sinus pacemaker for ventricles
-Danger re intermittent a. fib
Override pacing: for SVT |
|
|
Term
| Implantable cardioverter-defibrillator (ICD) |
|
Definition
Indications:
-Documented history of v. tach or v. fib, long QT syndrome
-Significant risk factor like familial history, severe heart failure
Usually combined with pacemaker, especially in HF patients who need biventricular pacing.
Able to convert with much less electricity (comfort, anxiety) |
|
|
Term
| Nursing care specific to CABG |
|
Definition
-Cardiac perfusion
-Fluid overload
-Dysrhythmias: A. fib, V. arrhythmias, Pacemakers (temp)
-Pericarditis, pericardial effusion, cardiac tamponade
-Perfusion of graft extremity
-Telemetry
-"Off pump" v. "On pump" |
|
|
Term
|
Definition
-If only one bypass needed (LIMA to LAD)
-Endoscopic
-Robotic assisted |
|
|
Term
| How long does a CABG last based on donor grafts? |
|
Definition
LIMA (left internal mammary artery): 90% patent after 10 years
SVG (Saphenous vein graft): 75% occluded after 10 years |
|
|
Term
|
Definition
-'On pump': heart-lung bypass machine (extracorporeal)
Heart stopped and blood circulates via machine
ECMO: extracorporeal membrane oxygenation, non-surgical support for oxygenation and perfusion
-"Off pump"-no CP bypass adn heart stabilized mechanically with tools for surgery |
|
|
Term
|
Definition
-Single incision
-Valve sounds
-Biomechanical (porcine, autograft, or cadaver allograft) vs mechanical valve |
|
|
Term
| Pre-procedure for cardiac cath |
|
Definition
-Look out for Heparin allergies (more common) HIT
-Left main CAD="widow maker", first artery off aorta |
|
|
Term
| Post-procedure cardiac cath: femoral access |
|
Definition
-Check groin access every 15 minutes for first hour-palpate
-When there is a bleed, HR will rise first, then BP is the second sign
-Hemodynamically stable: Outcome for Care Plan, AEB
-Interventions are mostly about limiting mobility adn using pressure devices |
|
|
Term
| Cardiac cath: radial access |
|
Definition
More the norm in Europe but becoming more popular in America
-It awesome because you have no activity restriction
-Just wear "button pressure device" for a few hours |
|
|
Term
|
Definition
-Purpose is to improve cardiac perfusion
-These patients have fluid overload
-A. Fib is most common complication
-Will give beta blockers and temp pacemakers to fix rhythm |
|
|
Term
|
Definition
| Difference between systolic and diastolic |
|
|
Term
|
Definition
-Should chest tube fall out, cover with Vaseline gauze
-Atelectasis: diminished at bases
-Pleural effusion: crackles
-Toradol is very common for surgical pain (non-opioid, NSAID) |
|
|
Term
|
Definition
| Initiation of treatment prior to firm diagnosis |
|
|
Term
| Bypass considerations comparing donor sites |
|
Definition
-Arteries are better than veins
-Patients with IMA bypass, pay attention to lungs
-Arteries do better than veins because they are made for the high flow
-SVG only last about 10 years, but LIMA last about 25 years
-Hypertension lowers life of grafts |
|
|
Term
| Heart valves (comparisons) |
|
Definition
Valves: before surgery there will be "murmur," after surgery (with a mech valve) it will be a "tick" sound
-Autograft: will take your own pulmonic valve and replace aortic valve and then give you a new pulmonic valve
-Porcine/autograft valve: don't require anti-coag, have les s blood damage, but don't last as long (only 10 yrs)
-Mech valve: can last rest of life |
|
|
Term
|
Definition
Airway and breathing
-includes entire respiratory system except alveoli |
|
|
Term
|
Definition
Gas Exchange
-Alveoli only |
|
|
Term
| What can cause O2 to dissociate more or less rapidly? |
|
Definition
|
|
Term
| What are normal values for ABGs? |
|
Definition
pH: 7.35-7.45
PaCO2: 35-45
HCO3: 22-26
PaO2: 80-100 |
|
|
Term
| What are signs and symptoms of impaired gas exchange? |
|
Definition
| Restlessness, irritability, confusion, significant decrease in oximetry results, decreased PaO2, and increased PaCO2 levels |
|
|
Term
|
Definition
Risk factors for VTE
1. Circulatory stasis
2. Endothelial injury
3. Hypercoagulable state |
|
|
Term
|
Definition
| Protein present in blood after coagulation cascade triggered. Negative result usually RULES OUT thrombus (Positive result requires follow up testing as also increased in DIC) |
|
|
Term
|
Definition
-Follow aPTTs closely: check 6 hours after every dose change, every 12-24 hours when stable. Goal: 1.5-2.5 times control
-Always get independent double-check
-Works quickly: half-life one hour
-Reversal agent: Protamine sulfate |
|
|
Term
| Why would you only use Lovenox or LMWH if patient is stable? |
|
Definition
| Because Lovenox lasts much longer than heparin (half a day as opposed to an hour) |
|
|
Term
|
Definition
| Newer class of anticoagulant--can be used with history of HIT |
|
|
Term
|
Definition
-For outpatient therapy and then long-term prophylaxis (6 mos)
-Therapeutic INR 2.0-3.0 |
|
|
Term
|
Definition
-DVT/PE with contraindication to anticoagulation
-DVT/PE despite anticoagulation
-Chronic DVT/PE |
|
|
Term
| Acute Respiratory Failure |
|
Definition
-Unable to maintain gas exchange for adequate tissue perfusion
--PaO2<60; PaCO2>50, acidosis
-May be ventilatory or alverolar or mixed etiology |
|
|
Term
| Acute Respiratory Distress Syndrome |
|
Definition
Acute respiratory failure with these indicators
-Hypoxemia that persists even when 100% oxygen is given
-Progressive respiratory distress 24-48 hrs after ALI
-Symptoms based on alveolar dysfunction and massive inflammatory response
-Often r/t acute lung injury
-High mortality rate
-Treatment is symptomatic and supportive |
|
|
Term
| What are causes of ARDS (direct injury factors)? |
|
Definition
-Pulmonary infection
-Aspiration
-Near-drowning
-Inhalation of toxic gases or smake
-Lung contusion |
|
|
Term
| What are causes of ARDS (indirect injury factors)? |
|
Definition
-Sepsis
-TRALI or massive transfusion
-Cardiopulmonary bypass
-Pancreatitis
-Burns
-Shocks |
|
|
Term
|
Definition
Accumulation of fluid in pulmonary interstitial spaces (lung tissue) and then in alveoli r/t fluid overload or pump failure.
-cardiogenic: usually a severe form of left-sided heart failure
-Non-cardiogenic: r/t ARDS |
|
|
Term
| Signs and symptoms of pulmonary edema |
|
Definition
-MEDICAL EMERGENCY!
-Sudden onset of dyspnea
-Crackles usually to lung apex and that do not clear with cough
-Cough with frothy pink sputum
-Anxiety, restlessness, agitation, cool and moist skin, tachycardia, JVD |
|
|
Term
| Pulmonary edema treatment |
|
Definition
-Oxygen, positioning
-Diuretics-usually start with IV lasix stat!
-Morphine
-Nitroglycerin: decreases preload and afterload
-Inotropes to increase contractility--dobutamine |
|
|
Term
| Pleural effusion caused by transudate |
|
Definition
| fluid from fluid overload |
|
|
Term
| Pleural Effusion caused by exudate |
|
Definition
| Fluid from inflammatory process in pleura |
|
|
Term
| Signs and symptoms of pleural effusion |
|
Definition
-Dyspnea
-Cough, non-productive unless underlying pneumonia
-Pleuritic chest pain
-Decreased or absent breath sounds
-Pleural friction rub
-Signs of generalized fluid overload (if transudative) |
|
|
Term
| Diagnosis and treatment of pleural effusion |
|
Definition
-Diagnosed with CXR
-Treatment: Drain effusion (thoracentesis, chest tube); treat cause |
|
|
Term
| What are two types of chest trauma? |
|
Definition
-Blunt force
-Penetrating injury
-CXR standard and effective for diagnosing chest trauma |
|
|
Term
|
Definition
| Loss of integrity of pleura, loss of negative pressure, collapse of affected lung or lobe. |
|
|
Term
| What is tension pneumothorax in blunt trauma? |
|
Definition
-Complication of pneumothorax
-Fatal if left untreated: air enters pleural space but can't leave
-Pressure accumulates and pushes toward/compresses unaffected lung and heart including great vessels. Seen in tracheal deviation towards unaffected side.
-Decreased CO and cardiopulmonary collapse. |
|
|
Term
| Assessment of pneumothorax |
|
Definition
-Inspection: Resp effort, rate, chest wall motion, obvious trauma
-Auscultation: decreased BS over affected area
-Palpation: Subcutaneous emphysema (crepitus), fractures (grating or unstable ribs) |
|
|
Term
| Treatment of pneumothorax |
|
Definition
-Urgent/Emergent: Needle aspiration
-Chest tube insertion for continuous negative pressure suction to reinflate lung. |
|
|
Term
|
Definition
-Massive vs simple blood loss into thoracic cavity-1500 ml dividing point
-Treat with insertion of chest tube; surgery indicated if more than 1500-2000 ml initial drainage or 2000ml/hr x3 hrs |
|
|
Term
|
Definition
-Placement varies depending on whether hemo- or pneumothorax
-May have multiple chest tubes
-Often placed at bedsid
-Nursing responsibilities are to monitor the patient |
|
|
Term
| What are the different purposes of each chamber in a Chest Tube Drainage system? |
|
Definition
-Chamber 1: collects fluid draining from patient
-Chamber 2: water seal prevents air from re-entering patient's pleural space and shows if pt. has air leak
-Chamber 3: suction control of system |
|
|
Term
| Management of chest tube drainage systems |
|
Definition
Patient: Resp assessment; dressing q 48 hrs, vasoline gauze for airtight seal; site
Drainage system: Do not "strip" chest tube. Can increase intrathoracic pressure.
-Keep lower than patient's chest
-Assess for air leak (bubbling in water seal chamber) |
|
|
Term
| What should you do if chest tube falls out or tubing separates? |
|
Definition
-Vaseline gauze dressing for chest tube falling out
-If tubing separates you could clamp for a minute-but risk for tension pneumothorax; most likely just reconnect it |
|
|
Term
| What are the major concerns of rib fractures and flail chest and what is the treatment for this? |
|
Definition
-They could cause more damage
-Treatment is usually to stabilize chest and let ribs heal on own |
|
|
Term
|
Definition
-Higher levels of oxygen delivery--control of amount of oxygen is determined by dial, not just flow meter setting.
-More controlled and precise deliver (24-50%)
-Control is not at flow meter, it's on the dial on the mask |
|
|
Term
|
Definition
-100% FiO2 when flowmeter at 15L and flaps intact
-Bag should remain slightly inflated
-No humidifier
-Patients on 100% NRB are considered unstable--monitor closely and escalate appropriately |
|
|
Term
| Nursing management for patient requiring intubation |
|
Definition
-Maintain aggressive respiratory support (bag with flow meter at 15L) until intubation
-Verify tube placement (end-tibal CO2 and CXR as well as breath sounds).
-Stabilize the tube and mark the depth to monitor placement. |
|
|
Term
|
Definition
-Long term mechanical ventilation, patient intubated for more than 2 weeks
-Facial trauma
-Head and neck surgery
-Failed ET intubation |
|
|
Term
| What are the indications for having a cuffed or uncuffed trach tube? |
|
Definition
Must have cuffed tube for mechanical ventilation; when getting better will uncuff so you can breath around trach.
-Fenestrated tube so you can talk |
|
|
Term
| Care for the patient with a tracheostomy |
|
Definition
-Trach care every shift (sterile procedure)
-Cuff pressure can cause mucosal ischemia. Prevent tissue damage.
--Use minimal leak and occlusive techniques.
--Check cuff pressure often.
--Prevent tube friction and movement.
-Prevent/treat malnutrition, hemodynamic instability, hypoxia |
|
|
Term
| Complications of suctioning |
|
Definition
-Hypoxia
-Tissue (mucosal) trauma
-Infection
--Sterile vs. clean, home vs. hospital
-Vagal stimulation, bronchospasm (if happens, stop suctioning)
-Cardiac dysrhythmias from induced hypoxia (if happens, stop suctioning) |
|
|
Term
| Why would a patient experience hypoxia from suctioning trach? |
|
Definition
-Ineffective oxygenation before, during and after suctioning
-Prolonged suctioning time
-Excessive suction pressure
-Too frequent suctioning
-Use of catheter that is too large for the airway (pediatric) |
|
|
Term
| What is the difference between CPAP and BiPAP? |
|
Definition
| CPAP is one pressure, and BiPAP is two pressures |
|
|
Term
|
Definition
-Most positive pressure
--During inspiration pressure generated pushes air into lungs
--Bipap also with preset expiratory (PEEP) positive end expiratory pressure
-Most often used for patients with hypoxemia and progressive alveolar hypoventilation with respiratory acidosis |
|
|
Term
| Potential ventilator complications |
|
Definition
-Cardiac: hypotension and fluid retention; hypotension caused by pp that increases chest pressure and inhibits blood return to the heart.
-Lung: barotrauma-trauma to lungs from positive pressure
-GI: stress ulcers
-Infection: ventilator-acquired pneumonia (VAP)
-Muscle deconditioning |
|
|
Term
|
Definition
-leading cause of cancer deaths worldwide
-Poor long-term survival due to late-stage diagnosis
-Bronchogenic carcinomas: arises from bronchial epithelium, most primary lung cancers from here
-Paraneoplastic syndromes
-Staged to assess size/extent of disease
-Etiology and genetic risk |
|
|
Term
|
Definition
| Low levels of oxygen in the blood |
|
|
Term
|
Definition
| Decreased tissue oxygenation |
|
|
Term
|
Definition
| Use the lowest fraction of inspired oxygen to have an acceptable blood oxygen level without harmful side effects |
|
|
Term
| Low-flow oxygen delivery systems |
|
Definition
O2 delivery is variable and depends on patient's breathing pattern since room air dilution occurs
-Nasal cannula
-Simple face mask
-Partial rebreather mask
-Non-rebreather mask |
|
|
Term
|
Definition
Deliver accurate O2 levels that meet patient's O2 needs when properly filtered (delivers concentration from 24% to 100% at 8L to 15L/min)
-Venturi mask
-Aerosol mask
-Face tent
-Tracheostomy collar
-T-piece |
|
|
Term
| How does noninvasive positive-pressure ventilation (NPPV) work? |
|
Definition
| Uses positive pressure to keep alveoli open and improve gas exchange without the need for airway intubation, using O2 and just room air |
|
|
Term
|
Definition
To manage:
-Dyspnea
-Hyperabia
-Acute exacerbations of COPD
-Cardiogenic Pulmonary edema
-Acute asthma attacks |
|
|
Term
| What are the 3 ways that home O2 therapy can be provided? |
|
Definition
1. Via an O2 concentrator
2. Compressed gas in a tank or cylinder
3. Liquid O2 in a reservoir |
|
|
Term
| Patient instructions for home trachostomy care |
|
Definition
-Instruct patient to use shower shield over trach tube when bathing to prevent water from entering airway
-Teach to cover airway to protect it during the day, filter the air entering the stoma, keep humidity in airway, and enhance appearance
-Teach to increase humidity in home and instruct pt. to instill normal saline into artificial airway 10-15 times a day
-Wear medical alert bracelet |
|
|
Term
| Hallmark of respiratory failure |
|
Definition
|
|
Term
|
Definition
Inward movement of the thorax during inspiration, with outward movement during expiration
-Often occurs in high-speed vehicular crashes, is more common in older patients, and has a high mortality rate |
|
|
Term
|
Definition
-A potentially lethal injury and the most common chest injury
-Often follows injuries caused by rapid deceleration during vehicular accidents with hemorrhage occurring in and between the alveoli
-The resultant respiratory failure develops over time rather than immediately |
|
|
Term
|
Definition
-11th leading cause of death in the United States
-6% of all deaths
-Most common cause of death in non-cardiac ICUs
- >1 million cases in 2010 |
|
|
Term
| 3 types of host defenses: |
|
Definition
1. Inadequate - overwhelming infection (death)
2. Adequate - infection control = regulation (survival)
3. Excessive - sepsis/organ dysfunction -> out of control immune response and death |
|
|
Term
| 4 stages from infection to severe sepsis |
|
Definition
| infection/trauma -> SIRs ->sepsis -> severe sepsis |
|
|
Term
|
Definition
| Systemic Inflammatory Response Syndrome - A clinical response arising from a nonspecific insult |
|
|
Term
|
Definition
- Temp >= 38 C or <= 36C
- HR >= 90 beat/min
- Resp >= 20/min
- WBC >= 12,000 or <= 4,000 or >10% immature neutrophils |
|
|
Term
|
Definition
| SIRS with a presurred or confirmed infection |
|
|
Term
|
Definition
Sepsis with >=1 sign of organ failure:
- Cardiovascular
- Renal
- Respiratory
- Hepatic
- Hematologic
- CNS
- Unexplained metabolic acidosis |
|
|
Term
|
Definition
| Severe sepsis with hypotension refractory to adequate fluid resuscitation |
|
|
Term
| Multiple Organ Dysfunction Syndrome (MODS) |
|
Definition
| Altered organ function in an acutely ill patient such that homeostatic regulation is lost |
|
|
Term
|
Definition
-Infections:
Bacteremia
Community acquired pneumonia
Hospital acquired pneumonia
UTI
Meningitis
Wound infection or cellulitis
Peritonitis
MDRO
- Age
-Critically ill
-Invasive lines (CVC, Foley, ET tube/trach)
-Chronic diseases (co-morbidities)
-Immunocompromised
-Malnourished
-Intra-abdominal surgery |
|
|
Term
| Source of infection in all surgical patients most commonly found in the ___? |
|
Definition
|
|
Term
|
Definition
-Infection (but blood cultures negative 40% of time)
-Ischemia
-Trauma
-Shock
-Surgery, especially abdominal
-Burns
-Aspiration
-Pancreatitis
-Immunodeficiency
-Transfusion reaction |
|
|
Term
| Mortality _____ with the number of SIRS symptoms: |
|
Definition
|
|
Term
| What causes sepsis not to progress? |
|
Definition
-Homeostatic mechanisms remain effective
-Genetic differences
-Early identification
-Rapid intervention—”Early goal-directed therapy” |
|
|
Term
| Cardiovascular dysfunction: |
|
Definition
-Endothelial dysfunction → increased capillary permeability → systemic vasodilation and loss of intravascular volume
-Decreased vascular tone → venous pooling/third spacing → decreased volume of blood returning to heart (preload) → decreased cardiac output
-Hypotension →hypoperfusion of end organs
-Tissue and organ edema→ hypoperfusion of end organs → organ dysfunction |
|
|
Term
| What do you monitor for cardiovascular dysfunction? |
|
Definition
Monitor for:
-SBP < 90, especially if refractory to fluids
MAP < 65
-Need for vasopressors to maintain pressure (ICU and ED only)
-Severe sepsis if low BP responds to fluids
-Septic shock if low BP does not respond to fluids (refractory) and needs vasopressors to maintain SBP & MAP |
|
|
Term
|
Definition
-Lungs are very vascular and very sensitive to hypoperfusion and edema—usually one of the first signs of trouble
-Pts require more O2 to maintain their saturation r/t increased cellular oxygen demand.
-May need to be intubated & vented for ARDS |
|
|
Term
| What do you monitor for respiratory dysfunction? |
|
Definition
Monitor for:
-Increase in O2 by 2L or 28% FiO2 in last 24 hours
-Drop in O2 sat >5% for at least 4 hours that occurred in the last 24 hours |
|
|
Term
|
Definition
Not related to a chronic problem (CRF, CKD)
increased demand on the kidneys to conserve fluids and remove toxins AND decreased renal tissue perfusion and intravascular volume deficit → AKI (acute kidney injury) |
|
|
Term
| What do you monitor for renal dysfunction? |
|
Definition
Monitor for:
-Acute increase in creatinine >50% from baseline
-UOP < 0.5ml/kg/hr (quick method to calculate: half their weight in kg=minimum uo in ml/hr)
-Patient requiring ACUTE hemodialysis |
|
|
Term
|
Definition
-Not related to a chronic problem or anticoagulation meds
-Problems with bleeding AND clotting
Platelet levels can drop below 100 if they have been activated by an inflammatory process and consumed.
-INR may increase beyond the normal limits if the sepsis process has activated a condition known as disseminated intravascular coagulation (DIC).
-May develop petechiae or bleeding from IV sites, or have septic emboli which cause gangrene |
|
|
Term
| What do you monitor for Hematologic Dysfunction? |
|
Definition
Monitor for:
-Platelet count < 100,000
-INR increase over the upper normal limit
-Mottling or cyanotic extremities |
|
|
Term
|
Definition
-Lactic acidosis r/t cells switching to anaerobic metabolism due to hypoxia & hypoperfusion
-Adrenal exhaustion—give low dose steroids
-Hyperglycemia—maintain tight glycemic control (“don’t feed the bacteria”) |
|
|
Term
| What do you monitor for Metabolic Dysfunction? |
|
Definition
Monitor for:
-pH < 7.30
-Lactate Level > 2.4 |
|
|
Term
|
Definition
-Not related to CHRONIC problem
-Due to primary infection in liver (exposure to bacteria) or secondary due to “gut-barrier failure” due to increased capillary permeability or edema |
|
|
Term
| What do you monitor for Hepatic Dysfunction? |
|
Definition
Monitor for:
-ALT > 72 (reflects liver functioning)
-Total Bilirubin > 2 (total bilirubin will rise with increased stress on the body) |
|
|
Term
|
Definition
-Not related to CHRONIC problem (dementia)
-Hypoxia and hypoperfusion cause altered LOC (delirium) |
|
|
Term
| What do you monitor for CNS Dysfunction? |
|
Definition
Monitor for:
-Altered LOC from BASELINE
-Reduced Glasgow Coma Scale |
|
|
Term
|
Definition
-A series of evidence-based therapies that, when implemented together, achieve better outcomes than when implemented individually.
-This bundle of interventions must be completed 100% of the time within 6 hours for patients with severe sepsis, septic shock and/or lactate >4 mmol/L (36 mg/dL) |
|
|
Term
| Sepsis Resuscitation: within 6 hours of identification: |
|
Definition
-Give oxygen to keep oxygen sat > 94%
May need 100% oxygen per non-breather
May need to be intubated and ventilated
-Obtain 2 separate blood cultures BEFORE starting antibiotic, also other cultures
-Initiate antibiotic therapy as soon as BC drawn.
-Fluid resuscitation—may need significant volume. Normal saline first choice
-Monitor for fluid overload…
-Measure lactate level
-Insert urinary catheter to monitor hourly urine output. |
|
|
Term
| Sepsis Management Bundle: within 24 hours |
|
Definition
-Efforts to accomplish these goals should begin immediately, but may be completed within 24 hours
-Administer low-dose steroids for septic shock in accordance with a standardized ICU policy.
-Maintain adequate glycemic control.
-Prevent excessive inspiratory pressures on mechanically ventilated patients. |
|
|
Term
|
Definition
-Vasopressors—start with norepinephrine
-Corticosterioids
-Low dose
-For septic shock for BP refractory to fluids and pressors
Important note: Xigris is no longer on the market, not proven to be effective. |
|
|
Term
| Problems with Severe Sepsis Management: |
|
Definition
-Inconsistency in early diagnosis
-Inadequate volume resuscitation
-Late or inadequate use of antibiotics (7% increase in mortality for each hour antibiotics are delayed)
-Failure to:
support adequate cardiac output
control hyperglycemia
use low tidal volumes and pressures in acute lung injury
treat adrenal inadequacy |
|
|
Term
|
Definition
-Infection prevention & control
Assessment, early identification
-Implementing medical interventions and monitoring effectiveness or lack thereof
-Implement POC to prevent standard complications re immobility & hospitalization
ex/ DVT, pressure ulcer, etc
-Patient and family education and support |
|
|
Term
|
Definition
-Has OR on standby 24/7
-Has to have enough patient's necessitate this and give experience |
|
|
Term
| Important information to get when a trauma patient is first admitted |
|
Definition
Mechanism of injury
-Blunt, penetrating, MVA, fall, GSW, blast, burn, etc.
-Predict types of injury
-Helps plan for appropriate care adn equipment.
Allergies
Significant PMH |
|
|
Term
| What do the ABCDE of the primary survey stand for? |
|
Definition
Airway
Breathing
Circulation
Disability
Exposure |
|
|
Term
|
Definition
| 0-4 with 0 being really bad and 4 being not as bad. |
|
|
Term
|
Definition
| Scale that aims to give objective data on patient's consciousness. 3-15 with 3 being a deep coma. It assesses verbal response, verbal response, and motor response. |
|
|
Term
| Primary survey: Circulation |
|
Definition
-Check all peripheral pulses
-2 large-bore IVs
-NS or LR, PRBCs
-Assess for hemorrhagic shock (tennis scores, love, 15, 30, 40) |
|
|
Term
| Primary survey: Disability |
|
Definition
-Basic neuro exam
-Gross motor and sensory exam
-AVPU
Alert
Responsiveness to voice
Responsiveness to pain
Unresponsive
-Glasgow Coma Scale |
|
|
Term
|
Definition
| One in which the number of people killed or injured in a single incident is large enough to strain or overwhelm the resources of local EMS providers |
|
|
Term
| Homeostatic functions of skin |
|
Definition
-Barriers to microorganisms
-Protections from injury via barrier and sensation
-Maintain F/E balance
-Regulate body temp
-Regenerate itself
-Provides personal identity |
|
|
Term
| Local responses to burn: Zones of injury |
|
Definition
-Zone of coagulation: irreversible tissue damage
-Zone of stasis: low perfusion, potentially salvageable tissue
-Zone of hyperemia: Increased perfusion r/t inflammatory response; will recover |
|
|
Term
|
Definition
-Depth & degree of injury
-Extent of burn: percentage of body area
-Location |
|
|
Term
| What criteria is essential for skin regrowth after a burn? |
|
Definition
|
|
Term
| Burns: Depth & degree of injury |
|
Definition
-Different terminology but essentially the same criteria
-First, second, third degree burns
-Superficial-, partial-, full-, deep full-thickness
-Minor, moderate, major-ABA criteria
--Based on depth, extent, and location, type of burn
--Burn center referral criteria |
|
|
Term
|
Definition
-Minor: Superficial: BSA < 50% (sunburns)
-Moderate: Superficial: BSA > 50%; Partial thickness: BSA <30 %; Full thickness: BSA <10%
-Major/Critical: Partial Thickness: BSA > 30%; Full Thickness: BSA >10%; Inhalation injury; Inhalation injury; Any partial or full thickness burn involving the hands, feet, joints, face, or genitals |
|
|
Term
| Superficial Partial Thickness |
|
Definition
Superficial dermal burn
-Necrosis confined to upper third of dermis
-Zone of necrois lifted off viable wound by edema
-Small zone of injury |
|
|
Term
|
Definition
Deep Dermal Burn
-Necrosis involving majority of skin layers
-Zone of necrosis adherent to zone of injury
-Smaller edema layer |
|
|
Term
|
Definition
| No remaining viable dermis |
|
|
Term
|
Definition
| Adult: 9% head, 9% arms, 18% legs, 18% chest 18% back; 1: perineum |
|
|
Term
| Inflammatory response r/t burns |
|
Definition
-Increased capillary permeability
-Vasodilation
-Massive fluid shifts from blood vessels into tissue--capillary leak syndrome
-SIRS |
|
|
Term
|
Definition
-Extensive burns may lead to massive edema: obstruction may result from upper airway swelling
-High risk of airway involvement: Burns on head, neck, chest or burned in an enclosed space; singed nasal hairs; Soot in nostrils or sputum
-Mechanisms of injury r/t heat or smoke: Direct injury and cellular damage (external)
-Inflammatory changes |
|
|
Term
| Burns: Airway Obstruction |
|
Definition
-Damage may not show for 8-24
-Assessment:
Tachypnea, dyspnea, stridor or cough
Use of accessory muscles
Dry, reddened mucous membranes
Swollen uvula
Drooling
Hoarseness
Dry, reddened mucous membranes
-Treatment: 100% NRB, bronchodilators, suctioning, bronchoscopy
-Be prepared to intubate early |
|
|
Term
|
Definition
In resuscitative or urgent phase: Gas exchange
-Hypoxia
-Carbon monoxide poisoning or toxic gases
-Smoke inhalation
-ARDS |
|
|
Term
| Burns: Fluid Resuscitation |
|
Definition
-IVF: Lactated Ringers
-The lactate in LR is metabolized into bicarb by the liver, which can help correct metabolic acidosis |
|
|
Term
| Parkland formula for burns |
|
Definition
-Calculates fluid requirements for burn patients in first 24-hours
-4 X wt in kg X TBSA burned = 24 hr fluids
First half of fluid delivered in first 8 hrs
Second half delivered over 16 hrs
-Adust based on patient response to avoid overhydration and increased fluid overload |
|
|
Term
|
Definition
-Maintenance fluids-usually changed to D5 1/2NS with KCL
-Basal rate + insensible fluidloss (both involve calculations)
-Complications of over-hydration:
Compartment syndromes: extremity, chest, abdominal
ARDS |
|
|
Term
|
Definition
| Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. Lead to muscle and nerve damage and problems with blood flow |
|
|
Term
|
Definition
-Hgb, Hct elevated as a result of fluid volume loss
-Serum elecrolytes: Na+ decreased (trapped in interstitial fluid (edema) and lost through plasma leakage; hyperkalemia at first due to cell injury/death, then hypokalemia
-BUN/Creatinine
-ABGs-Metabolic acidosis |
|
|
Term
| Collaborative and nursing management goals |
|
Definition
-Maintain respiratory function
-Restore fluid balance
-Thermoregulation
-Prevent infection
-Restore skin integrity
-Adequate pain control
-Adequate nutrition
-Provide emotional support |
|
|
Term
|
Definition
-Pain Management
-Monitor ECG
-IV access (multiple)
-Management perfusion needs (maintain hourly urine output 0.5mg/kg) |
|
|
Term
| What are the most painful burns? |
|
Definition
| Superficial partial-thickness burns |
|
|
Term
|
Definition
-Most common type of burns: heat transfer from external source
-Causes: Flames, Scalds from hot foods or liquids, including steam (70% of peds patients)
-Prevention: Home water heaters < 120 F
-Hot food, liquid out of children's reach |
|
|
Term
|
Definition
-Most common cause: adults: occupational; children: household
-May not be much external damage (look for entrance and exit sites)
-Deeper wounds from current traveling through the body, course may be erratic through body
-Special precautions for electrical burns: EKG and cardiac monitoring; C-spine precautions |
|
|
Term
|
Definition
Cause
-Overexposure to sun
-Radiation treatment for cancer
-Industrial accidents
Prevention
-Educate public to protect against UV exposure
-Educate about safety measure in industrial setting |
|
|
Term
|
Definition
Cause
-Skin contact with caustic chemicals
Treatment
-Remove all contaminated clothing
-Thoroughly irrigate affected area
-May need specific counter-agent
Prevention
-Keep chemicals in a safe place
-Know how to neutralize chemicals
-Occupational training |
|
|
Term
|
Definition
Cause
-Inhalation of heated air and smoke
Incidence
-More in elders, inability to escape fire
Prevalence
-20% to 30% of patients in burn centers
-Majority of burn injury deaths from smoke inhalation
-77% increased mortality rate with cutaneous injuries |
|
|
Term
| Functions of the Nervous System |
|
Definition
-What: Direct all physiological, cognitive, and psychological activities
-Why: Coordinates homeostasis
-How: Gather sensory information, integrateit, and respond to it via motor activity |
|
|
Term
| Diagnostics for spinal cord injury |
|
Definition
-CT is now standard--more sensitive and specific than regular x-rays
-Must assess entire spine
Labs:
CBC
ABG
UA
Lactate |
|
|
Term
|
Definition
| An insult to the spinal cord resulting in a change, either temporary or permanent, in its normal motor, sensory, or autonomic function |
|
|
Term
|
Definition
Plegia: complete lesion
Paresis: some muscle strength is preserved |
|
|
Term
| Tetraplegia (or quadriplegia) |
|
Definition
-Injury of teh cervical spinal cord
-Patient can usually still move his arms using the segments above the injury (e.g. in a C7 injury, the patient can still flex his forearms, using the C5 segment) |
|
|
Term
|
Definition
| -Injury involving the thoracic or lumbo-sacral cord, or cauda equina (T1 and distal) |
|
|
Term
|
Definition
-Paralysis of one half of the body
-Usually in brain injuries (e.g. stroke, TBI) |
|
|
Term
| Complete vs. Incomplete SCI |
|
Definition
-Complete: no sensory, morot or autonomic funciton below the level of injury
-Incomplete: some sensory, motor or autonomic function below the level of injury
-Can't be determined until after spinal shock resolves |
|
|
Term
| Most common levels of SCI? |
|
Definition
-Tetraplegia: C5
-Paraplegia: T12 |
|
|
Term
|
Definition
-Transient physiological depression of cord function below the level of injury
Symptoms:
-Complete loss of all neurologic function (including reflexes and rectal tone)
-Initially hypertensive but then becomes hypotensive
-Flaccid Paralysis
Lasts several hours to days until reflex arcs below the level of injury recover |
|
|
Term
|
Definition
-Results from unapposed parasympathetic stimulation
-Most commonly seen with SCI above T6
-Classic Triad of symptoms: Hypotension, Bradycardia, Peripheral vasodilation
Differentiate from spinal shock, hemorrhagic shock, and hypovolemia shock-how? |
|
|
Term
|
Definition
Can result from any noxious stimuli below the level of injury, which triggers limited sympathetic hyperactivity.
-Most commonly caused by:
-Bladder and bowel distention
-Any trauma or injury: blisters, burns, fractures, appendicitis
-Pregnancy
-Can cause HTN crisis which can lead to seizures, stroke, and death |
|
|
Term
| Most common causes of death after acute phase of SCI |
|
Definition
-Pneumonia
-Pulmonary emboli
-Septicemia |
|
|
Term
| Adrenal glands release which chemicals? |
|
Definition
-Cortisol
-Aldosterone
-Testosterone
-Epinephrine and norephinephrine |
|
|
Term
|
Definition
-Released under stress response
-Increases blood sugar
-Fat, protein, CHO metabolism
-Anti-inflammatory, anti-immune response |
|
|
Term
| Corticosteroid medication |
|
Definition
-Common cause of Cushing's and Addisons syndromes
-Do not suddenly stop, must be tapered off
-Monitor for:
-Emotional labile, may develop acute psychosis
-Risk for injury
-Risk for infection
-Skin integrity
-High blood glucose levels |
|
|
Term
|
Definition
-Tumor in adrenal medulla that causes increased catecholamines production
-Intermittent episodes of sympathetic overstimulation
-Treated by surgery |
|
|
Term
|
Definition
-Common in brain cancer, neurosurgical and TBI patients
-Diagnostics: UO > 4L/24 hrs; USG <1.005
-Meds: DDAVP by inhaler (may be lifelong) |
|
|
Term
|
Definition
-Treatment
Fluid restriction
Raise sodium steadily bu slowly (watch for pum edema)
Vasopressin antagonist |
|
|
Term
|
Definition
Hypothyroidism (autoimmune)
symptoms are the same as hypothyroid |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the most common source of iodine? |
|
Definition
|
|
Term
| Implications of hyperthyroidism |
|
Definition
-Chest pain - Order TSH
-Nutrition
-Drug metabolism
-Post-Op thyroidectomy
-Anterior neck surgery
-Thyroid storm
-I-131 therapy |
|
|
Term
| Implications of hypothyroidism |
|
Definition
-Peri-Operative
-Drug Metabolism
-Increased risk of complications
-Poor energy level |
|
|
Term
|
Definition
-DKA has ketones, kussmaul respirations, develops rapidly, BS >300
-HHNS has hyperosmoloarity, no ketones, slower development, BS >500 |
|
|
Term
| Treatment priorities for DKA and HHNS |
|
Definition
First: fluid balance
-IVF rehydration started before insulin
-Start with NS 1-2 L in 1-2 hours
-Then complete rehydration over 24 hours
Hyperglycemia: controlled decrease via insulin infusion (not SQ)
-Electrolyte balance
-Watch for complications: seizures, cerebral edema |
|
|
Term
| What do stool studies evaluate? |
|
Definition
- Function and integrity of the GI tract
- Detect the presence of infections, protozoa, parasites, and blood in the stool |
|
|
Term
| What is the priority care after a patient has an upper endoscopy examination? |
|
Definition
| Check for the return of the gag reflex before offering fluid or food, to avoid aspiration |
|
|
Term
| What should you asses for in patients who have endoscopies? |
|
Definition
-Bleeding
-Fever
-Severe pain |
|
|
Term
| What should you check for in patients who have just had a colonoscopy? |
|
Definition
| Passage of flatus before allowing fluids or food |
|
|
Term
| Why does Gastroesophageal Reflux Disease (GERD) occur? |
|
Definition
| As a result of reflux, or backward flow, of gastrointestinal contents in to the esophagus |
|
|
Term
| What are symptoms of GERD? |
|
Definition
-Dyspepsia
-Belching
-Flatulence
-Difficult or painful swallowing |
|
|
Term
|
Definition
| Protrusion of a portion of the stomach through the esophageal hiatus of the diaphragm into the chest |
|
|
Term
| What are the symptoms of a hiatal hernia? |
|
Definition
| Most patients are asymptomatic, but some have daily symptoms similar to those with GERD |
|
|
Term
| What are some key points to remember when caring for patients with esophageal disorders? |
|
Definition
-Remain with dysphagic pt. during meals to prevent/assist with choking episodes
-Teach oral exercises and correct positioning aimed at improving swallowing
-Elevate head of bed by 6 in. when sleeping to prevent nighttime reflux
-Instruct patient to sleep in right side-lying position to minimize the effects of nighttime episodes of reflux |
|
|
Term
| What are the most common stomach disorders? |
|
Definition
-Gastritis
-Peptic ulcer disease
-Gastric cancer |
|
|
Term
|
Definition
| Inflammation of the gastric mucosa |
|
|
Term
| What can cause acute gastritis? |
|
Definition
| Inflammation of the gastric mucosa or submucosa after exposure to local irritants or other cause |
|
|
Term
| What is the most common bacterial cause of gastritis? |
|
Definition
|
|
Term
| What are the symptoms of acute gastritis? |
|
Definition
| Mild to severe epigastric discomfort, anorexia, cramping, nausea and vomiting, abdominal tenderness and bloating, hematemesis, or melena |
|
|
Term
| What are the symptoms of chronic gastritis? |
|
Definition
| Few symptoms unless ulceration occurs |
|
|
Term
| What is the gold standard diagnostic tool for gastritis? |
|
Definition
| Esophagogastroduodenoscopy via an endoscope with biopsy |
|
|
Term
| What is priority management for gastritis? |
|
Definition
-Supportive care for relieving symptoms (acute gastritis healing is spontaneous, usually occurring within a few days)
-Removing cause of discomfort |
|
|
Term
|
Definition
| Mucosal lesion of the stomach or duoenum |
|
|
Term
| What are 3 types of ulcers? |
|
Definition
-Gastric ulcers
-Duodenal ulcers
-Stress ulcers |
|
|
Term
| What causes peptic ulcer disease? |
|
Definition
| Results when mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin |
|
|
Term
| What are the complications associated with peptic ulcer disease? |
|
Definition
-Hemorrhage
-Perforation
-Pyloric obstruction
-Intractable disease |
|
|
Term
| What are the signs of perforation of a peptic ulcer into the peritoneal cavity? |
|
Definition
| The patient has a rigid, boardlike abdomen accompanied by rebound tenderness |
|
|
Term
| What are the primary goals of drug therapy for peptic ulcers? |
|
Definition
1. Provide pain relief
2. Eliminate H. pylori infection
3. Heal ulcerations
4. Prevent recurrence |
|
|
Term
| What is important to know if a patient has an active GI bleed? |
|
Definition
| This is a life-threatening emergency and requires supportive therapy to prevent hypovolemic shock and possible death |
|
|
Term
| What are 3 general guidelines to keep in mind when caring for patients with stomach disorders? |
|
Definition
1. Identify patients at risk for gastritis and peptic ulcer disease, especially older adults who take large amounts of NSAIDs and those with H. Pylori
2. Teach patients with abnormal symptoms, such as abdominal tenderness, abdominal pain that is relieved by food or pain that becomes worse 3 hours after eating, dyspepsia, melena, and/or distention to consult with physician immediately
3. For patients who have undergone a gastrectomy, collaborate with dietitian and instruct the patient regarding diet changes to avoid distention and dumping syndrome |
|
|
Term
| What is Irritable Bowel Syndrome? |
|
Definition
| A functional GI disorder characterized by chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating |
|
|
Term
|
Definition
| List the characteristic symptoms, including abdominas pain relieved by defecation or falling asleep or associated with changes in stool frequency or consistency, abdominal distension, the sensation of incomplete evacuation of stool, and presence of mucus with stool passage |
|
|
Term
| Why would a patient with IBS have a hydrogen breath test? |
|
Definition
| When small intestinal bacterial overgrowth or malabsorption of nutrients is present, excess hydrogen is produced |
|
|
Term
| What are some interventions you need to implement for a patient with IBS? |
|
Definition
-Health teaching
-Drug therapy
-Stress management |
|
|
Term
| What patient education should be included for patients with IBS? |
|
Definition
-Teach patients to avoid GI stimulants, such as caffeine, alcohol, and milk and milk products
-Teach patients to manage stress |
|
|
Term
|
Definition
| A weakness or defect in the abdominal muscle wall through which a segment of the bowel or other abdominal structure protrudes |
|
|
Term
| What is the risk for a strangulated hernia? |
|
Definition
| Can cause ischemia and bowel obstruction, requiring immediate intervention |
|
|
Term
| What is an intestinal obstruction? |
|
Definition
| Common and serious disorder caused by a variety of conditions and is associated with significant morbidity |
|
|
Term
| What should you assess in a patient with a nasogastric tube? |
|
Definition
Check every 4 hours for:
-Proper placement
-Patency
-Output |
|
|
Term
|
Definition
| An acute inflammation which occurs when the lumen of the appendix is obstructed, leading to infection as bacteria invade the wall of the appendix |
|
|
Term
| What are the causes of appendicitis? |
|
Definition
-Fecaliths
-Malignant tumors
-Worms
-Other infections |
|
|
Term
| What is the difference between the risks for slow onset and rapid onset appendicitis? |
|
Definition
-An abscess may develop in slow onset
-A rapid process may result in peritonitis |
|
|
Term
| What are the complications of peritonitis? |
|
Definition
They are all serious, some examples are:
-Gangrene
-Perforation |
|
|
Term
| What lab tests would you look for in appendicitis? |
|
Definition
| WBCs "shift to the left," and if the elevation is greater than 20,000 it may indicate a perforated appendix |
|
|
Term
| What should you do with a patient admitted for suspected or known appendicitis? |
|
Definition
| Keep them NPO to prepare for the possibility of emergency surgery and to avoid making inflammation worse. Surgery is required ASAP. |
|
|
Term
|
Definition
| A life-threatening, acute inflammation of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity |
|
|
Term
| What are the cardinal signs of peritonitis? |
|
Definition
-Abdominal pain
-Tenderness |
|
|
Term
|
Definition
| An increase in frequency and water content of stools or vomiting related to infection and inflammation of the mucous membranes of the stomach and intestinal tract, usually self-limiting unless complications occur |
|
|
Term
| What should you be concerned about with a patient with gastroenteritis? |
|
Definition
| Weakness and cardiac dysrhythmias may be the result of loss of potassium from diarrhea |
|
|
Term
| What is inflammatory bowel disease? |
|
Definition
| Usually refers to disorders of the GI tract with no known etiology, such as ulcerative colitis and Crohn's disease, but may be idiopathic |
|
|
Term
| What is ulcerative colitis? |
|
Definition
| Creates a widespread inflammation of the rectum and rectosigmoid colon, associated with periodic remissions and exacerbations |
|
|
Term
| What are the symptoms of ulcerative colitis? |
|
Definition
-Patient's stool typically contains blood and mucus
-Patient's report tenesmus
-An unpleasant and urgent sensation to defecate
-Lower abdominal colicky pain |
|
|
Term
| What should you instruct the patient about activity after treatment for ulcerative colitis? |
|
Definition
| Activity is generally restricted because rest can reduce intestinal activity, provide comfort and promote healing |
|
|
Term
| What is the most definitive test for diagnosing ulcerative colitis? |
|
Definition
|
|
Term
| What should you assess for in a patient with an ileostomy? |
|
Definition
| Coping strategies and identify support systems |
|
|
Term
|
Definition
| An inflammatory disease of the small intestine, the colon, or both. It is a slowly progressive, unpredictable, and a recurrent disease with involvement of multiple regions of the intestine with normal sections in-between |
|
|
Term
| What are the signs and symptoms of Crohn's disease? |
|
Definition
-Severe diarrhea
-Malabsorption of vital nutrients
-Anemia is common
-Fistulas are common with acute periods |
|
|
Term
|
Definition
| An abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect |
|
|
Term
| What are the complications of fistulas? |
|
Definition
-Systemic infections
-Skin problems
-Malnutrition
-Fluid and electrolyte imbalances |
|
|
Term
| What are the treatments of the patients with a fistula? |
|
Definition
-Includes nutrition and electrolyte therapy
-Skin care
-Prevention of infection |
|
|
Term
|
Definition
| Pouch-like herniations of the mucosa through the muscular wall of any portion of the gut, but most commonly in the colon |
|
|
Term
| What is the difference in the food a patient with diverticulosis should eat compared with a patient with diverticulitis? |
|
Definition
| Teach patients with diverticulosis to eat a high-fiber diet; diverticulitis requires a low-fiber diet, such as avoid nuts, foods with seeds, and GI stimulants |
|
|
Term
| What is the risk associated with diverticulitis? |
|
Definition
| Can result in rupture of the diverticulum with peritonitis, pelvic abscess, bowel obstruction, fistula, persistent fever or pain, uncontrolled bleeding |
|
|
Term
|
Definition
| An extensive irreversible scarring of the liver, usually caused by a chronic reaction to hepatic inflammation and necrosis |
|
|
Term
| What are the most common causes for cirrhosis? |
|
Definition
| Alcoholic liver disease and Hep C |
|
|
Term
| What are the risks associated with hepatic cell damage? |
|
Definition
| May lead to portal hypertension, ascites, bleeding esophageal varices, coagulation defects, jaundice, portal-systemic encephalopathy with hepatic coma, hepatorenal syndrome and spontaneous bacterial peritonitis |
|
|
Term
| What should the nurse make certain is done for a patient with cirrhosis and a GI bleed? |
|
Definition
| These patients should receive antibiotics on admission to the hospital |
|
|
Term
| How long does it take for hepatitis to be considered chronic? |
|
Definition
| When liver inflammation lasts longer than several months, usually defined as 6 months |
|
|
Term
| What puts people more at risk for gallstones? |
|
Definition
-If they are female
-Obesity
-Pregnancy
-Estrogen
-Birth control pills |
|
|
Term
| What pathologies could happen as a result of acute pancreatitis? |
|
Definition
| Severe, life-threatening complications sucha s jaundice from swelling of the head of the pancreas, calculi or pancreatic pseudocyst, transient hyperglycemia from release of glucagon, left lung pleural effusions, and total destruction of the pancreas leading to type 1 diabetes |
|
|
Term
| What would the nurse be concerned about in a patient with severe pain in the mid-epigastric area or left upper quadrant? |
|
Definition
|
|
Term
| What is the priority patient care for patients with acute pancreatitis? |
|
Definition
-Relieving symptoms
-Decreasing inflammation
-Anticipating or treating complications |
|
|
Term
| What is the focus of caring for a patient with chronic pancreatitis? |
|
Definition
-Manage pain
-Assist in maintaining a sufficient nutritional intake
-Prevent recurrence |
|
|
Term
| What is an alternative way to measure a patient's nutritional status if BMI is unavailable? |
|
Definition
| Measure patient's calf circumference |
|
|
Term
| What type of patients are likely to receive total enteral nutrition using a feeding tube? |
|
Definition
-Those can eat but cannot maintain adequate nutrition intake by oral intake of food alone
-Those who have permanent neuromuscular impairment and cannot swallow
-Critically ill patients |
|
|
Term
| What are some complications related to tube feeding? |
|
Definition
-Irritation
-Sinusitis
-Tissue erosion
-Pulmonary compromis |
|
|
Term
|
Definition
| A life-threatening metabolic complication that can occur when nutrition is restarted for a patient who is in a starvation state |
|
|
Term
| How often should a nurse check gastric residual volumes for a patient on tube feeding and why? |
|
Definition
| Every 4-6 hours or per agency policy, because overfeeding is a serious problem |
|
|
Term
| Who is a candidate for bariatric surgery? |
|
Definition
-Those who have repeated failure of nonsurgical intervention
-A BMI equal to or greater than 40
-Morbid Obesity |
|
|
Term
| What are indicators of malnutrition? |
|
Definition
-Weight loss of 5% in 30 days
-Weight loss of 10% in 6 months
-BMI <18 |
|
|
Term
|
Definition
| Vasomotor symptoms that occur as a result of rapid emptying of food into Small Intestine, occurs around 30 minutes after eating; often seen with Gastric Bypass |
|
|
Term
| Dumping syndrome symptoms and treatment |
|
Definition
Symptoms:
-Vertigo
-Tachycardia
-Syncope
-Sweating
-Pallor
-Palpitations
Treaments: Small meals, low CHO |
|
|
Term
| What are Small Intestine Bowel Obstruction S&S, Diagnostic findings, and medical management? |
|
Definition
S&S:
-Colicky severe abd pain, N&V
-Absence of stool or flatus
-Late sign: fecal vomiting
Dx:
-X-ray and CT show abnormal amount of air/fluid in intestine
MM:
-Decompression with NG tube and bowel rest
-If worsens and bowel at risk for ischemia, bowel resection |
|
|
Term
| What are the S&S and Diagnostics of Large Intestine Bowel Obstruction? |
|
Definition
S&S: (slower onset than SBO)
-Constipation
-Abd distension
-Eventually fecal vomiting
DX:
-Abd X-ray
-CT reveal a distended colon |
|
|
Term
| Functions of the renal system |
|
Definition
-Fluid and electrolyte balance
-Blood filtration-remove waste products of the body's metabolic processes in the form of urine
-Acid-base balance
-Blood pressure regulation
-Erythropoetin production
-Vit D production |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Glomerular filtration rate |
|
Definition
Stage 1: kidney damage (90 or more GFR-ml/min)
Stage 2: kidney damage (60-80)
Stage 3: kidney damage (30-59)
Stage 4: kidney damage (15-29)
Stage 5: Kidney failure: ESRD (less than 15) |
|
|
Term
|
Definition
-Acute kidney injury (AKI): sudden onset and frequently reversible with supportive care
-Chronic Kidney Disease (CKD): gradual onset over months to years
-End-stage Renal Disease (ESRD) |
|
|
Term
| RIFLE criteria for Acute Kidney Injury |
|
Definition
Defines 3 grades of increasing severity of AKI
Risk
Injury
Failure
2 outcome classes
Loss
End-stage kidney disease |
|
|
Term
| Types of Acute renal failure |
|
Definition
Prerenal failure – results from conditions that interrupt the renal blood supply; thereby reducing renal perfusion (hypovolemia, shock, hemorrhage, burns impaired cardiac output, diuretic therapy).
Postrenal failure – results from obstruction of urine flow.
Intrarenal failure – results from injury to the kidneys themselves (ischemia, toxins, immunologic processes, systemic and vascular disorders). |
|
|
Term
| Symptomatic treatment for AKI |
|
Definition
-Hyperkalemia (urgent)
Kayexalate (binds with K+ for excretion in stool)
IV insulin
IV glucose
-Oxygen
-Medications (Diuretics sometimes)
-Dialysis: Hemodialysis, or continuous renal replacement therapy CRRT-ICU only |
|
|
Term
|
Definition
-Special large-volume high-flow catheters
For acute dialysis--temporary uncuffed
For chronic dialysis if patient has lost or is not a candidate for AV or AV shunt
-DO NOT FLUSH! Filled with heparin to avoid clotting |
|
|
Term
|
Definition
progressive decline in kidney function that correlates with loss of nephron
-Symptoms occur when overall renal function is less than 20-25% of nephrons remain
-ESRD: 90% nephron loss--uremic syndrome |
|
|
Term
| Dietary restriction for CKD |
|
Definition
-Low protein
-Low potassium, sodium, phosphorus |
|
|
Term
|
Definition
-Replace urinary output plus 500ml
-methods to manage thirst such as hard candy and ice |
|
|
Term
| Care of the patient on Peritoneal Dialysis |
|
Definition
Peritonitis is a major concern (“risk for infection”)—STERILE PROCEDURE
Wear mask and sterile gloves for procedure. Put mask on pt.
Assess drained “effluent” for clarity. Cloudy effluent is sign of peritonitis (like urine).
Assess for abdominal pain, hyperactive BS, diarrhea, unusual abd distention.
Notify MD immediately for any abnormal findings. Send specimen of effluent for C&S, WBCs |
|
|
Term
|
Definition
-Natural acquired immunity
-Artificial acquired immunity: mild if any symptomatic response but still immunogenic
-Natural passive immunity
-Artifical passive immunity: short-term (IVIG, RhoGam) |
|
|
Term
| Drugs that affect the immune system |
|
Definition
-Allergies: Corticosteroids, antihistamines, epinephrine
-Immunosuppressants: corticosteroids, cyclosporins, tacrolimus
-Boosting the immune system: Interferons, neupogen, IVIG
-Vaccinations |
|
|
Term
| 3 types of live vaccinations |
|
Definition
1. Varicella
2. Zoster
3. Measles, mumps, rubella |
|
|
Term
| Characteristics of metastatic neoplasms |
|
Definition
-Rapid and uncontrolled growht
-No contact inhibition; loose adherence; and migration
-Non-functional |
|
|
Term
| 7 early warning signals of cancer (CAUTION) |
|
Definition
1. Change in bowel or bladder habits
2. A sore that does not heal
3. Unusual bleeding or discharge
4. Thickening or a lump in the breasts, testicles, or elsewhere
5. Indigestion or difficulty in swallowing
6. Obvious change in the size, color, shape, or thickness of a wart, mole or mouth sore
7. Nagging cough or hoarseness |
|
|
Term
|
Definition
Strict aseptic technique for all invasive procedures, avoid unnecessary lines and tubes
Limit visitors (healthy adults only)
Private room and supplies—do not bring in common supplies (ie, BP machine)
Call for temp >100.5 , monitor for early s/s infection
Monitor WBC and ANC daily
No fresh flowers in room
Diet: “neutropenic diet” (no fresh fruits or veggies, or undercooked food)
Pt & family education |
|
|
Term
| Biologics, including immunotherapy for cancer treatment |
|
Definition
Cytokines
-Interferons—improve immune response, decrease rate of cancer cell growth
-Interleukins—improve immune response against cancer cells
-Hematopoietic growth factors
Thalidomine—decrease angiogenesis
Monoclonal antibodies—target specific antigens (CLL, non-Hodgkins, melanoma)
Vaccines
BCG therapy—bladder cancer only
Side effects— flu-like symptoms, severe allergic reactions |
|
|
Term
|
Definition
Done in special units or on oncology floor
For hematopoietic cancers
High dose chemo or radiation to destroy pt’s own bone marrow— pts are extremely ill
New stem cells are infused after matching HLA antigens
-Autologous
-Allogenic
New WBCs, RBCs, platelets within 2-4 weeks
Immunosuppression takes months to 1-2 years to resolve. |
|
|
Term
|
Definition
Infection: sepsis, DIC
Procoagulant: DVT & PE
F/E imbalance: SIADH, hypercalcemia
Compression by tumor:
-Spinal cord compression
-SVC syndrome
Response to therapy: tumor lysis syndrome |
|
|
Term
| DNR, DNAR, AND, Comfort Care |
|
Definition
DNR: Do Not Resuscitate
DNAR: Do Not Attempt Resuscitation
AND: Allow Natural Death
Comfort Care: must also have DNR/AND
POLST– Physician Orders for Life-Sustaining Treatment |
|
|
Term
| Physician's Orders for Life-Sustaining Treatment (POLST) |
|
Definition
Orders that specifically address different treatments that patients can have.
Covers CPR as well as ACLS orders
Also give providers information about patient’s GOAL :
-From aggressive curative care to comfort care only
-Directs specific ACTIONS to be taken or held (see example POLST orders) |
|
|
Term
| Physician's Orders for Life-Sustaining Treatment (POLST) |
|
Definition
Orders that specifically address different treatments that patients can have.
Covers CPR as well as ACLS orders
Also give providers information about patient’s GOAL :
-From aggressive curative care to comfort care only
-Directs specific ACTIONS to be taken or held (see example POLST orders) |
|
|
Term
| Pain meds for palliative care |
|
Definition
Opioids: scheduled and PRN for breakthrough pain
Neuroleptics for neuropathic pain
Multiple routes may be utilized (po, IV, SC, buccal, dermal) |
|
|
Term
| Dyspnea in palliative care |
|
Definition
Goal is relief of subjective dyspnea, not physical signs of respiratory effort
Treat cause when possible:
-Radiation to shrink obstructive tumors
-Dexamethasone to treat inflammatory lung conditions
-Pleural drainage for effusion
-Bronchodilators for asthma
-Paracentesis for abdominal pressure on lung expansion
Symptomatic treatment:
-Oxygen
-Opioids |
|
|
Term
|
Definition
| Oropharyngeal relation and upper airway secretions--very distressing to families. Treat with anit-cholinergics (scopolamine, hyoscyamine, glycopyrrolate, and atropine) and positioning |
|
|
Term
|
Definition
Requires physician certification that patient has less than six months to live
-Barrier to patients receiving hospice care with both physicians and patients/families
-Uncertainty of remaining length of life
Palliative care in an EOL context: addresses quality of life (QOL) issues but also emotional, social, spiritual, and financial preparation for death. |
|
|
Term
|
Definition
| The use of considerable resources without a reasonable hope that the patient would recover to a state of relative independence or be interactive with his or her environment. |
|
|
