TPN
What can be added to TPN solution?
Insulin and antacids
The four ways of heat exchange
Radiation - heat in if warmer, heat out if cooler
Convection - warm baths, cool fans
Evaporation - breath
Conduction - ice packs, stove
What meds do you stop at least 2 weeks before surgery and why?
Anticoagulants
Aspirin
NSAIDS
Vitamin E
Herbs
Due to risk of bleeding
My pH is >7.45 and my PCO2 is <35. I am hyperventilating and am dizzy. What am I?
Respiratory Alkalosis
Other causes - severe head injury or infection, ASA overdose
S/SX - fast breathing - <20/min, circumoral numbness, parasthesia, restlessness
Treatments - rebreather bag, administer meds related to cause (anti-anxiety/tranquilizers (PAMS)), reassure patient, talk calmly
Clear liquid diet:
what is it? why? what can they have?
Foods are clear and liquid at rm temp
Mainly water and sugar and electrolytes
Requires minimal digestion, leaves no residue or substance
Short term use only
Why - fever, to decrease feces before bowel tests, acute GI problems (N/V), post-op (til bowel sounds resume)
Foods - water, tea, coffee, fat-free broth, carbonated beverages, ginger ale, jello
Short term and long term TPN
Short term - central line
Long term - Port/Tunnel
Which way does my temp go if sweating, peripheral vasodilation are present?
Which way if vasoconstriction, piloerection and shivering are present?
Decreasing
Increasing
What are the 7 narcotics? How do they work?
Morphine
Codeine Sulfate
Oxycodone
Hydromorphone
Fentanyl
Hydrocodone
Propoxyphene
Stimulate the opiod receptors in the CNS to reduce the perception of pain
SE - sedation, disorentation, coma, constipation, resp depression
I am this when I am having cardiac arrest, shock or kidney failure. I am weak and have n/v. My pH <7.35. What am I?
Metabolic Acidosis
Other causes - diarrhea, starvation
Nursing interventions - monitor I&D, K, and other electrolytes because pf pH shifts. K is HIGH is acidosis
Treatments - Sodium Bicarb IV stat (1st!), defib if cardiac arrest (after receiving epi), dialysis if due to kidney failure, antibiotics if septic shock, anitdiarrheals (loperamide and diphenoxalate)
Full liquid diet
What is it? What can they have?
Foods that are liquid at rm temp and have little substance. Can supply adequate amounts of energy and nutrients
Foods - all liquids on clear liquid diet plus: milk, puddings, ice cream, vegetable and fruit juices, eggnog, plain ice cream and sherbet and soups without large chunks
Administering it?
hrough CL? PICC? Mixture? Solution?
Tubing with filter (.22 micron filter)
lipids must be attached below the filter (will clog)
Set out at room temp 30 minutes prior to infusing
Start slowly (about half ordered rate x2 hours) to prevent fluid and electrolyte shifts, then ordered rate
CL - 15-25% dextrose or higher and 5% protein
PICC (then called PPN) - 12.5% dextrose or lower and protein 5% or lower (because it's so irritating to the small veins)
Always a hypertonic solution
My temp is below 95 degrees. I am shivering. I have cyanosis of the lips and fingers, poor coordination, cold then painful extremities and later become confused. What am I?
Hypothermia
Late signs - body temp below 82.4, unconscious, stops shivering, pulse and RR difficult to detect or irregular
Death occurs at 70-75 degrees. Although some have made it to 60.8 degrees, but it is very uncommon.
Causes - surgery, exposure to extreme weather, immersion of cold water, lack of shelter or clothing
Treatments - temps below 86 degrees use warmed IV fluids, warm sweet drinks (to get glucose up and body to burn off sugar), blankets and warm baths
Non-opioid analgesics and dose
Acetaminophen
Available in 325 and 500 mg tablets. May give two tablets every 4 hours. DO NOT EXCEED 3000 MG (3G) in 24 HOURS!
SE - liver toxicity.
Function tests - ALT, AST, Bilibrubin
My pH is <7.35 and my PCO2 is >45. I have asthma and abnormal lung sounds. What am I?
Respiratory Acidosis
Other causes - any lung disease (bronchitis, pneumonia, lung cancer, CF, atelatasis), paralysis of resp. muscles (polio, Guillain Bare syndrome, Myasthemia Gravis), airway obstruction, narcotics
S&SX - slow breathing or shallow, abnormal lung sounds, SOA or dyspnea, cyanosis (late sign)
Priority interventions - do not give anti-anxiety meds (no PAMS), elevate HOB, TCBD, incentive spiro, suction, breathing treatments and assess pulse rate
Treatments - sit up, administer meds related to the cause, antibiotics if infection, mucolytics if thick mucous (guaifenesin), bronchodilators is asthma or wheezing (albuterol), O2 as ordered, MD may place an ET tube and order vent
Broth, milk, gravy, cream, soup or fruit juice (gives more calories instead of H2O)
Used for patients with chewing or swallowing difficulties, oral or facial surgery and wired jaws
Lipids
Administration and reactions
Lipids - the fat of TPN
Given as an Emulsion
Usually 10-20% and not combined with TPN (given through a separate line)
Should not appear clumped or separated in the bag
Administration - piggyback below filter, looks like milk in glass bottle, use vented tubing
Reactions - fever, nausea, vomiting (due to fat), chest or back pain, tachycardia, dyspnea, cyanosis, sweating and chills
Heat exhaustion
Treatments - cool location, lie down, loosen clothing, apply cool, wet clothes (groin, neck, under arm) and sip water
GI drugs
Antidiarrheals - atropine, diphenoxylate - NO MORE THAN 8 TABS in 24 HOURS
Stool softener - docusate, peri-colace
Stimulant - senna, bisacodyl
Lubricant - mineral oil
Bulk forming - psyllium
MUST DRINK LOTS OF FLUID (impaction)
Osmotic
My pH is >7.45. I am vomiting and have tetany. What am I?
Metabolic Alkolosis
Other causes - NG tubes, not reinjecting gastric contents, overuse of antacids (tums, rolaids, diuretics, steroids, sodium bicarb), hypoaldosteronism
S&SX - parathesia, muscle weakness
Nursing interventions - monitor I&D, K and electrolytes. K is LOw in alkaLOsis
Treatments - administer antimetics for vomiting (promethazine, ondan), reinject gastric contents, teach clients to take antacids as directed
Soft (bland, low-fiber diet) is for? Eat foods that are? Do not eat?
For people with chewing difficulties, upset stomach, diarrhea
Eat foods that are low in fiber, easily digested and lightly seasoned
Do not eat - spicy food, fresh fruits or vegetables with peel, coarse breads and cereals, hard foods (steak, pork chops), beans and other gas-forming foods
Side effects
Hyperglycemia (use SSI insulin per MD, monitor glucose q6 hours)
Infections - most common because of high glucose
Monitor for sepsis, use aseptic technique, dressing change q48 hours, tape connection areas
My temp is above 103 degrees. I am unable to produce sweat (brain in effected). I have a rapid, bounding pulse, throbbing headache, lethargic, dizzy and red, hot, dry skin. I am also at risk for seizures and coma. What am I?
Heat stroke
Nursing interventions - hydration, rest periods, proper dress, infants and elderly stay indoors, in air, when extremely hot.
Treatments - medical emergency, col environment, cool clothes or bath. DO NOT give oral fluids
Anti-hypertensive drugs - calcium channel blockers (end in pine)
Nifedipine
Amlodipine
Dilitazem
Uses - treat hypertension and angina
SE - hypotension, constipation, peripheral edema
Uncompensated?
Compensated?
Partially compensated?
Uncompensated - pH is abnormal and 1 other is abnormal
Compensated - pH is normal, other two are abnormal
Partially compensated - pH is abnormal, both others are abnormal
Mechanical Soft Diet - why? who for? what foods?
Regular diet modified in texture
Why? - limited chewing or swallowing
Who for? - patients with dysphagia, poorly fitting dentures, endentulous, had surgery to the head, neck or mouth or strictures of the intestinal tract
Foods - ground meats, canned fruits, softly cooked vegetables. No hard foods, dried fruits and vegetables, seeds and nuts