IV Therapy
A pt presents having 0.45% NaCl drip attached to their IV. What is this most likely being used to treat?
Hypernatremia
IV Therapy slide 25
What are the 3 general nursing responsibilities of IV med admin?
Oriented to machine and alarms
Know med used (usual dose, concentration, compatibility, and rate)
Important to always monitor IV site
IV Med slide 6
Adequate Tissue Perfusion Requires what 3 things?
Adequate cardiac pump, intact circulatory system, sufficient blood volume.
Shock slide 5
A pt presents with recent polyuria, polydipsia and has lost 30 lbs last month. These are all S/S of ______?
Type 1 DM
DM slide 4
Oral drugs work on 3 defects of type 2 DM, what are they?
Insulin resistance, decreased insulin production, increased hepatic glucose production.
DM slide 18
What is regional anesthesia? Give an Example:
Loss of pain sensation in an area without Loss of consciousness. Blocks nerve transmission resulting in muscle paralysis. Examples: Spinal, epidural, nerve block.
Post-op slide 36
Hypoxia/Hypoventilation can result from:
Pain
Constricting dressing
Obesity
Respiratory center depression
Increased airway resistance
Decreased lung compliance
Post-op slide 56
What are the treatments for Atelectasis?
C&DB- H.T. splinting
Incentive spirometer
Medication for pain/early pain control
Early ambulation (T&P if on bedrest)
Post-op slide 61
What does ABC stand for?
Airway, Breathing, & Circulation
Prioritization and leadership slide 16
What are the 3 stages of wound healing?
Inflammation, Granulation, Maturation phase and scar contraction.
Periop nutrition slide 31
Why would we consider Pre-albumin to be a better indicator of nutrition? And what is the normal range
It reflect acute changes quicker. Normal range: 15-36 mg/dL
Periop nutrition slide 6
Statement by the patient appointing someone to manage health care treatment decisions in the event that the patient is unable to do so
Health Care Proxy
Pre op slide 6
A pt diagnosed with Chronic HIV is at risk for ________ ___________.
Opportunistic infections.
STD hr 3 slide 8
What pt demographics are higher risk for Breast cancer?
Caucasian woman, and African American woman, Hereditary, Hormone level.
Woman's health slide 9
_______:drooping of the eyelid.
Ptosis
eye and ear slide 11
Fluids that contain protein or starches that remain in vascular space and increase osmotic pressure_____?
Colloids.
IV therapy Slide 32
What are the 2 potential risks of IV infusion?
IV infiltration, Extravasation.
IV Meds slide 7
What is Hypovolemic shock?
Decreased intravascular volume due to external fluid loss or internal fluid shift.
Shock Slide 14
A pt presents with Polyuria, polyphagia, and has noted some numbness and tingling in their feet. These are S/S of ______?
Type 2 DM
DM slide 6
Lantus is an example of_______.
Long-acting insulin product.
DM slide 28
Atelectasis, hypotension, loss of gag reflexes are all _______ effects of General anesthesia.
Undesirable. This also includes: Decr ciliary, Snoring, Decr peristansis, Decr peristalsis.
Post-op slide 32
Atelectasis can result from:
Airway obstruction, decreased lung expansion d/t pain, decreased mobility, not doing C&DB exercises, Not using incentive spirometer.
Post-op slide 58
SVT and/or DVT are caused by:
Venous stasis, injury to vessel wall, Increased blood coagulability.
Post-Op slide 70
A 16-year old patient with cystic fibrosis is admitted with increased shortness of breath and possible pneumonia. Which nursing activity is most important to include in the patient’s care?
A. Perform postural drainage and chest physiotherapy every 4 hours.
B. Allow the patient to decide whether she needs aerosolized medications.
C. Place the patient in a private room to decrease the risk of further infection.
D. Plan activities to allow at least 8 hours of uninterrupted sleep.
Correct Answer: A. Perform postural drainage and chest physiotherapy every 4 hours.
Remember your ABC’s
Airway, Breathing, & Circulation
Prioritization and leadership slide 16
What does stress do do to calorie intake requirements?
Increases.
Peri op nutrition slide 32
Aspiration pneumonia, constipation, electrolyte imbalance, and nausea and vomiting are all_______ of enteral feedings.
Complications.
Periop nutrition slide 60
_______ Can increase GI secretions during surgery even though the pt is NPO.
Smoking
Pre-op slide 13
What is HSV-1?
What is HSV-2?
HSV-1= oral herpes
HSV-2= genital herpes
STD hr 1 slide 5
Mammoplasty Augmentation is:
Any procedure done to change breast size.
Woman's health slide 34
Causes of Hearing Loss:
Age
Noise exposure
Frequent otitis media
Ototoxicity (Gentamycin)
Trauma
Congenital
Eye and ear slide 80
A pt is going to surgery, which gauge angio should be inserted?
a. 20 gauge
b. 18 gauge
c. 24 gauge
b 18 gauge
IV therapy slide 10
The nurse is preparing an IV bolus of Lasix 20 mg(10 mg/1mL). to be administered over 2 min. How many mL would be given every thirty seconds?
A. 0.3 mL
B. 0.5 mL
C. 0.2 mL
D. 1.5 mL
B. 0.5 mL
IV med slide 21
A pt is in Septic shock, what is happening to them?
Vasodilation, Maldistribution of blood flow, Myocardial depression( resp failure, organ shutdown).
Shock slide 11
Normal fasting BS.
74-106
DM slide 7
Repaglinide(Pradin) is an example of a _______. What should we know about this med?
Meglitinides.
do not take if a meal was skipped.
DM slide 18
WHY use MAC?
MAC anesthesia is used for uncomfortable procedures or minor surgeries that do not usually require general anesthesia.
Post-op slide 41
3 major causes of Nausea and vomiting in a post-op pt?
Anesthesia, pain, manipulation of internal organs.
Post op slide 87
Define Dehiscence.
wound edges open and disintegration of underlying layers.
Post-op slide 109
After a change of shift, you are assigned to care for the following patients. Which patient should you assess first?
A. A 60-year old patient on a ventilator for whom a sterile sputum specimen must be sent to the lab.
B. A 55-year old with COPD and a pulse oximetry reading from the previous shift of 90% saturation.
C. A 70-year old with pneumonia who needs to be started on intravenous (IV) antibiotics.
D. A 50-year old with asthma who complains of shortness of breath after using a bronchodilator.
Correct Answer: D. A 50-year old with asthma who complains of shortness of breath after using a bronchodilator.
•The patient with asthma did not achieve relief from shortness of breath after using the bronchodilator and is at risk for respiratory complications.
•This patient’s needs are urgent.
Prioritization and leadership slide 18
Which food group helps rebuild tissue and maintain cellular metabolism?
Protein
Periop nutrition slide 48
What feeding tube requires stoma care and is only used for slow continuous feeds?
Jejunostomy.
Periop nutrition slide 58
Document prepared by the patient & Lawyer providing specific instructions about what medical treatment the patient chooses to accept or refuse in the event that the patient is unable to make such decisions.
Living will
Pre op slide 6
Which 3 STDs that we learned about are curable?
Gonorrhea, Chlamydia, and Syphilis
STD HR 1 slide 31
STD HR 2 slide 4, 8
______ ______ are no longer common practice because of lasting psychological and health effects it can have on woman.
Radical Mastectomies.
Infection of the middle ear is called _____ ______.
Otitis Media
Eye and ear slide 85
Type of solution used to treat dehydration?
Hypotonic
IV Therapy slide 20
The professors put 3 examples of meds that might be administered via IV push, what are they?
furosemide(Lasix), hydromorphone (Dilaudid), ondansetron (Zofran).
IV med Slide 15
A pt suffers a massive MI. Which type of shock should the nurse be aware of?
Cardiogenic
Shock Slide 16
6 Factors that Lower BS.
Insulin, oral antibiotic meds, exercise, fasting, delay meal eating, medication side effects.
DM slide 9
Novolin R, Humulin R are example of _______.
Short-acting insulin products.
DM slide 28
Odanseetron(Zofran) and reglan are examples of ________. They reduce _______ and _______.
Antiemetics, Nausea, Vomitting.
Post-op slide 31
Pts at highest risk for DVT or SVT:
Dehydrated, stroke, GYN, drugs(hormonal), Family hx, bedrest, varicosities(obese, elderly, smokers).
Post op slide 71
What is the preferred INR for a pt who is at High risk for DVT?
DVT prophylaxis 1.5-2.0
Orthopedic surgery 2.0-3.0
DVT treatment 2.0-3.0
Pulmonary embolism 3.0-4.0
Post-op slide 84
The nurse plans care for a client in the post-anesthesia care unit. Which of the following should the nurse assess first?
A. Respiratory status
B. Level of consciousness
C. Level of pain
D. Reflexes and movement of extremities
Correct Answer: A. Respiratory status
Assessing respiratory status is the first priority.
Prioritization and leadership slide 20
True or False
The nurse can determine that a one day post operative patient is in a catabolic state because their intake is greater than their output?
FALSE!
We need other findings on our assessment such as decreased bowel sounds, edema, decreased K, increased Na to determine that they are in a catabolic state.
Periop nutrition slide 39
Which of the following lab values suggest protein deficiency for an acutely ill patient?
A. Serum albumin 3.5 g/dL
B. Serum prealbumin 5 mg/dL
C. Serum albumin 4.5 g/dL
D. Serum protein 6.5 mg/dL
B. Serum prealbumin 5 mg/dL
A. .Normal albumin level is 3.5-5 g/dL
B. .Normal prealbumin level is 15-36 mg/dL à 5 mg/dL is too LOW!
C. Normal albumin is 3.5-5 g/dL
D. Normal protein level is 6.4-8.3 g/dL
Periop Nutrition slide 9
Which specification typically doesnt want blood transfusions?
Jehovah's witness
What med is usually used to treat Syphilis? Bonus tell me the 2 alternatives they gave us.
Penicillin G benzathine
Doxycycline or tetracycline
STD hr 1 slide 31
HT a pt who ha been dx with Fibrocystic breast.
Definition: Excessive cellular growth in breast ducts, lobules and connective tissues (Benign breast tumors)
Low Na+ Diet: decreases swelling and pain in breasts
Decrease Caffeine: Health teach sources of caffeine
Vitamin E, may be beneficial in relieving swelling in breasts-200 IU bid to tid
Danazol (Danocrine): synthetic form of testosterone - may be prescribed for severe symptoms-side effects
PMS symptoms: B Vitamins esp.Vitamin B6; 50 mg. day 1-14 menstrual cycle; 100mg d 15-end; plus diet changes
Chocolate cravings mid cycle: Magnesium 250 mg q day may control cravings
Wear Supportive bra
woman's health slide 6
Womans health slide 6
What can cause a retina to detach?
Maybe caused by trauma, Other eye surgeries, extreme myopia or spontaneous for no apparent reason
Eye and Ear slide 35
You are evaluation a pt after a surgery that went well, what type of solution is the pt most likely on?
Isotonic
IV therapy slide 21
Flushing and locking is essential to ensure _______ and prevent _________.
Patency, occlusion.
IV med slide 32
How does Epinephrine & norepinephrine Increase the BP?
Causes vasoconstriction/ Increased HR
Shock slide 19
The 8 factors that Raise BS.
Illness, Fatigue, stress, lack of exercise, food, growth, medications, menstrual cycle.
DM slide 9
Dipetidyl Peptidase-4 Inhibitors are also known as _______. An example of these meds:
Incretin Modifiers
sitagliptin(Januvia)
DM slide 18
Benzodiazepines have what anesthetic effect on the pt?
amnesia and anxiety reduction.
Post-op slide 31
S/S of pulmonary embolus:
Chest pain, tachyardia, tachypnea, dyspnea, skin changes, LOC changes, hemoptysis, cough
Post- op slide 80
Which dressing drain needs to be compressed?
Jackson Pratt drain.
Post-op slide 105
Nurse Janus enters a room and finds a client lying on the floor. Which of the following actions should the nurse perform first?
A. Call for help to get the client back in bed
B. Establish whether the client is responsive
C. Assist the client back to bed
D. Ask the client what happened
B. Establish whether the client is responsive
Assess the client’s current level of consciousness first to determine whether the patient has had a loss of consciousness
Prioritization and leadership slide 22
What is the metabolic response to surgery
Hypermetabolic state.
Periop nutrition slide 34
A pt lab work has come back and you are reviewing it as the pt's nurse. Their protein came back 6.5 g/dL, what are your nursing interventions if there are any?
None. Normal protein range: 6.4-8.3 g/dL
Periop nutrition slide 4
A nurses Pre-op assessment will include what 7 things?
Reason for surgery
What is physical/mental status
Physical handicaps
Hx of symptoms- length of time, severity
Emotional status
Help?
Plan of care
Pre-op slide 19
How do we treat HPV?
Trichloracetic acid, podofilox gel, Imiquimod cream, cryotherapy, surgical tx.
STD hr 2 slide 17-19
S&S of Pelvic Inflammatory Disease:
Sharp pain, elevated temp, copious purulent vaginal discharge, nausea, malaise, dyspareunia.
Woman's health slide 41
Sensorineural Hearing loss affects _____ and is not ______
High frequency hearing, not correctable.
Eye and ear slide 76
A pt has increased swelling in his legs and abdomen. Which solution type would be most beneficial?
Hypertonic
IV Therapy Slide 31
After preparing and and attaching an IVPB to the upper port, what must a nurse do?
Back prime secondary tubing.
IV Med slide 36
What are the 4 stages of Shock in order?
1. Initial
2. Compensatory
3. Progressive
4. Refractory
Shock Slide 21
A pt has recently had blood work done. Their HgbA1c came back 6%. This is indicative of what?
Good control 2-5%
Fair Control 6-8%
Poor control >8%
DM slide 17
Sodium-Glucose Co-transporter 2 Inhibiter treat DM by________. An example is _______.
blocking glucose reabsorption in the kidney, increases urinary glucose excretion.
empagliflozin(Jardiance)
DM slide 19
Isoflurane is an example of ______.
Inhalation agents. others include: desflurane, sevoflurane, halothane. They all end in ANE.
Post op slide 30
How are mechanical bowel obstructions treated?
NPO, Monitor VS, minimal pain meds until dx, NG tube, endoscopy, exploratory laparoscopy/laparotomy.
Post- op slide 98
Symptoms of SVT? Bonus if u tell me the treatments.
Symptoms: palpable, cordlike vein. Surrounding area may be itchy, tender, reddened and warm.
Treatment: arm/leg exercises, TEDS, ambulation, ASA, NO massage/rubbing to area, (anticoagulant therapy is not usually needed for superficial vein thrombus)
Post-op slide 72
A client presents to the emergency room with dyspnea, chest pain, and syncope. The nurse assesses the client and notes that the following assessment cues: Pale, diaphoretic, blood pressure of 90/60, respirations of 33. The client is also anxious and fearing death. Which action should the nurse take first?
A. Administer pain medications
B. Administer IV fluids
C. Administer dopamine
D. Administer oxygen via nasal cannula
D. Administer oxygen via nasal cannula.
The promotion of adequate oxygenation is the most vital to life and therefore should be given the highest priority by the nurse.
When the nurse needs to prioritize patients, Maslow’s hierarchy of needs theory is used to decide which patient is to be seen first.
Prioritization and leadership slide 24
What 3 nutrients are important for wound healing?
Niacin, Thiamine, Riboflavin.
Periop nutrition slide 23
Which form of feeding tube is typically used long term and puts patients at risk for peritonitis?
Gastrostomy.
Periop nutrition slide 57
Consent signed after sedative given, consent does not correspond to OR schedule or patient statement, and abnormal lab values, Low pulse ox are all ________ __ ______ __ ______.
Problems to report to surgeon.
Preop slide 35
HIV can be known to cause some neurologic complications. These include:
Peripheral neuropathy, facial palsy, Guillain-Barre
STD Hr 3 slide 7
Colporrhaphy, hysterectomy, and Marshall-Marchettis-Bladder suspension are all treatments for________.
Uterine prolapse,
Woman's Health slide 42
Inner ear problems like Meniere's disease are known to cause:
Motion sickness, tinnitus, Vertigo, sensory hearing loss.
eye and ear slide 91
List the electrolyte solutions a pt could be given.
LR (Lactated Ringers), D5LR (5% Dextrose in Lactated Ringers), Ringers Injection, D5R (5% Dextrose in Ringers), Potassium Chloride (KCL) as an additive
IV therapy slide 28
Controlled Analgesia is what?
Safe method for pain management, med administered by pt at a set interval.
IV Med slide 51
What does the renal system do to help maintain homeostasis while the body is in shock?
Increase ADH for fluid retention, Aldosterone for NA & fluid retention, Angiotension for vasoconstriction.
Shock slide 25
The 14 S/S of Hypoglycemia.
BS <70, Cold and clammy skin, pallor, shakiness, nervousness, diaphoresis/weakness, dizziness, hunger, tachycardia, difficulty speaking, irritability, inability to concentrate, numbness in fingers, headache, unsteady gait.
DM slide 35
Glipizide(Glucotrol), and glyburide(DiaBeta) are examples of ________?
Sulfonylureas
DM slide 18
What are the 4 phases of Anesthesia in order? Bonus if you can describe them?
Pre Induction- pre-anesthesia evaluation and sedation to reduce pt anxiety
Induction- administration of anesthetic with endotracheal intubation
Maintenance – positioning pt, prepping skin, surgical procedure, anesthesia maintained
Emergence – surgery complete, anesthetics are decreased, pt begins to waken, airway removed
Post-op slide 33
A pt is recovering from an abdominal surgery, they're trying to sit up when they here a pop followed by pain and a gush of fluid. What is this a S/S of? Bonus , what do you do?
Evisceration. NS soaked sterile Dressing call surgeon STAT.
Post-op slide 109
A pt has not had flatus or bowel sounds for 6 days post op. They're experiencing nausea, discomfort in her abdomen, and distention. What might this pt be suffering from? Bonus tell me what med is commonly prescribed to treat this?
Paralytic Ileus. Metoclopramide(Reglan).
Post op slide 88
Nursing assessment of Anabolic phase:
´Loss of H2O & NA causes diuresis, I<O
´Increased appetite, peristalsis, bowel sounds
´K retained
´Glucocorticoids & catecholamine secretion stops- Insulin & growth hormone secreted, blood glucose normal
Periop nutrition slide 38
According to the Periop Nutrition power point what lab value being high can mean dehydration and being low can indicate malnutrition, third spacing, or an inflammatory disease amongst other issues?
Albumin
´Normal = 3.5-5 g/dL
´60% of the total protein
´Maintains colloidal osmotic pressure
´Transports blood constituents
´A measure of nutrition
´Increased = dehydration
Decreased = (among others)
´Malnutrition
´Third spacing
´Overhydration (fluid overload)
´Inflammatory disease
Periop nutrition slide 5
To being dx with AIDS pts need to meet which criteria?
CD4+ T cell count below 200 cells/μl
High viral load, very infectious
Specific opportunistic infection or/+ cancer
Specific opportunistic cancer
Wasting syndrome: lost at least 10% ideal body mass, especially muscle, diarrhea, extreme weakness and fever (not r/t infection)
STD hr 3 slide 14
Preventive meds for woman at high risk for breast cancer:
Tamxifen, Raloxifene, Anastrozole.
Woman's health slide 11
There are 3 kinds of cataracts. What are they, describe them.
Congenital- Rubella exposure during gestation
Traumatic – injury
Secondary- DM, renal disease, steroids
Eye and ear slide 53
A pt who has had an IV of NaCl is experiencing an irregular, weak pulse, muscle cramps, and constipation. what is the pt most likely suffering from and relate it to something.
Hypokalemia rt sodium increase from IV
IV therapy slide 39
What are the three types of PCA pump modes? Describe them.
Basal mode: pt receives a continuous infusion of a low dose of med to achieve pain relief
Demand mode: pt receives dose intermittently when a button is pushed by pt
Demand w. Basal mode: both used for additional pain control.
IV Med slide 52
Nurse notes BP WNL, cold, diaphoretic skin, decreased bowel sounds and confusion in the pt. This may indicate which stage of shock?
Compensatory
Shock slide 33
What are the 10 complications of Diabetes they give us?
Stroke, Hypertension, coronary artery disease, atherosclerosis, nephropathy, retinopathy/cataracts/glaucoma/blindness, Peripheral vascular disease/neuropathy, Neurogenic bladder, infections, gangrene.
DM slide 38
Liraglutide(Victoza), dulaglutide(Trulicity), exenatide(Byetta) are medications that are SQ injected. They are all examples of ______? Be specific.
Incretin Memetics.
DM slide 20.
What kind of meds are used with MAC? what 3 examples did they give us?
Meds used with MAC: sedative hypnotics- propofol, midazolam (Versed) and fentanyl.
What are the rules to KCL use in IV?
Check lab values of K+ and Na+ often
EKG done if ordered
Must have urine output >30cc/hr- KCL is excreted by kidneys
Never more than 80 mEq / liter of IV flds -40 mEq/L preferred amt
IVPB – NEVER IV PUSH
Rate of infusion
Assess IV placement in vein carefully. Infiltration will destroy tissue
Use large vein for IVPB – not hands. It is very irritating to vein.
Post-op slide 104
A pt has been healing a wound on their foot. It has been 16 days, what phase of healing are they most likely in?
Collagen-Building phase.
Inflamed phase: 1-5 days
Collagen- Building phase: 6-20 days
Remodeled skin phase: 3-24 months.
Post-Op slide 113
Nursing assessments that indicate catabolic state:
Decreased bowel sounds/peristalsis
Vasoconstriction- cool, pale skin, low BP
Elevated blood glucose
I>O, Urine retention, edema
Hypernatremia, hypokalemia
Periop nutrition slide 37
Which method of “tube” feeding places the patient at greatest risk for dumping syndrome?
Bolus.
Periop nutrition slide 68
Treatment of HIV includes what 7 things?
•Monitor disease progression & immune functioning
•Administration of ART (Antiretroviral Therapy)
•Prevention of opportunistic diseases
•Treating opportunistic diseases
•Management of symptoms
•Preventing complications
•Prevent HIV transmission
STD hr 3 slide 17
A total hysterectomy with a Bilateral Salping-oophorectomy would be:
A total uterus removal with removal of both fallopian tubes, and ovary.
Woman's health slide 61
How do we treat an acute attack of Meniere’s Disease.
Antihistamines (diphenhydramine)
Anticholinergics
Benzodiazepines
Decreases abnormal sensations and alleviate symptoms
Vertigo-bedrest, sedation and antiemetics
Eye and ear slide 93