Med Surg Midterm Flashcards

Causes loss of sensation, consciousness, reflexes, and memory of the surgery.

It is used for major surgery, or one that requires complete muscle relaxation.

Causes reduction of sensation in selected parts of the body due to blockage of peripheral nerves, or the spinal cord

ex: Epidural

Involves topical application of an anesthetic agent to the skin or mucous membranes

Family hx of Malignant Hyperthermia

Respiratory disease (Hypoventilation)

Cardiac disease (Dysrhythmias, alerted cardiac output)

Gastric Contents (Aspiration)

Alcohol or substance abuse

Allergy to ester-type anesthetics

Alterations in peripheral circulation

Older adults

Halothane, isoflurane, and nitrous oxide in combination with oxygen

Benzodiazepines, etomidate, propofol, ketamine and short acting barbiturates (Methohexital)

It is the most common anesthetic agent. Allergies to eggs and soybean oil and are contradictions.

Opioids, Benzodiazepines, Antiemetic, Anticholinergic, Sedatives, and Neuromuscular blocking agent.

Fentanyl, Sufentanil, Alfentanil

Uses: Sedation, analgesics to relieve pre-op, and post-op pain

A/E: Depressed CNS, RR depression, Delays awakening following surgery, Post-op constipation and Urine retention, can trigger nausea and vomitting

Diazepam, Midazolam,

Uses: Reduce anxiety pre-op, Promote amnesia, Produce mild sedation with little to moderate RR depression w/ careful titration

A/E: can result in cardiac and Respiratory arrest w/ rapid administration or w/o waiting for the full effect to develop

Ondansetron, Metoclopramide, Promethazine

Uses: Decrease post anesthesia nausea and vomiting, enhances gastric emptying (Metoclopramide), Induces sedation (promethazine), Decrease the risk for aspiration.

Atropine, Glycopyrrolate

Uses: Decrease the risk of Bradycardia during surgery due to the parasympathetic response to surgical manipulation

Also, block the muscarinic response to acetylcholine by decreasing salivation, perspiration, bowel motility and GI secretions

Also, decrease the risk for aspiration

A/E: Urinary Retention, Difficulty starting urination, tachycardia, dry mouth

Pentobarbital, Secobarbital

Uses: Sedative effect for preanesthesia sedation or amnesia, induction of general anesthesia

A/E: RR Depression

*Avoid giving within 14 days of starting or stopping MAOI

Succinylcholine, Vecuronium

Uses: Skeletal muscle relaxation for surgery, airway placement, In conjunction with IV anesthetic agents (propofol, opioids, benzodiazepines)

A/E: Total flaccid paralysis, requires mechanical ventilation because it blocks contraction of all muscles, including the diaphragm and RR system

Ensure that the client has signed consent form, Have pt urinate before meds, bed in low position, side rails are up, Monitor Airway and O2, Monitor Lab values, Monitor Cardiac status,

If hypotension occurs administer an IV Bolus

Malignant hyperthermia

Actions: Administer IV dantrolene, 100% O2, Obtain ABG's, Infuse Iced IV 0.9% sodium chloride, Cooling blanket and ice, Urinary cath to monitor output and hematuria, Monitor cardiac rhythm and tx dysrhythmias

Anesthetic toxicity -

Unrecognized hypoventilation -

Intubation Problems -

Anesthesia Awareness -

Spinal: Injection into the cerebrospinal fluid (CSF).

Complications: Headache, nausea, vomiting, and pain.

Epidural: Injection into the epidural space in the thoracic or lumbar areas of the spine to block sensory pathways

Complications: High spinal anesthesia, dura is punctured, leads to depressed respirations, respiratory arrest, severe hypotension, tx includes IV Fluids, vasopressors, and airway support

Headache, with spinal anesthesia

Nerve block: Injection around or into an area of nerves to block sensation often for surgery on an extremity or for chronic pain

Field block: Injection around the operative field for procedures of the chest, plastic surgery, dental, and hernia repairs

Nurse considerations:

Client will be awake during the procedure, staff should avoid nothing is said that the pt does not need to hear.

Topical: Directly to the skin

Local Infiltration: Inject directly into tissues through which the surgeon will make the incision.

Procaine and lidocaine

- Concurrent administration of a vasoconstrictor, usually epinephrine, prolongs effects and decreases the risk of systemic toxicity.

Considerations: Local anesthesia cannot be used if the incision is large and the amount of meds required to numb the tissue would be toxic to the pt.

A rapid-acting analgesic may be administered simultaneously to minimize pain w/ injection.

Local anesthesia is usually combined w/ a regional block

Complications: edema, inflammation, risk for gangrene, necrosis, and tissue abscess.

Systemic Toxicity, restlessness, altered speech, blurred vision, metallic taste, tremors, tachy, hypotension, cardiac arrest, apnea and death.

TX: Airway support and administration of a rapid-acting barbiturate.

If pt goes in to RR depression? Administer O2 and reversal agent (naloxone and flumazenil)

Insert an oral airway and suction

Hypotension ? provide fluids and vasopressors

Anaphylaxis? Administer Epinephrine

Obstructive Sleep Apnea: Airway Obstruction, O2 De Sat

Pregnancy: Fetal risk w/ anesthesia

Respiratory Disease: COPD, Pneumonia, Asthma

Cardiovascular disease: HF, MI, Hypertension, Dysrhythmias

DM: Decreased intestinal motility, altered blood glucose levels, delayed healing, infection.

Liver disease: Altered meds metabolism and increased risk for bleeding

Kidney Disease: Altered elimination and medication excretion

Endocrine Disorders: Hypo/hyperthyroidism, Addisons disease, Cushing's syndrome

Detailed History: Medical history, surgical history, tolerance of anesthesia, medication use, complementary or alternative practices (herbals), psychosocial history, cultural considerations, substance use (including tobacco), social support systems, occupation, and perceptions and knowledge about surgery.

Allergies: Meds, latex, contrast agents, and food products

Allergies to banana or kiwi can indicate the client is at ris for a reaction to latex.

Allergies to eggs or soybean oil is a contraindication to the use of propofol for anesthesia

Allergies to shellfish can result in a reaction to povidone-iodine

Diagnostic Procedures: UA, Blood type and cross match, CBC, Preg. test, Clotting studies, Blood electrolyte levels, Cr and BUN, ABG's, Chest X-Ray, 12-lead ECG

Diagnostic procedures: CBC, Metabolic Profile, ABG's, Lab tests,

PACU: Perform a full body assessment w/ priority given to airway, breathing, and circulation.

Airway/Breathing: assess for symmetry of breath sounds and chest well.

Circulation: Observe for internal bleeding, and external bleeding

Vital Signs: Obtain vital signs until stable (every 15min) and assess for trends

Positioning:

BMI higher than 25, HgA1C greater than 5.7%, HDL level less than 35 mg/dL or triglyceride level greater than 250 mg/dL

Client Edu: Carbs 45% intake, Protein 15-20% intake, Unsat. and Polysat fats: 20-35%

Consistency of food promotes blood glucose control.

Diet low in Saturated fats to decrease LDL.

Modify diet to include Omega 3 fatty acids and fiber to lower cholesterol.

Perform Physical Activity at least 3x per week 150 min/week.

Central obesity, hyperlipidemia, high blood pressure, hyperglycemia

Insulin resistance

Pancreatitis and cushing's syndrome: secondary causes of diabetes

Polyuria (excess urine), Polydipsia (excessive thirst due to dehydration), Polyphagia (excessive hunger and eating caused from inability to receive glucose),

Other: Acetone/fruity breath odor, headache, nausea, vomiting, vision change, weakness, slow wound healing

it is the best indicator of the average blood glucose level for the past 120 days

Biguanides: Metaformin

Reduces the production of glucose by the liver (gluconeogenesis).

need to stop medication 24-48hrs before any type of elective radiographic test w/ iodinated contrast dye and restart 48hrs after (it can cause lactic acidosis due to acute kidney injury)

take vitamin B12 and folic acid

Diabetic Ketoacidosis, uncontrolled hyperglycemia, metabolic acidosis, and an accumulation of ketones.

infection is the most common cause.

Start with rapid infusion of 0.9% sodium chloride for the first 1-3hrs, follow with a hypotonic fluid, once B.G decreases to 250 change IV to 5% dextrose.

Administer Regular insulin IV Bolus, then a continuous IV of Reg Insulin.

diet and lifestyle changes, advancing to medication use (antacids, H2-receptor antagonists, proton pump inhibitors and surgery.

Untreated Gerd leads to inflammation, breakdown and long term complications such as barrets esophagus or adenocarcinoma of the esophagus.

Dyspepsia, headache, hiccups, upper abdominal pain, nausea, reduced appetite, bloating,

When glucose levels are between 80-250mg/dL do not exercise if ketones are present in the urine.

E. Coli

dysuria, frequency (voiding more than every 2 hours), urgency, and suprapubic discomfort or pressure. The urine may have grossly visible blood (hematuria) or sediment, giving it a cloudy appearance.

Typically causes fever, chills, and flank pain

Phenazopyridine

an inflammation of the renal parenchyma and collecting system, including the renal pelvis. The most common cause is bacterial infection.

affects both kidneys equally. It is the 3rd leading cause of ESRD in the U.S.

acute - symptoms come suddenly it can be temporary or reversible.

Chronic - typically progresses slowly and can lead to irreversible renal failure

they include generalized edema, hypertension, oliguria, hematuria, and proteinuria. Fluid retention occurs because of decreased glomerular filtration, tera colored urine, weight gain, crackles in lungs

Rest is recommended until the signs of glomerular inflammation (proteinuria, hematuria) and hypertension subside. Restricting sodiumand fluid intake and giving diuretics can reduce edema. Severehypertension is treated with antihypertensive drugs. We may restrict protein intake if there is evidence of an increase in nitrogenous wastes (e.g., increased BUN). The protein restriction varies with the degree of proteinuria. Low-protein, low-sodium,
fluid-restricted diet. Antibiotics are given if the streptococcal infection is still present.

For chronic GN then add steroids to tx

Calcium Oxalate, Calcium phosphate, cystine, struvite and uric acid

Calcium stones.

usually severe pain that begins suddenly, it will be a sharp pain in the flank area, back and lower abdomen.

we call this pain "renal colic" , nausea and vomiting may occur due to the severe pain .

having renal colic pain will have someone standing, sitting, laying and repeat calling it the "kidney stone dance"

either a noncontrast CT scan or an ultrasound, and complete urinalysis helps confirm the diagnoses of a stone by assessing for hematuria and crystalluria.

Manage the acute attack by treating the pain, infection and/or obstruction. Opioid and/or NSAID's can relieve renal colic pain.

it can take weeks for a stone to pass.

Tamsulosin (Flomax) can help with stone passage. Also helps the men with BPH.

combination of stress and urge incontinence

-Occurs when pressure of urine in overfull bladder overcomes sphincter control and/or detrusor underactivity.

- Leakage of small amounts of urine is frequent or continual throughout day and night.

- concurrent incomplete bladder emptying

-Bladder can stay distended and is usually palpable

caused by bladder or urethral outlet obstruction or by underactive detrusor muscle. May occur after pelvic floor surgery.

-sudden increase in intraabdominal pressure causes involuntary passage of urine.

- can occur during coughing, laughing, sneezing, or physical activities, such as heavy lifting, exercising

-leakage usually is in small amounts and may not be daily

- often referred to as overactive bladder

-occurs randomly when urgency precedes involuntary urination

-leakage is periodic but can be frequent and varies in amount

-nocturnal frequency and incontinence are common