Adult Health I- Test 1
a. The surgeon obtains signed consent before sedation and/or surgery
b. The nurse clarifies facts and dispels myths about surgery
c. The nurse is not responsible for providing detailed information about the procedure.
Rules for informed consent
What requires that you provide a patient information about informed consent, dietary restrictions, specific preparation for surgery, exercises after surgery, and plans for pain management prior to surgery?
National Patient Safety Goals
The nurse should report any electrolyte ______________ or any other abnormal test results to the anesthesia team and surgeon before surgery.
______________ surgery relieves symptoms of a disease process, but does not cure it.
____________ such as hydroxyzine are given preoperatively to help reduce irritability.
_______________ such as lorazepam are give preoperatively to help induce sleepiness.
______________ such as Versed are given preoperatively to reduce anxiety.
__________________ such as morphine are used preoperatively for pain management.
______________ agents are given preoperatively to help reduce nasal and oral secretions.
______________________ are used preoperatively when procedures are long or stress ulcers are likely.
H2 histamine blockers
QSEN states that nurses must make sure that when they are prepping elderly patients with _______________ preoperatively that they have a bedside commode or are close to a restroom with safely rails.
The __________ nurse sets up the sterile field and anticipates the needs of the surgeons while maintaining the count of the instruments and irrigation fluids used throughout the procedure.
Assessment data is done in the ______________ patient to look for stable vital signs, normal body temperature, no overt bleeding, return of gag, cough, and swallow reflexes, ability to take liquids, and adequate urine output prior to discharge.
The nurse should assess for type, location, and intensity before and after giving medication during what type of assessment?
Postoperative pain assessment
What promotes complete lung expansion and helps prevent pulmonary problems post surgery?
a. Cover area with sterile moist dressings
b. Call physician
c. Do not try to put organs back into cavity
d. Raise HOB 15-20o
e. Take and document VS
f. Provide support for patient
Nursing intervention for dehiscence/evisceration
A patient's ____________ behavior during postoperative assessment may be indicative of shock, cardiac problems, increased metabolic rate, or pain.
Best practice for measuring skin turgor
Fluid intake/retention does not meet the body's fluid needs resulting in fluid volume deficit or _______________.
Elderly patients do not have good skin elasticity so ____________ on the back of the hand to assess for skin turgor is not best practice for assessing dehydration.
__________ rehydration is should be considered first when dealing with dehydration if the stomach and intestines are viable as it can be difficult to keep track of IV input and rate adjustments.
a. Patient history (what is causing symptoms?)
b. Cardiovascular (HR, decresased BP, weak pulse)
c. Respiratory (increased resp.)
d. Skin turgor
e. Neurological (altered mental status)
f. Renal (dark, concentrated urine, inc. specific gravity, output <500ml/day)
Assessment for Fluid Volume Deficit (FVD)
1 Liter of water =__________kg
A weight change of 1lb is equal to __________ mL.
Patients with dehydration should be monitored for _______________ hypertension.
Normal range for potassium is __________mEq/L
____________ is an electrolyte that helps regulate protein synthesis and glucose use and storage.
_________ potassium may be caused by the use of laxatives or diuretics.
Nerve transmission, smooth, skeletal, and cardiac muscle contractibility are all affected by _______________.
b. Respiratory depression
Symptoms of hypokalemia
A nurse should NEVER give potassium ____________.
Potassium levels must be normal before administering _____________ or there is a risk of drug toxicity.
____________ may be caused by renal failure or too much intake of salt substitutes.
Drug therapy for hyperkalemia is ____________ in enema or NG form to bind up the potassium or insulin which drives the potassium back into the cell.
Renal patients should decrease there intake of potassium rich _________ such as dried apricots, bananas, and beets as they tend to hold on it as their ability to excrete solutes declines.
____________ precautions should be taken in patients with low potassium as muscle weakness may cause their risk to elevate.
____________ develops with changes in normal hydrostatic pressure differences.
Diffusion is important in the transport of most ____________.
Diffusion of glucose into cell membranes cannot happen with the assistance of __________.
_____________ mechanism is an example of how osmosis helps maintain homeostasis.
Normal body osmolarity valus is ___________ mOsm/L which is considered isotonic.
The minimum urine amount needed to excrete toxic waste products is __________ mL.
Water lost through skin, lungs, and stool is called ____________ water loss.
Collaberative care for a patient with fluid overload includes assessing for pitting edema, decreased Hgb, and possibly putting them on diuretics and restricting their fluid and __________ intake.
Daily __________ for a patient with fluid overload is a very important part of the I/O assessment.
Normal sodium levels are __________ mmol/L.
____________ is vital for skeletal muscle and cardiac contraction, nerve impulse transmission, and normal osmolarity and volume of the ECF.
Low _________ causes water to be drawn into the cells causing them to swell.
______________ is caused by renal disease, fluid retention, CHF, liver disease, SIADH, watery diarrhea, excessive sweating, and diuretics.
_____________ for hyponatremia may include restriction of fluids or adding sodium if there is a large loss, and may even include a diuretic to get rid of excess water if it is diluting the sodium.
High sodium draws water out of the cells and causes them to shrink with ____________.
c. Weak pulse
d. Postural hypotension
e. Elevated hematocrit
Symptoms of hypernatremia
A low-sodium diet restricts sodium intake to <___________mg per day.
Tapping on the trigeminal nerve and having the patient "wink" back at you is a ____________ sign, signalling hypocalcemia.
When using a blood pressure cuff on a patient and a neuromuscular flexion reaction of the hand and wrist is noted, this is ____________ sign and may indicate hypocalcemia.
Normal calcium levels are between _____________mg/dL.
Absorption of ____________ requires the active form of vitamin D.
The ____________ gland releases PTH which tells the bones to release some of the stored calcium.
The thyroid gland releases ______________ to halt the release of calcium from the bones.
A symptom of hypocalcemia may be painful ____________ spasms.
Patient's with hypocalcemia are at risk for bone ___________ so special care should be taken when moving these patients, such as using a slide sheet or lift.
Patients with ______________ are at risk for increased blood clots and decreased peristalsis.
Drug therapy for hypercalcemia include IV NS to flush out the extra calcium, furosemide, calcium ___________ which help to bind the calcium together, calcitonin to drive the calcium back into the bone, phosphorus, biphosphonates, and prostaglandin synthesis inhibitors.
There is a/an ____________ relationship between phosphorus and calcium.
Normal phosphorus levels are between ____________ mg/dL.
____________ is found in bones and activates vitamins and enzymes assisting in cell growth and metabolism.
________________ results in decreased energy metabolism and is usually found with imbalances of other electrolytes and body fluids.
Musculoskeletal changes such as ________________ (muscle breakdown) can be seen in hypophosphatemia.
Problems caused by _________________ center on the hypocalcemia that results from the reciprocal relationship.
The ________________ system can respond quickly to acid/base imbalance by hyper/hypo-ventilation, thus blowing off or conserving CO2.
The _____________ react slower to acid/base imbalance but the reaction has a stronger propensity for regulation and balance by moving bicarbonate and helping in the formation of acids and ammonium.
______________ is the body's attempt to correct blood pH changes.
A pH of <6.9 or >7.8 is usually ___________.
Hot, dry, rapidly breathing with looks of dehydration is a usual sign of a patient in ____________.
Decreased PaO2 with a rising PaCO2
Hallmark of respiratory acidosis
a. pH <7.35
b. Bicarbonate HCO3 <21 n=mEq/L
c. PaO2 normal or slightly decreased
d. Serum potassium high
Laboratory assessment for metabolic acidosis
a. pH <7.35
b. PaO2 low
c. PaCO2 high
d. Serum bicarbonate HCO3 variable
e. Serum potassium levels elevated (if acute)
f. Serum potassium levels normal or low (if renal compensation present)
Laboratory assessment for respiratory acidosis
Decreased PaO2 with rising PaCO2
Hallmark of respiratory acidosis
_______________ is caused by prolonged vomiting, excess cortisol, hyperaldosteronism, thiszide diuretics, and prolonged NG suction.
a. Focus on improving ventilation and oxygenation
b. Drug therapy (bronchodilators, anti-inflammatories, mucolytics)
c. Oxygen therapy
d. Pulmonary hygiene
e. Ventilation support
f. Prevention of complications
Respiratory acidosis interventions
Hyperventalation brought on by anxiety, fear, improper vent settings, stimulation of central respiratory center due to fever, CNS lesion, or salicylates can cause ______________________.
Look for hypocalcemia, hypokalemia, CNS changes (positive Chvostek's and Trousseau's signs, tetany, CV changes, and respiratory changes in a/an _____________ patient.
Prevent further loss of hydrogen, potassium, calcium, and chloride ions, restore fluid balance, monitor changes, provide safety, modify or stop gastric suctioning, IV solutions with base, drugs that promote hydrogen ion excretion.
______________ respirations are the compensatory mechanism for the diabetic patient with metabolic acidosis.