front 1 General Anesthesia | back 1 Causes loss of sensation, consciousness, reflexes, and memory of the surgery. |
front 2 When is general anesthesia used? | back 2 It is used for major surgery, or one that requires complete muscle relaxation. |
front 3 Regional Anesthesia | back 3 Causes reduction of sensation in selected parts of the body due to blockage of peripheral nerves, or the spinal cord ex: Epidural |
front 4 Local Anesthesia | back 4 Involves topical application of an anesthetic agent to the skin or mucous membranes |
front 5 Risk factors for General Anesthesia | back 5 Family hx of Malignant Hyperthermia Respiratory disease (Hypoventilation) Cardiac disease (Dysrhythmias, alerted cardiac output) Gastric Contents (Aspiration) Alcohol or substance abuse |
front 6 Risk factors for local anesthesia | back 6 Allergy to ester-type anesthetics Alterations in peripheral circulation |
front 7 Who are more susceptible to these risk factors? | back 7 Older adults |
front 8 What are some anesthetic agents given via inhalation | back 8 Halothane, isoflurane, and nitrous oxide in combination with oxygen |
front 9 What are some anesthetic agents given via IV | back 9 Benzodiazepines, etomidate, propofol, ketamine and short acting barbiturates (Methohexital) |
front 10 Propofol | back 10 It is the most common anesthetic agent. Allergies to eggs and soybean oil and are contradictions. |
front 11 Pts also receive an adjunct medication to Achieve further reactions, what else do they receive? | back 11 Opioids, Benzodiazepines, Antiemetic, Anticholinergic, Sedatives, and Neuromuscular blocking agent. |
front 12 What are some Opioids? A/E? USES? | back 12 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 |
front 13 What are some Benzos? Uses? A/E? | back 13 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 |
front 14 What are some Antiemetics? Uses? A/E? | back 14 Ondansetron, Metoclopramide, Promethazine Uses: Decrease post anesthesia nausea and vomiting, enhances gastric emptying (Metoclopramide), Induces sedation (promethazine), Decrease the risk for aspiration. |
front 15 What are some Anticholinergics? Uses? A/E? | back 15 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 |
front 16 What are some sedatives? Uses? A/E? | back 16 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 |
front 17 What are some Neuromuscular blocking agents? Uses? A/E? | back 17 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 |
front 18 What are some nursing considerations? | back 18 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 |
front 19 What are some complications for G.A.? | back 19 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 - |
front 20 What are some methods to Administer Regional Anesthesia? | back 20 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. |
front 21 What are some methods to Administer Local Anesthesia? | back 21 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. |
front 22 Complications and what to do? | back 22 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 |
front 23 Preoperative nursing care Risk factors? | back 23 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 |
front 24 Preoperative Assessment | back 24 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 |
front 25 Postoperatvie Nursing Care | back 25 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: |
front 26 Week 2 DM Screening | back 26 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. |
front 27 DM Risk factors for DM 2 | back 27 Central obesity, hyperlipidemia, high blood pressure, hyperglycemia Insulin resistance Pancreatitis and cushing's syndrome: secondary causes of diabetes |
front 28 Expected Findings for DM | back 28 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 |
front 29 what is HbA1c? | back 29 it is the best indicator of the average blood glucose level for the past 120 days |
front 30 Oral Antidiabetic | back 30 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) |
front 31 what supplements do you need to take with insulin? | back 31 take vitamin B12 and folic acid |
front 32 What is a complication for D.M? | back 32 Diabetic Ketoacidosis, uncontrolled hyperglycemia, metabolic acidosis, and an accumulation of ketones. infection is the most common cause. |
front 33 what will you administer to someome with DKA? | back 33 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. |
front 34 GERD, What is the primary tx? | back 34 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. |
front 35 expected findings with GERD | back 35 Dyspepsia, headache, hiccups, upper abdominal pain, nausea, reduced appetite, bloating, |
front 36 when is it okay to exercise with D.M? | back 36 When glucose levels are between 80-250mg/dL do not exercise if ketones are present in the urine. |
front 37 Week 4 UTI What is the most common pathogen that causes UTI? | back 37 E. Coli |
front 38 What are the symptoms for a lower UTI ? | back 38 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. |
front 39 What are the symptoms for the upper UTI? | back 39 Typically causes fever, chills, and flank pain |
front 40 Which drug causes the urine to turn red or orange? | back 40 Phenazopyridine |
front 41 What is pyelpnephritis and what is the most common cause? | back 41 an inflammation of the renal parenchyma and collecting system, including the renal pelvis. The most common cause is bacterial infection. |
front 42 what is glomerulonephritis? | back 42 affects both kidneys equally. It is the 3rd leading cause of ESRD in the U.S. |
front 43 difference between acute and chronic glomerulophriits? | back 43 acute - symptoms come suddenly it can be temporary or reversible. Chronic - typically progresses slowly and can lead to irreversible renal failure |
front 44 what are the manifestations? | back 44 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 |
front 45 tx for glomerulophrits? | back 45 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,
For chronic GN then add steroids to tx |
front 46 There are 5 main types of Urinary stones, what are they? | back 46 Calcium Oxalate, Calcium phosphate, cystine, struvite and uric acid |
front 47 which stones are the most common? | back 47 Calcium stones. |
front 48 Clinical Manifestations of stones | back 48 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" |
front 49 how can we diagnose the stones? | back 49 either a noncontrast CT scan or an ultrasound, and complete urinalysis helps confirm the diagnoses of a stone by assessing for hematuria and crystalluria. |
front 50 How will the nurse care for the pt? | back 50 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. |
front 51 What is mixed incontinence? | back 51 combination of stress and urge incontinence |
front 52 overflow incontinence | back 52 -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. |
front 53 Stress incontinence | back 53 -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 |
front 54 Urge Incontinence | back 54 - 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 |