Med Surg 1 Flashcards

Questions and Answers

What is the primary purpose of the patient preoperative interview?

Provide and clarify info about the surgery (correct)

Assess the patient's emotional state and readiness for surgery (correct)

Ensure the patient's consent form has been signed and appropriate lab tests are done (correct)

Obtain the patient's health information (correct)

What are the most common psychological factors?

Anxiety, fear, and hope.

What are the important things to ask during a past health history?

Previous medical problems, last menstrual cycle, obstetric history, inherited traits, family history of cardiac and endocrine diseases, and adverse reactions/problems with anesthesia.

What are the important systems to look at during a review of systems?

Cardiovascular, respiratory, neurological, genitourinary, hepatic, integumentary, musculoskeletal, immune, electrolyte status, and nutritional status. Signup and view all the answers

What are the different physical status ratings for anesthesia administration?

P1 - normal healthy person, P2 - patient with mild systemic disease, P3 - patient with severe systemic disease, P4 - patient with severe systemic disease that is a constant threat to life, P5 - moribund patient who is not expected to survive without surgery, P6 - declared brain-dead patient whose organs are being removed for donor purposes. Signup and view all the answers

What is the purpose of ABGs and pulse oximetry?

Assesses respiratory and metabolic function, O2 status. Signup and view all the answers

What is the purpose of blood glucose testing?

Assesses metabolic status, diabetes mellitus. Signup and view all the answers

What is the purpose of BUN and creatinine testing?

Assesses renal function. Signup and view all the answers

What is included in a CBC and what is its purpose?

RBCs, hemoglobin, hematocrit, white blood count. Assesses immune status, infection. Signup and view all the answers

What is the purpose of an electrocardiogram?

Assesses cardiac disease, dysrhythmias. Signup and view all the answers

Why do we check electrolytes?

Assesses metabolic status, renal function, diuretic side effects. Signup and view all the answers

Why do we check HCG?

Assesses pregnancy status. Signup and view all the answers

What tests check coagulation studies?

PT, PTT, INR, platelet count. Signup and view all the answers

What does a serum albumin test indicate?

Nutritional status. Signup and view all the answers

What is the purpose of a type and cross-match?

See if there is blood available for replacement. Signup and view all the answers

Why do we get a urinalysis?

Check renal status, hydration, urinary tract infection. Signup and view all the answers

The presence of central perfusion is noted by?

Heart rate and blood pressure measurements within normal limits. Signup and view all the answers

Cerebral tissue perfusion is indicated by?

The patient's orientation to time, place, person, and situation; expected bilateral movement and sensation; clear speech; presence of carotid pulses; and absence of carotid bruit. Signup and view all the answers

Peripheral tissue perfusion is present when?

The patient's extremities are warm, radial and dorsalis pedis pulse rates are between 60 and 100 beats per minute, cap refill under 3 seconds, absence of continuous pain in fingers and toes, and absence of leg pain when walking. Signup and view all the answers

What are interventions for people with impaired tissue perfusion?

Nutrition therapy, activity, exercise, positioning, smoking cessation. Signup and view all the answers

What are pharmacotherapy options for people with impaired tissue perfusion?

Vasodilators, vasopressors, diuretics, antidysrhythmics, anticoagulants, and antiplatelet agents, thrombolytics, lipid-lowering agents. Signup and view all the answers

What are procedures and surgical interventions for people with impaired tissue perfusion?

Pacemaker insertion, electrical cardioversion, intra-aortic balloon pump, heart valve surgery, cardiac transplant, coronary artery bypass graft, peripheral artery revascularization, stent placement, angioplasty, endarterectomy. Signup and view all the answers

How do you perform an assessment of gas exchange?

Check baseline history, check problem-based history, check vital signs, perform inspection, auscultation, check lab tests such as ABGs, CBC, sputum sampling, skin tests, pathological analysis, perform radiologic studies, pulmonary function tests, and bronchoscopy. Signup and view all the answers

What are the 5 A's and 5 R's for tobacco use?

A: Ask, advise, assess, assist, arrange. R: Relevance, risks, rewards, roadblocks, repetition. Signup and view all the answers

What are the nicotine replacement agents?

All of the above Signup and view all the answers

What are the non-nicotine agents?

All of the above Signup and view all the answers

What are the steps for providing proper patient positioning?

Correct alignment, prevent undue pressure, provide adequate thoracic expansion, prevent occlusion of arteries and veins. Signup and view all the answers

What are the commonly used preoperative medications?

Antibiotics, anticholinergics, antidiabetics, antiemetics, benzodiazepines, beta blockers, histamine antagonists, opioids. Signup and view all the answers

What are the intravenous agents used for general anesthesia?

Barbiturates: Thiopental (Pentothal), Methohexital (Brevital), Nonbarbiturate hypnotics: Etomidate (Amidate), Propofol (Diprivan). Signup and view all the answers

What are the inhalation drugs used for general anesthesia?

Isoflurane (Forane), Desflurane (Suprane), Sevoflurane (Ultane), Halothane (Fluothane), Nitrous oxide. Signup and view all the answers

What is the dissociative anesthetic used for general anesthesia?

Ketamine (Ketalar). Signup and view all the answers

What are the four adjuncts to general anesthesia?

Opioids, benzodiazepines, neuromuscular blocking agents, antiemetics. Signup and view all the answers

What are Phase 1 and Phase 2 of the post-op period?

Phase 1: PACU, care during immediate post-anesthesia period. Phase 2: Inpatient unit, goal: prepare patient for discharge. Signup and view all the answers

What does the post-op assessment include?

ABCs, neurological, genitourinary, gastrointestinal, surgical site, pain, and labs. Signup and view all the answers

What are the important points of ABC's?

Airway: patency, artificial airway. Breathing: respiration rate and quality, breath sounds. Circulation: ECG monitoring, vitals. Signup and view all the answers

What is the number one thing that disrupts the airway?

Tongue. Signup and view all the answers

What do you do if someone gets nauseous?

Turn on side and get an emesis bag. Signup and view all the answers

What are the nursing interventions for respiratory complications?

OT therapy, cough and deep breathe, change positions every 1 to 2 hours, early mobilization. Signup and view all the answers

What is the correct patient position to prevent respiratory complications?

Lateral recovery position; once conscious - supine. Signup and view all the answers

What are the nursing interventions to prevent neuropsychological complications?

Monitor O2 levels, pain management, assess for anxiety and depression, adequate nutrition. Signup and view all the answers

What is the most common complication of hypertension?

Target organ damage. Signup and view all the answers

What is a hypertensive emergency?

BP above 220/140, develops over hours to days, evidence of target organ damage. Signup and view all the answers

What drug is used in a hypertensive emergency?

Sodium nitroprusside. Signup and view all the answers

What is hypertensive urgency?

BP above 180/110, develops over days to weeks, no evidence of target organ damage. Signup and view all the answers

What drug is used in hypertensive urgency?

Oral agents - captopril, labetalol, clonidine, amlodipine. Signup and view all the answers

What are the levels for troponin I?

Negative - 2.3 ng/ml. Signup and view all the answers

What are the levels for troponin T?

4%-6% of total creatine kinase. Signup and view all the answers

What is myoglobin?

Low-molecular-weight protein that is 99-100% sensitive for myocardial infarction. Rises 30-60 minutes after MI. Signup and view all the answers

What are the normal levels for myoglobin for male and female?

Male - 15.2-91.2 mcg/L; Female - 11.1-57.5 mcg/L. Signup and view all the answers

What is C-reactive protein?

Marker of inflammation that can predict the risk of cardiac disease and cardiac events. Signup and view all the answers

What are the levels for C-reactive protein?

Lowest risk - 3 mg/L. Signup and view all the answers

What is homocysteine?

Amino acid produced during protein catabolism which is a risk for cardiovascular disease. Signup and view all the answers

What are the normal levels for homocysteine for male and female?

Male - 5.2-12.9 mol/L; Female - 3.7-10.4 mol/L. Signup and view all the answers

What is b-type natriuretic peptide?

Causes natriuresis. Elevation distinguishes between cardiac vs. respiratory cause of dyspnea. Signup and view all the answers

What is the lab value for b-type natriuretic peptide that indicates heart failure?

Diagnostic for heart failure >100 pg/mL. Signup and view all the answers

What is NT-Pro-BNP?

Aids in assessing the severity of heart failure in symptomatic and asymptomatic patients. Signup and view all the answers

What is the most appropriate initial question for the nurse to ask a preoperative patient?

What type of surgery are you having and why are you having it done? Signup and view all the answers

After administering a benzodiazepine preoperatively, which side effects should the nurse monitor for?

Sedation Signup and view all the answers

What would the nurse suspect regarding a preoperative patient with elevated hemoglobin and hematocrit?

Dehydration Signup and view all the answers

Which activities should the nurse carry out in the preoperative period for a client scheduled for surgery? (Select all that apply)

Verify the presence of a signed consent form. Signup and view all the answers

Which patient-related factors contribute to a high degree of risk associated with surgery? (Select all that apply)

Involvement of vital organs Signup and view all the answers

For which priority needs should the nurse immediately assess the postoperative patient?

Vital signs, level of consciousness, presence of pain Signup and view all the answers

Which indicators suggest an alteration in tissue perfusion in a postoperative patient? (Select all that apply)

Fluid loss Signup and view all the answers

What is the purpose of encouraging the patient to move from side to side at least every 2 hours after surgery?

Let the lungs alternatively achieve maximum expansion Signup and view all the answers

What would be appropriate outcomes for a postoperative patient with acute pain? (Select all that apply)

Verbally rates pain as 3 on a 1 to 10 scale Signup and view all the answers

For what reason would the nurse check the bedclothes underneath a postoperative patient?

Detect for possible hemorrhage Signup and view all the answers

Symptoms consistent with abrupt onset of chest pain that worsens with inspiration in a patient who had pneumonia are indicative of what condition?

Pleurisy Signup and view all the answers

What condition is suggested by symptoms such as dyspnea and chest pain in a patient with a recent history of sexual assault?

Panic Attack Signup and view all the answers

What should the nurse suspect when an elderly patient has recent changes in mental status and low appetite?

Urinary tract infection Signup and view all the answers

What is Ted's greatest risk factor for a UTI related to his admission?

Indwelling urinary catheter Signup and view all the answers

What indicates effective patient education regarding pneumococcal vaccine for a 65-year-old patient?

I will need re-vaccination in five years Signup and view all the answers

Based on urine output and color after surgery, what should the nurse assess for?

Assess the patient for signs of acute kidney injury Signup and view all the answers

How will the nurse know patient teaching regarding cast care has been effective?

I will call my physician if I have an increase in pain or swelling. Signup and view all the answers

What is the priority action for the nurse before sending a patient to a CT scan with contrast?

Evaluate the morning creatinine and BUN lab results Signup and view all the answers

Identify ways to prevent contrast-induced nephropathy. (Select all that apply)

Avoid multiple procedures over a 24-48 hour time period Signup and view all the answers

What should be included in an initial assessment for a possible hip fracture? (Select all that apply)

Muscle spasms of the affected leg Signup and view all the answers

Which insulin can only be given intravenously?

Regular Signup and view all the answers

What nursing actions promote an optimal patient outcome to TPN therapy? (Select all that apply)

Record daily weights Signup and view all the answers

What clinical manifestation should the nurse closely monitor in a patient with type 1 diabetes?

Hypoglycemia Signup and view all the answers

What laboratory result would be expected when assessing a patient with abnormally low blood glucose concentration?

Lower than 50-60 mg/dL Signup and view all the answers

Which laboratory test result would help the nurse assess an elderly patient's nutritional status?

Pre-albumin level Signup and view all the answers

What is the appropriate nursing diagnosis for a patient with a Stage I pressure ulcer despite proper repositioning?

Impaired skin integrity related to the effects of pressure Signup and view all the answers

What characteristics would be expected in the skin of a normal older adult client? (Select all that apply)

Fragile skin that is wrinkled Signup and view all the answers

Which interventions should the nurse include to prevent pressure ulcers in bedridden patients? (Select all that apply)

Assess the condition of the bed linens frequently, changing whenever damp or soiled. Signup and view all the answers

Which patient wounds would heal by secondary intention? (Select all that apply)

A stage 4 pressure ulcer Signup and view all the answers

What is the purpose of a wet-to-dry dressing on a pressure ulcer?

Debride the wound Signup and view all the answers

What significant finding should be reported before a patient undergoes coronary angiography?

Patient reported an allergy to shrimp Signup and view all the answers

What menu choice indicates patient education regarding digoxin and furosemide is effective?

Chicken with baked potato and cantaloupe Signup and view all the answers

What is the best response to a patient asking about metoprolol after acute myocardial infarction?

Metoprolol slows your heart rate and decreases the amount of work it has to do so it can heal. Signup and view all the answers

What conclusion can the nurse draw about a patient with chest pain that was not relieved by rest?

The patient most likely has unstable angina. Signup and view all the answers

Study Notes

Preoperative Assessment

Initial question for preoperative patients: "What type of surgery are you having and why?"
Benzodiazepine side effects to monitor: anxiety, level of consciousness, sedation.
Elevated hemoglobin and hematocrit may indicate dehydration.
Preoperative activities include identifying health problems, verifying consent, and assessing effectiveness of teaching.

Surgical Risk Factors

High surgical risk factors include involvement of vital organs and history of respiratory disease or diabetes.
Priority assessment in PACU involves vital signs, consciousness, and pain presence.
Indicators of altered tissue perfusion: pallor or cyanosis, fluid loss, decreased urinary output.

Postoperative Care

Encourage side-to-side movement every 2 hours to promote lung expansion.
Outcomes for acute pain management: absence of nonverbal pain signs, patient rates pain as 3 on a 1-10 scale.
Check bedclothes for drainage to detect possible hemorrhage.

Common Conditions and Symptoms

Pleurisy indicated by abrupt chest pain with inspiration post-pneumonia.
Panic attack symptoms: dyspnea, choking sensation, chest pain, sweating.
Changes in mental status in elderly may suggest urinary tract infection.

Patient Education and Safety

Effective teaching on pneumococcal vaccine indicates need for re-vaccination in five years.
Monitor for acute kidney injury in postoperative patients with low urine output and dark urine.
Key signs of hip fracture: external rotation, shortening of the affected leg, and muscle spasms.

Medication Knowledge

Regular insulin can only be administered intravenously.
TPN therapy requires monitoring vital signs, I&O, weight, and serum electrolytes.
Hypoglycemia is the primary concern for patients with type 1 diabetes.

Nutritional Assessments

Pre-albumin level is critical for assessing nutritional status in elderly patients.
Stage I pressure ulcer implies impaired skin integrity related to pressure effects.

Wound Care Management

Wet-to-dry dressings are used primarily for debridement of wounds.
Secondary intention healing expected in large open wounds like stage 4 pressure ulcers.

Surgical Considerations

Report allergy to shrimp before coronary angiography.
Diet post-heart failure should be low in sodium; grilled chicken and vegetables are a good choice.

Angina Assessment

Chest pain not relieved by rest may indicate unstable angina.

Pharmacological Effects

Drugs that decrease preload: Nitroglycerin, morphine, and beta-blockers.

Anesthesia Preparation

Preoperative interview objectives include gathering health history, assessing emotional readiness, ensuring signed consent, and confirming lab tests.
Define physical status ratings for anesthesia administration to assess patient risk levels.

Laboratory Tests Purpose

ABGs and pulse oximetry evaluate respiratory and metabolic function.
Blood glucose tests assess metabolic status, crucial for diabetic patients.
BUN and creatinine tests are vital for renal function assessment.
CBC includes RBCs, hemoglobin, hematocrit, and WBC count for overall health assessment.### Immunology and Cardiology Assessments
Immune status is assessed to evaluate infection risk.
An electrocardiogram (ECG) identifies cardiac diseases and dysrhythmias.
Electrolyte testing measures metabolic status and renal function, along with assessing side effects from diuretics.
Human chorionic gonadotropin (HCG) levels confirm pregnancy status.
Coagulation studies include PT, PTT, INR, and platelet count for blood clotting assessment.

Nutritional and Blood Tests

Serum albumin evaluates nutritional status.
Type and cross-match tests ensure availability of compatible blood for transfusion.
Urinalysis checks renal function, hydration status, and urinary tract infections.

Perfusion Assessments

Central perfusion is indicated by heart rate and normal blood pressure.
Cerebral tissue perfusion is signaled by patient orientation, movement, speech clarity, and carotid pulse presence.
Peripheral tissue perfusion checks for warmth in extremities, pulse quality, capillary refill time, and absence of pain.

Tissue Perfusion Interventions

Interventions for impaired tissue perfusion include nutrition therapy, exercise, proper positioning, and smoking cessation.
Pharmacotherapy options consist of vasodilators, vasopressors, diuretics, anticoagulants, and thrombolytics.
Surgical interventions may involve pacemaker insertion, cardiac surgeries, and revascularization procedures.

Assessment Procedures

Gas exchange assessment combines patient history, vital signs, lab tests, and various diagnostic studies.
Tobacco use interventions use the 5 A's for those wanting to quit and 5 R's for those who do not wish to quit.

Surgical Procedures and Anesthesia

Preoperative medications include antibiotics, anticholinergics, antidiabetics, antiemetics, benzodiazepines, beta-blockers, histamine antagonists, and opioids.
Intravenous agents for general anesthesia include barbiturates and non-barbiturate hypnotics.
Inhalation drugs consist of volatile liquids and gaseous agents, with ketamine being a common dissociative anesthetic.

Postoperative Care

Post-op phases focus on immediate care in the PACU and preparing patients for discharge on the inpatient unit.
Assessments post-surgery cover airway, breathing, circulation (ABCs), neurological state, and surgical sites.
Airway disruption often stems from tongue obstruction; addressing nausea includes lying the patient on their side.

Complications and Management

Common complications of hypertension involve target organ damage.
Hypertensive emergencies feature dangerously high BP with organ damage, treated with sodium nitroprusside.
Hypertensive urgencies have high BP without organ damage, managed with oral medications like captopril and labetalol.

Biomarkers and Heart Failure Indicators

Troponin I levels indicate cardiac injury (<2.3 ng/ml negative).
Myoglobin is a sensitive marker for myocardial infarction, rising 30-60 minutes post-MI.
C-reactive protein serves as an inflammation marker and risk predictor for cardiac events.
Homocysteine, an amino acid linked to cardiovascular risk, has specific normal ranges by gender.
B-type natriuretic peptide levels >100 pg/mL indicate heart failure.
NT-Pro-BNP helps assess the severity of heart failure in patients.

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