Med Surg I Exam #2 Study Guide PDF

MED SURG EXAM \#2 STUDY GUIDE 1. **Members of the surgical team:** - - - - - - **Preadmission Testing** \> initiates the nursing assessment process 1. 2. 3. **Preoperative assessment:** - - - - - - - - - **Medications that potentially affect surgical ex...

MED SURG EXAM \#2 STUDY GUIDE 1. **Members of the surgical team:** - - - - - - **Preadmission Testing** \> initiates the nursing assessment process 1. 2. 3. **Preoperative assessment:** - - - - - - - - - **Medications that potentially affect surgical experience** **Corticosteroids** Cardiovascular collapse w/ sudden D/C ---------------------- ------------------------------------------- **Diuretics** Respiratory depression, FVD, Dysrhythmias **Antipsychotics** Increase risk of hypotension **Opioids & benzos** Sudden D/C will cause withdrawal **Insulin** Hypo or hyperglycemia intraoperative **Erythromycin** Apnea, respiratory paralysis **Anticoagulants** Increased risk of bleeding **Antiseizure** Need for seizure prevention **Thyroid** Metabolic collapse w/o **Special considerations during perioperative period** - - - - **Geriatric** → Many comorbidities. Surgical medications affect different and sometimes last longer. Healing time and resources need to be considered. Ethical issues of quality of life. Body's natural aging process causes increased risks **Bariatric (Obese)** → They have longer healing times, increased risk for infections or surgical complications due to their size, comorbidities and mobility status. Positioning needs to be carefully done. Airway may be issue due to shorter, larger neck area; as well as difficulty lying flat **Informed Consent:** - - - - - - **Patient education:** → Deep breathing, coughing, incentive spirometry → Mobility, active body movement → Pain management → Cognitive coping strategies → Instruction for patients undergoing ambulatory surgery **Intermediate preoperative nursing interventions:** - - - - - **General Preoperative Nursing Interventions:** - - - - - - - 2. **Intraoperative:** **[Roles in the OR:]** circulating nurse, scrub, surgeon, anesthesiologist **[Environment is controlled temperature:]** COLD & CLEAN **[OR zones:]** unrestricted (street clothes), semi-restricted, restricted (full or garb) **[Asepsis is maintained:]** sterilized, prepackaged, fields maintained **[OR environment:]** music, talking or no talking, teaching **[Electrical equipment risks:]** laser & radiation **[Anesthesia:]** general (out cold, airway supported or intubated) → inhalation and/or IV **[Know the positions]** **UNIVERSAL TIME OUT** 1. 2. 3. 4. **Asepsis** 1. 2. 3. **Principles of sterility** - - - - - - - - - - **Types of anesthesia:** 1. 2. 3. 4. **Surgical positions**  **Intraoperative Complications:** - - - - - - - **Adverse effects of surgery & anesthesia:** - - - - - - 3. **Postoperative:** - - - - - - - - - - - - - - **Outpatient surgery/direct discharge:** - - - - - - - **Maintain patent airway:** \> primary consideration: necessary to maintain ventilation, oxygenation - - - - - **Maintaining cardiovascular stability:** → Monitor cardiovascular status, IV lines, potential hypotension, shock, hemorrhage, hypertension, arrhythmias **Indicators of Hypovolemic shock / hemorrhage** \> pallor \> cool, moist skin \> rapid respirations \> cyanosis \> rapid, weak, thready pulse \> decreasing pulse pressure \> low blood pressure \> concentrated urine **Jackson Pratt (JT) drain:** \* Assess color, consistency ! **Hemovac drain:** **Wound complications:** - - - - - - - - - - - A. B. **Post-op complications:** - - - - - - - - - - - - - 4. **Three layers of the heart wall:** 1. - 2. - 3. - - - - - - -  **EKG:** - - - -  **Assessment of cardiovascular system:** - - - - - **Common symptoms:** - - - - - - **Physical Assessment of the Cardiovascular System:** - - - - - - - - *Most reliable source for pulse* → apical 5. **Laboratory Tests:** 1. 2. 3. 4. 5. a. 6. b. 7. c. 6. **CAD:** \> Coronary Artery Disease - - - - - - - - - - - - - - - - - **ANGINA:** \> chest pain - - - - - - - - - - - - - - - - - - - +-----------------------------------+-----------------------------------+ | Consistent Chest pain (can be at | Unstable occurs at rest | | home). Happens upon exertion. | | | | - - | | - - | | +-----------------------------------+-----------------------------------+ **HTN:** - - - - - - - - - - - - - - **MI:** - - - - +-----------------------------------+-----------------------------------+ | STEMI | Non STEMI | | | | | - - - | - - - | +-----------------------------------+-----------------------------------+ - - - - - - - - - - - 7. **Heart failure:**\ \> Heart failure (HF) is a clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of a ventricle to fill or eject blood; the heart is unable to pump enough blood to meet the body's metabolic demands or needs - \*Some cases are reversible depending on the cause \*Most HF is a chronic, progressive condition managed with lifestyle changes and medications  **Chronic Heart Failure** - - - **Clinical Manifestations of Heart Failure:** +-----------------------------------+-----------------------------------+ | **RIGHT sided** | **LEFT sided** | +===================================+===================================+ | Ineffective pimping of the R | Ineffective pumping of the left | | ventricle causing backflow of | ventricle causing backflow of | | blood to peripherals to sell the | blood in the lungs, if left | | body | untreated left takes over right | | | leading to RHF | | - - - - - - | | | | - - - - - - | | | | | |  | +-----------------------------------+-----------------------------------+ **Medical management of the patient with heart failure** - **Treatments:** - - - - - **Medications used to treat HF** 1. 2. 3. 4. 5. **Isotopes - cardiac glycosides** **Prototype →** digoxin **Routes of administration →** PO & IV **Action →** improves the contractility of the heart by blocking ion exchange. Decreases electrical impulsivity in arrhythmias **Use →** heart failure, a-fib, and a-flutter **Adverse effects →** very narrow therapeutic window **Interactions →** increased risk of dysrhythmias w/ epinephrine **Contraindications →** severe myocarditis, ventricular tachycardia, v-fib. Use caution with MI, heart block, stokes-adams syndrome, and Wolff-Parkinson-White syndrome, and electrolyte disturbances. **Nursing Implications →** therapeutic serum level 0.8-2.0 mg/mL. Draw level prior to administration and at least 6 hours after the last dose. If pulse is \