MS PRELIMS.pdf

MEDICAL SURGICAL - Common organ: LARGE M.A.D INTESTINE. - MGT: Put the organ on the PERIOPERATIVE NURSING...

MEDICAL SURGICAL - Common organ: LARGE M.A.D INTESTINE. - MGT: Put the organ on the PERIOPERATIVE NURSING side of the bed —> Cover with - Total Surgical Experience sterile gauze & sterile saline - Starts in Informed Consent up to —> Inform surgeon —> OR Last Follow-up Check-up. d. Early Ambulation - prevents pneumonia. PREOPERATIVE - longer laying in bed = ^ risk for CONSENT —> OPERATING ROOM pneumonia. I. Informed Consent - signed by the - sitting —> standing —> PATIENT. walking - Voluntary, Principle of III. Pre-Op Assessment - Data Gathering AUTONOMY. Right to self a. Demographic - Age, Gender, Civil determination. Status etc. Considerations: - Extreme Age - Old Age, and 1. Legal Age - 18 and above. children, increased risk for 2. Mentally Stable complications. - If unstable, the patient must be - Male - has greater in LUCID INTERVAL. complications. - Lucid Interval - moments b. Medical History patient is oriented, 1. Disease - such as DIABETES, asymptomatic, and stable. DEHYDRATION, If not met, they can sign the consent: CARDIOVASCULAR DISEASES. 1. Nearest Kin 2. Allergies 2. Doctor - Principle of Paternalism 3. Medications - Good Father Principle Steroids - anti-inflammatory, - EMERGENCY CASES. immunosuppresant. 1. Lower immune system - increased TASKS: risk for infection. a. Obtain - Doctor/Surgeon 2. Monitor TEMPRERATURE b. Secure - Nurse, MUST WITNESS 3. Give lower dose for fever. UNDERSTANDING. 4. Don’t stop abruptly, ^ sugar, ^ BP 5. STOP DURING SURGERY. II. Pre-Op Teaching Anti-Coagulant - prevents blood clot - Prevent post-op complications. formation. - Best time to endorse, NIGHT 1. Causes bleeding. BEFORE SURGERY. 2. Warfarin. a. Deep Breathing & Coughing Anti-biotic - prevent/treat infection. Exercise - prevent PNEUMONIA. 1. Decreased breathing, monitor RR. NOTE: Pneumonia is the most common 2. Erythromycin - causes respiratory lung infection after surgery. depression. b. Leg Exercises - Prevent DEEP Diuretics - removes liquids insides the VEIN THROMBOSIS body. - To test for DVT use HOMAN’S SIGN. 1. Can cause dehydration. - (+) Pain ( w/ Blood Clot) 2. Hydrochlorothiazide. - (-) Pain (w/out Blood Clot) c. Splintting - Applying gentle pressure IV. Pre-Op Medications to prevent OPENING OF SUTURE 1. Anxiolytics - prevents anxiety, LINE. promotes relaxation. - Use PILLOW or BINDER. - Diazepam Dehiscence - Opening of suture line. 2. H2 blockers - prevents/decrease - w/ drainage secretion of hydrochloric acid. - MGT: Use sterile gauze & - Ranitidine sterile saline to cover —> 3. Anticholinergic - decrease gastric Inform surgeon —> Bring secretions back to OR - Prevents aspiration Evisceration - Opening of suture line - Atropine Sulfate with organ/s. 4. Antiemetic - prevents vomitting. - w PROTRUSION - Metoclopramide  5. Sedatives - promotes ↑ Body Temp sedation/sleep. = MALIGNANT HYPERTHERMIA - Lowers level of consciousness. - ↑ 1-2C q5 mins - Barbiturates - Earliest /S: 6. Opiod Analgesics - Minimize pain 1. Tachycardia - >150 bpm - Can cause respiratory 2. Muscle Rigidity/Paralysis depression 3. ↑ Body Temperature - Monitor RR - Common to: - Morphine, 1. Male - Antidote: Narcan/Naloxone 2. Obese Note: Last sense to disappear, HEARING. - Antidote: Dantrolene Sodium Anesthetic Agent - Diazepam, Midazolam, INTRAOPERATIVE Propopol OR —> PACU/Recovery Room - Bevital - causes hiccups Check if informed consent in - Can be given RECTALLY signed. REGIONAL PRIORITY: 1. Secure patient Partial loss of consciousness. - Airway - ET tube/ Given through nerves. Oxygen Semi-conscious - Safety Location difference 2. Administration of Anesthesia Local Anesthetic STAGES OF ANESTHESIA a. Lidocaine 1. Induction b. Bupivacaine 2. Excitement c. Procaine 3. Surgical Amnesia Location 4. Danger/Exhaustion Local - Directly on affected site. GENERAL Conscious Sedation - IV Total loss of consciousness Spinal - L4-L5, subdural space Major Surgeries ○ D/A: Spinal Headache Target: Epidural - Epidural space, above ○ Sensory dura. Higher dose. ○ Motor ○ Autonomic POST OPERATIVE 1. Inhalation a. Patient Monitoring - q15 mins for GAS 1st hour 1. O2 - green container - q30 mins for the next hour 2. Air- yellow container, for suction - q4 hrs after being stable 3. Nitrous Oxide - Blue container, for b. Monitor Post-Op Complications Euphoria Effect, Laughing Gas c. Nutrition and Diet VOLATILE LIQUID NUTRITION 1. Halothane - Red container 1. Protein - Wound Healing - Monitor BP 2. Vit. C - repairs cell - S/E Hypotension 3. Vit. K - prevents bleeding 2. Isofluraine - Violet Container, can DIET cause RESPIRATORY 1. NPO - until platus DEPRESSION 2. Clear Liquid 3. Enflurance - Orange container, can 3. Full Liquid cause RESPIRATORY 4. Soft Diet DEPRESSION 5. DAT 2. IV 1. Opioid Analgesic - Morphine, Wound Closure Fentanyl Primary - Suturing Immediately 2. Muscle Relaxant - targets motor Secondary - Granulation (production function. of new cells.) - Succinylcholine Tertiary - Delayed suturing D/A - Muscle Paralysis - Deep and delayed suturing ↓ Contractions ↓ Blood Flow PURPOSE OF SURGERY ↓ Oxygen Levels - produce Lactate Acid = 1. Diagnostic PAIN 2. Curative  3. Repairative 3. Vesicular- low pitch sound (base of 4. Palliative the lungs) TYPES OF SURGERY ABNORMAL BREATH SOUNDS 1. Emergent 1. Wheezing 2. Urgent - High pitch musical sound. 3. Required - Bronchoconstriction 4. Elective - Open airway but limited 5. Optional - Upon exhalation - Sudden loss of wheezing = closed Members of the OR Team airway 1. Surgeon - Ex. Asthma 2. Assistant Surgeon - DOC: Bronchodilator 3. Scrub Nurse 2. Stridor 4. Patient - Low pitch sound 5. Circulating nurse - Upon inhalation 6. Anesthesiologist - Caused by Laryngospasm - Ex. Croup’s disease (Laryngotracheobronchitis) ZONES IN OR 3. Ronchi 1. Unrestricted - Snoring if there’s OSA (Obstructive 2. Semi-restricted Sleep Apnea) 3. Restricted 4. Crackles - Fluid in lungs ANATOMY OF RESPIRATORY SYSTEM - Ex. Pneumonia, Pulmonary Edema & CHEST INJURY 5. Friction Rub UPPER RESPIRATORY TRACT - Sign of PERICARDITIS. - responsible for the passageway of - Inflammation of O2 and Carbon Dioxide. pericardium. - Where O2 is humidified Nasal Cavity Filters air, and CHEST DEFORMITIES humidifying the O2. 1. Barrel’s Chest - Over-inflation. Pharynx Connects nasal - 2:1 ratio, Ex. COPD cavity to larynx. 2. Funnel Chest - Depressed sternum (inward) Larynx Voice Box (vibrates - Sign of Marfun Syndrome with air) - Hereditary 3. Pigeon Chest LOWER RESPIRATORY TRACT - Protruding sternum (outward) - Ex. Down Syndrome Trachea Passageway UPPER RESPIRATORY DISORDER Primary Bronchi Passageway 1. Viral Rhinitis Lungs Main Organ for - (+) Drainage GAS EXCHANGE. - Common colds Where ALVEOLI is. - Self- Limiting: Can be cured without medications. 2. Obstructive Sleep Apnea - Airways obstruction w cessation of ALVEOLI - produce surfactant for lung breathing. expansion. - Episodes of dyspnea. CAPILLIARIES - location where gas - Common to: Obese, and Alcoholics. exchange happens. - MGT: Weight loss, Limit alcohol intake. NORMAL BREATH SOUNDS - CPAP - continuous O2 1. Bronchial - high pitch sound - BIPAP - O2 given upon (trachea) dyspnea. 2. Bronchovesicular - moderate pitch 3. Laryngeal Cancer sound (scapula)  - Common to: Smokers, COPD, - Removal and insertion is done by Alcoholics. Pulmonologist. S/Sx: - If no movement: - Hoarseness of voice >2weeks 1. Obstruction - Resistent Cough 2. Re-expansion - Dyspnea & Dysphagia - Auscultate to check for breath Risk Factors: sounds. - Smoking, Alcohol, COPD. - Good movement of lungs. DOC: Chest X-Ray to confirm: 1. Anti-Lucid - dry cough, stop 1. Obstruction coughing reflex. 2. Re-expansion 2. Mucolytics - Productive cough, Notify physician for any result. dissolves mucous. Disconnected - submerge tube in MGT: NSS 1. Chemotherapy Dislodged - Cover chest with sterile 2. Radiation Therapy gauze —> Notify physician. 3. Laryngectomy SUCTIONING - Remove blood/air in lungs TRAUMATIC DISEASE - Expected to have continuous Ribs - protect lungs bubbling. CHEST INJURY MUST HAVE FOR PX WITH CTT: Closed 1. Clamp - for air leak - internal 2. Bottle of NSS - if disconnected - Non-penetrating 3. Sterile Gauze - if dislodged Ex. 1. Rib Fracture - 3 ribs ACID BASE IMBALANCE - caused by steering wheel injury. - Severe pain PCO2 PH NAHCO3 - Low RR (Carbon (Sodium - Paradoxical Chest Movement Dioxide) Bicarbonate - X MORPHINE - can cause ) respiratory depression - / DEMEROL 35-45 7.35-7.45 22-26 Hemothorax - blood in lungs Pneumothorax - air in lungs, commonly PROBLEM: found in 2nd intercoastal space of ribs. PH & PCO2 = Respiratory CHEST TUBE THORACENTESIS PH & NAHCO3 = METABOLIC - for drainage of blood and air. NOTE: Respiratory - Lungs BOTTLE SYSTEM Metabolic - Kidneys COMPENSATION Fully Compensated - N PH Partially Compensated - No normal values Uncompensated - Normal either PCO2 & NAHCO3 PULMONARY EMBOLISM Fat - bone marrow (solid), reserved trendelenburg Air - 5mL (common: IV insertion) WATER SEAL trendelenburg - Water Fluctuation = Tidaling: Rise and Fall of water Thrombo - Blood Clot ( common: injury) - Intermittent Bubbling = Good - Continuous Bubbling =Sign of air TESTS —> Clamp the tube —> Notify D-Dimer Test - test the blood clot physician.  Homan's Sign - to determine if there ○ Observe for 24-48 hrs is blood clot. CHEST X-RAY - to determine if may scarring; or progression. MGT: SPUTUM EXAM / AFB (CONFIRMATORY) oxygen therapy ○ Acid-Fast Bacilli Thrombolytic - group of medication ○ to check presence OF dissolves blood clot. Causes MYCOBACTERIUM Bleeding ○ Urokinase = -KINASE" CONTRAINDICATED: HEMOPTYSIS Anti-coagulant - prevent blood clot (confirmed for PTB) formation. Causes Bleeding HEPARIN (Parenteral) BEST TIME DONE: specipically subcu in abdomen) Morning;Before meal Antidote: PROTAMINE SULFATE (No oral Hygiene, after test only) MONITOR: APTT (activated partial TECHNIQUE: DEEP HACKING COUGH thromboplastin time) ( N: 40-60 sec.) Nurse Poxn: Side of Pt. ; wear mask (KN49 WARFARIN (oral) or surgical) ○ SIDE EFFECT: BLEEDING BEST: 6 ft / 13 feet distance away (STOP the warfarin) ○ Antidote: VIT K (do not eat PTB TYPES leafy green veggie if taking warfarin) PULMONARY - infxn direct in lungs EXTRAPULMONARY - outside lungs MONITOR: PT (Prothrombin Time) ( N: POTT'S DsE. - bones 9-16 sec.) MILIARY DsE. - skin (rare) PRIMARY COMPLEX - Child nas TB POSITIONS: CLASSIFICATION TRENDELENBURG ; REVERSE TRENDELENBURG 0: NO TB I : Exposed (category 1) II: Latent Infection - (Asymptomatic) INFECTIOUS DISORDER (+) sputum Pulmonary tuberculosis - caused by III: Active Dse. - (symptomatic) (+ MYCOBACTERIUM TUBERCULOSIS Sputum) IV: Non-active Dse. - (+ Sputum) Signs/ symptoms: (Asymptomatic) (x-ray - see searing) ○ Usually sa recovery stage low grade fever (10mm (TB), 75mm (HIV), (living with HIV) 3. PYRAZINAMIDE (-) 38.5C) CHEST PHYSIOTHERAPY Rusty Sputum (Reddish Brown) Consolidated Lungs (tumitigas ang PERCUSSION - to loosen secretions lungs dt. retention of secretion) Crackles - CUP HANDS (Before meal) (after 2-3 hrs meal) TEST VIBRATION - PALM Sputum Exam (test Bacteria) chest X-RAY (confirmatory) - MOBILIZE SECRETIONS CAUSES OF PNEUMONIA POSTURAL DRAINAGE - Positioning, opposite side Streptococcus Pneumoniae - Common - drain secretions. Meningitidis TO KNOW SECRETIONS: AUSCULTATE TYPES OF PNEUMONIA HIGH FOWLER: 40-90 COMMUNITY ACQUIRED PNEUMONIA - SEMI: 30-25 Outside Hospital Low : 200 PROBLEM: pumping / ventricles ↓ ↓ BLOOD FLOW RIGHT SIDED LEFT SIDED ↓ Circulatory Pulmonary ↓ O2 Congestion Congestion ANGINA PECTORIS MYOCARDIAL PROBLEM: PROBLEM: INFARCTION Circulation Lungs Chest —> Shoulder Chest —> All parts of body Backward Effect Forward Effect Problem: Venous Problem: No O2 Lactate Acid Necrosis Return from lungs Temporary Permanent Congestion Reversible Irreversible Monitor Central Monitor Pulmonary < 30 mins > 30 mins Venous Pressure Capillary Wedge N: 0.8 mmHg / 2-8 Pressure Relieve with rest unrelieved by rest mmHg N: 4-12 mmHg Localized, sharp pain Radiating, Crushing Pain MGT: Monitor Blood Cholesterol ○ LDL - 160-200 ○ HDL - 30-70 Identify Risk Factors (Precipitating and Predisposing Diet ( ↓ Sodium, ↓ Fat, ↑ Fiber) Antilipidemic - dissolves cholesterol (Atorvastatin) - given @ night, causes drowsiness - Monitor: SGPT & SGOT - liver enzymes - Hepatotoxic Surgery ○ Coronary Arterial Bypass Graft Add Saphenous Vein ○ Percutaneous Transluminal Coronary Angioplasty Add Stent MGT ANGINA: O2 Nitroglycerine - vasodilator ○ Max dose: 3 doses q5mins ○ Store in dark colored container ○ Photosensitive ○ 6 months expire Aspirin - antiplatelet effect/blood thinner MGT MYOCARDIAL INFARCTION Morphine - reduce O2 demand O2 Nitroglycerine - vasodilator ○ Max dose: 3 doses q5mins ○ Store in dark colored container ○ Photosensitive ○ 6 months expire Aspirin - antiplatelet effect/blood thinner