Level I W2013

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Author:
amelia.m.norton
ID:
194267
Filename:
Level I W2013
Updated:
2013-01-21 17:12:55
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TestI
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Description:
Lab Analysis, Perioperative
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  1. Goals of Perioperative
    • Patient Safety
    • Optimal patient recovery
  2. Preoperative Assessment
    • Gather data to id risk factors and plan care to ensure client safety
    • establish baseline data; subjective & objective
  3. Perioperative Diagnostic Tests
    • CBC
    • U/A
    • Chest-XR - CXR
    • ECG
    • Blood Type
    • PT/INR
    • ABG
    • Pulse Oximetry
  4. Perioperative Teaching
    • explain timelines & describe environments pt will be in
    • preparations before surgery
    • NPO status
    • pain assessment/management
    • Abdominal Surgery
    • -wound care
    • -deep breathing & IS
    • -leg/foot exercises
    • -turning/positioning
  5. Perioperative Informed Consent
    • Info fully understood by client
    • Voluntary
    • Signature witnessed
    • Physicians
    • -benefits
    • -risks
    • -alternatives
    • RN
    • -confirm voluntary consent
    • -witness sig
  6. Beta Blockers
    manage hypertension
  7. Benzodiazepines
    • sedative
    • amnesic effects
  8. Narcotic Opiods
    decrease pain and anesthetic requirement
  9. Anticholinergics
    decrease oral secretions
  10. Anti-Emetics
    decrease Nausea vomiting
  11. H2-Receptor blockers
    decrease gastric volume HCL acid secretion
  12. Antibiotics
    prevent post-op infections
  13. Antidiabetics
    stabilize blood glucose
  14. Surgery Team
    • surgeon - team leader/performs procedure
    • Surgical Asst - exposes op-site, retracts tissue, sponging/suctioning wounds, suturing
    • Anesthesiologist/CRNA - pre-anesthesia assessment, IV's meds, continuous
    • Circulating RN - coordinates care pre/during/post
    • Surgical Tech/Scrub RN - handles equip adjacent to sterile field
  15. General Anesthesia
    • Loss of sensation & consciousness
    • Dissociative anesthesia - ketamine derivative of PCP
    • IV & Inhalant
    • Sedated & paralyzed
    • Mechanically ventilated
  16. Local Anesthesia
    • Loss of sensation at surgical site
    • Lidocaine
  17. Regional Anesthesia
    • Loss of sensation in a particular region
    • Nerve or Spinal blocks, epidural
    • Peripheral Nerve Block - Epidural
  18. Monitored Anesthesia Care
    • Conscious Sedation
    • Responsive & breath w/out assistance
  19. Conscious Sedations & Risks
    • Pt. responds but is groggy-verbal
    • IV narcotics & antianxiety needs
    • Strict protocols reversing agents, ACLS
    • Special training-consent, universal protocol
    • Priority is Airway - Narcan, Romazican
  20. Anesthesia Complications
    • Cardiac Depression
    • Anaphylaxis
    • Malignant hyperthermia
    • CSF leakage r/t spinals, epidurals
  21. PACU Assessment Interventions
    • Airway, Obstruction, vomitus, swelling
    • Lung sounds, RR, SP02, upper airway sounds, quality of respirations - reflexes
    • Interventions - Jaw thrust, suctioning, respositioning
  22. Post-OP Complications Respiratory
    • Atelectasis: alveolar collapse
    • Hypoxemia
    • Hypoventilation
    • Pneumonia
    • Pulmonary Embolism
    • Thrombophlebitis
    • Hemorrhage/Shock
  23. Acute Pain
    • sudden onset
    • less that 6 months
    • intensity: mild to severe
    • cause is usually identifiable
    • decreases resolves over time
    • best pain control
  24. PQRST
    • provokes, palliative, precipitating
    • quality; sharp, dull, crampy, thrombing, aching, stabbing, tight, pressure, etc.
    • region, radiation
    • severity 0-10
    • timing
  25. Chronic Pain
    • gradual or sudden onset
    • larger than 6 months
    • cause may be unknown
    • intensity: mild to severe
    • waxes & wanes
    • Flat affect, fatigue, physical mvmt/activity, social withdraw
    • Goal of treatment - increased function & life quality
  26. Hypernatremia
    • Excessive Salt, salt retention (kidney failure)
    • decreased H20
    • S/S: intense thirst, red swollen tongue, flushed, dry skin, oliguria/anuria, agitation/lethargy, high urine SG, high HCT
    • Trtmt: decrease fluid volume w/ D5W, loop diuretics can increase Na excretion, decrease sodium diet, avoid processed foods
    • ND: risk for injury r/t altered consciousness or altered nutrition: more Na than required
  27. Serum Osmolality
    275-295 mmol/Kg
  28. Urine Specific Gravity
    1.003-1.030
  29. Creatinine
    0.8-1.4 mg/dL
  30. BUN
    8-25 mg/dL
  31. BUN:Creatinine
    10:1-20:1
  32. Hematocrit
    • men: 42-52%
    • Women: 37-48%
  33. Serum Glucose (fasting)
    70-110mg/dL
  34. Albumin
    3.4-5.0g/dL
  35. Protein
    6.0-8.0g/dL
  36. Serum CO2
    22-26 mEq/L
  37. Sodium
    135-145mEq/L
  38. ABCDEFGH
    • airway
    • breathing
    • circulation
    • dressing/drains/disability
    • environment
    • full sets of VS
    • Give Comfort measures
    • Head-to-toe assessment
  39. Chloride
    95-105 mEq/L
  40. Potassium
    3.5-5.0 mEq/L
  41. Calcium
    • 4.5-5.3 mEq/L
    • 8.6-10.0
  42. Phosphorous
    1.7-2.5 mEq/L
  43. Magnesium
    1.5-2.5 mEq/L
  44. HCO3 Bicarbonate
    • Metabolic
    • 24.0-30.9mEq/L
    • Acid-Base
  45. PaCO2
    • Respiratory
    • 35-45mmHg
    • Base-Acid
  46. pH
    H+
    • 7.35-7.45
    • Acid-Base
  47. Hypercalcemia
    • Excessive antacids, excessive vit D intake, conditions that promote release Ca from bones, immobilization, glucocorticoids
    • S/S: confusion, slurred speech, bradycardia, dysrhythmias, kidney stones, N/V, Constipation, muscle fatigue, flabby muscles
    • Trtmt: hydration w/ NS to dilute Ca, Loop diuretics, calcitonin
  48. Hypermagnesemia
    • renal failure
    • S/S: hypotension, absent deep tendon reflexes, respiratory depression, coma, cardiac arrest
    • Tx: CaCl or gluconate IV for acute symptoms, Hydration/diuretics
  49. Hypomagnesemia
    • decrease intake/absorption, increased loss, diuretic therapy
    • S/S: hyperreflexia, paresthesias, agitation, ECG changes
    • Tx: diet, whole grains, nuts, dried fruits, more severe issues - MgSO4 IM/IV
  50. Hypocalcemia
    • decreased intake/absorption of Ca, pancreatic disease, PTH/vitamin D deficiency
    • S/S: paresthesis, tingling, convulsions, dyssrhythmias, N/V, diarrhea, muscle spasms, Chostek's/Trousseaus's
    • Tx: If mild - high Ca diet or oral Ca salts, Acute - Ca Gluconate/Ca Chloride IV
    • ND: risk for injury r/t tetany, Altered Nutrition
  51. Calcium/Phosphorous
    • Ca - 99% cation in body, 1% in blood stream
    • 1% - 55% is bound to albumin, 45% ionized Ca
    • PTH maintains serum Ca level
    • Phosphorous inhibits Ca absorption in GI, vit D promotes it
    • Phosphorous & calcitonin increase reabsorption Ca to bone
  52. Hyperkalemia
    • excess K intake, tissue trauma, acidosis, kidney failure w/ oliguria
    • S/S: irregular heartbeats, hypotension, bradycardia, muscle twitcing, cramps, paresthesis, hyperactive bowel tones, diarrhea
    • Tx: low K diet, cation exchange resin, dialysis, correct acidosis w/ HCO3-, Insulin/Glucose
    • ND: Risk for decreased CO, diarrhea, Altered health maintenance, VS & renal functions
  53. Hyponatremia
    • dilution from excessive free H2O,overactive ADH - SIADH, abnormal loss of GI secretions, medications
    • S/S: depression of CNS(h/a, confusion), general weakness, abdominal cramps, nausea, urine SG down, low HCT
    • Tx: treat salt loss or water overload, water restriction, Na replacement, NS, LR, 3% NaCl
    • ND: diarrhea, Pain (h/a), Risk for altered health maintenance, Potential for injury - LOC
  54. Hypokalemia
    • loss of GI secretions, K wasting diuretics, renal disease, chronic use of steroids, alkalosis
    • S/S: lethargy, weakness, leg/abdominal cramps, constipation, weak shallow RR, weak thready pulse, numbness/tingling in hands feet
    • Tx: replace K w/ oral or dilute IV less than 10mEq/hr
    • ND: Risk for decreased cardiac output, Risk for injury
    • Foods: Oj, bananas, kiwi, avocado

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