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Oxygenation Patient Education Incentive Spirometer

• 10x per hour when they’re awake

• breath into the spirometer

• way to train the lungs to expand and strengthen

• avoid atelectasis

Oxygenation Patient Education Smoking Cessation

stop smoking

Oxygenation Patient Education Tripod Positioning

• forearms over the bedside table

• expands the lungs

Oxygenation Patient Education Pharmacological

• rinse mouth for inhaled medication

• rinse device for inhaled medication

Perfusion Patient Education Exercise

• have them walk around

• prevents decrease in perfusion

Perfusion Patient Education Healthy diet

• lower fats

• lower cholesterol

• lower sodium

• especially for patients for hyperlipidemia

• especially for patients with hypertension

Perfusion Patient Education Smoking Cessation

stop smoking

Perfusion Patient Education Pharmacological

ensure medication compliance

Oxygenation Nursing Intervention Administer O2

• highest: non rebreather

• lowest: nasal cannula

• specific: vent mask

Oxygenation Nursing Intervention Sitting up

allows lungs to expand

Oxygenation Nursing Intervention Suctioning

• give when needed

• remove secretions

• lay pt. on side to drain secretion when necessary

Oxygenation Nursing Intervention Pharmacological

• bronchodilators

• mucolytics

• cortcosteriods

Perfusion Nursing Intervention

• ambulation

• ROM exercises

• SCD (compression socks)

Perfusion Nursing Intervention Pharmacological

• administer anticoagulants

• heparin

• aspirin

• Lovenox

Circulation Risk Factors: Bed rest

leads to inadequate perfusion as well as reduced lung expansion

Circulation Risk Factors: Smoking

causes narrowing of blood vessels and decreased perfusion

Circulation Risk Factors: Hypertension

• blood pushes again blood vessels with too much pressure, leads to damage and atherosclerosis, and ultimately narrowing of arteries

• decreases blood flow to vital organs and can result in ischemia and organ damage

Circulation Risk Factors: Hyperlipidemia

increase deposits in the blood vessels (atherosclerosis) leads to a decrease diameter of blood vessels, which decrease perfusion

DVT Risk Factors

• impaired circulation

• decreased motility

• prolonged bed rest

• smoking

• obesity

What makes up CBC?

• red blood cells

• hemacrit

• hemoglobin

• leukocytes

• platelets

Red blood cells Function

contains hemoglobin

What happens when there is a LOW of red blood cells, hemacrit, and hemoglobin?

• anemia

• decrease in oxygen circulation and exchange

Hemacrit Function

volume of blood red blood cells to the total volume of blood

Hemoglobin Function

protein responsible for transporting oxygen in the blood

Leukocytes Function

white blood cells (immune defense)

Platelets Function

involved in clotting and coagulation

What happens when there is a HIGH of red blood cells, hemacrit, and hemoglobin?

• polycythemia (high number of red blood cells)

• possible risk of bleeding

What happens when there is a LOW of leukocytes?

risk of infection (need to be protected)

What happens when there is a HIGH of leukocytes?

fighting infection

What happens when there is a LOW of platelets?

risk for bleeding (fall risk)

What happens when there is a HIGH of platelets?

risk for hyper coagulability (likely to blood clot)

Evidence Based Practice Highest

meta analysis

Evidence Based Practice Lowest

Opinion of authorities and/or reports of expert committees

Why do nurses use Evidence Based Practice?

because it has been proven to have worked

Qualitative Research

• quality of something

• typically done through interviewing patients and understanding their experiences

Quantitive Research

• measure quantity of something

• precise and systematic

• focus on numerical data, statistical analysis and controls

Why do nurses use PICOT?

Nurses use PICOT to clearly define a clinical inquiry, which guides an efficient literature search for the best available evidence to answer that question. A well-constructed PICOT question helps find the most relevant and high-quality research to apply to clinical practice. It promotes evidence-based nursing care tailored to specific patient scenarios.

PICOT: P

patient population of interest

PICOT: I

intervention or area of interest

PICOT: C

comparison intervention or area of interest

PICOT: O

outcome

PICOT: T

time

Acute pain

• less than 3-6months

• identifiable cause

Chronic Pain

• more then 6 months

• idiopathic

• disturbs ADL

Is pain subjective or objective?

SUBJECTIVE (always believe patient)

Non pharmacological relief measures

• Compassionate care: respond promptly, be reliable

• Relaxation

• Guided imagery

• Biofeedback: patient sees vital signs normalizing, this helps them to relax

• Music, TV, reading

• Meditation: breathing techniques

• Cutaneous stimulation: TENS, massage, heat, cold, acupuncture, acupressure

• Herbals 

• Pet therapy

Assessing and Treating Pain: Assessing

• assess effects

• behavior and influence on ADL

• believe patient and family when they report pain ans what usually relieves it

• COLDSPA

Assessing and Treating Pain: Diagnosis

acute pain vs chronic pain

Assessing and Treating Pain: Planning

• set realistic expectations

• complete pain relief is probably not possible

• collab with other teams for more optimal and hollistic approach

Assessing and Treating Pain: Implementation

implement pain relieving measures (nonpharm first than pharm)

Assessing and Treating Pain: Evaluation

• how has pain imporved

• how is functioning

• compare vitals (Pain scale)

Preop: Nurse role

make sure that patient does not have any questions or misinformation

Preop: Providers role

explain the procedure to the patient and answer specific questions

Can the nurse explain a procedure to a patient?

NO they must call the provider is the patient has questions about the procedure

Preop: Do they have their consents?

If not, call the provider and have them consent to the pt. You cannot consent to a patient.

What medications can patients NOT be on when they go in for surgery?

• antibiotics

• antidysrhymthics

• anticoagulants

• anticonvulsants

• antihypertensives (especially beta blockers)

• corticosteriods

• Insulin (need to know blood glucose baseline)

• diuretics (fluid and electrolyte balance)

• NSAIDS (bleeding)

When do you start patient teaching for surgery?

discharge pateint education starts right away because they will be drowsy

Intraop: Time out

• Verify the patient, site, and procedure

• Always check patient’s history, consent, documents, implants/prosthesis required, patient identification (also look at their arm band)

• Mark the procedure site

• Time out for the team:

  • Correct patient

  • Correct procedure

  • Correct side and site

  • Agreement we are set to go!

Circulating Nurse

• There to document during the surgery as well as be additional hands for anything nonsterile

• Cannot cut, clamp, or tie tissue

• Counting objects for surgery

  • Must be done by two parties: circulating nurse and nurse or surgical tech

First Assist

• Advanced nurse

• CAN cut, clamp, tie tissue

Surgical scrub tech

Cannot cut, clamp, or tie

Postoperative Nursing Assessment

• airway/respiration

• circulation

• temperature control

• metabolism

• neurological function

• fluid & electrolyte balance

• skin integrity

• wound condition

• GI

• GU

• comfort

Low blood pressure with high rate means?

Hemorrhage!!! big sign for bleeding because the heart is trying to keep up with the loss of blood volume

Post Op complications: Hemorrhage S/S

• restlessness

• anxiety

• increase drainage (bleeding)

• cold/clammy/molted skin

• decreased BP

• increased HR

• deep/rapid respirations

• decreased urine output

Post Op complications: Hemorrhage Intervention

• Turn pt to ensure that there is not pooling blood on backside

• #1 STOP THE BLEEDING! Apply pressure dressing to the bleeding site (DO NOT REMOVE DRESSING!! Apply additional gauze if necessary)

• Notify the surgeon IMMEDIATELY!

• Back into the OR

Post Op complications: Hypovolemic Shock S/S

• altered mental status

• tachycardia

• hypotension

• cool/clammy skin

• dyspnea

• decrease urine output

Post Op complications: Hypovolemic Shock Intervention

• Notify the surgeon IMMEDIATELY!

• establish/maintain airway space

  • Administer O2

• Place pt supine with legs elevated 30-45 degrees

  • Promotes blood going to heart

• Maintain body warmth with covers

• Fluid replacement

Post Op complications: PE/DVT S/S

• DVT: pain/cramping, redness and swelling, increased temperature, increased diameter of affected extremity

• PE: wheeze, shortness of breath, increased heart rate, increased respiration rate

Post Op complications: PE/DVT Interventions

• PREVENTION is #1 intervention!!!!!

• TED hose, SCD

• Early ambulation 

• Anticoagulant 

• DO NOT massage legs with known DVT!

Post Op complications: Pneumonia and atelectasis S/S

• fever

• chills

• cough producing rust/purulent sputum

• crackles/wheezes

• dyspnea

• chest pain

Post Op complications: Pneumonia and atelectasis Interventions

• Semi-fowler (30-45°) or fowler’s (45-60°) position

• cough/deep breathing exercises, incentive spirometer

• Oral hygiene

• Early ambulation!

Post Op complications: Wound infection S/S

• Dehiscence and evisceration

• bleeding

• heat

• purulent discharge

• fever

Post Op complications: Wound infection Intervention

• Maintain hydration and nutritional status

• diet high in protein, carbohydrate, calories, vitamins

• Proper hand hygiene!

• Sterile technique when changing dressings/drains/tubes at surgical site

Post Op complication: Malignant hyperthermia: anesthesia emergency! S/S

• tachycardia/tachypnea→ very early sign

• tetany/muscle rigidity→ often noted in the jaw

• Increasing capnography (ETCO2)→ amount of CO2 in exhaled air

• PVC rhythm, unstable BP, Cyanosis

• Skin mottling

• Increase Fever (late sign)

• Hypovolemic

Post Op complication: Malignant hyperthermia: anesthesia emergency! Treatment

• Medication→ Dantrolene Sodium (IV)!

• Lower body temperature→ cooling blanket and/or ice

• Treat complication such as acid-base imbalance

Integrative health: Complementary

therapies used together with conventional medicine

Integrative health: Alternative

therapies used in place of conventional medicine

Integrative health: Integrative

brings conventional medicine and complementary medicine together in a coordinated way emphasizing a holistic, patient focused approach to healthcare and wellness

Spiritual health

• NOT associated with any specific religion

• Helps people identify meaning and purpose in life

• Helps patients maintain faithfulness to their belief system and worship practices

Spiritual health: Spirituality

a person’s relationship with a nonmaterial life force or higher power

Spiritual health: Spiritual well-being

exists when a person’s universal spiritual needs are met

Spiritual health: Faith

belief in something without proof

Spiritual health: Religion

organized set of beliefs that can include spiritual practices

Grief: Anticipatory

grieving something that hasn’t happened yet

Grief: Bereavement

 state of grieving from loss of a loved one

Grief: Mourning

actions and expressions of grief, including the symbols and ceremonies that make up outward expression of grief

Stages of Grief

• Denial

• Anger

• Bargaring

• Depression

• Acceptance

Factors that can influence loss and grief?

• Human development

• Personal relationships

• Nature of loss (was it sudden or expected?)

• Coping strategies

• Socioeconomic status

• Culture and ethnicity

• Spiritual and religious beliefs

• Hope

What is hospice?

For patients with less than 6 months to live

What is palliative care?

• Pain and symptom management

• Primary goal is to help patients and families achieve the best possible quality of life.

What are the needs for dying person? Physical needs

• pain control

• hygiene

• nutritional needs

What are the needs for dying person? Psychological needs

• control over fear of uf unknown

• pain, separation

• leaving other behind

• \loss of control

• unfinished business

What are the needs for dying person? Needs for intimacy

patient needs ways to be physically intimate that meets needs of both partners

What are the needs for dying person? Spiritual needs

patient needs meaning and purpose, love and relatedness, forgiveness and hope

Sodium normal ranges

135-145 mEq/L

Sodium Function

• Has a water-retaining effect

• maintains body fluids

• Regulates acid-base balance by combining chloride or bicarbonate ions

HYPOnatremia (low sodium) causes

• Vomiting

• diarrhea

• NG suction

• Excessive perspiration

• Diuretics

• Kidney disease

• Water intoxication

• IV D5W

• SIADH (Syndrome of  Inappropriate ADH)

• Burns

HYPOnatremia (low sodium) S/S

• Confusion

• Hypotension

• Edema

• Muscle cramps

• Muscular weakness

• Dry skin

HYPOnatremia (low sodium) Treatment

• Water restriction

• Normal Saline IV

HYPERnatremia (high sodium) Causes

• Excessive salt intake

• Excess water loss

• Dehydration