Med Surg Exam 1 Part 2

Phases of Perioperative Care (what they are, what each is, what is done)

- preoperative: from when the patient is scheduled for surgery until transferred to the OR (surgical checklist, consent, baseline assessment, H/P, labs, NPO, site marking)

- intraoperative: from surgery until transfer to PACU (know surgery, anesthesia, aseptic technique, monitor, assist, help position, time out)

- postoperative: after surgery until full recovery (pain, vitals, nausea, monitor airway, wound care, prevent complications, discharge teaching)

CONTINUITY OF CARE

Domains of Perioperative Nursing (what to monitor)

- safety, behavioral response, physiological response, health system

- client-centered approach

Teaching for Abdominal Surgery (what to teach)

- How to use an incentive spirometer (use every 1-2 hours)

- Pain will be controlled after surgery

- Cough and deep breathe

- How to splint the incision

- They may remain NPO after surgery

- Use of compression devices/calf exercises

- Turn every 2 hours

- May have tubes, lines, drains

What provides low-income food benefits to families? (What are they)

- Supplemental Nutrition Assistance Program (SNAP): low-income families

- Women, Infants, and Children (WIC): supports pregnancy, nursing, and children up to 5 years old

- School Lunch Programs: reduced-price or free

Factors that Cause Hyperglycemia (what they are)

- infection

- genetics

- stress/surgery

- corticosteroids

- missing insulin/diabetic meds

- too high carb intake

- inactivity, obesity

- TPN/ dextrose infusions

Factors that Cause Hypoglycemia (what they are)

- too much insulin

- skipped meals

- exercise without food

- alcohol without food

- vomiting

General Factors that can lead to problems with blood sugar

- onset/peak/duration of insulin

- delay in food intake after insulin

- grams of carbs consumed

Pathophysiology of T2DM (what happens, what it can lead to)

- Insulin resistance develops in the receptors, so glucose cannot enter the cells.

- Beta cells produce some insulin, but not enough

- The liver increases glucose to compensate

- Initially, the pancreas increases insulin production, but then they fatigue and decreases production, increasing glucose levels (HHS)

Hyperthyroidism S/S (what they are)

- Everything speeds up

- heat intolerance

- tachycardia

- weight loss

- nervousness

- goiter

-buldging eyes

- diarrhea

- insomnia

- menstrual irregularities

Effects of Hypothyroidism on Hormones (impacts on each, where they are secreted)

- High TSH (pituitary)

- low T3 and T4 (thyroid)

Effects of Hyperthyroidism on Hormones (impacts on each, where they are secreted)

- Low TSH (pituitary)

- High T3 and T4 (thyroid)

Hypothyroid S/S (what they are)

- Everything slows down

- fatigue

- constipation

- cold intolerance

- weight gain

- bradycardia

- bradypnea

- thinning of hair

- facial edema

- slowed cognition/confusio

- heavy periods

- hoarseness

EBP Definition (what it is)

-providing care based on available research and using critical thinking skills

Client-Centered Care Definition (what it is)

- care that is respectful and involves the patient's needs and values, while making sure the patient is involved in decision-making

Professionalism Definition (what it is)

- the way an employee conducts themself in a professional environment

Ethics Definition (what it is)

- the moral principles that dictate how a person will conduct themself

Incilivity Definition (what it is, example)

- Rude, intimidating, disrespectful behavior that can negatively impact outcomes and can turn into bullying

- e.g., eye-rolling

Microaggression Definition (what it is, examples)

- small, subtle aggressive behavior or attack toward another person part of a marginalized group

- ex: unfair assignments, exclusion from conversations

Medicare (what it is, whom it covers)

- Federally funded insurance program for those 65 and older

- can help younger people with disabilities

Medicaid (what it is, whom it covers)

- joint federal and state program to provide insurance for families/individuals with low income

Low Health Literacy (what it is, impacts, how to help)

- Spend more time in the ED and more time in the hospital

- Limited ability to process and understand health information

- Use basic language (6th grade) and the teach-back method

Outcomes of Metabolic Syndromes (diseases/conditions that cause)

- diabetes

- cancer

- dementia

- non alcoholic fatty liver disease

SIADH Findings (what happens, what they are)

- ADH is retained, so water is not released. Decrease in sodium

- hyponatremia

- decreased urine output

- fluid overload, weight gain

- increased urine specific gravity

- headache, confusion, cramps, tremors, seizures

Diabetes Insipidus Findings (what happens, what they are)

- deficiency of ADH/vasopressin; too much dilute urine is released

- dilute urine, low urine specific gravity

- dehydration, dry mucous membranes, poor turgor

- polydipsia (extreme thirst)

- hypotension

- hypernatremia

- lethargic, weak

- cardiovascular collapse

Normal Urine Specific Gravity

1.005- 1.030

Reporting if Thyroid Storm (why it happens, S/S)

- Happens when a large amount of thyroid hormones enter the bloodstream

- Hyperthermia, hypertension, delirium, vomiting, abdominal pain, tachyarrhythmias, chest pain, dyspnea, palpitations

- Can lead to tachycardia, Afib, stroke, heart failure

Informed Consent

- Obtained by the surgeon; the nurse is the witness

- Explain the procedure, risks, benefits, alternatives, and consequences of not receiving treatment