NURS 366 Exam 2

cognitive impairment

cognitive impairment

any type of intellectual disability mild, moderate, severe, profound- based on IQ levels, 85% are mild 3 components- intellectual functioning (IQ od 70-75 or below), functional strengths and weaknesses, younger than 18 at diagnosis suspicion over time by family, teachers, or healthcare providers

developmental delay

any significant lag in a child's physical, cognitive, behavioral, emotional, and/or social development, when compared against developmental norms appropriate diagnosis when definitive diagnosis of CI doesn't exist standardized tests- differentiate between true intellectual disability (CI) and developmental delay

early behavioral signs of cognitive impairment

irritable or unresponsive to contact decreased alertness to movement or voice delayed or difficult speech delayed gross motor skills- delayed rolling, sitting up, crawling, walking feeding problems- swallowing difficulties, disorganized feeding pattern poor or abnormal eye contact during feeding dysmorphic features- down syndrome/fragile x syndrome

etiology of CI

primary causes of severe CI are genetic, biochemical, and infectious although actual etiology is undetermined in may cases familial, social, environmental, organic also common causes

events that may lead to CI

gestational disorders prenatal influences- prenatal care, pre/post maturity, preg problems, SGA, micro/hydrocephaly postnatal brain disease- neurofibromitosis, tuberosclerosis infection and intoxication- congenital rubella, maternal drugs, FAS, chronic lead, syphillis trauma or physical cause- pre/peri/post natal chromosomal abnormalities metabolic disorders and malnutrition- fetal ketonuria, congenital hypothyroidism environmental influences- deprived environment psychiatric disorders during child's development- autism

nursing care of children with impaired cognitive function

educate child and family- minimal short term memory, one step directions, positive reinforcement, on a spectrum, what to expect early intervention programs- early and prompt referral is key teach child self-care skills- independence promote child's optimal development- stems from love and care of family, physical and social wellbeing encourage play and exercise provide means of communication- receptive and expressive skills, verbal and nonverbal establish discipline- limit setting appropriate for child's mental age, consistent and simple encourage socialization- active rehearsals and positive reinforcement provide info on sexuality- social abuse and assult help family adjust to future care care for child during hospitalization support measures to prevent cognitive impairment

down syndrome

most common chromosomal abnormality of a generalized syndrome- 1/691-1000, not affected by socioeconomic class, more in whites than african americans etiology- multiple causality, 95% due to extra chromosome 21 (non-familial), increased risk if maternal age >35

diagnostic evaluation of down syndrome

usually diagnosed by clinical manifestations alone chromosomal analysis confirms genetic abnormality

clinical manifestations of down syndrome

separated sagittal suture oblique palpebral fissures (upward, outward slant) small nose with depressed nasal bridge high, arched, narrow palate and protruding tongue excess skin in neck folds palmar creases wide space & plantar crease between big and 2nd toes hypotonia and hyperflexibility

common physical problems of down syndrome

congenital heart malformations- most common are septal defects (ASD/VSD) respiratory tract infections- chief cause of death when combined with cardiac abnormalities hypotonicity of chest and abdominal muscles- support head well dysfunction of immune system thyroid dysfunction increased incidence of leukemia dry, cracked skin

therapeutic management of down syndrome

no cure echocardiogram during early neonatal period regular medical care- vision and hearing screenings, thyroid function testing surgical correction of serious congenital anomalies- congenital heart defects and stabismus prognosis- improved life expectancy in recent years, >80% survive to age 60 years and beyond

nursing care of children with down syndrome

support family at time of diagnosis- informative literature, support groups, etc assist family in preventing physical problems- correct positioning and support (hypotonicity of muscles and hyperextension of joints), measures to reduce risk for respiratory tract infections (bulb syringe, rinse mouth after feeding, increase fluids, cool vapor), support feeding and nutrition changing positions frequently, hand hygiene, nasal saline and suction prior to feedings, long straight-handled spoon for feedings- refeed thrust out food, prevent constipation practice proper skin care to prevent cracking and infection- minimal soap to prevent drying of skin, apply lubricants and lip balm regularly assist in prenatal diagnosis and genetic counseling- amniocentesis and chorionic villus sampling of fetal cells will confirm the presence of trisomy or translocation

fragile x syndrome

most common inherited cause of cognitive impairment 2nd most common genetic cause of cognitive impairment present in all ethnic groups and races- inheritance pattern is x-linked dominant with reduced penetrance occurs in both males and females, although males are usually more severely affected- 1/3600-4000 for males, 1/4000-6000 for females

etiology of fragile x syndrome

abnormal gene on the lower end of the long arm of the x chromosome fragile site is present in the cells of affected males and females in carrier females- fragile site is caused by a gene mutation that results in excessive repeats of nucleotide in a specific DNA segment of the X chromosome 50-200 base-pair repeats- carrier (premutation) 200+ base-pair repeats- affected (full mutation)

clinical manifestations of fragile x syndrome

carrier are generally intellectually normal with mild/varied symptoms long, narrow face with prominent jaw (prognathism) large, protruding ears large testes (macroorchidism) in postpubertal males stabismus mitral valve prolapse and/or aortic root dilation hypotonia/hyperflexibility mild to severe cognitive impairment ADHD/ADD and/or autistic like behaviors

therapeutic management of fragile x syndrome

no cure, but expected to live a normal life span pharmacological management- serotonin agents to control violent temper outbursts, CNS stimulants to improve attention span and decrease hyperactivity multidisciplinary medical management- cardiology, neurology, and orthopedics early intervention programs- speech and language therapy, occupational therapy, special education as needed

nursing care of children with fragile x syndrome

care is similar to the care provided for any child and family of a child with cognitive impairment- educate, support, and refer as needed genetic counseling to inform parents and siblings about risks of transmission genetic testing for any child with unexplained or nonspecific mental impairment referral to the national fragile x foundation

autism spectrum disorder

complex neurodevelopmental disorder of unknown etiology alterations in social interaction and verbal impairment repetitive, restricted, and stereotyped behavioral patterns previously divided into separate diagnoses- autistic disorder, asperger syndrome, pervasive developmental disorder (PDD) not otherwise specified

prevalence of ASD

typically noticed during early childhood- symptoms generally manifest between 18-36 months, often not diagnosed until 2-3 years after symptom onset occurs in 1/68 US children about 4 times more common in males females are generally more severely affected not related to socioeconomic level, race, or parenting style

etiology of ASD

genetic disorder of prenatal and postnatal brain development immune and environmental factors may interact with the genetic susceptibility to increase the incidence of ASD strong evidence for genetic basis in twins is consistent with autosomal recessive pattern of inheritance high risk of recurrence of ASD in families with one affected child no specific gene for ASD has been identified not caused by MMR or thimerosal-containing vaccines may be some relationship to prenatal and perinatal events associated with other conditions

clinical manifestations of ASD

poor eye contact avoidance of body contact speech and language delay at an early age- no babbling or gesturing at 12 months, lack of single words by 16 months, no 2-word phrases by 24 months, loss of previously spoken words and/or sounds; developmental regression limited functional play unusual and/or odd interactions with toys significant GI symptoms- constipation cognitive impairment ranging from moderate to severe savants

diagnostic criteria of ASD

total of 6 or more items from qualitative impairments in social interaction (2), qualitative impairments in communication (1), restricted repetitive and stereotyped patterns of behavior, interests, and activities (1) delays or abnormal functioning in at least one of the following with onset before age 3- social interaction, language as used in social communication, symbolic or imaginative play the disturbance is not better accounted for by Rett's disorder or child disintegrative disorder

prognosis of ASD

usually severely disabling condition some children show improvement in language skills and communication with others most require lifelong adult supervision, although some are ultimately able to achieve independence prognosis is most favorable for children with higher intelligence, functional speech and less behavioral impairment early recognition and intervention is key to more positive outcomes/improved prognosis

nursing care for ASD

no cure but numerous therapies to improve functioning, level of functioning varies positive reinforcement increase social awareness teach verbal communication skills decrease unacceptable behavior highly structured and intense behavior modification shows the most promising results- structured routine! family support- 'family disease', help parents understand they're not the cause, encourage counseling and family support groups, provide info about state/local departments in mental health/developmental disabilities, encourage family to care for child at home locate a long-term care placement if necessary refer to autism society of america early

nursing care of hospitalized child with ASD

parents should stay with child as much as possible individualized care is key decrease stimulation- private room encourage family to bring child's favorite items minimize holding of eye contact communication should be brief and concrete use care when performing procedures or feeding/administering meds child may refuse meds/food, gag, hoard, mouth and/or swallow inedible objects, or throw food

attention deficit hyperactivity disorder (ADHD)

developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity clinically significant impairment in social, academic, or occupational functioning invokes negative responses from others and can affect self concept distractibility, immaturity, selective attention, inappropriate social skills, excessive physical risks, don't consider consequences of actions

diagnostic evaluation of ADHD

complete medical and developmental history obtained consider child's behavior in multiple settings- home, school, other social activites consider the perspective of the child's behavior from multiple observers diagnostic evaluation done by behavioral checklists and adaptive scales- vanderbuilt assessment scale, conners parent and teacher rating scales, etc

symptoms of ADHD

not every child have every symptom of the condition 6 or more for at least 6 months in at least two settings three subtypes- combined type (most common, 6 symptoms of inattention and 6 of hyperactivity), predominately inattentive type (6 of inattention but <6 of hyperactivity), predominately hyperactive-impulse type (<6 of inattention and 6 of hyperactivity) inattention must not be a symptoms of another disorder

nursing care of ADHD

early detection and intervention is key ADHD is relatively stable with appropriate intervention- symptoms may continue into adulthood or subside treatment is individualized based on child's age and severity of symptoms and desires of parent's (child too if old enough) medications- stimulants, methylphenidate hydrochloride and dextroamphetamine behavioral therapy- prevents undesired behavior parenting education- decrease distraction and make organizational charts, highly structured coping strategies

med management of ADHD

dosing is titrated based on symptoms (weight dosing also) close follow-up is very important monitor for side effects- suppression of appetite, BP, height, weight monitored nutritional considerations

nursing care management of ADHD

worth with families and school personnel to help plan and implement therapeutic regimens and evaluate the effectiveness of therapy coordinate services serve as a liaison between health and education professionals educate patient and family about diagnosis, prognosis and treatment plan may only need meds on holidays/weekends

eating disorders

eating disorders can occur at any age and are present in both females and males can occur individually or in combination several factors can contribute to the etiology of each type of eating disorder three most common- obesity, anorexia nervosa, bulemia

obesity

BMI is most accurate screening measure for obesity in children and adolescents obesity- an increase in body weight resulting from an excessive accumulation of body fat relative to lean body mass (greater than 95% percentile for age, gender, height) african american and hispanic children parental obesity- 2-3x more likely balance between energy intake and expenditure little evidence about correlation between obesity and low metabolism

overweight

the state of weighing more than average for height and body build- BMI between 85th-95th percentiles for age, gender, height

causes of obesity

overeating is dominant feature in childhood- institutional factors support unhealthy eating habits, increased availability and promotional 'pricing' of high fat/sugar foods physical inactivity <5% obesity cases are attributed to underlying disease psychological factors negatively impact eating patterns- associate eating with a sense of well-being, security, and the comforting presence of a nurturing person

nursing care of obesity

PREVENTION through counseling and promotion of proper nutrition and exercise assess, manage, and evaluate the progress of overweight adolescents- ascertain that child and family are ready for change treatment plan- nutritional counseling/diet modification, behavioral therapy, group involvement, family involvement, increased physical activity (60min/day), limit screen time, meals together, eating breakfast for school age- no 'diet'- just slow weight trajectory in relation to weight/age

bulemia nervosa

repeated episodes of binge eating followed by inappropriate compensatory behaviors (purging)- self-induced vomiting, excessive exercise, fasting, misuse of laxatives, enemas, diuretics, and other meds binge behavior consists of secretive, frenzied consumption of large amounts of high calorie (or forbidden) foods during a brief time (<2 hours) as condition progresses, frequency of binges and amount of food consumed increases, and control over the binge/purge cycle is lost

clinical manifestation of bulemia nervosa

binge-purge episodes followed by self-deprecating thoughts, depressed mood, awareness that the eating pattern is abnormal of average or slightly above average weight tooth erosion and esophageal damage diarrhea, constipation, and/or other GI symptoms russell sign- on hands, teeth hitting hands while purging

anorexia nervosa

eating disorder characterized by a refusal to maintain a minimally normal body weight severe weight loss in the absence of obvious physical causes etiology remains unclear- combo of genetic, neurochemical, psychodevelopmental, sociocultural, environment factors female athlete triad- eating disorder, amenorrhea, osteoporosis

diagnostic criteria of anorexia nervosa

refusal to maintain body weight over a minimal normal weight for age and height intense fear of gaining weight or becoming fat even though underweight disturbance of body image denial of seriousness of the current low body weight amenorrhea in postmenarchal females

clinical manifestations of anorexia nervosa

bradycardia and hypotension hypothermia/cold intolerance dry skin, brittle hair and nails, and lanugo hair

nursing care for eating disorders

maintain a kind/supportive yet firm manner avoid creating a passive-dependent attitude encourage activities that strengthen self-esteem but not exercise intensive closely monitor vitals, especially CV maintain consistency and structured environment communication among team members is essential consider a behavioral contract remove binge foods; restrict eating to one room- supervised, timed refer to appropriate community resounrces risk for refeeding syndrome

important for behavioral/CI disorders

no matter what the child's diagnosis, or what level of CI and/or behavioral challenges exist, the child is first and foremost a CHILD, and we must preserve that childhood and encourage the highest amount of functioning and the greatest level of academic and social success in the LEAST RESTRICTIVE SETTING possible

IV therapy

homeostasis- med administration, alterations in fluid including blood volume, alterations in electrolytes (secondary to preexisting disease, traumatic event, surgery, nutritional losses

monitor during IV therapy

vital signs for increased BP or stabilizing, labs (blood sugar, potassium), I/O (fluids, diet), weight is IV still needed, risk for infection, self-care at discharge

IV site assessment

clear dressing is occlusive needle insertion- red, streaking, swelling if swollen or leaking- take out and start a new one

phlebitis

erythema- streak formation pain edema DC IV and apply warm compress for vasodilation

infiltration

fluid seeps into tissue and not into vein skin blanched cool to touch edema pain bruised DC IV and apply warm compress to encourage absorption

extravasion

drugs getting into tissue that are toxic DC infusion, attempt to aspirate the drug apply ice, research med for antidote notify health care provider may need a central venous device to prevent further damage

hypertonic

higher osmolality than blood serum causes cells to shrink D5W 0.45% NS, D10W

hypotonic

lower osmolality than blood serum hydrates cells, causes them to expand 0.45% NS, D5W

isotonic

same osmolality as blood serum cells remain unchanged expands ECF LR or 0.9% NS

supplies for starting an IV

gloves tape alcohol prep IV catheter tourniquet connector tubing saline flush dressing gauze drip set IV fluid

sites for IV insertion

hand veins- digital veins, metacarpal veins, dorsal vein, cephalic vein, basilic vein good vein- superficial, smooth, bouncy, no pulsation, avoid bifurcation, not close to joint, normal skin arm veins- cephalic, brachial, basilic, median cephalic, median basilic, radial, ulnar, median

peripheral IV

inserted into small peripheral vein IV catheter is short, length varies depending on gauge short term use inserted by RNs clean dressing changes saline only flushes

central venous catheter

inserted to large central vein (internal jugular preferred, subclavian, femoral) line is long and tip terminates near the heart (superior vena cava) long term use for IV fluids, meds (antibiotics, chemo), frequent blood draws and TPN inserted by specially trained staff and surgeons and verified by radiology sterle dressing changes generally require saline and heparin flushes

general maintenance and care of central venous catheters

flush with before and after each use and routinely when not in use before- saline only after- saline and heparin routine- saline followed by heparin clamp must be closed when not in use sterile dressing changes, with mask and sterile gloves and equipment- frequency of dressing change is generally 5-7 days depending on hospital policy, type of dressing, and integrity of dressing

complications of all CVCs

infection- local and systemic, CLABSI air embolism thrombosis fibrin sheath- caused by debris inside catheter take care not to injure the line

peripherally inserted central catheter (PICC)

short-moderate term (days, weeks, months) if they can't get a peripheral IV can go into umbilical for infants to adults placed peripherally into upper extremity and threaded into the superior vena cava placed by specially trained nurses, physicians, or interventional radiologists- bedside procedure depending on age of pt and person inserting placed with local anesthesia only, sedation for children placement verified by radiology dressing changed 5-7 days with sterile technique and biopatch, secured with statlock device or sometimes sutured

tunneled central catheter

can have multiple lumens enter the skin in one place and the vein in another part of the catheter is tunneled under the skin to the point of vein entry- generally on chest, can be placed on the leg for infants or people with hx of multiple line placements a cuff is usually present on the catheter just under the skin for catheter securement and infection prevention always placed for long term use- months to years Hickman, Groshong, Broviac secured with sutures flush with saline and follow with heparin to maintain patency when not in use

non-tunneled central catheter

short term acute care, emergencies, ICU

implanted port

can access and deaccess over years (2+)- reservoir under skin, port pocket usually for cancer patients placed in the OR many shapes and sizes requires monthly access with saline followed by heparin flush when not in use/not accessed larger flush volumes due to port reservoir accessed with non-coring needle (Huber needle) using sterile technique if accessed- change needle every 5-7 days

curos caps and tips

place a green disinfectant cap on the needleless adaptor of central line lumens not in active use place on all central line IV tubing side ports place in peripheral access too, if patient also has a central line use green disinfectant tips when IV tubing is temporarily disconnected if on for 15 min, dont need to scrub for 15 s

saline flush for peripheral IVs

flush with about 1-3 ml 0.9% NS or enough to clear tubing- maintain patency of peripheral IV, following admin of meds if PIV not infusing, flush 1-2 times a shift when not in use don'f forget to clamp when not in use heparin flush is not used for peripheral IVs scrub hub for 15 s saline-administer-saline or pause infusion-saline-administer-saline-resume infusion

flushing CVCs

5-10 ml NS before starting continuous IV infusion, before and after intermittent IV meds, to cap when ending continuous infusion, twice daily for patency when not in use attach flush to end of catheter or needless device scrub the hub for 15 s always use 10ml syringe- smaller syringe exerts more pressure than a larger one, risk for rupturing the line pump or stop/go method creates best turbulence for clearing the line

heparin flush for CVCs

administer 3 ml of heparin solution to CVCs administer 5 ml of heparin to implanted ports (larger reservoirs) lines are flushed- when CVC not in use, to maintain patency, no need to flush with heparin for patency if line is infusing continuously ***different heparin flush concentrations- 100:1 units for anyone >12 months old, 10:1 units for children <12 months old saline-administer-saline-heparin clamp pause-saline-administer-saline-resume

calculated IV flow rates

to safely regulate the delivery of fluids and meds to adults and children- must consider delivery device when calculating flow rate- gravity flow vs positive-pressure pump to deliver fluids over a specific time period- want to avoid infusions that are too fast or too slow

formula for IV infusion rate using electronic pump

volume to be given (mL)/number of hours to infuse = milliliters (mL)/hour

male sure infusion time is in HOURS

formular for IV infusion rates less than 1 hour in duration

x (ml/hour) = (total volume (ml) x 60 min) / total time (min)

less than an hour- infusion time is in MINUTES

calculating drops per minute for gravity flow devices (2 step)

1. amount of fluid to be given (ml) / hours to infuse = ml/hour

2. (ml/hour x drop factor) / 60 min = gtt/min round to nearest whole number

calculating drops per minute for gravity flow devices (1 step)

(amount of fluid x drop factor) / time (min) = gtt/min don't forget to convert hours to minutes

macrodrip

drop factor = 10, 15, 20 gtt/ml

microdrip

drop factor = 60 gtt/ml drops per minute (gtt/min) will equal rate (ml/hour)

pediatric IVs

veins are located in same areas as adults but more subq fat look everywhere- large veins in the legs (greater saphenous) is better then small hand vein foot veins are fine as long as child hasn't begun walking or won't be walking during hospitalization use transilluminators if needed may not feed a 'pop' for peds, advance slowly bc blood return may be small, not readily appear and don't want to pierce opposite vein wall

supplies for peds IVs

remember comfort tourniquet (smaller) IV catheters- 22-24 gauge, small will allow hemodilution of meds/fluids as it flows and will last longer (unless surgery or needing bloodO normal saline flush, 1cc if bigger one causes it to blow, or 3 cc pediatric tegaderm- tape mesh wrap infant heel warmers promote vasodilation for infants or warm blankets/tape heel warmer for older children for 5-7 min

scalp IVs for peds

place a rubber band with a tape tab above the eyebrows and ears always go towards the heart- frontal veins, superficial temporal vein, posterior auricular vein make sure tourniquet isn't too tight (red/purple skin) good for babies <9 months old (or a year) easy to see, bigger than hands and feed veins have no valves, don't roll use of scalp veins can be scary/worrisome for parents

starting a scalp IV

30 degree angle with tip pointed to heart lift rubber band using tape tab; cut and secure site and IV tubing explain to parents it doesn't hurt more in scalp and better veins/easier to see baby may get first haircut so offer the hair, use scissors not a razor blade (can cause microabrasions/infections)

holder for peds IVs

most important person in the room makes the site more visible while making sure the child doesn't move hold firmly but don't overextend a joint- can cause damage and is uncomfortable

parents when starting IVs in peds

has the right to be present when an IV is started on their child other family members and/or family friends may be allowed to stay if parent requests it, as long as they don't interfere explain the procedure- show parents supplies admit that the IV stick will hurt but more about being restrained (necessary to protect the child) can be an observer, sit near their head and calm them, or step outside the room- don't force parental participation if they stay- can't interfere in any way, presence may upset child and will be asked to leave, may leave at any time if uncomfortable make sure they know rules prior to starting IV

educating child of IV- baby

what you tell them and how depends on chronological age and developmental level baby (<1)- focus on educating parents, provide comfort measures like pacifier or oral sucrose, encourage the baby to hold their fav blanket/toy

educating child of IV- toddler

toddler (1-3)- keep the explanation short and simple, understand body part involved and limited to that area, describe how stick will feel, ok to cry or yell but not to kick, bite, or hit, comfort measures like pacifier if still used or fav toy/blanket

educating child of IV- preschool

preschool (3-5)- show and tell, talk to child and get child-life involved, perform on animal/doll first, offer for kid to start IV on animal/doll, allow to touch supplies, start ASAP after explanation, provide comfort measures (fav toy/blanket), talk through procedure and praise for bravery

educating child of IV- school age

school age (6-12)- want to know, brief step by step explanation, stress the benefits, try to put IV in nondominant hand if possible, comfort measures (sense of control in deciding if mom/dad stay, distraction, parent hold hand/talk, focus on sometime else like game/tv/etc, involve child life

perioperative nursing

total surgical episode pre- intra- post- departments- preop (& holding room), intraop, postop (PACU & unit)

surgery

planned alteration of the body in order to- arrest, alleviate, eradicate a pathological process performed for diagnosis, cure, palliation, prevention, cosmetic improvement, exploration

classifications of surgery

seriousness- major vs minor urgency- elective, urgent, emergent purpose- diagnostic, ablative, palliative, reconstructive/restorative, procurement, constructive, cosmetic

surgical termis

ectomy- excision/removal lysis- destruction orrhaphy- repair/suture oscopy- looking into ostomy- creating an opening otomy- cutting/incision plasty- repair/reconstruction

perioperative nurse qualities

detail oriented flexible juggle multiple priorities adept with technical/mechanical skills team players excellent communicators critical thinkers handle a fast-paced, challenging environment problem solvers emotional stamina

pre-op assessment

name, DOB, MRN allergies HPI (history of present illness) & H&P vital signs trends nutritional status hx of anesthesia current infections use of medications use of contraindicated meds/supplements- metformin can cause renal failure current labs- trends and values physiological status psychological status- more anxious-more complications

preop patient concerns

fear of unknown fear of anesthesia fear of pain fear of death fear or body image disturbance financial and employment worries social and family concerns anxiety anger depression tendency to exaggerate sadness, tearful, clingy inability to concentrate short attention span failure to follow simple directions

nursing interventions for preop concerns

very important to address explore patient's feelings and concerns allow patients to speak openly provide accurate information- brief, direct, simple terms empathy consider religious preference and support

preop routine testing

CBC- WBC indicates immune function, increased is infection or leukemia, decrease is immune suppression; Hgb/Hct (RBC) necessary for carrying O2 in the blood (transfusion?); Plt are needed for clotting type and cross match- blood transfusion needed intra or post op BMP or CMP- evaluate status of fluids, electrolytes, kidney (and liver status for CMP) PT, PTT, INR- clotting time measured fasting blood glucose- high BG may indicate undiagnosed DM, infection complications and poor wound healing BUN and creatinine- kidney function ALT/AST/Alk Phos, billirubin- liver function albumin and total protein- nutritional status urinalysis- urine composition, UTI chest x-ray- respiratory status, heart size, any abnormalities ECG- cardiac rhythm and any preexisting cardiac problems

preop teaching

anesthesia causes decreased surfactant in lungs, atelactasis, pneumonia incentive spirometer diaphragmatic breathing coughing splinting turning foot and leg exercises early mobility and ambulation

consent for surgery

informed consent- an active, shared decision making process between the provider and the recipient of care. 3 components- adequate disclosure understanding and comprehension of above voluntary consent

adequate disclosure

of the diagnosis, nature, and purpose of the proposed treatment, probability of successful outcome, risks, and consequences of moving forward with treatment or alternatives, the prognosis if treatment is not instituted, and if treatment is deviated from standard for their condition

understanding and comprehension of above

this has to be assessed before sedating medications can be given (minors cannot consent, severely mentally ill or severely developmentally challenged also cannot consent)

voluntary concent

cannot be coerced into going through with a procedure. this consent can be revoked at any point leading up to the procedure

responsibilities for consent

physician- responsible to obtain informed consent from pateints nurse- make sure it is obtained before surgery, patient advocate, may witness the consent and answer some questions patient must voluntarily consent with knowledge of the situation and potential complications

consent in an emergency

need for consent is overridden necessary to protect life of the patient next of kin, medical POA, advanced directive or if above not available- 2 physicians signatures incident report to explain

results of surgery

stress response initiated defense against infection lowered vasculature disrupted organ function disturbed body image disturbed change in lifestyles (temporary or permanently)