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Texas State - NURS 3440 - Lifespan Exam 2 Study Guide - Study Guide

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Texas State - NURS 3440 - Lifespan Exam 2 Study Guide - Study Guide

School: Texas State University
Department: Nursing and Health Science
Course: Nur Care Lifespan
Professor: Regina Jillapalli
Term: Spring 2018
Tags:
Name: Lifespan Exam 2 Study Guide
Description: This study guide covers what is going to be on the test
Uploaded: 03/03/2018
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background image Lifespan Exam 2 Study Guide Regina Jillapalli Blueprint headings in Purple  Subheadings in Red  Answer from book and powerpoints in Black Key Points highlighted  Perioperative nursing management  Preoperative assessments:  Allergies.  Shellfish=iodine, banana=latex. Find out history of allergic 
reactions, or if family has had allergic reactions. Also high number of previous
surgeries increases risk for allergic reaction.
Medications. Hold all meds except those for respiratory diseases, seizures 
and HTN.  Allow those with a sip of water before surgery. Don’t take long 
acting insulin, just short. Tell them to stop all herbs around surgery, cause 
interact with anesthesia.
Substance use. Find out about drug use, because during surgery pt. could go 
into alcohol or drug withdrawal. Tobacco products increase the risk for 
pulmonary complications. 
Find out if patient is pregnant Get full physical assessment done before surgery to provide a baseline to 
compare to afterwards
o Alert surgeon of abnormal vitals. Chronic illness, malnutrition or poor  kidney function all impact healing after the surgery.  Level of 
Consciousness, orientation and ability to follow commands effect 
surgery process.  Find out psychosocial stuff like anxiety level, coping 
skills or resources for after the surgery.
Lab assessments. Most common are urinalysis (creatinine, bacteria) blood 
type, CBC(WBCs), clotting studies (PT, PTT, INR) and electrolytes (such as 
potassium.  Hyperkalemia can cause dysrhythmias. Hypokalemia increases 
risk of digoxin toxicity and cardiac irritability.
Role of the nurse in the OR  A nurse can play many different roles in the OR.  Nurse  anesthetists assist the anesthesiologist by bringing medicine, fluids or blood 
products and assessing level of anesthesia, oxygenations, cardiac function, vitals 
and I&O.  Circulating Nurses set up the OR, make sure everything is clean and 
ready, manages patient status (such as positioning), watches that safety, sterility 
and privacy are maintained and also performs official communications, including 
documentation, alerting the surgeon to needs and working with the family.  Scrub 
nurses set up/maintain the sterile field, and monitor sponges, fluids, instruments 
and medication used.
Basic Principles of Aseptic Technique  A “surgical scrub” does NOT make the skin  sterile, but does reduce the number of organisms on it.  Must use surgical 
antimicrobial soap. Must scrub vigorously for 3-5 min. Keep hands and elbows flat, 
so water flows off, rather than up or down the arms. After hand scrubbing person is 
background image assisted into a sterile gown, putting on sterile gloves with the sleeves of the gown. 
Gown and gloves are the last PPE to be applied. New sterile PPE is applied if current 
PPE gets soiled.
Types of anesthesia General Anesthesia-combination of medications that achieves total amnesia, 
analgesia, unconsciousness and muscle relaxing. Has four stages: 1) 
induction to loss of consciousness: patient is drowsy, has reduced sensation 
and memory but can still hear very well. Stage 2) loss of consciousness to 
relaxation: patient may have muscle spasms, and irregular breathing, 
vomiting. Stage 3) relaxation to loss of reflexes and vital depression. 
“Working” phase of anesthesia, when surgery is actually performed. 
Breathing is quiet and normal, patient cannot sense anything. Stage 4) 
depression of vital functions to respiratory failure, cardiac arrest and death.  
BAD stage to get into.  Patient going into physical shutdown.  Can be rescued 
from this stage, must be documented. 
o Malignant hyperthermia: hereditary reaction of muscle cells to  anesthesia.  Increased muscle calcium and metabolism result is signs 
and symptoms of tachycardia, dysrhythmias, skin mottling, muscle 
rigidity, fever, cyanosis and myoglobinuria. Fastest indication is sudden
increase of CO2, plus decrease O2 and tachycardia. Treatment is 
Dantrolene , the faster the better.  Also cool the patient. 
Local/Regional Aesthesia-disruption of feeling to certain place in body. Patient
is conscious and has gag reflex. Important to support the patient emotionally,
and deal with complications. Do not want systemic absorption, anaphylaxis or
overdose. Treat with barbituates, O2 and maintaining ABCs. 
Moderate (Conscious) Sedation-sedatives and hypnotics and analgesics to 
relax the patient but without losing gag reflex, or ability to follow directions. 
Nurse needs to evaluate level of sedation and risk of respiratory depression.
Postoperative assessments (circulating nurse and anesthetist perform hand-off to 
PACU nurse) 
Information to know during handoff from surgery to PACU (postanesthesia 
care unit) includes:
o Significant pre-surgery info (vitals, allergies, chronic diseases,  prosthetics, primary language of the patient and special requests.) o Significant intr-surgery info (type and extent of the surgery and  anesthesia, any complications, vitals, I&O that includes blood products,
last pain medication, intra-operative respiratory function, and any 
intra-operative positioning that impacts ongoing care.)
o Things to know for the future care of the patient (when the next pain  med, antibiotic or other medications are due, location and type of any 
incisions, dressing, catheters, tubes or drains.)
background image Respiratory-Need RR >10 per min, bilateral chest movement, air moving in 
lungs.  
Vitals-compare to baseline and look for trends going forward I&O: look for wound drainage and watch IV fluids (don’t want to give fluid 
overload). Need urine output at least 30ml/hr. 240 ml/8hr and 720ml/24hrs. 
Do NOT let the patient leave PACU if not giving this output. Make sure drains 
and machines are working properly and are patent
Monitor LOC, movement and sensation in extremities Monitor dressing for drainage To leave PACU, must have 9 or greater on a discharge scoring system Watch for wound dehiscence (opening of wound) and wound evisceration 
(protrusion of organs through open wound). If these occur, stay with the 
patient, get the surgeon, adjust pt. body to prevent further opening, cover 
wound with moist, sterile dressings.
Respiratory Disorders Identify signs and symptoms (s/sx) of inadequate oxygenation and implications 
of these findings
Cyanosis (blue coloring of skin) means there is inadequate tissue perfusion. 
Labored breathing (use of accessory muscles, high respiratory rate, wheezing) 
means there is inadequate gas exchange occurring in the lungs. Abnormal 
breath sounds indicate a variety of things:
Consolidation is bronchial sounds heard in the lobes of the lung.  Sound 
transmitted from bronchioles to edges through fluid or gunk in the lungs. 
Ex: TB, cancer, pneumonia
Fine crackles indicate fluid in alveoli. Ex: cystic fibrosis, pneumonia and 
cannot be cleared by coughing
Course crackles are caused by mucous or bronchospasm in larger airways.
May clear with coughing. Ex: bronchitis and aspiration
Wheezing is air passing through narrowed airways, as in asthma, COPD or 
cancer
Stridor is loud crowing on inspiration, caused by upper airway obstruction.
Ex: aspiration of food into trachea
Pleural Friction Rub sounds like leather rubbing on leather, is not affected 
by cough or cycle of respirations. Ex: pleuritis 
Inadequate oxygenation is also detected by change in LOC, SpO2 readings and 
arterial blood gas (ABG) readings. A shift to the left in O2-Hemoglobin Dissociation 
curve means that O2 is attaching quickly to hemoglobin in the lungs, but slowly 
going to tissue. This is NOT good. Associated with increased pH and decreased CO2,
temperature and 2,3 DPG (enzyme that helps O2 leave RBC and go to tissue).
background image Know the process of oxygenation including manifestations of adaptation to altered 
states
O2 comes into the lungsdiffuse across alveoli cellsdissolves into bloodattaches 
to hemoglobin in RBCsdissolve into blooddiffuses into cells
Hypoxia is ↓ O2 in tissue despite adequate O2 in RBCs. Measured with pulse ox Hypoxemia is ↓ O2 in blood (PaO2). Measured with ABGs  FiO2 is the percentage of air in the lungs that is O2. In room air, FIO2 is 21%.  
Different devices can increase the FiO2.
Low-Flow Delivery 
System
FiO2 Liters Nasal Cannula 24-40% 1-6 Simple Mask 40-60% 5-8 Partial Rebreather 60-75% 6-11 Nonrebreather 80-95% Enough to keep bag 2/3 
open
High-flow Delivery 
System
FiO2 Liters Venturi Mask 24-50% 4-10 Aerosol mask, face tent, 
trach collars, mechanical 
ventilation
24-100% ≥10 Complications of Oxygen Therapy Oxygen Toxicity: Frequently intubated, mechanically ventilated patients. 
When there is > 50% O2 for >24-48 hrs↑free radicalsdamage to alveolar 
membrane.  S/sx are substernal chest pain w/ deep breathing, dyspnea, 
hypoventilation, cough. To avoid this, keep O2 low, only enough to keep SpO2
>95% and PaO2 >60mmhg.
Oxygen-induced hypercapnia: Frequently COPD patients, who have 
chronically ↓O2 and ↑CO2.  S/sx are ↓RR, and ↓LOC. Prevent this with 
careful management of O2 to achieve ≥92%, use a venturi mask to improve 
accuracy of O2 therapy
Absorptive atelectasis: Small amount of nitrogen in alveolialveoli collapse 
when O2 go into blood. S/sx are new onset of crackles, ↓lung sounds
Dry mucous membranes: O2 is very drying, which kills cells.  Must humidify 
anything >4L. Do not let condensation back into lungs once it has come out
Tracheostomy-opening in front of throat to let air into lungs without using nose and 
mouth
A new trach will have a small amount of blood, but constant oozing of blood 
not normal. 

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School: Texas State University
Department: Nursing and Health Science
Course: Nur Care Lifespan
Professor: Regina Jillapalli
Term: Spring 2018
Tags:
Name: Lifespan Exam 2 Study Guide
Description: This study guide covers what is going to be on the test
Uploaded: 03/03/2018
14 Pages 71 Views 56 Unlocks
  • Better Grades Guarantee
  • 24/7 Homework help
  • Notes, Study Guides, Flashcards + More!
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