Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023, Exams of Nursing

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Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Focus points for Exam 1 Medical Surgical Nursing Lab Values Magnesium 1.7-2.2 BUN (Blood Urea Nitrogen) 7-20 Creatine Kinase – presence of muscle trauma or disease INR 2-3 Alkaline Phosphatase Presence of bone trauma or disease WBC 4.5-10 thousand/mm 3 Chloride 95-105 RBC Female 4-5.0 million /mm3 BUN/Cr Ratio 6-25 Platelets 150-400 thousand/mm3 Hemoglobin female 12-15 Potassium 3.5-5 Carbon Dioxide 22-30 RBC Male 4.6-6.0 million /mm3 Sodium 135-145 Hematocrit Female 36-46% Hemoglobin male 13.5-18 Creatine 0.5 -1.2 Phosphorus 2.5-4.5 Minimum Urine Output/hr 30ml/hr CRP/ESR Inflammation bio-markers Hematocrit male 40-54% Fasting blood glucose 70-110 Calcium 9-11 Pre- Albumin Levels – Nutritional status, very specific Dehiscence – partial or complete separation of the outer wound layers and sometimes described as splitting open of the wound - What to do for it – recover the open section of the wound with a steri-strip - Often occurs in obese patients and those with diabetes, immune deficiency or malnutrition or those on steroids. - Notify the doctor Surgical Risk Factors - Age older than 65 - Medications o Antihypertensives Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 o Tricyclic antidepressants o Anticoagulants o NSAIDS o Immunosuppressive - Medical History o Decreased immunity o Diabetes o Pulmonary disease o Hemodynamic instability o Multi system disease o Any chronic disease o Coagulation defect or disorder o Infection o Hypertension o Hypotension - Prior Surgical experiences o Less than optimal reaction o Anesthesia reactions or complications o Post operation complications - Health History o Malnutrition or obesity o Drug, tobacco, alcohol or illicit substance use or abuse o Altered coping ability o Herbal use o Allergies - Family History o Malignant hyperthermia o Cancer o Bleeding disorder o Anesthesia reactions or complications - Type of surgical procedure planned o Neck, oral, or facial procedures (airway complications) o Chest or high abdominal procedures (pulmonary complications) Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 might be painful o 3. Observe behaviors o 4. Evaluate Physiologic indications o 5. Conduct an analgesic trial o Need for Airway, oxygenation, circulation and potential for disability need for shelter o Need for safe and secure environment over a need for socialization Opioid Reversal Agent - Naloxone – Generic name - Narcan – Brand name o Opioid antagonist may be needed to reverse the acute effects of opioid depression Benzodiazepine Reversal Agent - Flumazenil – generic name - Romazicon – Brand name o Used in the complete or partial reversal of the sedative effects Patient Controlled Analgesia Pump (PCA PUMP) - Is patient controlled - Set on a timer, only release in small doses every fifteen minutes or what the timer is set to. - Doesn’t matter how many times the patient hits the pump it will only release when the time is up from the previous dose Pain Indicators and the most reliable indicator - The most reliable indicator is the patient o Vital signs, facial expressions, guarding of the area, gait change, changes in interpersonal actions, changes in activity patterns or routines, mental status can indicate pain but the Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 ▪ If excessive sedation is detected reduce opioid dose to prevent respiratory depression ▪ Eliminate unnecessary sedating drugs such as antihistamines, anxiolytics, muscle relaxants and hypnotics. If necessary to administer these drugs during opioid therapy, monitor sedation and respiratory status closely ▪ Reassure patients taking long term opioid therapy that tolerance to this side effect develops with regular daily opioid doses ▪ Be aware that stimulants such as caffeine may counteract opioid-induced sedation ▪ Consider switch to another opioid for unresolved excessive sedation during long term opioid therapy Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 - Respiratory depression ▪ Be aware that counting respiratory rate alone does not constitute a comprehensive respiratory assessment . proper assessment of respiratory status includes observing the rise and fall of the patients chest to determine depth and quality in addition to counting respiratory rate for 60 seconds ▪ Recognize that snoring is a respiratory obstruction and an ominous sign ▪ Remember that sedation precedes opioid-induced respiratory depression; identify patient and iatrogenic risk factors and monitor sedation level and respiratory status frequently during the first 24 hours of opioid therapy ▪ Stop opioid administration immediately for clinically significant respiratory depression, stay with the patient continue attempts to arouse patient, support respirations call for help (consider rapid response team or code blue) and consider giving naloxone ▪ Reassure patients taking long term opioid therapy that tolerance to this side effect develops with regular daily opioid doses o Pasero Opioid-Induced Sedation Scale (POSS) with interventions ▪ S = sleep, easy to arouse ▪ Acceptable, no action necessary; may increase opioid dose if needed • 1. Awake and alert o Acceptable ; no action necessary; may increase opioid dose if needed • 2. Slightly drowsy, arousable drifts off to sleep during conversation o Acceptable ; no action necessary; may increase opioid dose if needed • 3. Frequently drowsy, arousable drifts off to sleep during conversation o Unacceptable – monitor respirator status and sedation level closely until sedation level is stable at less than 3 and respirator status is satisfactory; decrease opioid dose 25% to 50% Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 or notify primary or anesthesia prov orders; consider administering a non-sedating, opioid -sparing nonopioid such as acetaminophen or a NSAID if not contraindicated ask the patient to take deep breaths every 15 – 30 minutes • 4. Somnolent; minimal or no response to verbal and physical stimulation o Unacceptable – stop opioid; consider administering naloxone, call rapid response team (code blue) stay with patient, stimulate and support respiration as indicated by patient status, notify primary or anesthesia provider, monitor respirator status and sedation level closely until sedation level is stable at less than 3 and respirator status is satisfactory - Highest risk patients for surgery o Older patients with poor liver and kidney function - Shortness of air Interventions ? What would you do first o A. Airway/cervical spine ▪ Establish a patent airway by positioning, suctioning, and oxygen as need ▪ Protect the cervical spine by maintaining alignment; use a jaw-thrust maneuver if there is a risk for spinal injury ▪ If the Glasgow Coma scale score is 8 or less the patient is at risk for airway compromise, prepare for endotracheal intubation and mechanical ventilation o B. Breathing ▪ Assess breath sounds and respiratory effort ▪ Observe for chest wall trauma or other physical abnormality ▪ Prepare for chest decompression if needed ▪ Prepare to assist ventilations if needed o C. Circulation Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 mg/dL o Causes excitable tissues to be less sensitive to normal stimuli, thus requiring stronger stimulus to function ▪ The excitable tissues affected by most hypercalcemia are the heart, skeletal muscles, nerves and intestinal smooth muscles • Hypocalcemia – total serum calcium level below 9.0 mg/dL o Frequent report of frequent painful muscle spasms in the calf or the foot during rest or sleep o Over stimulation of the nerves and muscles o Occur first in the hands and feet o Phosphorus (Phos) – 2.5 -4.5 mg/dL ▪ Hyperphosphatemia - serum phosphate greater than 4.5 mg/dl • Increased membrane excitability leading to life threating side effects ▪ Hypophosphatemia – serum phosphate less than 2.5 mg/dl • Cardiac, musculoskeletal, hematologic, CNS Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 preferences, values and needs o Team work and collaboration ▪ Function effectively within nursing and interprofessional teams fostering open communication , mutual respect and shared decision making to achieve quality and patient care o Evidence Based Practice ▪ Integrate best current evidence with clinical expertise and patient family preferences and values for delivery of optimal healthcare o Quality Improvement ▪ Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems o Safety ▪ Minimize risk of harm to patients and providers through both system effectiveness and individual performance o Use Informatics ▪ Use information and technology to communicate, manage knowledge, mitigate errors, and support decision making - Role of the Nurse o Caregiver o Educator o Advocate o Leader or manager o Delegator – right task to the right person for the right reason o Researcher Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 - Ethics and dilemmas in Nursing o Autonomy – make own decisions; personal right to make a decision o Beneficence – to do good for the patient o Fidelity – a promise, cannot promise something you don’t know the outcome to o Veracity – to tell the truth o Nonmaleficence – do no harm, prevent harm ( patient advocate) o Social justice – no discrimination - Core Measures / Care Bundles – Why ? o Interventions - Safe Handoff where should this occur o Transferring patient care into another providers hand ▪ Should occur in the clients/patient room along with the client/patient ▪ At the patient’s/clients bedside - Elderly considerations in the perioperative period o Cardiovascular systems ▪ Decreased cardiac output ▪ Increased blood pressure ▪ Decreased peripheral circulation o Respiratory system ▪ Reduced vital capacity ▪ Loss of lung elasticity ▪ Decreased oxygenation of blood o Renal/Urinary System ▪ Decreased blood flow to kidneys ▪ Reduced ability to excrete waste ▪ Decline in glomerular filtration rate ▪ Nocturia common o Neurologic System ▪ Sensory deficits ▪ Slower reaction times ▪ Cognitive impairment Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 saline place in a low-fowlers position with hips and knees bent monitor for shock and notify provider immediately. Do not attempt to reinsert organs - Conscious Sedation : is the patient conscious ? Awake ? Asleep? Alert ? Unconscious o The patient is sleepy, awake, but not alert o Is the Iv delivery of sedative, hypnotic and opioid drugs to reduce sensory perception but allow the patient to maintain a patent airway o Moderate sedation is used to reduce the level of consciousness during minor surgical procedures, endoscopy, cardiac catheterization, closed fracture reduction and cardioversion - Post -op complications : prevention, early ambulation is key to preventing most o Other complication : DVT, pneumonia, PE, Paralytic ileus, Infections - Malignant hyperthermia o An inherited muscle disorder is acute, life threating complication of certain drugs used for general anesthesia ▪ Its characterized by many problems including inadequate thermoregulation ▪ The reaction begins in skeletal muscles exposed to the drugs, causing increased calcium levels in muscle cells Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 ▪ Description of potential harm, pain, and discomfort that can occur ▪ Options for other treatments ▪ The right to refuse treatment - Administering opioids : Precautions o Head trauma o Liver disease o History of addiction to opioids o Use cautiously in patients with underdiagnosed abdominal pain - Elderly, Pain, Asses easily? Why or Why Not o Have a high threshold o Not easily assessed because they have been living with it for a long time o Older adults are at high risk for undertreated pain and those with cognitive impairment are at even higher risk - Nursing Process : Steps involved o Assessment o Diagnosis o Planning o Implementation o Evaluation ▪ Is a continuous cycle ▪ Interchangeable - Nomalthermia: vs. Hypothermia : what complications are prevented if normalthermia o Normalthermia – Normal temperature of the client ▪ Complications Prevented if Normalthermia is maintained Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 through surgery • Decrease cardiac death • Decrease in infection • Pain after surgery is improved • Patient has better surgery outcomes - Rights to the patient regarding pain management o Use a multimodal approach that combines analgesics with different underlying mechanisms with the desired outcome of achieving optimal pain relief with lower doses than would be possible with a single analgesic; lower doses result in fewer side effects - Physiological responses to acute pain? Put yourself in the position , what would you experience if you fell and broke your arm o Increases heart rate, blood pressure and oxygen demand o Decreases GI motility o Causes immobility o Decreases immune response o Pain is localized o Fight or flight - HIPAA o Health Insurance Portability and Accountability Act ▪ Protect the confidentiality of health care information and give the client the right to control the release of this info ▪ Right for the client to obtain medical record and submit request to amend erroneous or incomplete info ▪ The right of clients privacy and confidentiality ▪ HIPAA regulations also provide penalties in the event of non-compliance with the regulation - Wound drainage marking the dressing reinforcement Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Note: ASA is a salicylate however; you will often see it in the Category of NSAID (It is not an NSAID but act likes one ) o Cefazolin (Generic Name) ▪ Brand name – Ancef ▪ Prevents skin and skin structure infections in orthopedic and general surgeries and is associated with lower risk of mortality in older adult patients ▪ Nursing implications • Patients with beta-lactam allergies receive vancomycin or clindamycin ▪ Classification – Antibiotic ▪ Used for the treatment of a number of bacterial infections • Cellulitis • UTI • Pneumonia • Endocarditis • Joint infections • Biliary tract infections • Perioperative prophylaxis • Genital infections • Bacterial endocarditis • Prophylaxis for dental • Upper respiratory tract procedures ▪ Do not give to people with a History of anaphylaxis to penicillin o Flumzenil (Generic Name) ▪ Brand Name – Romazicon ▪ Reverses the effects of benzodiazepine sedatives such as Valium, Versed, Xanax, Tranxene ▪ Drug Class : Benzodiazepine antagonist o Naloxolone (Generic Name) ▪ Brand name – Narcan ▪ Use with opioid overdosing ▪ Drug class – opioid antagonist Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 • H2 histamine blocker • Used when procedures are long or stress ulcers are likely to occur o Midazolam (Generic Name ) ▪ Brand Name : Versed ▪ Therapeutic antianxiety agents ▪ Sedative hypnotics ▪ Conscious sedation ▪ Aids in the induction of anesthesia as part of balanced anesthesia ▪ Acts at many levels of the CNS to produce generalized CNS depression ▪ Short term sedation ▪ Post op amnesia ▪ Decreases anxiety and produces sedation • Monitor for respiratory depression, hypotension drowsiness and lack of coordination o Metoclopramide (Generic Name) ▪ Brand Name : Reglan • Dealing with gastric emptying • Prevent nausea and vomiting - Antiemetics o Manage nausea and vomiting ▪ Example Metoclopramide, and Ondansetron - Anticoagulants o Prevention and treatment of thrombotic disorders including DVT, Pulmonary Embolism and Atrial fibrillation o Also used in the management of Myocardial Infarction o Used to prevent clot and formation o Example ▪ Heparins Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023 ▪ Warfarin - Antibiotics o Used in surgery to reduce the risk for a surgical site infection ▪ Given 60 minutes before the incision is made o Kill or inhibit the growth of susceptible pathogenic bacteria ▪ Not active against viruses or fungi o Treatment and prophylaxis of various bacterial infection - Opioids o Manage moderate to severe pain in nociceptive pain such as ▪ Postoperative ▪ Surgical ▪ Trauma ▪ Burn pain o Example ▪ Fentanyl o Bind to opiate receptors in the CNS and block the release of the neurotransmitter substance P - NSAIDS o Non-Steroidal Anti-Inflammatory Drugs o Have analgesic, antipyretic and anti-inflammatory properties o COX 2 inhibitors o Examples ▪ Motrin, Novo-Profen o Risk Factors ▪ Being older than 60 years or having a history of peptic ulcer or cardiovascular disease ▪ Do not use after high risk open heart surgery o Adverse Effects ▪ Gastric Toxicity, Ulceration - Analgesics o Categorized into 3 main categories Nursing Medical Surgical Exam 126 Best Exam Solution With Latest Updates 2022/2023