25. Signs and symptoms of an allergic reaction to medication:
*anaphylactic shock, which is avery severe reaction which can lead to death (hypostension, tachycardia, bronchospasm, and possibly pulmonary edema.
*Hives: which are multiple small, itchy, swollen areas on the skin
*wheezing
*palpitations: unusual heart beat of the chest
*skin rash
*swelling of one or more parts of the body
*acute situational anxiety: generalized anxiety disorder, anxiety disorder, panic disorder, post traumatic stress disorder, obsessive compulsive disorder, phobias
***I found this on the internet, if anyone can find it in the book that would help, i could only find anaphylactic shock in the book
Sunday, October 15, 2006
Saturday, October 14, 2006
#15
15. Lewis P.989-999 and Techniques P. 616
Assessment of TPN (Total Parenteral Nutrition)
*cHECK FOR ALLERGIES TO ANY OF THE CONTENTS IN THE SOLUTION. (water, protein, carbohydrates, electrolytes, minerals, and vitamins)
*Vital signs should be monitored ever 4-8 hrs (if fever or vital signs are abnormal, notify physician; an elevated temp is one of the earliest signs of catheter-related sepsis)
*Daily wts. give indication of hydration status
-Body wt. is considered the changes in protein, fat, and water.
-On a daily basis, body water fluctuates more that protein and fat.
-Analysis must be made of whether gains or losses in wt. are caused by fluid gained from edema, fluid loss through diuresis, or an increase or decrease in tissue wt.
*Measure daily fluid intake and output an calorie intake
*Blood levels of glucose, electrolytes, and BUN; a CBC; and a hepatic enzyme studies are followed 3x per week until stable and the weekly.
*Observe site under dressing for signs of inflammation and infection.
-Phlebitis can readily occur in the vein as a result of the hypertonic infusion, & area can become infected.
(FYI: Many patients on TPN are receiving chemotherapy, corticosteroids, or antibiotics, which can mask signs of infection)
*If sutures are used to anchor catheter, they may become infected
-If an infection is suspected a culture specimen of the site and drainage should be sent for analysis, and notify Physician
*Blood glucose levels should be checked every 4-6 hrs with a glucose testing meter (TPN patients are at RF Hyperglycemia)
*Check the amt. infused and the rate every 30 min-1 hr.
-too fast of an infusion can put a lrg. amt. of glucose into blood causing hyperglycemia and too slow an infusion rate can cause hypoglycemia.
- An infusion pump must be used during admin. of TPN
*Before setting up and administering TPN, the nurse must check the label and ingredients in the solution to see that they are what the health care provider ordered.
*Examine solutions for contamination, such as cloudy appearance.
*Discontinue TPN and replace with a new solution bag every 24 hr.
*Catheter-related infection and septicemia can occur.
Assessment of TPN (Total Parenteral Nutrition)
*cHECK FOR ALLERGIES TO ANY OF THE CONTENTS IN THE SOLUTION. (water, protein, carbohydrates, electrolytes, minerals, and vitamins)
*Vital signs should be monitored ever 4-8 hrs (if fever or vital signs are abnormal, notify physician; an elevated temp is one of the earliest signs of catheter-related sepsis)
*Daily wts. give indication of hydration status
-Body wt. is considered the changes in protein, fat, and water.
-On a daily basis, body water fluctuates more that protein and fat.
-Analysis must be made of whether gains or losses in wt. are caused by fluid gained from edema, fluid loss through diuresis, or an increase or decrease in tissue wt.
*Measure daily fluid intake and output an calorie intake
*Blood levels of glucose, electrolytes, and BUN; a CBC; and a hepatic enzyme studies are followed 3x per week until stable and the weekly.
*Observe site under dressing for signs of inflammation and infection.
-Phlebitis can readily occur in the vein as a result of the hypertonic infusion, & area can become infected.
(FYI: Many patients on TPN are receiving chemotherapy, corticosteroids, or antibiotics, which can mask signs of infection)
*If sutures are used to anchor catheter, they may become infected
-If an infection is suspected a culture specimen of the site and drainage should be sent for analysis, and notify Physician
*Blood glucose levels should be checked every 4-6 hrs with a glucose testing meter (TPN patients are at RF Hyperglycemia)
*Check the amt. infused and the rate every 30 min-1 hr.
-too fast of an infusion can put a lrg. amt. of glucose into blood causing hyperglycemia and too slow an infusion rate can cause hypoglycemia.
- An infusion pump must be used during admin. of TPN
*Before setting up and administering TPN, the nurse must check the label and ingredients in the solution to see that they are what the health care provider ordered.
*Examine solutions for contamination, such as cloudy appearance.
*Discontinue TPN and replace with a new solution bag every 24 hr.
*Catheter-related infection and septicemia can occur.
#11
11) Discuss the complications of surgery.
Unanticipated intraoperative events occasionally occur. Although some might be anticipated (e.g., cardiac arrest in an unstable patient, massive blood loss during trauma surgery), others may occur without warning, demanding immediate intervention by all members of the OR team. Two such events are anaphylactic reactions and malignant hyperthermia.
Anaphylaxis is the most severe form of an allergic reaction, manifesting with life-threatening pulmonary and circulatory complications. An anaphylactic reaction causes hypotension, tachycardia, bronchospasm, and possibly pulmonary edema. Antibiotics and latex are responsible for many perioperative allergic reactions.
Malignant hyperthermia is a rare metabolic disease characterized by hyperthermia with rigidity of skeletal muscles that can result in death. It occurs in affected people exposed to certain anesthetic agents. Succinylcholine (Anectine), especially in conjunction with the volatile inhalation agents, appears to be as stress, trauma, and heat, have been implicated. Other complications are: pain, respiratory, mobility, bowel, urinary, death.
Lewis pg 390 and powerpoint
Unanticipated intraoperative events occasionally occur. Although some might be anticipated (e.g., cardiac arrest in an unstable patient, massive blood loss during trauma surgery), others may occur without warning, demanding immediate intervention by all members of the OR team. Two such events are anaphylactic reactions and malignant hyperthermia.
Anaphylaxis is the most severe form of an allergic reaction, manifesting with life-threatening pulmonary and circulatory complications. An anaphylactic reaction causes hypotension, tachycardia, bronchospasm, and possibly pulmonary edema. Antibiotics and latex are responsible for many perioperative allergic reactions.
Malignant hyperthermia is a rare metabolic disease characterized by hyperthermia with rigidity of skeletal muscles that can result in death. It occurs in affected people exposed to certain anesthetic agents. Succinylcholine (Anectine), especially in conjunction with the volatile inhalation agents, appears to be as stress, trauma, and heat, have been implicated. Other complications are: pain, respiratory, mobility, bowel, urinary, death.
Lewis pg 390 and powerpoint
#16
16. Kozier p. 1157-1158
PCA- Patient Controlled Analgesia
PCA is an interactive method of pain management that permits clients to treat their pain by self administering doses of analgesics. With parenteral routes the client administers a predetermined dose of narcotic by an electronic infusion pump. This allows the client to maintain a more constant level of relief yet need less medication for pain relief.
PCA can be effectively used for clients with acute pain related to surgical incision, traumatic injury, or for labor and delivery, and for chronic pain as with cancer.
The physician prescribes the analgesic dose, route, and frequency, w/ the client administering the med. Clients pain must be assessed at regular intervals and analgesic use is documented in the clients record.
PCA's are designed with built-in safety mechanisms to prevent client overdose, abusive use, or narcotic theft. After pushing the button and the preset dose is delivered a programmable lockout interval (usually 10-15 mins) follows the dose, when an additional dose cannot be given even if the client presses the button
PCA- Patient Controlled Analgesia
PCA is an interactive method of pain management that permits clients to treat their pain by self administering doses of analgesics. With parenteral routes the client administers a predetermined dose of narcotic by an electronic infusion pump. This allows the client to maintain a more constant level of relief yet need less medication for pain relief.
PCA can be effectively used for clients with acute pain related to surgical incision, traumatic injury, or for labor and delivery, and for chronic pain as with cancer.
The physician prescribes the analgesic dose, route, and frequency, w/ the client administering the med. Clients pain must be assessed at regular intervals and analgesic use is documented in the clients record.
PCA's are designed with built-in safety mechanisms to prevent client overdose, abusive use, or narcotic theft. After pushing the button and the preset dose is delivered a programmable lockout interval (usually 10-15 mins) follows the dose, when an additional dose cannot be given even if the client presses the button
#10
10) Discuss the purpose of the pre-op checklist. Give examples of when the nurse would need to call the physician.
The overall goal of the preoperative assessment is to gather data in order to identify risk factors and plan care to ensure patient safety throughout the surgical experience. Goals of the assessment are to
1. Determine the psychologic status of the patient in order to reinforce coping strategies to undergo the proposed surgery.
2. Determine physiologic factors related and unrelated to the surgical procedure that may contribute to operative risk factors.
3. Establish baseline data for comparison in the intraoperative and postoperative period.
4. Identify prescription medications and over-the-counter drugs and herbs that have been taken by the client that may affect the surgical outcome.
5. Identify if the results of all preoperative laboratory and diagnostic tests are documented and communicated to appropriate personnel.
6. Identify cultural and ethnic factors that may affect the surgical experience.
7. Determine if the client has received adequate information from the surgeon to make an informed decision to have surgery and that the consent form is signed.
Examples: fear of death, excessive anxiety, fear of pain and discomfort
Lewis pg 361-362
The overall goal of the preoperative assessment is to gather data in order to identify risk factors and plan care to ensure patient safety throughout the surgical experience. Goals of the assessment are to
1. Determine the psychologic status of the patient in order to reinforce coping strategies to undergo the proposed surgery.
2. Determine physiologic factors related and unrelated to the surgical procedure that may contribute to operative risk factors.
3. Establish baseline data for comparison in the intraoperative and postoperative period.
4. Identify prescription medications and over-the-counter drugs and herbs that have been taken by the client that may affect the surgical outcome.
5. Identify if the results of all preoperative laboratory and diagnostic tests are documented and communicated to appropriate personnel.
6. Identify cultural and ethnic factors that may affect the surgical experience.
7. Determine if the client has received adequate information from the surgeon to make an informed decision to have surgery and that the consent form is signed.
Examples: fear of death, excessive anxiety, fear of pain and discomfort
Lewis pg 361-362
#8
I am just trying to get us started so if you have more info please add it. The more people who discuss the info the better everyone will be able to understand. If we all do a little it makes the load easier.
8) Discuss the assessment needed for the surgical client in pain.
The client should be observed for indications of pain (e.g., restlessness) and questioned about the degree and characteristics of the pain. Identifying the location of the pain is important. Incisional pain is to expected, but other causes of pain, such as a full bladder, may be present. Research has shown that many clients are undermedicated for pain. Pain assessment may be difficult in the early postoperative period. The client may not be able to verbalize the presence or severity of pain. The nurse should observe for behavioral clues of pain such as a wrinkling face or brow, a clenched fist, moaning, diaphoresis, and an increased pulse rate.
Lewis pg 399 and 409
8) Discuss the assessment needed for the surgical client in pain.
The client should be observed for indications of pain (e.g., restlessness) and questioned about the degree and characteristics of the pain. Identifying the location of the pain is important. Incisional pain is to expected, but other causes of pain, such as a full bladder, may be present. Research has shown that many clients are undermedicated for pain. Pain assessment may be difficult in the early postoperative period. The client may not be able to verbalize the presence or severity of pain. The nurse should observe for behavioral clues of pain such as a wrinkling face or brow, a clenched fist, moaning, diaphoresis, and an increased pulse rate.
Lewis pg 399 and 409
#9
9. Lewis P.393-395 and Parts of all of Chap. 17
Initial assessment: ACP gives report to admitting PACU nurse
Priority care includes: Monitoring and management of respiratory, and circulatory function, pain, temp, an surgical site.
Assessment should begin with evaluation of the airway, breathing, and circulation (ABCs) status of the patient.e
Assess patients airway patency and rate and quality or resp. made. Breath sounds are ascultated through out all fields.
O2 therapy should be used if patient has had general anesthesia or if ACP orders it. (By nasal cannula or face mask)
Pulse oximetry monitoring is intitiated.
Electrocardiographic (ECG) monitoring is initiated to determine cardiac rate and rhythm.
BP measured and compared to baseline readings.
Invasive monotoring (e.g.arterial BP monitoring) will be initiated if needed.
Body temp, skin color and condition noted
Neurologic: level of consciousness, orientation, sensory and motor status, and size, equality, and reactivity of pupils.
Urinary system: intake and output and fluid balance
* note presence of all IV lines, irrigation sloutions and infusions, and all output devices. Including catheters and wound drains.
Assess surgical site: noting condition of dressing and amt. of any drainage
GOAL: identify actual and potential problems that may occur as a result of anesthetic admin. and surgical intervention and intervene appropriately.
ANTICIPATE: airway compromise (obstruction), resp. insufficiency, cardiac compromise (hypo or hypertension, arrythmias), neurlogic compromise (emergence delirium, and delayed awakening), hyperthermia, pain, and nausea and vomiting.
ONGOING ASSESSMENT:
1. Airway patency (resp. rate, patterns, and breath sounds)
2. Vital Signs every 15 mins. (Inc: BP. HR, P, skin temp)
3. Observe indications of pain (restlessness, behavioral clues)
4.Temperature (oral,tympanic, axilla)
5.Question about feelings of nausea
6. examine urine for quantity and quality (atleast 0.5mL/kg/hr., and most urinated 6-8 hours post-surgery)
7.Ascultate all 4 quads for frequency, pitch of bowel sounds
8.Assess wound (drainage is expected to change for sanguiness (red) to serosanguiness (pink) to serous (clear yellow)
*check for dehiscence
Initial assessment: ACP gives report to admitting PACU nurse
Priority care includes: Monitoring and management of respiratory, and circulatory function, pain, temp, an surgical site.
Assessment should begin with evaluation of the airway, breathing, and circulation (ABCs) status of the patient.e
Assess patients airway patency and rate and quality or resp. made. Breath sounds are ascultated through out all fields.
O2 therapy should be used if patient has had general anesthesia or if ACP orders it. (By nasal cannula or face mask)
Pulse oximetry monitoring is intitiated.
Electrocardiographic (ECG) monitoring is initiated to determine cardiac rate and rhythm.
BP measured and compared to baseline readings.
Invasive monotoring (e.g.arterial BP monitoring) will be initiated if needed.
Body temp, skin color and condition noted
Neurologic: level of consciousness, orientation, sensory and motor status, and size, equality, and reactivity of pupils.
Urinary system: intake and output and fluid balance
* note presence of all IV lines, irrigation sloutions and infusions, and all output devices. Including catheters and wound drains.
Assess surgical site: noting condition of dressing and amt. of any drainage
GOAL: identify actual and potential problems that may occur as a result of anesthetic admin. and surgical intervention and intervene appropriately.
ANTICIPATE: airway compromise (obstruction), resp. insufficiency, cardiac compromise (hypo or hypertension, arrythmias), neurlogic compromise (emergence delirium, and delayed awakening), hyperthermia, pain, and nausea and vomiting.
ONGOING ASSESSMENT:
1. Airway patency (resp. rate, patterns, and breath sounds)
2. Vital Signs every 15 mins. (Inc: BP. HR, P, skin temp)
3. Observe indications of pain (restlessness, behavioral clues)
4.Temperature (oral,tympanic, axilla)
5.Question about feelings of nausea
6. examine urine for quantity and quality (atleast 0.5mL/kg/hr., and most urinated 6-8 hours post-surgery)
7.Ascultate all 4 quads for frequency, pitch of bowel sounds
8.Assess wound (drainage is expected to change for sanguiness (red) to serosanguiness (pink) to serous (clear yellow)
*check for dehiscence
#7
Please fill free to add more.
Explain the purpose of administering preoperative medication.
*Provide analgesia
*Prevent nausea and vomiting
*Promote sedation and amnesia
*Decrease anesthetic requirements
*Facilitate induction of anesthesia
* Relieve apprehension and anxiety
*Prevent autonomic reflex response
*Decrease respiratory and gastrointestinal secretions
Lewis pg 372
Explain the purpose of administering preoperative medication.
*Provide analgesia
*Prevent nausea and vomiting
*Promote sedation and amnesia
*Decrease anesthetic requirements
*Facilitate induction of anesthesia
* Relieve apprehension and anxiety
*Prevent autonomic reflex response
*Decrease respiratory and gastrointestinal secretions
Lewis pg 372
#6
Add info will be appreciated
Explain the types of prevention and their purposes; Give examples.
Prevention, in a narrow sense, means avoiding the development of disease in the future, and in the broader sense, consists of all interventions to limit progression of a disease. The levels of prevention occur at various points of a course of disease progression. There are three levels of prevention: primary, secondary, and tertiary. Five steps describe these levels: Primary prevention focuses on (a) health promotion and (b) protection against specific health problems (e.g., immunization against hepatitis B). The purpose of primary prevention is to decrease the risk of exposure of the individual or community to disease. Secondary prevention focuses on (a) early identification of health problems and (b) prompt intervention to alleviate health problems. Its goal is to identify individuals in an early stage of a disease process and to limit future disability. Tertiary prevention focuses on restoration and rehabilitation with the goal of returning the individual to an optimal level of functioning. Table 8-1 provides examples of activities for each level of prevention.
Kozier pg 120
Explain the types of prevention and their purposes; Give examples.
Prevention, in a narrow sense, means avoiding the development of disease in the future, and in the broader sense, consists of all interventions to limit progression of a disease. The levels of prevention occur at various points of a course of disease progression. There are three levels of prevention: primary, secondary, and tertiary. Five steps describe these levels: Primary prevention focuses on (a) health promotion and (b) protection against specific health problems (e.g., immunization against hepatitis B). The purpose of primary prevention is to decrease the risk of exposure of the individual or community to disease. Secondary prevention focuses on (a) early identification of health problems and (b) prompt intervention to alleviate health problems. Its goal is to identify individuals in an early stage of a disease process and to limit future disability. Tertiary prevention focuses on restoration and rehabilitation with the goal of returning the individual to an optimal level of functioning. Table 8-1 provides examples of activities for each level of prevention.
Kozier pg 120
Need Supplemental Help?
Hey y'all. I have just struck paydirt with learning links for tutorials, quizzes, charts, graphs, slide shows, animations, simulations and anything else you can think of to help your individual learning style.
This link will take you to a medical site that has 9 pages of links. Each page has around 100 links. Check it out and share anything that you find helpful with the rest of us. This is a great find for visual and kinisthetic learners.
Medical Learning Links
This link will take you to a medical site that has 9 pages of links. Each page has around 100 links. Check it out and share anything that you find helpful with the rest of us. This is a great find for visual and kinisthetic learners.
Medical Learning Links
The Student Nurse's Prayer
Dear Lord: I know we go through this every day but please give me the knowledge
as to why I actually wanted to go to nursing school.
Lord, give me the strength to make it through
those boring three hour lectures without falling asleep.
Lord, please give me the patience to make it through twelve hour clinicals
with instructors that can't just give you the right answer
and on the same note, give the nurses the ability to remember
what it was like to be a student and give us just a little more respect.
Lord, give me the endurance to read all the assigned readings
and be able to remember it when I am taking a test with four right answers.
Lord, give my family and friends the ability to realize
I really am on the edge of insanity.
Finally, Lord, give me the vision to see that one day I will be a real nurse
and I will never have to wear this ugly uniform again.
by Meredith Joyner
Inspirational Page
as to why I actually wanted to go to nursing school.
Lord, give me the strength to make it through
those boring three hour lectures without falling asleep.
Lord, please give me the patience to make it through twelve hour clinicals
with instructors that can't just give you the right answer
and on the same note, give the nurses the ability to remember
what it was like to be a student and give us just a little more respect.
Lord, give me the endurance to read all the assigned readings
and be able to remember it when I am taking a test with four right answers.
Lord, give my family and friends the ability to realize
I really am on the edge of insanity.
Finally, Lord, give me the vision to see that one day I will be a real nurse
and I will never have to wear this ugly uniform again.
by Meredith Joyner
Inspirational Page
number 5
risk factors for the surgical client:
- age: very young and elderly clients are at greater risk
- general health: the presence of infections or other pathophysiology increases risks.
- malnutrition or dehydration (complications: delayed wound healing)
- infection of any kind
- obesity(complications: hypertension, cardiac problems, respiratory problems,delayed wound healing, wound infection)
- cardiac conditions (complications: decreased cardiac output, poor tolerance ofanasthesia)
- respiratory disorders such as asthma (complications: post-op lung infections,poor tolerance of general anasthesia)
- renal disease (complications: fluid and electrolyte imbalance, inadequateexcretion of drugs)
- bleeding disorders (complications: hemorrhage, shock)
- diabetes mellitus (complications: delayed healing, infection)
- liver disease (complications: inability to detoxify medications, hemorrhage,delayed healing)
- neurologic disease (complications: seizures)
- mental status: mental illness, mental retardation, anxiety, and dementia affect the clientsability to cope with surgery. dementia may cause unpredictable response to anasthesia as well.
FOUND IN ATI BOOK PAGE 437
#4 study guide
#4 Discuss nursing interventions to promote oxygenation in the
surgical client.
Positioning of client to allow for maxium chest expansion.
Encourage/provide frequent changes in position when possible.
Encourage ambulation when possible.
Implement measures that promote comfort such as giving pain meds, good pain
control.
Encourage deep breathing (abdominal, pursed lips) and coughing excercises.
Educate/encourage use of incentive spirometer
Keeping airways clear/suctioned when necessary.
Monitor oxygen saturation levels, watch trend.
Maintain proper application/levels of oxygen therapy when in use.
Kozier skills book pg.425
surgical client.
Positioning of client to allow for maxium chest expansion.
Encourage/provide frequent changes in position when possible.
Encourage ambulation when possible.
Implement measures that promote comfort such as giving pain meds, good pain
control.
Encourage deep breathing (abdominal, pursed lips) and coughing excercises.
Educate/encourage use of incentive spirometer
Keeping airways clear/suctioned when necessary.
Monitor oxygen saturation levels, watch trend.
Maintain proper application/levels of oxygen therapy when in use.
Kozier skills book pg.425
Study Guide Question #1
1. Describe the correct documentation of a surgical wound. (Kozier Pg. 925)
- Apperance- Inspect the color of the wound and surrounding area approximation of wound edges.
- Size- Note size and location of dehiscence, if present.
- Drainage- Observe location, color, consistency, odor, and degree of saturation of dressings. Note number of gauzes saturated or diameter of drainage on guaze.
- Swelling- Observe the amount of swelling; minimal to moderate swellig is normal in early stages of wound healing.
- Pain- Expect severe to moderate postoperative pain for 3 to 5 days; persistent severe pain or sudden onset of severe pain may indicate internal hemorrhaging or infection.
- Drains or Tubes- Inspect drain security and placement, amount and character of drainage, and functioning of collecting apparatus, if present.
Math Test!?!
OK, I am on the "Short Bus" NOW! I sucked on the math test. I calculated just fine, but I screwed up on the "Insulin Syringe" (I thought it was 1ml). I am sure I pased with greater than 72%. No way did I score Greater than 90%! For those, that may not have not done very well. Take a deep breathe, we will Conquer this.
Friday, October 13, 2006
Thursday, October 12, 2006
Car Show on Sunday @ Delta!!!
Okay ladies, now I know this isn't Nursing related, but I just wanted to inform you all that on Sunday Oct. 15 my dance group Tamari'i Matairea (you know the polynesian dance group who performed at our Welcoming Tea) will be having a car show to raise funds to bring our main instructor down from Tahiti. All proceeds will go towards the group (i.e. costumes), so if you have the time ( come on now you know you want take a break from our chaotic lives) come on by. And if you know anyone who may want to put their car in just have them contact Alex @209-969-6102. The car show will be at the Cunningham 1 parking lot from 10am-4pm. Come on by!!
Question of the week 10.09.06
The registered nurse has just admitted a client with severe depression. What domain should be the priority focus as the nurse identifies the nursing diagnoses?
1. Nutrition
2. Elimination
3. Activity
4. Safety
1. Nutrition
2. Elimination
3. Activity
4. Safety
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