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ATI Remediation for MED/Surg Test

Postop Nursing Care


Transferring a client who is postoperative from the operating suite to the postanesthesia care unit (PACU) is the responsibility of the anesthesia provider who is either an anesthesiologist or a certified registered nurse anesthetist (CRNA). The circulating nurse will give the report to the PACU nurse. Postoperative care is usually provided initially in the PACU, where skilled nurses can closely monitor a clients recovery from anesthesia. In some instances a client is transferred from the operating suite directly to the intensive care unit. Initial postoperative care involves making assessments, providing medications, managing the clients pain, preventing complications, and determining when a client is ready to be discharged from the PACU

Heart Failure and Pulmonary Edema


Heart failure occurs when the heart muscle is unable to pump effectively, resulting in inadequate cardiac output, myocardial hypertrophy, and pulmonary/systemic congestion. The heart is unable to maintain adequate circulation to meet tissue needs. Heart failure is the result of an acute or chronic cardiopulmonary problem, such as systemic hypertension, myocardial infarction (MI), pulmonary hypertension, dysrhythmias, valvular heart disease, pericarditis, and cardiomyopathy. Pulmonary edema is a severe, life-threatening accumulation of fluid in the alveoli and interstitial spaces of the lung that can result from severe heart failure.

Electrolyte Imbalances
Electrolytes are minerals (sometimes called salts) that are present in all body fluids. They regulate fluid balance and hormone production, strengthen skeletal structures, and act as catalysts in nerve response, muscle contraction, and the metabolism of nutrients. When dissolved in water or other solvent, electrolytes separate into ions and conduct either a positive (cations magnesium, potassium, sodium, calcium) or negative (anions phosphate, sulfate, chloride, bicarbonate) electrical current. Electrolytes are distributed between intracellular (ICF) and extracellular (ECF) fluid compartments. While laboratory tests can accurately reflect the electrolyte concentrations in plasma, it is not possible to directly measure electrolyte concentrations within cells.

Cardiovascular Diagnostic and Therapeutic Procedures


Cardiac enzymes are released into the bloodstream when the heart muscle suffers ischemia. A lipid profile provide information regarding cholesterol levels and is used for early detection of heart disease. Cardiac enzymes are a specific marker in diagnosing an MI. Indications Angina MI

Heart disease Hyperlipidemia Preprocedure Nursing Actions Explain the reason for the test to the client. Intraprocedure A blood specimen is drawn from client via venipuncture. Postprocedure Lab findings will be discussed with the client by the provider, and choice of treatment will be determined.

Stress Testing
The cardiac muscle is exercised by the client walking on a treadmill. This provides information regarding the workload of the heart. Once the clients heart rate reaches a certain rate, the test is discontinued. Clients sometimes become too tired and are unable to finish the test. The provider can reorder the test to be done as a pharmacological stress test. Indications Angina Heart Failure Myocardial Infarction Dysrhythmia

Anemias
Anemia is an abnormally low amount of circulating RBCs, Hgb concentration, or both. Anemia results in diminished oxygen-carrying capacity and delivery to tissues and organs. The goal of treatment is to restore and maintain adequate tissue oxygenation. Anemias are due to: Blood loss. Inadequate RBC production (hypoproliferative). Increased RBC destruction (hemolytic). Deficiency of necessary components such as folic acid, iron, and/or vitamin B12. Iron-deficiency anemia due to inadequate intake is the most common cause of anemia in children, adolescents, and pregnant women.

Diabetes Mellitus
Risk Factors Genetics may predispose an individual to the occurrence of type 1 or type 2 diabetes. Toxins and viruses can predispose an individual to diabetes by destroying the beta cells leading to type 1 diabetes mellitus. Obesity, physical inactivity, high triglycerides (greater than 250 mg/dL), and hypertension may lead to the development of insulin resistance and type 2 diabetes. Secondary causes of diabetes include pancreatitis and Cushings syndrome. Vision and hearing deficits may interfere with the understanding of teaching, reading

of materials, and preparation of medications. Tissue deterioration secondary to aging may impact the clients ability to prepare food, care for self, perform ADLs, perform foot/wound care, and perform glucose monitoring. A fixed income may mean that there are limited funds for buying diabetic supplies, wound care supplies, insulin, and medications; this may result in complications. Older adult clients may not be able to drive to the health care providers office,

Angina and Myocardial Infarction


Angina pectoris is a warning sign of an impending acute MI. Women and older adults do not always experience symptoms typically associated with angina or MI. The majority of deaths from an MI occur within 1 hr of symptom onset. The average time for a person seeking treatment is 4 hr. Early recognition and treatment of an acute MI is essential to prevent death. Research shows improved outcomes following an MI in clients treated with aspirin, betablockers, and angiotensin-converting enzyme (ACE) inhibitors.

Heart Failure and Pulmonary Edema


Heart failure occurs when the heart muscle is unable to pump effectively, resulting in inadequate cardiac output, myocardial hypertrophy, and pulmonary/systemic congestion. The heart is unable to maintain adequate circulation to meet tissue needs. Heart failure is the result of an acute or chronic cardiopulmonary problem, such as systemic hypertension, myocardial infarction (MI), pulmonary hypertension, dysrhythmias, valvular heart disease, pericarditis, and cardiomyopathy. Pulmonary edema is a severe, life-threatening accumulation of fluid in the alveoli and interstitial spaces of the lung that can result from severe heart failure.

Gastrointestinal Therapeutic Procedures


Gastrointestinal therapeutic procedures are performed for reasons including treatment of obesity, treatment of gastrointestinal obstructions and other disorders, and the maintenance of nutritional intake. Gastrointestinal therapeutic procedures that nurses should be knowledgeable about Bariatric surgeries Nasogastric decompression Ostomies Enteral feedings Total parenteral nutrition (TPN) Paracentesis Bariatric Surgeries Bariatric surgeries are done as a treatment for morbid obesity when other weight control methods have failed.

Liver Cancer Health Promotion and Disease Prevention

Avoid excessive alcohol intake. Eat a low-fat diet and maintain a BMI less than 30. Receive a hepatitis B vaccination. Take precautions against hepatitis B and C (recognize that multiple sexual partners, IV drug use, and the sharing of needles all increase risk).

Respiratory Diagnostic Procedures


Respiratory diagnostic procedures are used to evaluate a clients respiratory status by checking indicators such as the oxygenation of the blood, lung functioning, and the integrity of the airway. Respiratory diagnostic procedures that nurses should be knowledgeable about include: Pulse oximetry ABGs Bronchoscopy Thoracentesis Pulse oximetry is a noninvasive measurement of the oxygen saturation of the blood, but it is not a replacement for ABG measurement. A pulse oximeter is a battery- or electric-operated device with a sensor probe that is attached securely onto the clients fingertip, toe, bridge of nose, earlobe, or forehead with a clip or band. Pulse oximetry measures arterial oxygen saturation (SaO2) via a wave of infrared light that measures light absorption by oxygenated and deoxygenated Hgb in arterial blood. SaO2 and SpO2 are used interchangeably.

Acid-Base Imbalances
For cells to function optimally, metabolic processes must maintain a steady balance between the acids and bases found in the body. Acid-base balance represents homeostasis of hydrogen (H+) ion concentration in body fluids. Hydrogen shifts between the extracellular and intracellular compartments to compensate for acid-base imbalances. Minor changes in hydrogen concentration have major effects on normal cellular function. Arterial pH is an indirect measurement of hydrogen ion concentration and is a result of respiratory and renal compensational function. Arterial blood gases (ABGs) are most commonly used to evaluate acid-base balance. The pH is the expression of the balance between carbon dioxide (CO2), which is regulated by the lungs, and bicarbonate (HCO3 -), a base regulated by the kidneys. The greater the concentration of hydrogen, the more acidic the body fluids and the lower the pH. The lower the concentration of hydrogen, the more alkaline the body fluids and the higher the pH.

Heart Failure and Pulmonary Edema


Heart failure occurs when the heart muscle is unable to pump effectively, resulting in inadequate cardiac output, myocardial hypertrophy, and pulmonary/systemic congestion.

The heart is unable to maintain adequate circulation to meet tissue needs. Heart failure is the result of an acute or chronic cardiopulmonary problem, such as systemic hypertension, myocardial infarction (MI), pulmonary hypertension, dysrhythmias, valvular heart disease, pericarditis, and cardiomyopathy. Pulmonary edema is a severe, life-threatening accumulation of fluid in the alveoli and interstitial spaces of the lung that can result from severe heart failure.

Hyperthyroidism
The thyroid gland produces three hormones: thyroxine (T4), triiodothyronine (T3), and thyrocalcitonin (calcitonin). Secretion of T3 and T4 is regulated by the anterior pituitary gland through a negative feedback mechanism. When serum T3 and T4 levels decrease, thyroid-stimulating hormone (TSH) is released by the anterior pituitary. This stimulates the thyroid gland to secrete more hormones until normal levels are reached. T3 and T4 affect all body systems by regulating overall body metabolism, energy production, and fluid and electrolyte balance and controlling tissue use of fats, proteins, and carbohydrates.

Amputations
Amputation is the removal of a body part, most commonly an extremity. Amputations are described in regard to the extremity and whether they are located above or below the designated joint. The term disarticulation describes an amputation performed through a joint.

Pancreatitis
Pancreatitis is an autodigestion of the pancreas from premature activation (before reaching the intestines) of pancreatic digestive enzymes (exact mechanism unknown). It can result in inflammation, necrosis, and hemorrhage. Classic signs and symptoms of an acute attack include severe, constant, and knife-like pain (right upper quadrant, gastric, and/or radiating to the back) that is unrelieved by nausea and vomiting. Acute pancreatitis is an inflammation of the pancreas from activated pancreatic enzymes autodigesting the pancreas. Severity varies, but overall mortality is 10% to 20%.

Cushings Disease/Syndrome
Cushings disease and Cushings syndrome are caused by an over secretion of the adrenal cortex. The adrenal cortex produces: Mineralocorticoids Aldosterone (increases sodium absorption, causes potassium excretion in the kidney) Glucocorticoids Cortisol (affects glucose, protein, and fat metabolism; the bodys response to stress, and the bodys immune function) Sex hormones Androgens and estrogens With Cushings disease, there is an excess of glucocorticoids, resulting in increased cortisol and increased androgens.

Hemodialysis and Peritoneal Dialysis


Functions of dialysis Rids the body of excess fluid and electrolytes. Achieves acid-base balance. Eliminates waste products. Restores internal homeostasis by osmosis, diffusion, and ultrafiltration. Dialysis can sustain life for clients who have both acute and chronic renal failure. Dialysis does not replace the hormonal functions of the kidneys.

Pacemakers
Pacemakers may be temporary or permanent. Pacemakers are composed of two parts: The pulse generator houses the energy source (battery) and the control center. The electrodes are wires that attach to the myocardial muscle on one side and connect to the pulse generator on the other. Nurses should be familiar with the various types of pacemakers, how they function, and the care involved with their placement/insertion.

Chest Tube Insertion


Chest tubes are inserted into the pleural space to drain fluid, blood, or air; reestablish a negative pressure; facilitate lung expansion; and restore normal intrapleural pressure. Chest tubes can be inserted in the emergency department, at the clients bedside, or in the operating room through a thoracotomy incision. Chest tubes are removed when the lungs have reexpanded and/or there is no more fluid drainage.

Oxygen Therapy and Mechanical Ventilation


Oxygen is a tasteless and colorless gas that accounts for 21% of atmospheric air. Oxygen is used to maintain adequate cellular oxygenation. It is used in the treatment of many acute and chronic respiratory problems. Oxygen is administered in an attempt to maintain an SaO2 of at least 95% to 100% by using the lowest amount of oxygen without putting the client at risk for complications.

Fluid Imbalances
Body fluids are distributed between intracellular (ICF) and extracellular (ECF) fluid compartments. Fluid can move between compartments (through selectively permeable membranes) by a variety of methods (diffusion, active transport, filtration, osmosis) to maintain homeostasis. Fluid imbalances that nurses should be familiar with are: Fluid Volume Deficits Fluid Volume Excess

Cardiovascular Hemodynamics

Hemodynamic status is assessed with several parameters. Central venous pressure (CVP) Pulmonary artery pressure (PAP) Pulmonary artery wedge pressure (PAWP) Cardiac output (CO) Intra arterial pressure Mixed venous oxygen saturation (SvO2) indicates the balance between oxygen supply and demand. It is measured by a pulmonary artery catheter with fiberoptics. A pressure-monitoring system comprised of a catheter with an infusion system, a transducer, and a monitor is used to display a clients hemodynamic information.

Chronic Skin Conditions


Psoriasis is a skin disorder that is characterized by scaly, dermal patches and is caused by an overproduction of keratin. This overproduction can occur at a rate up to nine times the rate of normal cells. It is thought to be an autoimmune disorder and has periods of exacerbations and remissions. In some clients, psoriasis can also affect the joints, causing arthritis-type changes and pain. Seborrheic dermatitis is a skin disorder caused by inflammation of areas of the skin that contain a high number of sebaceous glands. It is characterized by papulopustules (oily form) or flaky plaques (dry form) that form on the surface of the skin. Dandruff is a type of seborrheic dermatitis.

Hyperthyroidism
The thyroid gland produces three hormones: thyroxine (T4), triiodothyronine (T3), and thyrocalcitonin (calcitonin). Secretion of T3 and T4 is regulated by the anterior pituitary gland through a negative feedback mechanism. When serum T3 and T4 levels decrease, thyroid-stimulating hormone (TSH) is released by the anterior pituitary. This stimulates the thyroid gland to secrete more hormones until normal levels are reached. T3 and T4 affect all body systems by regulating overall body metabolism, energy production, and fluid and electrolyte balance and controlling tissue use of fats, proteins, and carbohydrates.

Osteoporosis
Osteoporosis is the most common metabolic bone disorder resulting in low bone density. Osteoporosis occurs when the rate of bone resorption (osteoclast cells) exceeds the rate of bone formation (osteoblast cells) resulting in fragile bone tissue and subsequent fractures. Osteopenia, the precursor to osteoporosis, refers to low bone mineral density for what is expected for the clients age and sex. Peak bone mineral density occurs between the ages of 30 and 35. After peak years, bone density decreases, with a significant increase in the rate of loss in postmenopausal women due to estrogen loss.

Disorders of the Eye


Disorders of the eye can be caused by injury, disease process, and the aging process.

Disorders of the eye that nurses should be knowledgeable about include: Reduced vision Macular degeneration Retinal detachment Cataracts Glaucoma Macular degeneration (often called age-related macular degeneration AMD) is the central loss of vision which affects the macula of the eye.

PUD Health Promotion and Disease Prevention


Drink alcohol in moderation. Smoking cessation. Use stress management techniques. Avoid NSAIDS as indicated.

Burns: Lab Tests


Laboratory values that should be evaluated include CBC, serum electrolytes, BUN, ABGs, fasting blood glucose, liver enzymes, urinalysis, and clotting studies. Initial fluid shift (first 24 hr after injury) XX Hct and Hgb Elevated due to loss of fluid volume and fluid shifts into interstitial spacing (third spacing) XX Sodium Decreased due to third spacing (Hyponatremia) XX Potassium Increased due to cell destruction (Hyperkalemia) Fluid mobilization (48 to 72 hr after injury) Hgb and Hct Decreased due to fluid shift from interstitial back into vascular fluid Sodium Remains decreased due to renal and wound loss Potassium Decreased due to renal loss and movement back into cells (Hypokalemia) WBC count Initial increase then decrease with left shift

Pancreatitis
Pancreatitis is an autodigestion of the pancreas from premature activation (before reaching the intestines) of pancreatic digestive enzymes (exact mechanism unknown). It can result in inflammation, necrosis, and hemorrhage. Classic signs and symptoms of an acute attack include severe, constant, and knife-like pain (right upper quadrant, gastric, and/or radiating to the back) that is unrelieved by nausea and vomiting. Acute pancreatitis is an inflammation of the pancreas from activated pancreatic enzymes autodigesting the pancreas. Severity varies, but overall mortality is 10% to 20%.