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 client’s 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 client’s 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

●● Iron-deficiency anemia due to inadequate intake is the most common cause of anemia in children. ◯◯Vision and hearing deficits may interfere with the understanding of teaching. and pregnant women. and choice of treatment will be determined. This provides information regarding the workload of the heart. ◯◯Obesity. ◯◯Secondary causes of diabetes include pancreatitis and Cushing’s syndrome. ●● Indications ◯◯Angina ◯◯Heart Failure ◯◯Myocardial Infarction ◯◯Dysrhythmia Anemias ●● Anemia is an abnormally low amount of circulating RBCs. Stress Testing The cardiac muscle is exercised by the client walking on a treadmill. physical inactivity. ◯◯Toxins and viruses can predispose an individual to diabetes by destroying the beta cells leading to type 1 diabetes mellitus. ◯◯Clients sometimes become too tired and are unable to finish the test. ◯◯ Inadequate RBC production (hypoproliferative). ●● Anemias are due to: ◯◯Blood loss. ◯◯Deficiency of necessary components such as folic acid. and hypertension may lead to the development of insulin resistance and type 2 diabetes. Hgb concentration. reading . adolescents. high triglycerides (greater than 250 mg/dL). ●● Intraprocedure ◯◯A blood specimen is drawn from client via venipuncture. The goal of treatment is to restore and maintain adequate tissue oxygenation. Once the client’s heart rate reaches a certain rate. ●● Anemia results in diminished oxygen-carrying capacity and delivery to tissues and organs. and/or vitamin B12. or both. Diabetes Mellitus ●● Risk Factors ◯◯Genetics may predispose an individual to the occurrence of type 1 or type 2 diabetes. iron. The provider can reorder the test to be done as a pharmacological stress test. the test is discontinued.◯◯Heart disease ◯◯Hyperlipidemia ●● Preprocedure ◯◯Nursing Actions ■■ Explain the reason for the test to the client. ●● Postprocedure ◯◯ Lab findings will be discussed with the client by the provider. ◯◯ Increased RBC destruction (hemolytic).

◯◯Older adult clients may not be able to drive to the health care provider’s office. and medications. pulmonary hypertension. treatment of gastrointestinal obstructions and other disorders. and cardiomyopathy. insulin. and the maintenance of nutritional intake. ◯◯Tissue deterioration secondary to aging may impact the client’s ability to prepare food. myocardial hypertrophy. ●● Research shows improved outcomes following an MI in clients treated with aspirin. perform foot/wound care. and angiotensin-converting enzyme (ACE) inhibitors. ●● Women and older adults do not always experience symptoms typically associated with angina or MI. The average time for a person seeking treatment is 4 hr. Heart Failure and Pulmonary Edema ●● Heart failure occurs when the heart muscle is unable to pump effectively. ●● Heart failure is the result of an acute or chronic cardiopulmonary problem. wound care supplies. valvular heart disease. life-threatening accumulation of fluid in the alveoli and interstitial spaces of the lung that can result from severe heart failure. and preparation of medications. myocardial infarction (MI). Liver Cancer Health Promotion and Disease Prevention .of materials. care for self. and perform glucose monitoring. Gastrointestinal Therapeutic Procedures ●● Gastrointestinal therapeutic procedures are performed for reasons including treatment of obesity. Angina and Myocardial Infarction ●● Angina pectoris is a warning sign of an impending acute MI. ●● The majority of deaths from an MI occur within 1 hr of symptom onset. perform ADLs. ●● Pulmonary edema is a severe. The heart is unable to maintain adequate circulation to meet tissue needs. dysrhythmias. and pulmonary/systemic congestion. ◯◯A fixed income may mean that there are limited funds for buying diabetic supplies. this may result in complications. Early recognition and treatment of an acute MI is essential to prevent death. ●● 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. resulting in inadequate cardiac output. pericarditis. such as systemic hypertension. betablockers.

◯◯A pulse oximeter is a battery. the more alkaline the body fluids and the higher the pH. and the sharing of needles all increase risk). Respiratory Diagnostic Procedures ●● Respiratory diagnostic procedures are used to evaluate a client’s respiratory status by checking indicators such as the oxygenation of the blood. Acid-Base Imbalances ●● For cells to function optimally. ◯◯Acid-base balance represents homeostasis of hydrogen (H+) ion concentration in body fluids. Arterial blood gases (ABGs) are most commonly used to evaluate acid-base balance. which is regulated by the lungs. Heart Failure and Pulmonary Edema ●● Heart failure occurs when the heart muscle is unable to pump effectively.or electric-operated device with a sensor probe that is attached securely onto the client’s fingertip. lung functioning. ◯◯Minor changes in hydrogen concentration have major effects on normal cellular function. and the integrity of the airway. metabolic processes must maintain a steady balance between the acids and bases found in the body. bridge of nose. SaO2 and SpO2 are used interchangeably. ●● Take precautions against hepatitis B and C (recognize that multiple sexual partners. resulting in inadequate cardiac output. toe. . ■■ The lower the concentration of hydrogen. and bicarbonate (HCO3 -). ◯◯The pH is the expression of the balance between carbon dioxide (CO2). myocardial hypertrophy. the more acidic the body fluids and the lower the pH. earlobe. a base regulated by the kidneys. ●● Eat a low-fat diet and maintain a BMI less than 30. ●● Receive a hepatitis B vaccination. Hydrogen shifts between the extracellular and intracellular compartments to compensate for acid-base imbalances. ●● Arterial pH is an indirect measurement of hydrogen ion concentration and is a result of respiratory and renal compensational function. ◯◯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. and pulmonary/systemic congestion. IV drug use. or forehead with a clip or band. ■■ The greater the concentration of hydrogen. but it is not a replacement for ABG measurement.●● Avoid excessive alcohol intake. ●● 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.

and thyrocalcitonin (calcitonin). dysrhythmias. and hemorrhage. necrosis. energy production. but overall mortality is 10% to 20%. Cushing’s Disease/Syndrome ●● Cushing’s disease and Cushing’s syndrome are caused by an over secretion of the adrenal cortex. ●● The adrenal cortex produces: ◯◯Mineralocorticoids – Aldosterone (increases sodium absorption. and the body’s immune function) ◯◯Sex hormones – Androgens and estrogens ●● With Cushing’s disease. . and knife-like pain (right upper quadrant. Amputations ●● Amputation is the removal of a body part. such as systemic hypertension. myocardial infarction (MI). life-threatening accumulation of fluid in the alveoli and interstitial spaces of the lung that can result from severe heart failure. constant. there is an excess of glucocorticoids. the body’s response to stress. Hyperthyroidism ●● The thyroid gland produces three hormones: thyroxine (T4). ●● Acute pancreatitis is an inflammation of the pancreas from activated pancreatic enzymes autodigesting the pancreas. proteins. ●● Classic signs and symptoms of an acute attack include severe.The heart is unable to maintain adequate circulation to meet tissue needs. pulmonary hypertension. Pancreatitis ●● Pancreatitis is an autodigestion of the pancreas from premature activation (before reaching the intestines) of pancreatic digestive enzymes (exact mechanism unknown). ●● Heart failure is the result of an acute or chronic cardiopulmonary problem. and carbohydrates. resulting in increased cortisol and increased androgens. triiodothyronine (T3). pericarditis. It can result in inflammation. thyroid-stimulating hormone (TSH) is released by the anterior pituitary. most commonly an extremity. Severity varies. and cardiomyopathy. ●● Amputations are described in regard to the extremity and whether they are located above or below the designated joint. causes potassium excretion in the kidney) ◯◯Glucocorticoids – Cortisol (affects glucose. ●● Pulmonary edema is a severe. protein. Secretion of T3 and T4 is regulated by the anterior pituitary gland through a negative feedback mechanism. gastric. ●● T3 and T4 affect all body systems by regulating overall body metabolism. and fluid and electrolyte balance and controlling tissue use of fats. ●● When serum T3 and T4 levels decrease. and fat metabolism. and/or radiating to the back) that is unrelieved by nausea and vomiting. ●● The term disarticulation describes an amputation performed through a joint. This stimulates the thyroid gland to secrete more hormones until normal levels are reached. valvular heart disease.

●● 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. diffusion. or in the operating room through a thoracotomy incision. ●● Dialysis can sustain life for clients who have both acute and chronic renal failure. ●● Nurses should be familiar with the various types of pacemakers. ●● Pacemakers are composed of two parts: ◯◯The pulse generator houses the energy source (battery) and the control center. or air. facilitate lung expansion. at the client’s bedside. and ultrafiltration. and restore normal intrapleural pressure. ◯◯Achieves acid-base balance. ●● Dialysis does not replace the hormonal functions of the kidneys. reestablish a negative pressure. ●● Oxygen is used to maintain adequate cellular oxygenation. ●● 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. Fluid Imbalances ●● Body fluids are distributed between intracellular (ICF) and extracellular (ECF) fluid compartments. ◯◯Restores internal homeostasis by osmosis. and the care involved with their placement/insertion. ●● Fluid can move between compartments (through selectively permeable membranes) by a variety of methods (diffusion. ●● Chest tubes can be inserted in the emergency department. ◯◯Eliminates waste products. how they function. osmosis) to maintain homeostasis. blood. It is used in the treatment of many acute and chronic respiratory problems. Pacemakers ●● Pacemakers may be temporary or permanent. ◯◯The electrodes are wires that attach to the myocardial muscle on one side and connect to the pulse generator on the other. ●● Fluid imbalances that nurses should be familiar with are: ◯◯Fluid Volume Deficits ◯◯Fluid Volume Excess Cardiovascular Hemodynamics . Chest Tube Insertion ●● Chest tubes are inserted into the pleural space to drain fluid. active transport.Hemodialysis and Peritoneal Dialysis ●● Functions of dialysis ◯◯Rids the body of excess fluid and electrolytes. filtration.

It is thought to be an autoimmune disorder and has periods of exacerbations and remissions. ■■ 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. psoriasis can also affect the joints. ●● Osteopenia.◯◯Hemodynamic status is assessed with several parameters. ●● T3 and T4 affect all body systems by regulating overall body metabolism. bone density decreases. the precursor to osteoporosis. ●● When serum T3 and T4 levels decrease. It is characterized by papulopustules (oily form) or flaky plaques (dry form) that form on the surface of the skin. energy production. Chronic Skin Conditions ●● Psoriasis is a skin disorder that is characterized by scaly. and fluid and electrolyte balance and controlling tissue use of fats. ●● Seborrheic dermatitis is a skin disorder caused by inflammation of areas of the skin that contain a high number of sebaceous glands. and the aging process. causing arthritis-type changes and pain. with a significant increase in the rate of loss in postmenopausal women due to estrogen loss. Dandruff is a type of seborrheic dermatitis. This overproduction can occur at a rate up to nine times the rate of normal cells. refers to low bone mineral density for what is expected for the client’s age and sex. After peak years. ●● Peak bone mineral density occurs between the ages of 30 and 35. Secretion of T3 and T4 is regulated by the anterior pituitary gland through a negative feedback mechanism. Disorders of the Eye ●● Disorders of the eye can be caused by injury. ●● In some clients. proteins. triiodothyronine (T3). and carbohydrates. Hyperthyroidism ●● The thyroid gland produces three hormones: thyroxine (T4). 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. dermal patches and is caused by an overproduction of keratin. Osteoporosis ●● Osteoporosis is the most common metabolic bone disorder resulting in low bone density. a transducer. ◯◯A pressure-monitoring system comprised of a catheter with an infusion system. and thyrocalcitonin (calcitonin). disease process. It is measured by a pulmonary artery catheter with fiberoptics. thyroid-stimulating hormone (TSH) is released by the anterior pituitary. This stimulates the thyroid gland to secrete more hormones until normal levels are reached. . and a monitor is used to display a client’s hemodynamic information.

●● Classic signs and symptoms of an acute attack include severe. PUD Health Promotion and Disease Prevention ●● Drink alcohol in moderation. ABGs. BUN. gastric. and knife-like pain (right upper quadrant. ●● Acute pancreatitis is an inflammation of the pancreas from activated pancreatic enzymes autodigesting the pancreas. ●● Use stress management techniques. necrosis. fasting blood glucose. . and/or radiating to the back) that is unrelieved by nausea and vomiting. ☐☐ 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). ●● Avoid NSAIDS as indicated. but overall mortality is 10% to 20%. serum electrolytes. Burns: Lab Tests ■■ Laboratory values that should be evaluated include – CBC. and hemorrhage. ●● Smoking cessation.●● 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. Severity varies. and clotting studies. urinalysis. It can result in inflammation. constant. liver enzymes.

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