Med surge study guide

Page 177 table 12-8 and 12-9

Pg 169

When a patient comes into the hospital with a high BAC level what would you be
watching for? Does not matter the BAC, if they been drinking for a long time and they
come in what would you look for? She is going to give a BAC, so look over the little box;
look at the BAC levels and see how they are responding to it. Symptoms for each level.
Withdrawal symptoms

Pg 187 perioperative care

Respiratory and bleeding- these are risks for any operative procedures when alcohol is
involved. These are the main two you would be looking for. What kind of risks does
someone intoxicated bring with them to surgery?

Know that Narcan reverses a narcotic

Chapter 10 Pain
Pg 138

Don’t give Demerol to a patient for chronic pain because it may cause neurotoxicity.
Look at what drugs you would not give for chronic pain vs. acute pain. Darvon is only as
effective as 600 mg of Aspirin and not given for chronic pain due to toxic levels
produced.

Pg 170
What age group would you focus on as a nurse for prevention teaching on tobacco if the
majority starts around ages 18-25?
You would start teaching at high school or before the age of 18.

Pg 134
How does chronic pain affect someone?
It interferes with ADL’s.

Pg 168
What do you think is a sign of Heroin abuse?
Track marks
Tobacco use- their hair and clothes smell
Marijuana-
Cocaine- nasal sores, septal necrosis or perforations, chronic sinusitis, cardiac
dysrhythmias, myocardial ischemia and infarction
Pg 169, 175
What is the most important intervention for a nurse to watch for with someone on
methamphetamines? Crystal meth
They could have possible MI’s or cardiac problems- hook them up to EKG and watch for
ST depression on monitors

Pg 177 complications
Acute alcohol toxicity may occur with binge drinking or the use of alcohol with other
CNS depressants. Alcohol-induced CNS depression leads to respiratory and circulatory
failure manifested by depressed respirations, hypotension, hypothermia, and a decreased
LOC. Look at physical complications in box 12-9.
One complication of chronic alcohol abuse is Wernicke’s encephalopathy, an
inflammatory, hemorrhagic, degenerative condition of the brain. It’s caused by a
thiamine deficiency resulting from poor diet and alcohol induced suppression of thiamine
absorption. Treatment is administering thiamine. If left untreated it may lead to
Korsakoff’s psychosis, an irreversible form of amnesia characterized by loss of short-
term memory and an inability to learn. Make sure you know your priorities. Give them
the thiamine first over giving them ativan to calm them down because calming them
down is not going to help much or work.

Pg 175 table 12-7

Know your priorities!! What comes first?
If they are having short of breath, you’re going to put on oxygen before anything. It’s not
listed on the chart, but breathing comes first. They may not need to be intibated, but they
are having SOB and maybe heart palpitations, put on O2 first.

Pg 352
Same day surgeries- what is a concern for the patient? Transportation, how are they going
to get home…?
If they have sleep apnea, you’re not going to send them home; look at questions you
would ask preoperatively to the patient for teaching. Table 18-7, maybe tables 18-3 and
18-5. Teaching the patient to reduce fear and anxiety

Pg 347 Complementary and Alternative therapies

Blue table
Some cause increase bleeding with anticoagulants, some prolong anesthetic effects.
These things cause patients to recover slower from surgery

*If a patient does not understand the procedures, do not make them sign the consent
form. Hold it and call the doctor so he can come back in and reteach the patient.

*What do you want to teach pt having abdominal surgery?

Deep breath and cough
Pg 37 Culture
What do you do when you don’t have an interpreter and need to communicate with the
patient?
Use gestures or hand signals

Pg 35
Empaco- a condition described as food forming into a ball that clings to the stomach or
intestines, causing pain and cramping. Empaco is treated by folk remedies such as strong
massage over the stomach, use of medications, or gently pinching and rubbing the spine.
Your patient has Empaco and they explain what it is what are you going to do?
As them, “what treatments help you with the pain?”

Pg 34 Immigrants and Immigration

Problems- cultural stress from relocating to new place and tuberculosis (TB). Asians have
the highest rate of TB

Pg 114 summary of stress response

The fight-or-flight response is a very important adaptive mechanism of the body to acute
stress. The acute stress response is a state of physiologic and psychological arousal
characterized by increased sympathetic nervous system activity that leads to increased
heart and respiratory rate, increased BP, increased muscle tension, increased brain
activity and decreased skin temperature.
If someone comes in the ER that has just been raped, you may see the above signs and
symptoms. You take the vital signs when they arrive, make sure you take vital signs
before they leave to make sure that their BP and HR was just increased due to the major
stress they just experiences.

What are you going to say when someone has a lot of stressors in their life and they tell
you they can’t take it anymore?
Ask them, can you tell me about your life? Get them to talk about it to get them some
relief.

What happens to blood sugars when you’re stressed?

They increase, diabetics will stress in the hospital and will have higher blood pressures.
They may control their sugars with diet and exercise and they come into hospital and they
need insulin they freak out.

Pg 138
Side effects of opioids- constipation is the most common one and they should be started
on a gentle stimulant laxative.
If someone is nauseated from them, give them Reglan- reduces the full feeling

Pg 138
Talwin- is an opiate
• They cause more agitation- most common problem
Give Tylenol before you give something stronger like morphine

Anyone who is going to surgery, you better be checking their blood glucose before they
go to surgery. When you get the labs back take them to OR immediately.

If a patient states to you that they have had Rheumatic fever at sometime in their life and
are going to have surgery, this is a major problem. They need to have prophylactic
antibiotics. They could have bacterial endocarditis from this.

What kinds of questions will they ask you before you have anesthesia?
Allergies – make sure you find out family history if anyone in family have had problems
with anesthesia.

Why do they have all those pieces of tapes in the OR?

To reduce the transmission of infection

Pg 364 admitting the patient; first paragraph

They have to be able to state their name, doctor’s name, the operative procedure and
location. These are compared with patients ID band and charts.

Pg 369 IV barbiturates

What drugs are used in conscious sedation? Versed

Pg 370 neuromuscular blocking agents

What do they do, what do they target?

Pg 378 PACU
What is the first thing the PACU nurse checks for when a patient comes from another
floor to the PACU?
Airway and pulse ox

Pg 386 nursing assessment- parameters

Pg 389
What is post-op hypothermia?
Who is at risk for it? Long surgeries most at risk

A patient goes from the PACU to the med surge floor, the first action the nurse does is
ABC’s

Patients are at risk for DVT’s after surgery due to immobilization

Pg 392
Most patients urinate with in 6-8 hours after surgery; if nothing by then palpate the
abdomen for distention. Distention for retention

If you suspect any bleeding after surgery, what do you do?

Take VS for Hypovolemic shock

Know signs and symptoms of DVT’s

What are signs of Atelectasis?

Temperature of 100.4 (pg 390 table 20-6)

Make sure you secure IV lines when a patient is waking up from anesthesia.

For final- study NCLEX books, workbooks and CD questions

Cardiac, neuro, GI and this study guide for final