Test Yourself: Fluid, Electrolytes, Acid-Base Imbalances, and Burns Practice Test

 

Grab a pen and paper and test yourself. Answers and rationale at the end of the exam. Good luck!

Care of Clients with Burns

 

Grab a pen and paper and test yourself. Answers and rationale at the end of the exam. Good luck!

Nursing Care of Clients with Fluid, Electrolytes, & Acid-Base Imbalances - PNLE/NCLEX Review

 

Grab a pen and paper and test yourself. Answers and rationale at the end of the exam. Good luck!

Perioperative Nursing - PNLE/NCLEX Must Knows

 Purposes of Surgery:

Ø  Diagnostic - Removal and study w/ use of instruments to make a diagnosis

Ø  Exploratory - More extensive means to diagnose, exploration of body cavity or use of scopes inserted through small incision

Ø  Curative - Removal or replacement of defective tissue to restore fxn

Ø  Palliative  - Relief of symptoms or enhancement of function w/o cure

Ø  Cosmetic  -Improve the appearance and correction of defects

Ø  Transplant  - Replaces malfunctioning structures

Types of Surgery

Ø  Emergency – done immediately to save life or limb

Ø  Elective – done at patient’s and surgeon’s convenience

Ø  Major – complicated, prolonged, large blood losses, vital organs involved

Ø  Minor – few complications, often outpatient

3 Phases:

Ø  Pre-operative

Ø  Intra-operative

Ø  Post-operative

 PRE-OPERATIVE PERIOD

Ø  Used to physically and psychologically prepare the patient for surgery

Ø  Nursing Diagnoses:

o   Anxiety

o   Knowledge Deficit

o   Diagnostic evaluation:

o   CBC,

o   Urinalysis        

o   ECG, CXR (Cardiopulmonary Clearance)

o   Blood chemistries

o   Electrolyte levels (cardiac arrhythmias)

Ø  Nursing Responsibilities:

o   Encourage the patient to verbalize feelings

o   Encourage to participate in decision making- help maintain sense of control

o   Provide teaching (DBCE, splinting, use of IS, leg exercises)- decrease complications

o   Provide the necessary information needed by the client

o   Informed consent (disclosure, understanding, competence)

Ø  Nursing Care - Physical:

o   GI – NPO, Laxatives, Enema

o   Provide adequate rest and sleep

o   Night before surgery:

o   Barbiturates – help go to sleep

o   Provide quiet environment – eliminate noise and distrations

o   Provide back rubs

Ø  Nursing Care – Skin Preparation:

o   Scrub with antimicrobial agent

o   Hair should remain unless it interferes with surgical procedure

o   Note for nicks, cuts, irritations

o   Depilatory creams or clipping of hair is preferred to shaving with a razor

o   Skin prep may be done in surgery

Ø  Pre-operative medications:

o   Anticholinergics

o   Analgesics

o   Sedatives

o   Anti-histamines

o   Antibiotics

Ø  Day of Surgery:

o   AM care

o   Pre-operative checklist

o   Remove nail polish, jewelry, contact lenses, dentures

o   Give valuable items

o   Chart disposition of items

o   Proper identification: Check band for secureness and legibility; surgical site may be marked to prevent error

 

INTRAOPERATIVE PERIOD: ANESTHESIA CARE

Ø  Regional

o   Intact consciousness, loss of motor and sensory perception to a particular area of the body

Ø  Spinal – local anesthetic to subarachnoid space in lumbar area

Ø  Epidural – epidural space

ANESTHESIA CARE

Ø  Regional

o   Uses: Lower legs, abdominal or perineal area

o   Nursing Responsibilities:

§  Assess VS

§  Assess for return of sensation and motor function

§  Keep flat on bet at least 3-4 hrs

§  Provide adequate hydration

Ø  General Anesthesia

o   Produces unconsciousness; blocks motor and sensory pathway to major nerve and muscle groups

o   Inhalation gas or IV injection or rectal

o   Ex: Inhalation anesthetics

o   Nitrous oxide

o   Halothane

o   Isoflurane

 

Ø  Preinduction

o   Initiation of IV access, administration of pre-op meds

o   RN Role:

§  Check consent

§  Complete pre-op assessment

§  Complete surgical time out

Ø  Induction

o   Initiation of drugs that make patient unconscious

o   RN Role:

§  Help with application of monitors

§  Assist in airway management

Ø  Maintenance

o   Procedure being done

o   Patient is unconscious

o   RN Role:

§  Adjust pt position PRN

§  Monitor pt safety

Ø  Emergence

o   Procedure is completed

o   Return to consciousness

o   Removal of airway assist devices

o   RN Role:

§  Help place dressing

§  Protect pt during return of reflexes

§  Prepare transfer to PACU

Post-Anesthesia Care Unit (PACU)

Ø  Monitor ABC

Ø  Airway and Breathing – Check O2 Sat also

Ø  Prevent aspiration – Side-Lying

Ø  Circulation – Bleeding, BP, HR

Ø  Monitor return of sensation and motor function

POST-OPERATIVE PERIOD

 Concerns during the post-op period:

Ø  A – Atelectasis

Ø  B – Bleeding or hemorrhage

Ø  C – Cardiac events (MI, arrhythmias)

Ø  D – Deep vein thrombosis

Ø  E – Electrolyte imbalances

Ø  F – Fever or infection

POST-OPERATIVE COMPLICATIONS

Ø  Altered Respiratory Function

o   Causes: Airway obstruction, Anesthesia, Atelectasis, COPD, Pain

o   Assessment: Dyspnea, tachycardia (hypoxia), decreased breath sounds (alveolar collapse), crackles, rhonchi and noisy respirations, pallor, anxiety, restlessness

**Atelectasis – most common cause of increased body temperature (>38°C) during the 1st 24 hours of surgery

o   Nursing Care: Maintain patent airway

§  DBCTE, use of IS

§  Splinting of incision

§  Early ambulation

§  Administer analgesics as ordered

§  Administer antibiotics as ordered

Ø  Altered Mental Status

o   Nursing Care

§  Monitor LOC- GCS

§  Observe for decreased reflexes (gag, cough, swallow and DTR)

§  Observe for pupillary response (brisk or sluggish)

§  Observe patient’s safety at all times

§  Be careful in giving narcotics

Ø  Discomfort and Pain

o   Nursing Care

§  Administer narcotics as ordered (Codeine, Morphine, Demerol, Nalbuphine)

§  Reposition every 2 hours

§  Reduce anxiety and teach relaxation techniques

Ø  Altered Gastrointestinal Function

o   May be due to anesthesia, bowel manipulation, paralytic ileus

o   Nursing Care

§  Observe for N/V due to decreased peristalsis

§  withhold food and fluids until bowel sounds return

§  Maintain IV access and administer F&E

§  Monitor for abdominal distention and discomfort

§  NGT drainage as needed

§  Gradually change the diet of the patient

§  Ambulate as soon as possible

Ø  Decreased Urine Output

o   Monitor U.O. – should resume after 6-10 hours after surgery

o   Encourage to increase fluid intake

o   Promote urination

o   Insert indwelling catheter or straight catheterization

Ø  Impaired Skin Integrity

o   Keep incision clean and dry

o   Encourage ambulation (movement stimulates vascular perfusion)

o   Splint incision to prevent dehiscence or evisceration

o   Cover wound with dressing with sterile solution and notify MD

o   Instruct not to cough or move

Ø  Impaired Circulation

o   Observe for Homan’s sign (do not elicit)

o   Assess for warmth, pain and tenderness in calf muscles

o   Provide anti-embolic stockings to compress superficial veins and increase blood flow to deep veins and prevent venous pooling

o   Don’t put pressure on popliteal area

o   Don’t massage the patient’s legs

o   Promote ambulation ASAP

o   Treat thrombophlebitis by bedrest, anticoagulant drugs

Ø  Malignant Hyperthermia

o   Characterized by hyperthermia with skeletal muscle rigidity

o   Succinylcholine – primary trigger

o   Genetic

o   Management:

§  Dantrolene

§  Prevention – careful family history

Navigating the Challenges of Nursing: From Shortages to Patient Safety and Beyond

        

 

         One of the most pressing issues in our field is the shortage of nurses. According to Buerhaus et al. (2017), the United States is projected to have a shortage of between 300,000 & 1 million nurses by 2030. This shortage will not only affect patient care but also will add up to the additional burden on nurses who are already overworked & stressed.

        Lack of support & resources for nurses who are dealing with mental health issues is another concern that has to be addressed. In fact, nurses who experience high levels of job-related stress are at a higher risk of experiencing depression, anxiety, & burnout (Elfering et al., 2017). As nurses, we need to make sure that we take care of our mental health & seek out the resources available to us.

        In addition to these issues, nurses also face challenges related to workplace violence. This is very prevalent among nurses in the emergency departments where they experience high levels of physical & verbal abuse from patients & their families (Jackson et al., 2018). This type of violence can have a long-lasting impact on nurses, both physically & mentally.

        One area of nursing that has received a lot of attention in recent years is the issue of patient safety. It is a major concern for nurses, who often struggle with balancing patient needs with the demands of the healthcare system (Papastavrou et al., 2016). As nurses, we need to advocate for our patients & make sure that their safety is always our top priority.

        Another issue that is affecting nurses is the lack of diversity in the field; while nursing is a diverse field, there is still a lack of representation among certain groups, such as men & people of color (Murray et al., 2017). This lack of diversity can have a negative impact on patient care & outcomes, as patients may feel more comfortable receiving care from someone who shares their background.

        Finally, one issue that I personally have experienced is the lack of work-life balance in nursing. Hu, et al. (2018) found that many nurses struggle with balancing their work responsibilities with their personal lives. As nurses, we need to make sure that we take care of ourselves, both physically & mentally, so that we can provide the best care possible to our patients.

        In conclusion, the nursing profession is facing a number of challenges, from the shortage of nurses to workplace violence to the lack of diversity in the field & still a lot to identify & will emerge; hence, we should work together to find solutions to these issues & to advocate for ourselves & our patients.

 

References:

Buerhaus, P. I., Auerbach, D. I., & Staiger, D. O. (2017). The recent surge in nurse employment: Causes and implications. Health Affairs, 36(9), 1588-1594.

Elfering, A., Grebner, S., & Muller, U. (2017). Exploring resources and demands related to work-related stress among nurses working in Swiss hospitals: A cross-sectional study. Journal of Clinical Nursing, 26(23-24), 4346-4357.

Hu, Y. Y., Parker, S. H., Lipsitz, S. R., Arriaga, A. F., & Gawande, A. A. (2018). Surgeons' work hours and patients' outcomes: A multicenter, prospective cohort study. Annals of Surgery, 268(2), 246-253.

Jackson, D., Peters, K., Andrew, S., Edenborough, M., Halcomb, E., Luck, L., & Salamonson, Y. (2018). Understanding the nature and scale of nursing student exposure to interpersonal violence: A cross-sectional analysis of survey data from seven countries. Nurse Education Today, 60, 67-74.

Murray, T. A., Guo, J. W., & Ngo-Metzger, Q. (2017). Race and ethnicity data collection in the US primary care setting. Preventive Medicine, 103, S91-S95.

Papastavrou, E., Andreou, P., & Tsangari, H. (2016). Patient safety culture in healthcare organizations in Cyprus. Journal of Nursing Education and Practice, 6(9), 1-13.