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Term 1 โ Medical Surgical Lecture Pointers Pre-operative Nursing *Key Medications *Anxiolytics (Tranquilizers & Sedatives)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Diphenhydramine *Analgesics *Nalbuphine (Nubaine) *Anti-Cholinergic *Atropine-Sulfate *Anti-Ulcer (Proton Pump Inhibitors) Omeprazole (Losec) Famotidine *Antibiotics Informed Consent โ Most important document for an operation, must be SIGNED, DOCUMENTED always. *If pt refused a medical procedure that would help them in treating their health and illness you need to also document because you will be filing an AMA (Against Medical Advice) form on the patient.
Keywords to Remember at Informed Consent
- For mentally Ill or Unconscious patient, consent must be taken from legal guardians or parents.
- If patient is unable to write, an X is accepted if there is a WITNESS.
- Permission from cellphones or telephone are accepted on an emergency situation but must be signed within 24 hours Diagnostic/Procedures and Laboratories *Fasting - Top priority for pt before surgery / STRICTLY NPO *Blood Typing or Cross Matching- Should be done as earliest as possible especially on emergency *CBC- Complete Blood Count, which shows platelet,wbc,rbc, etc. *Chest Xray- To determine any abnormalities within the chest area *ECG- Electrocardiogram *Urinalysis Sleep Apnea โ or also known as OSA (OBSTRUCTIVE SLEEP APNEA) S/S - Snoring,Sorting,Gasping,Choking โ Commonly Reported by the sleeping partner Continuous Positive Airway Pressure or (CPAP) - Used to treat SLEEP APNEA Surgical Procedures are *Simple Tonsilectomy *Uvulopalatopharyngoplasty *Nasal Septoplasty *Tracheostomy RANDOM NOTE โ NOSEBLEED IS CALLED EPISTAXIS
Pneumothorax โ The presence of Air or Gas in the pleural space (Cavity) which impairs oxygenation ad ventilation Diagnosis: Altered Tissue Perfusion, Ineffective Airway Clearance, Altered Breathing Patterns and Etc. Clinical manifestations of pneumothorax include Sharp, stabbing chest pain that worsens when trying to breathe in Shortness of breath Bluish skin caused by a lack of oxygen Fatigue Rapid breathing and heartbeat A dry, hacking cough The immediate treatment for pneumothorax is tube thoracostomy, or the insertion of a chest tube. How does it work? : A long, flexible, hollow, narrow tube is inserted through the ribs into the pleural space, and the tube is attached to a suction device. This allows the air to be evacuated from the pleural space, and allows the lung to re-expand Asthma โ A chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production. Diagnosis โ Altered Tissue Perfusion, Ineffective Airway Clearance. Most Common Clinical Manifestation โ Wheezing, Dyspnea and Cough Pathophysiology Includes *Activation- Mast cells are activated - > Releases a chemical called MEDIATORS
*Perpetuation โ Chemicals Perpetuate the inflammatory response > Increase Blood Flow and Vasoconstriction - > fluid leak from vasculature - > attracts white blood cells to area - > then BRONCHOCONSTRICTION. *Bronchoconstriction- acute bronchoconstriction from the allergens resulted to release of MEDIATORS from mast cell that directly contacted the airway. *Progression โ Asthma becomes persistent, becomes more inflamed and other factors are now involved in airflow limitation Medication โ Corticosteroid for severe asthma Inhalers like Salbutamol + ipatropium Peak Flow Meter Rate
Green Zone : 80 to 100 percent of your usual or "normal" peak flow rate
signals all clear. A reading in this zone means that your asthma is in good
control. Keep using the medicines as directed.
Yellow Zone : 50 to 80 percent of your usual or "normal" peak flow rate
signals caution. This zone indicates that your airways are narrowing, and you
need to take action. Take the additional medicine(s) listed in the yellow zone
of your asthma action plan. Call your doctor and let them know.
Red Zone : Less than 50 percent of your usual or "normal" peak flow rate
signals a medical alert. This zone indicates that there is severe airway
narrowing. Take your quick-relief medicine right away. Contact your
healthcare provider right away and if symptoms donโt improve, call 911 or go
the nearest emergency room.
SIDE NOTE:
SEVERE ASTHMATICUS โ SEVERE FORM OF ASTHMA
Pulmonary Embolism Risk factors for pulmonary embolism include^1234 :
Thrombolysis is used in patients with massive pulmonary embolism. Outpatient treatment with LMWH and a vitamin K antagonist (warfarin) or direct- acting oral anticoagulants is possible for low-risk cases. Enoxaparin is an anticoagulant medication used to treat or prevent deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism)^12. It is also used to treat and prevent pulmonary embolism (PE) including during pregnancy and following certain types of surgery Iron deficiency anemia โ Common type of anemia and a condition which blood lacks adequate healthy red blood cells. It is said to be most common in pregnant and menstruating women Diet should be- Certain foods can increase your blood iron levels if you have iron deficiency anemia. These include meat, poultry, eggs, and fish that are rich in a type of iron called heme iron. Fruits, vegetables, beans, nuts, and certain grains contain non-heme iron which can support an anemia diet. Dairy foods and foods rich in tannin (such as coffee, tea, and chocolate) should be limited as they can interfere with the absorption of iron. Thalassemia - is an inherited blood disorder. It results in excessive destruction of red blood cells, leading to anemia. There are four types of alpha thalassemia, ranging from mild to severe. People with this condition can pass it on to their children, and there is no cure. Hypochromia โ Decrease of hemoglobin content on erythrocytes and extreme microcytosis (smaller than normal erythrocytes. Pernicious Anemia - Pernicious anemia is one cause of vitamin B12 deficiency anemia. Itโs thought to mainly be caused by an autoimmune process that makes a person unable to produce a substance in the stomach called intrinsic factor. This substance is needed to absorb dietary vitamin B12(COBALAMIN)in the small intestine. Vitamin B12 is a required nutrient that helps allow proper red blood cell production and function in the body.
Ferrous sulfate is an iron supplement used to treat iron-deficiency anemia when dietary sources are inadequate123. It comes in tablet and liquid form. Side effects may include constipation and stomach cramps1. Ferrous sulfate is commonly used to address iron deficiency and anemia by increasing hemoglobin production3. It is just one of many forms of iron used in dietary supplements. NOTE: STOOLS MAY BE DARK IN COLOR BECAUSE OF THIS HYPERTENSION โ Commonly caused by lifestyle, Environment, Age or Secondary to a diagnosis. LOW SODIUM DIET โ as always. Nitroprusside - is a vasodilator that is used to treat hypertensive emergency123. It serves as a source of nitric oxide, a potent peripheral vasodilator that affects both arterioles and venules1. Nitroprusside is often administered intravenously to patients who are experiencing a hypertensive emergency1. It is also used to treat acute heart failure and to decrease bleeding following surgery Antihypertensives โ includes all the following, diuretics, ccb(calcium channel blockers), ACE inhibitors, beta blockers, Lisonopril, Metaprolol, Amlodipine, Losartan. Hydrochlorothiazide, Furosemide, Carvedilol, Atenelol, Spironolactone, Clonidine. Hypertensive emergency versus urgency 180/120 above is a hypertensive emergency (Can cause death) 140/90 above is a hypertensive urgency (Needs to be observed)
Percutaneous Coronary Intervention (PCI) is a non-surgical procedure to improve blood flow through narrowed or blocked coronary arteries^1. It is used for coronary artery disease, chronic total occlusion, acute coronary syndromes, and angina^1. PCI may involve implanting a stent in the affected artery^1. PCI can improve outcomes for people with CAD and other types of cardiac disease^2. Before the procedure, a medical professional may prepare the access area by removing some of the individualโs hair and cleaning the site of the operation Medication for cad *Plavix โ prevent blood clots *Metaprolol- Metoprolol controls irregular heartbeats because a slower heart rate tends to allow the electrical signals in the heart to fire more regularly and thus the heart to beat more regularly. *Lipitor - Lipitor (atorvastatin) is a medication commonly used for patients with coronary artery disease (CAD). It is a type of statin that helps lower cholesterol levels. Statins, including Lipitor, have been shown to benefit patients with CAD by reducing the risk of vascular events. The recommended LDL cholesterol levels for patients with CAD are less than 100 mg/dL, and for those at very high risk, a goal of less than 70 mg/dL is considered. However, high-dose statin therapy is not unequivocally recommended for all patients due to concerns about side effects and cost
Myocardial Infarction
SHORTENED Pathophysiology โ Ischemia - > Hypoxia - > Necrosis - >
FOREST LAKE RIP
Troponin T (TnT) and troponin I (TnI) - Cardiac enzymes are proteins produced by
the heart muscle that speed up specific chemical reactions in the body^12. They are released by the heart muscle when it is injured, such as during a heart attack (myocardial infarction) or a severe case of angina^2. The most specific cardiac enzymes to a heart attack are troponin T (TnT) and troponin I (TnI)^1. Doctors measure these enzymes to diagnose a heart problem
Medical management for myocardial infarction includes^1 : Treating arrhythmic complications Minimizing ischemic time before reperfusion Using antithrombotic therapy to inhibit thrombus propagation and embolization Improving oxygen supply-demand imbalance Inhibiting adverse remodeling Treating mechanical complications Medications such as antiplatelets, anticoagulants, nitrates, beta-blockers, and statins Emergency reperfusion via fibrinolytic drugs, percutaneous intervention, or coronary artery bypass graft surgery for ST-segment-elevation myocardial infarction. The following are the nursing priorities for patients with myocardial infarction: Managing pain and ischemia. Monitoring for potential complications. Promoting adequate tissue perfusion. Reducing anxiety. Cardiac rehabilitation is a complete program designed to help patients recover and get stronger after cardiac surgery or treatment for heart issues, such as a heart attack. The program includes education, exercise, risk factor modification, and counseling
*CONGESTION OF PERIPHERAL TISSUES
*ENLARGED LIVER, SPLEEN
(HYPERATROPHY)
*LIVER + GI TRACT CONGESTIONS
ARI YA ASSOCIATED SA IMO PERIPHERAL
SYSTEMS PAKADTO SA PINAKADALOM
LIVER / GI X HEART
*PULMONARY CONGESTION
*MOST COMMON HEART FAILURE
*DECREASED CARDIAC OUTPUT +
PULMONARY CONGESTION
*IMPAIRED GAS EXCHANGE
BASTA ASSOCIATED NI SA LUNGS IN
SIMPLIER TERMS
LUNGS X HEART
Digoxin - It strengthens the force of the heart muscle's contractions, helps restore a normal, steady heart rhythm, and improves blood circulation. Digoxin is one of several medications used to treat the symptoms of heart failure. It may also be prescribed if you have atrial fibrillation (a common irregular heart rhythm). Furosemide (Lasix) - Diuretics ni which is commonly attributed to treat fluid retention (edema) and swelling caused by congestive heart failure, liver disease, kidney disease, or other medical conditions. COMMON NI NGA MEDICATION FOR LEFT SIDED HEART FAILURE. Unless nalang if may edema kita sa RHF. Dopamine - Dopamine is used in the treatment of heart failure to stimulate cardiac muscle contraction and increase the heart rate, which results in improved cardiac output. Nitroglycerin - have become widely used agents in the treatment of severe forms of heart failure. Their beneficial effects in this disease results from their ability to reduce preload and afterload of the heart muscle leading to an increase of cardiac index, a decrease in mean pulmonary artery and wedge pressures as well as pulmonary and peripheral vascular resistances. Warfarin - Warfarin is not superior to aspirin for preventing a combined risk of death, stroke, and cerebral hemorrhage in heart failure patients with normal heart rhythm. However, in patients with heart failure who also have coronary artery disease, warfarin may reduce the rates of ischemic stroke and nonfatal or fatal myocardial infarction RHEUMATIC HEART FEVER
Management of rheumatic heart fever includes^1 Prevention of rheumatic fever through antibiotics to treat strep infections. Anti-inflammatory drugs to reduce inflammation, fever and pain. In severe cases, surgery to replace or repair a badly damaged valve may be required. People who have had heart inflammation during rheumatic fever might need to continue preventive antibiotic treatment for 10 years or longer. Continuous antibiotic prophylaxis to prevent recurrent infection with Group A streptococcus( GABHS) is key to ARF/RHD management. Benzathine penicillin G dosed every 3-4 weeks is superior to oral penicillin. MAJOR FINDINGS FOR RHF *ERETHYMA MARGINATUM, CARDITIS, POLYATHRITIS, CHOREA, SUBCUNTANEOUS NODULES. MINOR FINDINGS FOR RHF FEVER, POLYATHRALGIA, PROLONGED PR INTERVAL, INCREASED ESR. Fluid and Electrolytes HYPERKALEMIA โ EXCESSIVE K (Potassium sa lawas) ang normal level naton is only around 3.5 to 5 mEq/L. HYPERNATREMIA โ EXCESSIVE SODIUM naman ni sa lawas ta. Ang normal level naton is only around 135-145 mEq/L TYPES OF SOLUTIONS ISOTONIC โ basta IV muni gid ni permi ang ginahatag. ISOTONIC solutions. Balance Osmotic pressure (as things should be) Homeostatis lg dapat. Mga 0.9 NACL (sodium chrolide), Dextrose in water (D5W), Lactated Ringerโs 5% Dextrose in Water (D5LSR), Ringers Solution. HYPOTONIC โ Low down. lower osmotic pressure
