Editing Medical-Surgical Nursing – RN Flashcards (section)

== Perioperative, Shock, and Safety ==

;Nursing response to evisceration
:Cover the viscera with sterile gauze moistened with sterile normal saline, place the patient in low Fowler position with knees slightly bent, keep the patient nothing by mouth, monitor for shock, stay with the patient, and notify the surgeon immediately. Never attempt to reinsert the organs.

;Two shock types that do not present with cool clammy skin
:Neurogenic shock, which presents warm, dry, and bradycardic, and early septic shock, which presents warm and flushed with bounding pulses before progressing to the classic cold picture.

;Time-critical sepsis bundle elements
:Obtain blood cultures before antibiotics when it does not delay care, give broad-spectrum antibiotics within the first hour, give rapid crystalloid resuscitation, measure and remeasure lactate, and add vasopressors if hypotension persists after fluids.

;Parkland formula and its timing pitfall
:4 mL of lactated Ringer solution per kilogram per percent of total body surface area burned in the first 24 hours, with half given in the first 8 hours calculated from the time of injury, not from arrival, and the balance over the next 16 hours. Titrate to urine output of about 30 to 50 mL per hour.

;Actions when a transfusion reaction is suspected
:Stop the transfusion immediately, keep the line open with normal saline using new tubing, take vital signs, assess the patient, and notify the provider and blood bank. Acute hemolytic reaction presents with fever, chills, flank or low back pain, hypotension, and dark urine.

;Why rectal temperatures and suppositories are avoided in neutropenia and thrombocytopenia
:They cause mucosal trauma, which allows bacterial translocation into the bloodstream in neutropenia and causes bleeding in thrombocytopenia. Fever in a neutropenic patient is an emergency, because it may be the only sign of infection.

;Meaning of new confusion in a hospitalized older adult
:Delirium until proven otherwise, and it is a symptom of an underlying problem such as infection, hypoxia, medication effect, pain, urinary retention, or electrolyte imbalance. It is never dismissed as normal aging or assumed to be dementia.

[[Category:Medical-Surgical Nursing]]
[[Category:Registered Nurse (NCLEX-RN)]]
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