RN ADULT MEDICAL SURGICAL PROCTOR REMEDIATION 2019

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ANTICOAGULANTS HEPARINS - Therapeutic uses: stroke; PE; DVT; prophylaxis for post-op venous thrombosis; treatment of DIC - Heparin toxicity: admin PROTAMINE slowly IV no faster than 20 mg/min or 50 ... mg in 10 min; do not exceed 100 mg in 2hr; prevent protamine toxicity - Hemorrhage secondary to heparin toxicity: monitor vitals; observe for bleeding (increased HR; decreased BP, bruising, petechiae, hematomas, black tarry stools); monitor aPTT (keep value 1.5 – 2 x baseline); stop heparin admin - Epidural/spinal hematoma risk - Monitor platelet count throughout treatment; stop heparin for platelet count < 100,000 LMW HEPARINS - Therapeutic uses: DVT prevention and treatment; PE; prevent complications of angina; non-Q wave MI; STEMI - Enoxaparin - Hemorrhage: monitor vitals; monitor platelet count; observe for bleeding; avoid aspirin ACTIVATED FACTOR XA INHIBITOR - Therapeutic uses: DVT and PE prevention postop; acute DVT or PE treatment in conjunction w/ warfarin - Fondaparinux - Hemorrhage: monitor vitals; monitor platelet count; monitor for bleeding; avoid aspirin CONTRAINDICATIONS - Thrombocytopenia - Use during/following surgeries of eyes/brain/spinal cord/lumbar puncture/regional anesthesia - Use caution in clients w/ hemophilia; increased capillary permeability; dissecting aneurysm, PUD, severe HTN, hepatic/kidney disease, threatened abortion INTERACTIONS - Increased risk of bleeding w/ antiplatelet agents: ASPIRIN; NSAIDS - Increased risk of bleeding w/ RESVERATROL; SAW PALMETTO; GARLIC; GINGER; GLUCOSAMINE; GINKGO BILOBA NURSING ADMIN - Must be given via SUBQ injection or IV infusion - Rotate sites - Monitor for indications of bleeding - Use electric razor - Use soft toothbrush VITAMIN K INHIBITORS (COUMARINS) WARFARIN - Prevention of venous thrombosis and PE - Prevention of thrombotic events w/ a-fib or prosthetic heart valves - Reduce risk of recurrent TIA or MI COMPLICATIONS - Hemorrhage: monitor vitals; observe for bleeding; obtain baseline PT and INR - Warfarin toxicity: admin vitamin K1 - Hepatitis: monitor liver enzymes; assess for jaundice CONTRAINDICATIONS - Pregnancy/breastfeeding - Thrombocytopenia/uncontrollable bleeding - During/following surgeries of eyes; brain; spinal cord; lumbar puncture; regional anesthesia - Clients w/ vitamin K deficiencies; liver disorders; alcohol use disorder - Clients w/ hemophilia; dissecting aneurysm; PUD; severe HTN; threatened abortion INTERACTIONS - Concurrent use of HEPARIN; ASPIRIN; ACETAMINOPHEN; GLUCOCORTICOIDS; SULFONAMIES; PARENTERAL CEPHALOSPORINS, INCREASES RISK OF BLEEDING - Concurrent use of PHENOBARBITAL; CARBAMAZEPINE; PHENYTOIN; ORAL CONTRACEPTIVES; VITAMIN K - Foods high in vitamin K: dark green leafy vegetables, cabbage, broccoli, brussel sprouts, mayo, canola/soybean oil - RESVERATROL, SAW PALMETTO, FEVERFEW, GARLIC, GINGER, GLUCOSAMINE, GINKGO BILOBA NURSING ADMIN - Oral, once daily, same time each day - Baseline vitals - Monitor PT (18-24 sec); INR (2-3) - Baseline/monitor CBC, platelet count, Hct - Have vitamin K for warfarin toxicity - Wear medical alert bracelet - Soft bristle toothbrush and electric razor SKIN CANCER ABCDE TO EVALUATE MOLES - Asymmetry - Borders - Color - Diameter - Evolving AMPUTATIONS: PROVIDING SUPPORT - Allow client/family to grieve for loss of body part/change in body image - Feelings of depression, anger, withdrawal, grief - Asses psychosocial well-being of client; feelings of altered self-concept/self-esteem; willingness and motivation for rehab - Supportive environment BURNS: INDICATIONS OF HYPOVOLEMIC SHOCK - Inadequate perfusion, confusion, hypotension decreased urine output, increased cap refill time; decreased bowel sounds, DM MANAGEMENT: MEDICATION TO WITHOLD PRIOR TO CT SCAN W/ CONTRAST MEDIA - METFORMIN; stop for 24-48 hr before any test w/ contrast dye and restart 48 hr after; can cause lactic acidosis due to acute kidney injury HEARTH FAILURE AND PULMONARY EDEMA: INTERVENTIONS FOR FLUID VOLUME OVERLOAD - High fowlers positioning; O2 admin; rapid acting loop diuretics; medications to improve cardiac output; monitor I/O; daily weights; check abgs and electrolytes; restrict fluid intake; slow/discontinue IV fluids STROKE: ADMIN OF TPA - Give w/i 4.5 hr of initial manifestations for clients experiencing ischemic stroke due to embolic event as evidenced by CT scan results GI THERAPEUTIC PROCEDURES: FINDINGS TO REPORT FOR CLIENT RECEIVING TPN - Metabolic complications: hyperglycemia; hypoglycemia; vitamin deficiencies - Air embolism: sudden onset of dyspnea; chest pain; anxiety; hypoxemia - Infection: observe central line insertion site for infection (erythema; tenderness; exudate) - Fluid imbalance: crackles in lungs/respiratory distress POST OP NURSING CARE: CARING FOR CLIENT FOLLOWING APPENDECTOMY - Airway, breathing, circulation - Vital signs - Positioning - Response to anesthesia (sedation, nausea, vomiting) - Intake/Output - Surgical wound/incision site/dressing - Pain - Mentation NONINFLAMMATORY BOWEL DISORDERS: FINDINGS TO REPORT - HERNIA: report redness or swelling at incisional site - IRITABLE BOWEL SYNDROME: report constipation, fever, increased abdominal pain, fatigue, dark urine, bloody diarrhea, rectal bleeding - INTESTINAL OBSTRUCTION: Dehydration; persistent vomiting; metabolic disturbances; abdominal distention; absent bowel sounds LEGAL RESPONSIBILITIES: WITNESSING INFORMED CONSENT - Ensure provider gave client necessary information; client understood information and is competent to give informed consent; have client sign informed consent document; notify provider if client has more questions or appears not to understand any of the information; document questions client has/notification of provider/reinforcement of teaching/use of interpreter [Show More]

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