Week 11 Discussion ~ Medical Surgical

Week 11 Discussion ~ Medical Surgical Nursing

Who has the responsibility for providing detailed information to the client prior to surgery?

The surgeon is responsible, not the nurse.

Which members of the operative team do not need to perform a surgical scrub?

The circulating nurse and the anesthesiologist are not required to perform a surgical scrub.

Describe the clinical manifestations associated with Malignant Hyperthermia and give the drug of choice.  

Clinical Manifestations – Tachycardia, Skin mottling, Cyanosis, Myoglobinuria, Rise in end tidal carbon dioxide, Elevated temperature.

Drug of Choice – Dantrolene (muscle relaxant). It is given intravenously until a patient has stabilized. Then, the medication typically is continued in pill form for three days.

What is the difference between General and Regional Anesthesia? 

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General Anesthesia – A reversible loss of consciousness induced by inhibiting neuronal impulses in several areas of the central nervous system (CNS). The patient is unconscious and unaware, and has loss of muscle tone and reflexes. Agents are administered by inhalation and IV injection.

Local or Regional Anesthesia – Disrupts sensory nerve impulse transmission from a specific body area or region. The patient remains conscious and able to follow instructions. o Local – Delivered topically (applied to the skin or mucous membranes of the area to be anesthetized) and by local infiltration. o Regional – Type of local anesthesia that blocks multiple peripheral nerves in a specific body region. It includes field block or nerve block and spinal or epidural routes of delivery.

What is the difference between Anticoagulants, Fibrinolytics, and Platelet Inhibitors? 

Anticoagulants – Work by interfering with one or more steps involved in the blood clotting cascade. They prevent new clots from forming and limit or prevent extension of

Week 11 Discussion ~ Medical Surgical Nursing

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formed clots. They do not break down existing clots. They are thrombin inhibitors, vitamin K antagonists, and indirect factor X inhibitors.

Fibrinolytics (also known as thrombolytic drugs or “clot busters”) – Selectively break down fibrin threads present in formed blood clots. The mechanism to start fibrin degradation is activation of the inactive tissue protein plasminogen to its active form, plasmin. Plasmin directly attacks and degrades the fibrin molecule. The use of these results in the best clot breakdown with less disruption of blood clotting.

Platelet Inhibitors (anti-platelet drugs) – prevent either platelet activation or aggregation (clumping). The most widely used drug for this effect is aspirin, which inhibits the production of substances that activate platelets, such as thromboxane. St. John’s Wort, inhibit platelet activity.

What is the recommended diet for the client with B12 deficiency anemia?

When anemia is caused by a dietary deficiency, the focus of management is to increase the intake of foods rich in vitamin B12 (animal proteins, eggs, and dairy products). 

Extra Information:

The Dietary Guidelines for Americans describe a healthy diet as one that: 

Emphasizes a variety of fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products: Milk and milk products are good sources of vitamin B12. Many ready-to-eat breakfast cereals are fortified with vitamin B12.

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Includes lean meats, poultry, fish, beans, eggs, and nuts.

Fish and red meat are excellent sources of vitamin B12. Poultry and eggs also contain vitamin B12.

Is low in saturated fats, Trans fats, cholesterol, salt (sodium), and added sugars.

Stays within your daily calorie needs.

What are the recommended interventions for the client with Polycythemia Vera?  

Drink at least 3 liters of liquids each day.

Avoid tight or constrictive clothing, especially garters and girdles.

Week 11 Discussion ~ Medical Surgical Nursing

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Wear gloves when outdoors in temperatures lower than 50 F. Keep all health care-related appointments.

Contact your physician at the first sign of infection.

Take anticoagulants as prescribed.

Wear support hose or stockings while you are awake and up.

Elevate your feet whenever you are seated.

Exercise slowly and only on the advice of your physician.

Stop activity at the first sign of chest pain.

Use an electric shaver.

Use a soft-bristled toothbrush to brush your teeth.

Do not floss between your teeth.

Which blood product is the standard for care of the client with Hemophilia? Why? The bleeding problems of Hemophilia A are managed by either regularly scheduled infusions of synthetic factor VIII or factor VIII cryoprecipitate (highly concentrated blood product, replaces fibrinogen) or intermittent infusions as needed.

Hemophilia is actually two different hereditary bleeding disorders resulting from clotting factor deficiencies. Hemophiliacs form platelet plugs at the bleeding site, but the clotting factor deficiency impairs the formation of stable fibrin clots.  

Hemophilia A (Classic Hemophilia) is a deficiency of factor VIII and accounts for 80% of cases of hemophilia.

Hemophilia B (Christmas disease) is a deficiency of factor IX and accounts for 20% of cases.

Week 11 Discussion ~ Medical Surgical Nursing

References Ignatavicius, Donna D. Medical-surgical Nursing: Patient-centered Collaborative Care. 7th ed.

St. Louis: Elsevier Saunders, 2013. Print.

"Vitamin B12." Dietary Supplement Fact Sheet: â&#x20AC;&#x201D; Health Professional Fact Sheet. Web. <http://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/>.