Emily Shared "Med Surg" - 337 Picmonics
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Med Surg
Stages of Hypothermia
- Mild
- 32 to 35°C (90 to 95°F)
- Shivering
- Moderate
- 28 to 32°C (82 to 90°F)
- Obvious Motor Impairment
- Slowed Thinking
- Severe
- < 28°C (< 82°F)
- Shivering Stops
- Paradoxical Undressing
- Arrhythmias
3 mins
Hypothermia Interventions
- Remove From Environment
- Remove Wet Clothing
- Passive Rewarming
- Warm Clothing
- Active Rewarming
- Heated Blankets
- Warm IV Solutions
- Heated Oxygen
- Warm Gastric Lavage
- Considerations
- Warm Trunk BEFORE Extremities
2 mins
IV Solutions
- Hypotonic (< 280 mOsm/L)
- 1/4 Normal Saline (0.225% NaCl)
- 1/2 Normal Saline (0.45% NaCl)
- Isotonic (280-300 mOsm)
- Normal Saline (0.9% NaCl)
- Lactated Ringer's (LR)
- Dextrose 5% in Water (D5W)
- Hypertonic (> 300 mOsm)
- 3% or 5% NaCl
- Dextrose 5% in 0.45% NaCl
- Dextrose 10% in Water (D10W)
3 mins
Types of Blood Products
- Types
- Whole Blood
- Packed Red Blood Cells
- Fresh Frozen Plasma
- Immunoglobulins
- Clotting Factors
- Albumin
- Platelets
- Considerations
- Use within 24 Hours
- Washing Removes Antibodies
- Irradiation Destroys WBCs
2 mins
Blood Types and Compatibilities
- ABO Compatibility
- No Antigens (Type O Blood)
- Universal Donor
- A Antigen (Type A Blood)
- B Antigen (Type B Blood)
- AB Antigen (Type AB Blood)
- Universal Recipient
- Rhesus (Rh) Compatibility
- Rh (Rhesus) Antigen
- Never Rh+ to Rh-
- Considerations
- Blood Transfusion
- Obstetric Patient
2 mins
Blood Transfusion Administration
- Proper Patient Identification
- Large Bore Needle
- Y Tubing
- Baseline Vital Signs
- Slow IV Infusion
- Monitor During First 15 Minutes or 50 mL of Blood
- Monitor for Reactions
- Considerations
- Do Not Add Anything To Same IV Line
- No Dextrose or Lactated Ringers
- Jehovah's Witnesses, No Transfusions
3 mins
Transfusion Reactions
- Acute Hemolytic
- Febrile, Non-Hemolytic
- Mild Allergic
- Anaphylactic
- Circulatory Overload
- Sepsis Reaction
- Transfusion-Related Acute Lung Injury (TRALI)
- Massive Blood Transfusion
2 mins
Normal Electrolyte Lab Values
- Potassium (K+)
- 3.5 to 5.0 mEq/L
- Calcium (Ca2+)
- 8.5 to 10.5 mg/dL
- Phosphate (PO43–)
- 2.5 to 4.5 mg/dL
- Magnesium (Mg2+)
- 1.5 to 2.5 mEq/L
- Sodium (Na+)
- 135 to 145 mEq/L
- Chloride (Cl–)
- 95 to 105 mEq/L
2 mins
Magnesium (Mg2+) Lab Value
- 1.5 to 2.5 mEq/L
28 secs
Phosphate (PO43-) Lab Value
- 2.5 to 4.5 mg/dL
29 secs
Potassium (K+) Lab Value
- 3.5 to 5.0 mEq/L
20 secs
Calcium (Ca2+) Lab Value
- 8.5 to 10.5 mg/dL
26 secs
Chloride (Cl-) Lab Value
- 95-105 mEq/L
28 secs
Sodium (Na+) Lab Value
- 135-145 mEq/L
24 secs
Aseptic Technique
- Invasive Procedures
- Skin Integrity Broken
- Sterility
- Hands Up for Scrubbing
- Keep Objects in View
- Only Sterile Objects in Field
- Only Sterile Touches Sterile
- Contamination
- Edges of Sterile Field
- If Sterility Questioned
- If Wet or Prolonged Exposure to Air
- Considerations
- Never Leave Sterile Area
- PPE Order
2 mins
Preoperative Care
- Preop Education
- Surgical Procedure
- NPO
- Turn, Cough, Deep Breathe, Incentive Spirometer
- Lower Extremity Exercises
- Compression Stockings or SCD's
- Pain Management
- Safety
- Informed Consent
- Physical Preparation
- Preop Checklist
- Handoff to Surgery
- Universal Precautions
2 mins
Postoperative Care
- Head to Toe Assessment
- Complications
- Hemorrhage
- Clotting
- Pain
- Dehiscence or Evisceration
- Respiratory Complications
- Paralytic Ileus
- Infection
2 mins
Postoperative Fever
- 5 W's
- Wind (Days 1-3)
- Atelectasis
- Pneumonia
- Water (Days 3-5)
- Urinary Tract Infection from Catheter
- Walking (Days 4-6)
- Deep Vein Thrombosis (DVT)
- Pulmonary Embolism
- Wound (Days 5-7)
- Infection
- Wonder Drugs (Days 7+)
- Drugs
2 mins
Cardiac Enzyme Evaluation: Troponin
- Measures
- Cardiac Muscle Injury
- Time Ranges
- Detection in Blood: 4 Hours
- Peak: 24 - 36 Hours
- Return to Normal: 5 - 14 Days
- Considerations
- Most Specific for Cardiac Muscle
- Treat Aggressively
2 mins
Cardiac Enzyme Evaluation: Myoglobin
- Measures
- Skeletal or Cardiac Muscle Injury
- Time Ranges
- Onset: 1 - 4 Hours
- Peak: 12 Hours
- Return to Normal: 24 Hours
- Considerations
- Elevation After 24 Hours: Reinfarction
2 mins
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