NURS6560 / NURS 6560 Final Review Q & A (Latest 2021): Advanced Practice Care of Adults in Acute Care Settings II - Walden

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NURS 6560 Advanced Practice Care of Adults in Acute Care Settings II Final Review Q & A NURS 6560 Advanced Practice Care of Adults in Acute Care Settings II NURS 6560 Final Review Q & A ... General Pre and Post Op Care 1. Hemoglobin in relation to surgery, what is the level that it needs to be to safely do surgery? Practice in the U.S has generally includes baseline CBC, Electrolytes for patients over 40 and a chest xray and EKG for patients over 50.Pre planning by having blood product available is appropriate. Hemoglobin of 8 is generally physiologically safe, but not considered adequate for a cardiac patient. 2. Predictors of increased morbidity and mortality post operatively Nutrition Assessment Malnutrition increases risk of death. A weight loss of 20 percent from illnesses increases risk of death and post-operative infection. serum albumin less than 3 and serum transferrin of 150 indicate impairment. Supportive measures ( tube feed/ TPN) Preopertively are indicated if there is history of weight loss 10 % or more and or pt will not be fed orally for a prolonged period of time. Immune Competence Immune defiecity is linked back to malnutrition ad well. Testing total lympcyted and skin tests are common diagnostics to test for immunity. Factors leading to increased infection Medications 1)Corticosteroids 2)cytotoxic 3)immunosuppressive 4)pro longed abx therapy Conditions *Renal failure is associated with wound and pulmonary infections *Leukemia’s are associated with sepsis *Uncontrolled diabetic at risk for infection Assessing Pulmonary Dysfunction Assessing respiratory impairment is imperative especially for intrathoracic surgery and abdominal surgery Assessing for: Smoking hx Cough Obesity Advanced age Known Pulmonary disease Physical exam is concerning if you find wheezes, prolonged expiration Diagnostics/labs to order Chest xray Ekg ABG (Looking for Co2 retention, using too much 02 can cause more retention and acidosis ) PFT ,FVC and FEV1- FEV1 < than 50 % signifies serious airway disease high risk Morbidity Risk Respiratory COMPLICATION ARE THE SINGLE MOST COMMON CASUE OF Morbidity and the 2nd MOST COMMON CASUE OF POST OP DEATH IN PPL 60 YRS OLDER *Elderly copd ,PF pts all at even higher risk *Atelectasis affects 25 % of patients (decreased amount of oxygenated blood) *atelectasis manifests as fever ,tachypnea and tachycardia Post op Aspiration – due to intubation and NG pts at risk of aspiration *PNA-Most common pulm complication in surgical pts that die 20- 40 %) typically, gram neg baccili (from aspiration inhaled bacteria from the ventilator causes pseudomonas aeruginosa [Show More]

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