Chpt 2 Care Of Surgical Pt.

Question 1

Three phases of anesthesia

Answer 1

Induction, maintenance,emergent

Question 2

Regional anesthesia

Answer 2

You don’t lose consciousness but you’re sedated

Question 3

Local anesthesia

Answer 3

Loss of sensation at desired site

Question 4

Conscious sedation

Answer 4

Depressed level of consciousness;moderate sedation

Ex:burn victim having bandages removed

Question 5

Why do some pills have enteric coating?

Answer 5

Protects mucosal lining

Question 6

Types of surgeries

Answer 6

Elective , urgent and emergent

Question 7

Common surgical settings

Answer 7

Inpatient - pt hospitalized for surgery
One day -( same day) admitted day of surgery and discharged same day
Outpatient-pt is admitted to either short stay unit or directly to surgical suite
Short stay surgical center-independently owned;surgery performed when overnight hospitalization isn’t required ( also called ambulatory surgical center or 1 day surgery center)
Short stay unit-dept or floor where a pts stay doesnt excede 24 hrs
Mobile surgery unit-unit that moves from place
To place ; moves the pt instead of pt traveling to unit

Question 8

Three phases of surgery

Answer 8

Preoperative (before) Intraoperative (during) postoperative (after)

Question 9

Influencing factors of surgery

Answer 9

Age, physical condition ,nutritional factors ,psychosocial , socioeconomic/cultural needs

Question 10

Common fears associated with surgery

Answer 10

Fear of loss of control , of the unknown, of anesthesia, pain, death, separation, disruption , change and detection

Question 11

An acutely ill person/ pt may have as many as 10-20 meds in the operative setting

Answer 11

*

Question 12

Garlic

Answer 12

Potential for increased bleeding

Question 13

Ginger

Answer 13

Risk of prolonged clotting times

Question 14

Ginkgo biloba

Answer 14

Potential for increased bleeding

Question 15

ST johns wart

Answer 15

Antidepressant ; decreases effectiveness of warfarin

Question 16

Do pre op teaching 1-2 days before surgery

Answer 16

It helps reduce pts anxiety associated with fear of the unknown , the amt of anesthesia needed , and post surgical pain ,corticosteroid production

Question 17

Anticoagulants need to b given same time , every day to continue therapeutic effect

Answer 17

.

Question 18

Don’t ask questions that can have yes or no answers

Answer 18

.

Question 19

Potassium level 3.5-5.5 normal

Answer 19

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Question 20

Informed consent

Answer 20

Patients must give informed consent before a specific test/procedure. Must b competent and agree to have the procedure stated

Question 21

Npo

Answer 21

Nothing by mouth

Question 22

Neomycin and erythromycin is prescribed for GI surgeries

Answer 22

.

Question 23

Latex allergy considerations

Answer 23

Three allergies 1. As irritant contact dermatitis 2.type IV allergic reactions 3. Type 1 allergic reactions

Question 24

Incentive spirometer

Answer 24

Expands lungs and helps remove by products ; prevents aspiration pneumonia and good for pts with increased risk of atelectasis

Question 25

Two types of incentive spirometer

Answer 25

1. Flow oriented - this type is inexpensive and measures inspiration. 2. Volume oriented-maintains a known volume of inspiration

Question 26

Thrombus

Answer 26

Accumulation of platelets, fibrin, and cellular elements of the blood attached to interior wall Of a vessel, sometimes occluding the lumen.

Question 27

Embolus

Answer 27

Dislodged thrombus traveling to the lungs, heart, or brain where it can be occluded

Question 28

Infarct

Answer 28

Localized area of necrosis

Question 29

Surgeries for which coughing is contraindicated or modified

Answer 29

Intracranial , eye, ear, nose, throat, spinal

Question 30

Anesthesia

Answer 30

Absence of all sensation, including pain

Question 31

General anesthesia

Answer 31

Produces amnesia ,analgesia, muscle paralysis,and sedation . Patient n state of unconsciousness ThAts reversible , used for major surgeries

Question 32

Benzos( diazepam, lorazepam)

Answer 32

Decrease anxiety - monitor for respiratory depression

Question 33

Opioids

Answer 33

Morphine , fentanyl -monitor for respiratory depression

Question 34

H2 receptor antagonists

Answer 34

Pepsid, zantac-reduces gastric acid

Question 35

Antiemetic

Answer 35

Reglan, zofran-enhance gastric emptying

Question 36

Anti chili ethics

Answer 36

Robinul- reduces oral and respiratory secretions to decrease risk of aspiration - decrease vomiting and laryngo spasm -gastric, bronchial , salivary secretions

Question 37

Antibiotics

Answer 37

Ancef, cefazolin, cefotaxime sodium, ceftriaxone- bacterialcidal

Question 38

Adrenocortical steroid

Answer 38

Methylprednisolone- decreases inflammation

Question 39

NSAID

Answer 39

Ketorolac -decreases inflammation

Question 40

Anticoagulant -lovenox- produces anti coagulation

Answer 40

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Question 41

Heparin ( anticoagulant)-PTT labs drawn ; anti dote-protamine sulfate

Answer 41

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Question 42

Warfarin sodium ( Coumadin) antidote vit k, PT with INR

Answer 42

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Question 43

Black stools

Answer 43

Internal bleeding

Question 44

Coffee ground vomitus

Answer 44

GI bleed

Question 45

Regional anesthesia

Answer 45

1. epidural -safer than spinal , injected into epidural space outside the dura mater , depth of anesthesia Is lighter 2. Nerve block -injected into nerve;blocking nerve supply to operative site 3. Spinal anesthesia- lumbar puncture performed and introduced local anesthetic into cerebrospinal fluid in the subarachnoid space ; often used for lower abdominal , pelvic and lower extremity procedures, urologic procedure and surgical obstetrics

Question 46

Local anesthesia

Answer 46

Loss of sensation at desired site

Question 47

Venous stasis

Answer 47

A disorder in which the normal flow of fluid thru a vessel of a body is slowed or halted , is the underlying cause of thrombus formation

Question 48

Early ambulation is a significant factor in hastening postoperative recovery and preventing postoperative complications

Answer 48

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Question 49

To check gastrointestinal status check each quad for 1 min each . You should hear 5-30 gurgles per minute . If bowel sounds absent , assess each quad for 3-5 mins

Answer 49

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Question 50

WBC

Answer 50

5000-10,000

Question 51

Physical dependence

Answer 51

Physically craving something. Having withdrawals if not able to have .

Question 52

Psychological dependence

Answer 52

An emotional desire

Question 53

``` Five schedules of drugs Schedule 1-Most addictive / no medical use, cocaine Schedule 2 -Percocets, OxyContin Schedule 3-steroids Schedule 4-Ativan, valium , xanax Schedule 5- cough syrups with codeine ```

Answer 53

,

Question 54

Immediate post op complications

Answer 54

Hypoxia ( inadequate 02 supply), shock, hemorrhage

Question 55

S/S of shock

Answer 55

Low bp , high HR , high respirations

Question 56

Airway is always a priority

Answer 56

,

Question 57

Pain 12-24 hours after surgery post op most severe

Answer 57

.

Question 58

Neuro assessment

Answer 58

Check PERRLA, all extremities for movement and sensation , patients LOC

Question 59

Malignant hyperthermia

Answer 59

A genetic disorder caused by uncontrollable skeletal contractions - can lead to fatal hyperthermia , may b caused by reaction to anesthesia

Question 60

S/S of malignant hyperthermia

Answer 60

High temp , rigid painful muscles , sweating , rapid irregular heartbeat, confusion

Question 61

T/x for malignant hyperthermia

Answer 61

Administer dantrolene

Question 62

Narrowing pulse pressure

Answer 62

Force generated by the heart with each contraction

Question 63

Elevate legs for shock - blood return (supine)

Answer 63

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Question 64

Dehiscence

Answer 64

More common with obese ppl, the splitting or bursting open of a wound

Question 65

Evisceration

Answer 65

Protrusion of wound

Question 66

S/s infection at incision site

Answer 66

Pain , warmth, edema , erythema

Question 67

A temp from a wound infection will typically occur 2 days after surgery

Answer 67

.

Question 68

S/s atelectasis and pneumonia

Answer 68

Chest pain , fever, productive cough , difficulty breathing Pt needs to turn and cough every two hours Splint site Make sure patient has pain meds first Early mobility Frequent positioning Percussion and drainage

Question 69

S/s pulmonary embolism

Answer 69

Sudden Cheat pain , tachycardia , cyanosis, hypotension Nursing intervention- head of bed elevated and increase 02 Don’t let pain get to severe levels

Question 70

Homans sign

Answer 70

Indicator for DVT ( pain in calf ) Perform leg exercises every two hours Prevent venous stasis - don’t cross legs , ambulate , avoid pillows under knees, place under feet avoid knee gatch If thrombus suspected -keep patient in bed to avoid traveling clot , don’t rub lower extremities , administer anticoagulant per order

Question 71

Peristalsis is occuring if there’s flatulence ( this is good )

Answer 71

.

Question 72

Paralytic ilieus

Answer 72

Decrease in or absence of intestinal peristalsis that may occur after abdominal surgery , trauma , severe metabolic disease

Question 73

S/s paralytic ileus

Answer 73

Vomiting , abdominal fullness, diarrhea, bloating , stomach pain , constipation

Question 74

T/x paralytic ileus

Answer 74

Dietary restrictions IV fluids with electrolytes replacement NG tube Meds to promote peristalsis

Question 75

Always keep count of patients BM’s

Answer 75

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Question 76

Warm beverages promote peristalsis

Answer 76

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Question 77

Decreased peristalsis post op, due to following :

Answer 77

Lack of solid food Manipulation of intestines during surgery Bed rest

Question 78

Potassium can cause vein irritation ; if burning continues , stop IV then Infiltrate

Answer 78

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Question 79

If patient is on an IV, a strict I & O is to be documented , also daily wt. Drink 6-8 daily Offer fluids frequently WITHOUT a straw

Answer 79

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Question 80

Record the amount , type and frequency of any vomitus so the dr will be aware of the patients fluid balance and to avoid electrolyte imbalance

Answer 80

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