Exam 1 Flashcards
(300 cards)
1
Q
Discharge instructions for diet
A
type of diet and importance of proper nutrition for healing
dietary restrictions
avoid alcohol for 1st 24hr
special dietary recommendations
recommended fluid intake
2
Q
Discharge instructions for activity
A
recommended exercise and frequency
instructions for equipment
schedule for breathing exercises
recommended rest periods
activity restrictions
use and care of antiembolism stockings
3
Q
discharge instructions for wound care
A
hand hygiene
dressing changes and frequency
cleansing of wound
drainage observations
signs to report
use of heat or cold packs for discomfort
supplies and where to obtain them
4
Q
discharge instructions for temp monitoring
A
record time & temp
report temp greater than 100
5
Q
Discharge instructions for bathing
A
type of bath
frequency
6
Q
discharge instructions for meds
A
analgesics
antibiotics
sedatives
vitamin supplements
other meds
7
Q
discharge instructions for precautions related to anesthesia or med reactions
A
caution regarding machinery
caution regarding making decisions for 24 hrs
drug interactions
potential for constipation
potential for urinary retention
8
Q
discharge instructions for S&S to report
A
elevated temp
increasing malaise
severe pain or swelling
bleeding through bandage
decreased sensation below surgical site
severe nausea and vomiting
failure to urinate within 8 hrs
9
Q
Aldrete scoring system
A
used to determine readiness for transfer
activity, respiration, circulation, consciousness, skin color, and oxygen saturation are each given a score
10
Q
when is patient ready to transfer to nursing unit
A
Aldrete scoring system score of 9 or 10
11
Q
anaphylaxis
A
severe allergic reaction
hypersensitivity to a drug or other allergen
12
Q
Atelectasis
A
collapse of alveoli in the lungs
some degree exists after anesthesia
leads to pneumonia or resp distress
13
Q
prevention of atelectasis
A
coughing
deep breathing
IS
walking
14
Q
dehiscence
A
disruption or separation of some or all layers of surgical wound
15
Q
embolus
A
thrombus or clot that travels and lodges elsewhere in body
16
Q
evisceration
A
wound completely separates and the contents of the abdominal cavity protrude through the incision
only occur only in abdominal wounds
17
Q
hematoma
A
blood-filled swelling
18
Q
malignant hyperthermia
A
a rare but life-threatening complication of general anesthetic agents
19
Q
paralytic ileus
A
failure of forward movement of bowel contents
paralyzed bowels
causes abdominal pain
20
Q
treatment of paralytic ileus
A
gum chewing
21
Q
Hypostatic pneumonia
A
results when lack of movement or of position change causes stasis of secretions= breeding ground for bacteria
22
Q
purulence
A
pus
23
Q
seroma
A
serum-filled swelling
24
Q
thrombophlebitis
A
clot and inflammation in a blood vessel
25
thrombosis prevention
SCDs- remove once per hr
danger decreases= compression stockings
26
indications of atelectasis
low-grade fever in 1st 24-48 hrs
decreased breath sounds
dyspnea
27
preventing atelectasis
use of incentive spirometer
deep breathing and coughing
early ambulation
teach to cough properly
28
increased risk of atelectasis
abdominal or thoracic surgery
29
how often should an incentive spirometer be used
every hr for first 24hrs after surgery then every 2hrs after
30
What are post-op complications
atelectasis
pneumonia
paralytic ileus
thrombophlebitis
urinary retention
UTI
hypoventilation
wound infection
PE
hemorrhage and shock
wound dehiscence
evisceration
fluid imbalance
malignant hyperthermia
31
pneumonia prevention
treat atelectasis quickly (72 hrs will lead to this)
turning
coughing
deep breathing
ambulation
incentive spirometer
ROM exercises
32
malignant hyperthermia S&S
high temp
cardiac dysrhythmias
muscle rigidity
hypotension
tachypnea
dark cola-colored urine
33
fluid imbalance S&S
signs of overhydration- crackles in lungs, edema, weight gain
signs of dehydration- weight loss, diminished pulse, dry mucous membranes, decreased tissue turgor
34
prevention of fluid imbalance
control IV flow rate
monitor I&O
correct imbalances
auscultate lungs each shift
monitor weight
check for edema
35
evisceration S&S
intestines visible through abdominal incision
36
wound dehiscence S&S
discharge of serosanguineous drainage from wound and sensation that something gave
separation of wound edges
37
hemorrhage & shock S&S
evidence of copious bleeding
decreased BP and respirations
cold clammy skin
decreased urinary output
38
prevention of hemorrhage & shock
give blood or volume expander
stop bleeding
place in shock position with feet & legs elevated and head flat
admin ordered meds to raise blood pressure
admin oxygen
measure VS frequently
39
PE S&S
SOB
anxiety
chest pain
rapid pulse & aspirations
cyanosis
cough
bloody sputum
decreased oxygen saturation
40
wound infection S&S
redness
swelling
pain
warmth
drainage
fever
increased leukocytes
rapid pulse and respirations
41
wound infection prevention
assess wound characteristics and drainage
monitor WBC and temp
aseptic technique for wound care
encourage adequate nutrition and fluids
encourage activity
antibiotics
42
hypoventilation S&S
decreased rate and depth of breathing
decreased O2 and increased CO2
decreased level of consciousness
43
hypoventilation prevention
rouse patient frequently until anesthesia meds have cleared system
monitor pulse & ETCO2
give opioid meds cautiously
encourage fluids & movement
44
UTI S&S
dysuria
frequency
foul smelling urine
45
UTI prevention
force fluids when allowed
encourage frequent voiding
reach proper perineal cleanliness
keep catheter clean and patent
use aseptic technique to empty drainage bag
46
urinary retention S&S
distended bladder
inability to void spontaneously
47
urinary retention prevention
palpate bladder or use bladder scanner
encourage voiding
if unable to void within 8hr obtain order for cath
medicate to increase urinary sphincter tone as ordered
48
thrombophlebitis prevention
heparin for at risk or high risk of
encourage leg exercises
keep patient hydrated
encourage ambulation
anti embolic stockings
49
pneumonia S&S
fever
malaise
increased sputum
purulent sputum
cough
flushed skin
dyspnea
pain on inspiration
abnormal breath sounds
crackles
rhonchi
50
prevention of dehiscence
splinting when coughing
assess wound edge approximation with each assessment
monitor any drainage after wound edges are closed
protect exposed tissue and report
51
most at risk for dehiscence/eviscereation
diabetic
obese
malnourished
dehydrated
malignancy
experienced multiple traumas to abdomen
infected wound
older
52
treatment of dehiscence
antibiotics
notify provider and follow instructions given
saline, gauze, prep OR
53
prevention of embolus
ambulate/turning
ROM exercises
antiembolism stockings
adequate fluid intake
54
treatment of PE
oxygen
therapeutic anticoagulation
55
Treatment of evisceration
supine with knees flexed
cover wound with sterile saline-soaked gauze or towels
return to operating room for repair
monitor for shock
56
malignant hyperthermia prevention
genetic predisposition
can only monitor and treat symptoms
57
treatment for malinant hyperthermia prevention
apply cooling blanket and ice packs
give dantrolene as ordered
58
Paralytic ileus S&S
no bowel sounds 24-36hrs after surgery or fewer than five sounds/min
59
Prevention of paralytic ileus
monitor bowel sounds
encourage early ambulation
clear fluids as tolerated
nonopioid meds for pain control
60
pneumonia
inflammation and accumulation of exudate in the lung
61
thrombophlebitis S&S
pain or warmth in calf or leg
swollen leg
warm to touch
possible temp elevation
62
what promotes wound healing
adequate rest
sufficient blood supply
proper nutrition- high protein, high Vit C
63
what delays wound healing
smoking
64
foods high in Vit C
citrus fruits/juices
strawberries
cantaloupe
tomatoes
bell pepper
cabbage
turnip or collard greens
broccoli
mangos
peaches
pineapple
potatoes
65
Foods high in protein
meats- chicken, beef, pork, lamb
cottage cheese
milk
cheese
peanut butter
beans
eggs
ice cream
grain products- breads, pasta
tofu, soy products
66
Home care for postsurgical patients
knows meds to be taken and when
understands diet
understands alcohol must be avoided for 24hr
verbalizes restrictions on activity
understands not to drive or make decisions for 24hrs
verbalizes type of bath permitted
can demonstrate cleaning and dressing of wound
verbalizes S&S to report
understands how to schedule follow-up
understands written instructions for essential points of care and consultation
67
acute pain cause
known cause
surgical procedure
minor burn
sprained ankle
injury causing tissue trauma
68
acute pain
of recent onset, lasting less than 6 mths
69
acute pain duration
hours to days
70
acute pain prognosis for relief
good
may resolve spontaneously or in response to analgesic therapy
71
acute pain psychosocial effects
usually transient or none
may temp disrupt normal activities or routine
72
acute pain effect of therapy
med is usually beneficial
surgery is often helpful
73
gate control theory
recognizes that stimuli other than pain pass through the same gate
large volume of nonpainful stimuli competing= pain impulses blocked
high volume of pain overrides other stimuli and passes through the gate, causing perceived pain
74
endorphins
endogenous opiates
75
Phantom pain
pain that occurs where no actual tissue is involved but the pain is real
76
What are the 3 classifications of pain
acute
cancer
noncancer
77
2 classifications of pain
nociceptive
neuro pathic
78
nociceptive pain
associated with pain stimuli from either somatic or visceral structures
79
somatic
body tissue
80
visceral
organ
81
somatic nociceptive pain
trauma
burns
surgery
skin
bone
muscle
blood vessels
connective tissue
82
visceral nociceptive pain
pathophysiologic conditions
organs in GI tract
tumors
obstructions
83
characteristics of somatic nociceptive pain
sharp
burning
dull
aching
cramping
84
characteristics of visceral nociceptive pain
poorly localized
diffuse
burning
deep cramping or splitting
sharp
stabbing
85
sources of acute postoperative somatic nociceptive pain
incisional pain
pain at insertion sites of tubes and drains
wound complications
orthopedic procedures
skeletal muscle tissue
86
sources of acute postoperative visceral nociceptive pain
chest tubes
abdominal tubes and drains
bladder distention or spasms
intestinal distention
87
sources of chronic pain syndromes of somatic nociceptive pain
bony metastases
osteoarthritis and rheumatoid arthritis
low back pain
peripheral vascular diseases
88
sources of chronic pain syndromes of visceral nociceptive pain
pancreatitis
liver metastases
colitis
appendicitis
89
structure involved in neuropathic pain
peripheral and central nerve fibers, spinal cord, and CNS
90
characteristics of neuropathic pain
poorly localized
shooting
burning
fiery
shocklike
sharp
painful numbness
91
sources of acute postoperative neuropathic pain
postmastectomy pain
nerve compression or injury caused by a surgical procedure
92
sources of chronic pain syndromes of neuropathic pain
HIV-related pain
diabetic neuropathy
postherpetic neuralgia
chemotherapy-induced neuropathies
multiple sclerosis
93
4 pain processes of nociceptive pain
transduction
transmission
perception
modulation
94
transduction
begins when tissue damage causes the release of substances that stimulate the nociceptors and initiate the sensation of pain
95
transmission
involves movement of pain sensation to the spinal cord
96
perception
occurs when impulses reach the brain and the pain is recognized
conscious experience of pain
97
modulation
occurs when neurons in the brain send signals back down the spinal cord by release of neurotransmitters
98
Neuropathic pain
associated with a dysfunction of the nervous system that involves an abnormality in the processing of sensations
99
neuropathic pain and nursing
analgesics and opioids don't relieve
adjuvant meds: NSAIDs, tricyclic antidepressants, anticonvulsants, and corticosteroids relieve
100
pain threshold
the point at which pain is perceived
101
what can alter perception of pain
relaxation and distraction strategies
102
pain tolerance
the length of time or the intensity of pain a person will endure before outwardly responding to it
103
influences of pain tolerance
culture
pain experience
expectations
role behaviors
104
acute pain
recent onset, lasting less than 6 months
can turn into chronic pain
105
symptoms of acute pain
increased pulse and resp rate
increased BP
diaphoresis
increased muscle tension
nausea
vomiting
106
chronic pain
lasting longer than 6 months or years
may have learned adaptive methods that allow them to have some control over their pain
107
symptoms of chronic pain
irritability
depression
withdrawal
insomnia
108
acute pain causes
known cause
surgical procedure
minor burn
sprained ankle
injury causing tissue trauma
109
prognosis for relief of acute pain
good
may resolve spontaneously or in response to analgesic therapy
110
prognosis for relief of chronic pain
poor unless complicating factors are removed
spontaneous relief is unusual
111
cause of chronic pain
sometimes known but diagnosis may be complex or undetermined
112
psychosocial effects of acute pain
usually transient or none
may temp disrupt normal activities or routine
113
psychosocial effects of chronic pain
can affect ability to earn a living, enjoy social activities, or maintain self-esteem
114
effect of therapy on acute pain
meds usually beneficial
surgery often helpful
115
effect of therapy on chronic pain
meds may be helpful but patient may become dependent
multiple-meds regimen may be used
surgery may help but also may worsen the problem
116
how often should pain be assessed
every time vitals signs are taken
ask about pain level and describe characteristics
117
physiologic cues of pain
rapid, shallow, or guarded respirations
pallor
diaphoresis
increased pulse
elevated BP
dilated pupils
the tenseness of skeletal muscles
118
appearance of pain
face may look tense, drawn, or pale
may grimace or even a look of fear
body may be rigid, nonmoving position
119
behavior of pain
verbal patient becomes quiet or withdrawn
pleasant person may become irritable, demanding, or argumentative
may protect or cradle painful area
tears, refusal of food or drink, or any behavior out of the ordinary
120
activity level of pian
reduces activity to a minimum
staying in bed
creeping slowly from place to place
stooping over during ambulation
stopping frequently to rest or lean against a support
121
terms for degree of pain
absent
minimal
mild
moderate
fairly severe
severe
very or extremely severe
excruciating
122
terms for quality of pain
crushing
tingling
itching
throbbing
pulsating
twisting
pulling
burning
searing
stabbing
tearing
biting
blinding
nauseating
debilitating
123
terms for frequency of pain
constant
intermittent
occasional
related to something specific
124
referred pain
pain felt in a part of the body that is different from where the pain originates
125
NSAIDs primary use
block pain at the PNS level by decreasing inflammation
126
NSAIDs nursing implications
educate patients not to use in combo with OTC dose of the same med
127
opioids primary use
block pain at CNS level
128
opioids nursing implications
constipation common, can be severe
can cause resp depression
129
antidote for opioids
naloxone: Narcan
130
buccal mucosa
mucous membrane lining the inside of the mouth
131
Patient-controlled analgesia (PCA)
an infusion device controlled by the patient that injects the prescribed dose of analgesia
132
epidural
med infused directly into the epidural space near the base of the spine using a programmable pump
133
nonanalgesic medications used for pain control
antidepressants
immunosuppressants
anticonvulsants
muscle relaxants
marijuana
134
side effects of pain meds
constipation
135
nonpharmacologic approaches to pain
sleep
heat
menthol
cold
distraction
relaxation
guided imagery
meditation
hypnosis
biofeedback
music
binders
massage
acupuncture and acupressure
electrostimulation devices
spinal cord stimulator
invasive treatments
136
Transcutaneous electrical nerve stimulation (TENS)
uses a small electrical stimulator attached to the skin with electrodes placed around the area of pain
137
Scrambler therapy
involves an electrical stimulus delivered through the skin like TENS
designed to scramble pain signals and replace them with a nonpainful stimulus
138
Reasons for surgery
diagnostic
curative
restorative
palliative
cosmetic
139
what is diagnostic surgery
performed to determine the origin and cause of a disorder or the cell type for cancer
140
what is curative surgery
performed to resolve a health problem by repairing or removing the cause
141
what is restorative surgery
performed to improve a patient's functional ability
142
what is palliative surgery
performed to relieve symptoms of a disease process, but does not cure
143
what is cosmetic surgery
performed primarily to alter or enhance personal appearance
144
what condition is reason for diagnostic surgery
breast biopsy
exploratory laparotomy
arthroscopy
145
what condition is reason for curative surgery
laparoscopic cholecystectomy
mastectomy
hysterectomy
146
what condition is reason for restorative surgery
total knee replacement
finger reimplantation
147
what condition is reason for palliative surgery
colostomy
nerve root resection
tumor debulking
ileostomy
148
what condition is reason for cosmetic surgery
liposuction
revision of scars
rhinoplasty
blepharoplasty
149
what are the type of urgency for surgery
elective
urgent
emergent
150
What is elective surgery
planned for correction of a nonacute problem
151
What is urgent surgery
requires prompt intervention
may be life-threatening if treatment is delayed more than 24-48hrs
152
What is emergent surgery
requires immediate intervention to prevent life-threatening consequences
153
what condition is reason for elective surgery
cataract removal
hernia repair
hemorrhoidectomy
total joint replacement
154
what condition is reason for urgent surgery
intestinal obstruction
bladder obstruction
kidney or ureteral stones
bone fracture
eye injury
acute cholecystitis
155
what condition is reason for emergent surgery
gunshot or stab wound
severe bleeding
abdominal aortic aneurysm
compound fracture
appendectomy
156
Degree of risk of surgery
minor
major
157
what is minor surgery
procedure without significant risk
often done with local anesthesia
158
what is major surgery
procedure of greater risk, usually longer and more extensive than a minor procedure
159
what condition is reason for minor surgery
incision and drainage
Implantation of a venous access device
muscle biopsy
160
what condition is reason for major surgery
mitral valve replacement
pancreas transplant
lymph node dissection
161
what are types of extent of surgery?
simple
radical
Minimally invasive surgery
162
what is simple surgery
only the most overly affected areas are involved in the surgery
163
what is radical surgery
extensive surgery beyond the area obviously involved
directed at finding a root cause
164
what is minimally invasive surgery
surgery performed in a body cavity or body area through one or more endoscopes
can correct problems, remove organs, take tissue for biopsy, reroute blood vessels and drainage systems
is a fast-growing and ever-changing type of surgery
165
what condition is reason for simple surgery
simple/partial mastectomy
166
what condition is reason for radical surgery
radical prostatectomy
radical hysterectomy
167
what condition is reason for minimally invasive surgery
arthroscopy
tubal ligation
hysterectomy
lung lobectomy
coronary artery bypass
cholecystectomy
168
robotics
design of computerized, mechanical instruments
169
post-op of robotics surgery
small incisions= less pain postoperatively
requires less time to heal
less scarring
170
autologous
related to self
a persons own blood
171
advantages of autologous blood transfusion
decreased anxiety of patients who fear infection with bloodborne virus
172
bloodless surgery
uses a combo of techniques to minimize blood loss and maximize blood volume and function
173
advantages of bloodless surgery
completely avoids risks of blood transfusions
174
what meds should be on hand for bloodless surgery
epoetin alfa
175
perioperative
refers to the care of the patient before, during, and after surgery
176
What assessments should be done in perioperative stage?
health history and psychosocial assessment
cultural assessment
spiritual assessment
physical assessment
lab and diagnostic test data
177
what causes prolonged uptake of anesthetic drugs
obesity
178
What labs and diagnostics are done in the preoperative phase?
CBC, UA, PT/INR, PTT, blood type and crossmatch, pregnancy test, metabolic panel, AST, ALT, bilirubin, BUN, creatinine, blood glucose, electrolytes ECG, chest x-ray
179
What tests should be done on people over 40?
ECG
chest x-ray
blood glucose
180
What education should be given during preop
preoperative procedures
technical info
day of surgery
PACU
hospital room location
181
surgical risk factors
Diabetes mellitus and other chronic diseases
advanced age with inactivity
very young person
malnutrition
dehydration
obesity
cardiovascular problems
peripheral vascular disease
liver disease
respiratory disease
substance abuse or alcohol dependence
smoking
regular use of certain drugs: Aspirin, NSAIDs, anticoagulants, corticosteroids
excessive fear
182
dehiscence
wound separation
183
pneumonia
inflammation and consolidation of lungs
184
atelectasis
collapsed alveoli
185
what does corticosteroids do with surgery patients
reduce body's response to infection and delay the healing process
186
general goals for all preoperative patients:
prepared for surgery physically and emotionally
able to demonstrate deep-breathing, coughing, and leg exercises
able to verbalize understanding of the procedure and the expectations for the postop period
able to maintain fluid and electrolyte balance throughout the perioperative period
187
When does consent need to be done
before any post op meds are given
188
Who signs the consent
patient/guardian and doctor
189
informed consent
printed form that the patient signs before surgery
must be competent to sign it
190
when should someone be NPO before surgery
often restricted 8hrs prior
a light meat such as toast & clear liquids may be allowed up to 6hrs prior
clear liquids may be allowed up till 2 hrs prior to elective surgery
191
What does elimination have to do with preop
colon solution or enemas may be order to clear fecal matter before colon surgery
make sure patient empties bladder before preop meds
192
What is skin prep for surgery
night or morning of shower with special antibacterial cleanser or just soap and water to remove microorganisms
193
Why would hair be removed
only hair that may interfere with surgery is removed
use hair clippers only to reduce surgical site infection
194
stasis
slowing of blood
195
thrombophlebitis
blood clot and inflammation of a vessel
196
What are postoperative foot and leg exercises?
flex and extend right foot, moving toes up and down 4-5 times
repeat with left foot
trace circles to the right 5 times then to the left 5 times with each foot
bend knee sliding foot back toward the buttocks as far as possible; raise bent leg off bed, dorsiflex foot; extend foot and lower leg to bed
tighten the buttocks muscles for a count of 10 and release
repeat each exercise 4 times
197
What is deep breathing
sit up away from mattress
take deep breath in through nose, hold for a few, slowly exhale
repeat 4 times
perform every 2hrs during day and when awakened at night for vital signs
198
what is forced exhalation coughing
sit up away from mattress
splint the incision: take beep breath through nose and cough; if no secretions= force exhalation cough; take deep breath through nose and forcibly exhale, producing huff; repeat process using 3 huffs to bring secretions to mouth then repeat till no secretions; do every 2hrs while awake and awakened for vitals
199
why are preop meds given
reduce anxiety and promote a restful state
decrease secretion on mucus and other body fluids
counteract nausea and reduce emesis
enhance the effects of the anesthetic
200
Who does the surgical team contain
physician
1st surgical assistant- another physician or specially trained RN
scrub nurse
circulating nurse
anesthesiologist
201
functions of the scrub nurse
STERILE
gather equipment
prepare sterile material
gowns and gloves surgeon on entry
assists with sterile draping of patient
maintain sterility within sterile field
hand supplies to operating team during surgery
maintains neat instrument table
labels and handles surgical specimens correctly
maintains as accurate count
monitors for breaks in sterile technique
clean up after surgery
202
functions of circulating nurse
NOT STERILE
coordinates care in the OR
greets and performs patient assessment
verifies consent signed
sets up OR
gathers, counts, checks all equipment
opens sterile supplies for scrub nurse
assists with transferring patient
preps skin before draping
initiates procedural time-out
observes for breaks in sterile field
ears & hands for outside the OR
203
anesthesia
loss of sensory perception
204
goals of anesthesia
prevent pain
achieve adequate muscle relaxation
calm fears and ease anxiety
induce forgetfulness of an unpleasant experience
205
what are the stages of anesthesia
induction
maintenance
emergence
206
what is the induction stage of anesthesia
unconsciousness is induced
207
what is the maintenance stage of anesthesia
period during surgical procedure is performed
208
what is the emergence stage of anesthesia
surgery is complete and patient prepared to return to consciousness; neuromuscular blocking agents are reversed
209
What are types of anesthesia?
general
regional
procedural/conscious sedation
210
what is inhalation general anesthesia used for
extensive surgery for which patient to be unconscious with relaxed muscles
211
what is intravenous general anesthesia used for
shorter surgery
rapid induction
212
what is inhalation general anesthesia advantage
well controlled with assisted ventilation
few side effects
213
what is intravenous general anesthesia advantage
little postop nausea or vomiting
214
what is spinal regional anesthesia used for
surgery in lower half
used for patients not able to undergo general anesthesia
215
what is epidural regional anesthesia used for
for gynecologic procedures and child birth
216
what is nerve block regional anesthesia used for
foot surgery and some orthopedic surgeries
217
what is local regional anesthesia used for
minor surgical procedures
218
what is spinal regional anesthesia advantage
patient can be conscious
does not require fasting
no nausea or vomiting
219
what is epidural regional anesthesia advantage
no diet restrictions postop
220
what is nerve block regional anesthesia advantage
patient is conscious
can cooperate with instructions
221
what is local regional anesthesia advantage
can produce good pain control for many hrs postop
patient may remain conscious
numbs are for short period of time
222
What is the use of procedural/conscious sedation anesthesia used for
surgery of short duration for which unconsciousness is undesirable
may be use in combo with local, spinal, nerve block
223
What is the use of hypnosis anesthesia used for
surgery for patients unable to have general anesthesia and where regional is inappropriate
224
What is the use of cryothermia anesthesia used for
surgery for patient who cannot tolerate other anesthesia, such as life-threatening trauma
225
what is procedural/conscious sedation anesthesia advantage
reversal is rapid
patient is unaware but can breathe without assistance
little if any nausea or vomiting
amnesia of surgery
226
what is hypnosis anesthesia advantage
no drug side effects
227
what is cryothermia anesthesia advantage
provides decrease in pain
228
capnography
measurement of inhaled and exhaled carbon dioxide
229
potential intraoperative complications
hemorrhage
infection
fluid volume excess or deficit
hypothermia
malignant hyperthermia
injury related to positioning
230
what is malignant hyperthermia
an inherited disorder
muscle metabolism and heat production increase rapidly and uncontrollably in response to the stress of surgery and some anesthetic agents
231
S&S of malignant hyperthermia
fever
tachycardia
cyanosis
tachypnea
muscle rigidity
diaphoresis
hypotension
irregular HR
not treated quickly= cardiac arrest
232
interventions for malignant hyperthermia
circulating nurse and anesthesiologist monitor patients temp
change in temp= stop surgery, stop anesthesia, take measures to correct
meds- dantrolene
233
What meds are allowed to still be taken before surgery
BP meds
heart meds
anticonvulsants
234
Maslow's hierarchy of needs order
physiological needs
safety
social
esteem
self-actualization
235
what are physiological needs
ABC's
nutrition
sleep
fluids
hygiene
elimination
236
what are safety needs
stress & anxiety
emotional support
comfort
environment
medical safety
237
what are social needs
person's innate need for love, belonging, acceptancewh
238
at are esteem needs
recognizing and respecting others as a valued person, self-worth
239
what is self-actualization needs
reaching highest level of ability
240
why is weight & height needed before surgery
to calculate correct anesthesia dose
241
Who does Atropine affect adversly
Asian patients- monitor for Tachycardia
242
OR temp
66-70
243
What does BMP monitor
electrolyte balance and kidney function
244
What is the wong Baker scale and who do we use it on
a picture pain scale
children and people who don't speak English
245
what is included in the initial pain assessment
location
intensity
duration of pain
method used to assess
aggravating factors
alleviating factors
246
what are opiate agonists forms
morphine
codeine
hydrocodone
hydromorphone
oxycodone
fentanyl
methadone
ultram
247
what are opiate partial agonsists
buprenorphine
nalbuphine
pentazocine
248
what are the benefits of opiate partial agonsits
decreased risk of addiction
not as strong as opiates
longer acting/use
249
What lab needs to be checked when on acetaminohen
LFTs
250
What are salicylates
aspirin
diflunisal
251
what should you monitor on salicylates
Kidney/ liver function
252
What are NSAIDS drug names
ibuprofen
Indocin
ketorolac
meloxicam
naproxen
253
Adverse effects of NSAIDS
GI upset
GI bleeding
254
Side effects of pain meds
constipation
drowsiness & euphoria
itching and hives
respiratory depression
addiction
255
vital signs for post-op
q15min x4
q30min x4
q1hr x4
q4hr for 1st 24-48
first 2hrs nurse must do vitals
256
minimum urine amount after surgery
no urine for 1st 4-8 hours
30 mls per hour
257
what can we do for nausea/vomiting
zofran
cool washcloth
reduce smell
quiet room
dim lights
258
treatment for malignant hyperthermia
infuse cold fluids
throw cold blankets on patient
dantrium
259
what can be delegated to CNAs
ADLs
specimens
turning
260
What can not be delegated
initial assessments
care planning
education
critical decision making
261
what are challenges of delegation
communication
role confusion
lack of trust
over delegation of tasks
262
what are advantages of delegation
used to ease work load
decrease stress
263
PT time range
11-12.5 sec
264
what is PT time
how long it takes for blood to clot
265
WBC range
5,000-10,000
266
what is function of WBC
looks at immune function
increased= infection, cancer, leukemia
267
Platelets range
150,000- 400,000
268
what are platelets for
essential for blood clotting
269
range of Hgb
males: 14-18
females 12-16
270
what is Hgb for
looks at protein and how it carries oxygen to RBCs
O2 carrying capacity
271
Hct range
males: 42- 52%
Female: 37-47%
272
What does a CBC look at
overall health, clotting, infection
273
what is included in a CBC
Hgb
Hct
WBC
platelets
RBC
274
complications of people >75 in surgery
3x higher complications
less able to adjust and compensate for stress
need reduced dosages of preoperative narcotics & sedatives due to declining liver & kidney function
more likely have have impaired renal, hepatic, respiratory, and cardiac functions that alter metabolism
chronic disease- causes vulnerability to fluid & electrolyte imbalances
experiencing serious depression
difficulty maintaining core body temp
275
What is a BMP for
evaluate electrolyte balance & kidney function
276
What is included in a BMP
Na
K
Cl
BUN
creatinine
glucose
277
What are coagulation studies for
bodies ability to clot
typically used when on coumadin, warfarin
278
what is included in coagulation studies
PT
INR
279
What do LFTs look at
the function of the liver
280
What is included in LFTs
AST
ALT
Bilirubin
Alkaline
281
what are ABGs for
evaluating respiratory or metabolic status
282
What is included in ABG test
pH
PaCO2
HcO3
PaO2
283
What is x-ray for
common for diagnosing fracture, bowel obstruction, pneumonia
readily available
284
nursing interventions for x-ray
position patient correctly
remove metal
285
What is a CT for
cross sectional
shows organs & soft tissues
used for tumor, trauma, stroke
286
nursing interventions for CT
can have dye- check allergies for contrast & shellfish
adequately hydrated
look at BUN & creatinine before giving dyes
287
What is MRI for
most detailed
shows soft tissues, brain, spinal cord, joints
noninvasive
no radiation exposure
288
nursing interventions for MRI
can have contrast- assess allergies
assess for metal anywhere in body
will not use with pacemaker or metal implant
289
What is ultrasound for
evaluate organs
guided biopsy
common in cardiology
290
nursing interventions for ultrasound
position patient well
noninvasive
291
what is echocardiogram for
ultrasound of heart
checks ejection fraction & cardiac output
292
troponin for
cardiac marker
test for heart attack
293
D-dimer for
rule out clots
294
BNP for
indicates heart failure
295
lactate for
sepsis/shock suspected
296
C-reactive protein & ESR for
markers for inflammation
297
Nursing considerations for labs
verify order & patient order
understand normal & abnormal values
communicate critical values promptly
educate patient about purpose & procedure
ensure appropriate patient prep
298
corticosteroid effects on surgery
delay wound healing
alter fluid and electrolyte balance
affect metabolic functions
299
roles of pacu nurse
attempt to wake patient 1st after receiving report
physical & neuro assessment
place on side or turn head to side
look at fluids, drains, dressings
wait till gag response returns to give water
300
how to relieve or reduce flatus
take small amounts of liquid/food at a time
drink only tepid liquids
refrain from using straw
ambulation
modified Trendelenburg
