Exam 1: surgical

Question 1

Priority concepts with surgery

Answer 1

gas exchange, pain

Question 2

Surgical care improvement project

Goal

Answer 2

reduce and prevent surgical complications

core measures: infections, venous thrombotic events, serious cardiac events, maintaining normothermia

Question 3

ectomy

Answer 3

removal of an organ or gland

Question 4

rrhaphy

Answer 4

repair

Question 5

ostomy

Answer 5

providing an opening (stoma)

Question 6

otomy

Answer 6

cutting into

Question 7

plasty

Answer 7

formation or plastic repair

Question 8

scopy

Answer 8

looking into

Question 9

Ablative surgery

Answer 9

surgically destroy abnormal tissue or tumor

Question 10

Curative surgery

Answer 10

resolve health problem by removing/repairing diseased tissue

Question 11

Curative surgery

Answer 11

resolve health problem by removing/repairing diseased tissue

Question 12

Diagnostic surgery

Answer 12

determine the origin and cause of a disorder by taking a tissue sample with the intention of diagnosing

Question 13

Palliative surgery

Answer 13

increases the quality of life while reducing stressors on the body; non-curative

Question 14

Preventative surgery

Answer 14

intervention with the intention that a condition will not develop

Question 15

transplantation surgery

Answer 15

replace a malfunctioning structure

Question 16

Reconstructive surgery

Answer 16

to improve functional ability on abnormal or damaged body structures

Question 17

Timing of surgery: elective

Answer 17

planned, non-essential, non-acute problem

Question 18

Timing of surgery: urgent

Answer 18

unplanned, required timely intervention, life threatening if treatment is delayed more than 24 to 48 hours

Question 19

Timing of surgery: emergent

Answer 19

must be performed immediately to preserve life and limb

Question 20

Surgical approach: simple

Answer 20

limited to defined anatomic location

Question 21

Surgical approach: radical

Answer 21

involves dissection of tissue and structures beyond immediate operative site

Question 22

Surgical approach: minimally invasive

Answer 22

fiberoptic endoscopes, smaller incisions

Question 23

Surgical approach: endoscopic

Answer 23

diagnostic as well as therapeutic can be used in conjunction with open technique; uses natural body opening or porthole incisions

Question 24

Surgical approach: open

Answer 24

traditional opening of body cavity, more extensive surgical approach, might produce more postop pain, longer recovery time

Question 25

Pre operative: dietary restrictions NPO

Answer 25

patient advised nothing by mouth for 6 to 8 hours before surgery (decreases the risk for aspiration, patients should be given written and oral directions to stress adherence, surgery can be canceled if not followed)

Question 26

What is the general skin preparation for pre op patients

Answer 26

shower using antiseptic solution--CHG wipes

Question 27

How do you use an Incentive spirometer

Answer 27

place in sitting position put mouthpiece in mouth and make a tight seal take a slow deep breath, raise the blue piston and keep the blue tab between the arrows as soon as you stop inhaling the piston will fall, continue to hold your breath for 5 seconds before breathing out. This forces the air down in your lungs repeat this process 10 times, slowly, every hour while you are awake

Question 28

When does the intraoperative phase begin

Answer 28

transfer of the patient onto the OR bed and continues until the patient is admitted to the PACU or ICU

Question 29

What is the role of sterile drapes with microbes

Answer 29

surgical scrub reduced the number of resident bacteria (broad-spectrum, surgical antimicrobial solution, vigorous rubbing to create friction, scrub for another 3 to 5 minutes)

Question 30

Anesthesia: induced state

Answer 30

partial or total loss of sensation occurs with or without LOC

Question 31

Anesthesia: purpose

Answer 31

block nerve transmission suppress reflexed promote muscle relaxation achieve a controlled LOC

Question 32

General anesthesia

Answer 32

reversible LOC induced by inhibiting neuronal impulses in several areas of the CNS involves a single agent of a combo agents

Question 33

4 stages of general anesthesia

Answer 33

Analgesia and sedation, relaxation a. This stage can be initiated in a preoperative anesthesiology holding area, where the patient is given medication and may begin to feel its effects but has not yet become unconscious. This stage is usually described as the “induction stage” i. Roll them into the operating room 2. Excitement, delirium a. This stage is marked by features such as disinhibition, delirium, uncontrolled movements, loss of eyelash reflex, hypertension, and tachycardia i. Airway reflexes remain intact during this phase and are only hypersensitive to stimulation ii. Airway manipulation during this stage of anesthesia should be avoided 3. Operative anesthesia, surgical anesthesia a. This is the targeted anesthetic level for procedures requiring general anesthesia. Ceased eye movements and respiratory depression are the hallmarks of this stage. Airway manipulation is safe at this level. 4. Danger/overdose a. This stage occurs when too much anesthesia is given relative to the area of surgical stimulation, which results in worsening of an already severe brain or medullary depression. This stage begins with respiratory cessation and ends with potential death

Question 34

Local anesthesia

Answer 34

briefly disrupts sensory nerve impulse transmission from a specific body area or region delivered topically and by local infiltration

Question 35

Regional anesthesia

Answer 35

type of local anesthetic that blocks multiple peripheral nerves in a specific body region nerve block spinal block epidural block

Question 36

Spinal vs epidural

Answer 36

spinal is usually quicker response due to direct into CSF epidural is not as good with a longer onset (25-30minutes)

Question 37

When anaphylaxis occurs what is one of the signs

Answer 37

stridor (airway obstruction)

Question 38

W/ moderate sedation: amnesia is ____ and ____ return of ADL

Answer 38

short; rapid

Question 39

Post anesthesia care: phase 1

Answer 39

encompasses care of the patient from emergence until physiologically stable, including return of protective reflexes and motor function

Question 40

Post anesthesia care: phase 2

Answer 40

begins with the return of baseline LOC, patent airway with upper airway reflexes, manageable pain, and stable pulmonary cardiac and renal funcitoning

Question 41

Post anesthesia care: phase 3

Answer 41

23 hours observation suites in hospital units, and recovery care centers within hospital and community

Question 42

What is the protocols for post op vital signs

Answer 42

every 15 minutes for 1 hour, every 30 minutes for 2 hours and then, every 4 hours for 24 hours

Question 43

T/F the incidence of periop MI is expected to increase as the population ages and more surgical procedures are performed on older adults

Answer 43

T

Question 44

Thermoregulation: hypothermia

Answer 44

shivering increases oxygen demange up to 400% impairs coagulation causes decreased cerebral perfusion

Question 45

Thermoregulation: hyperthermia

Answer 45

this can be caused by an infectious process sepsis malignant hyperthermia (might occur or recur as late as 24 to 72 hours after surgery)

Question 46

Pain management priority

Answer 46

expected to attain and maintain optimal level of comfort

Question 47

Urinary retention is characterized by

Answer 47

inability to void over a 6 to 8 hours period need foley placement usually resolves within 48 hours

Question 48

Potential complications: wound healing

Answer 48

factors include advanced age, nutritional status, vascular disease, diabetes

Question 49

Potential complications: hemorrhage

Answer 49

most likely occurs within 48 hours post operatively; might be related to sutures or small vessel leakage

Question 50

Potential complications: infection

Answer 50

factors include: hematoma foreign body dead space hypothermia

Question 51

Potential complications: dehiscence and evisceration

Answer 51

usually occurs 3 to 10 days post op