Exam Study Guide Flashcards
(26 cards)
What are the key components of hand-off reporting in PACU?
IV fluids, vital signs, anesthesia provided, estimated blood loss, and patient status updates.
Ensure effective communication between the OR and PACU nurses.
What should patients understand about the surgical environment?
Patients should understand staff attire, operating room conditions, and the role of nurses in assisting them.
Family members typically cannot enter the operating suite.
What are important risk factors for surgery?
Age, obesity, nutritional status, and existing health conditions.
Screening for risk factors helps prevent postoperative complications.
What does postoperative nursing care involve?
Monitoring for complications such as fluid imbalance, airway obstruction, and vital sign variations during transport.
Assessing pain, encouraging incentive spirometry use, and supporting wound healing.
What should be done during the PACU to medical-surgical floor transition?
Vital signs should be obtained immediately upon transfer to monitor patient stability and detect potential complications.
Why is postoperative fluid and electrolyte balance important?
Recording intake and output is essential for tracking fluid balance.
Weight comparison with preoperative baseline can help assess fluid status.
What symptoms may indicate malignant hyperthermia in the OR?
Symptoms like hypercarbia, tachycardia, and muscle rigidity may indicate malignant hyperthermia, requiring immediate intervention.
What are the roles of the circulating nurse and scrub nurse in the OR?
The circulating nurse manages patient care and coordination, while the scrub nurse assists with sterile procedures.
Preoperative nurses prepare patients by reviewing labs, allergies, and consents.
What should be assessed for skin integrity?
Focus on pressure points, presence of granulation tissue, and signs of infection.
Identify risk factors such as immobility, incontinence, and poor nutrition.
What is assessment of skin integrity?
Focus on pressure points, presence of granulation tissue, and sound of infection identify risk factors such as immobility ,incontinence, and poor nutrition.
How to prevent and treat pressure injuries?
Staging pressure ulcers from Stage I (intact skin) to Stage IV (deep tissue damage) guides care.
Key interventions include proper repositioning, using transfer devices, and assessing for early signs of breakdown.
How should wounds be cleansed?
Always clean wounds from least to most contaminated areas.
Use appropriate wound care techniques based on healing by primary, secondary, or tertiary intention.
What is important for evisceration management and dehiscence?
Proper management techniques are crucial for evisceration and dehiscence.
What nutritional support is recommended for wound healing?
High-protein meals with vitamins A and C, zinc, and adequate fluids promote recovery.
Avoid nutrient-poor meals like fried foods and sugary beverages.
What pain and comfort measures should be taken?
Encourage splinting of incisions with pillows during coughing.
Provide pain management education, including medication timing before mobility exercises.
What can nursing assistive personnel (NAP) do?
NAP can assist with turning and repositioning but cannot assess or document care plans.
Why is collaboration important in patient care?
Collaboration with dietitians, case managers, and respiratory therapists supports holistic patient care.
What is correct body alignment?
Head, shoulders, and hips aligned; even weight distribution; spinal curvature maintained.
What can occur if range of motion (ROM) is not performed adequately?
Joint contractures can occur.
What should you do before assisting an immobile patient to stand?
Let them sit up on the bedside.
What is a risk associated with immobilization?
Kidney stones.
What lab test checks for kidney stones?
Uric acid level and hypercalcemia
What should you encourage immobilized patients to maintain?
Activities of daily living (ADL) such as brushing hair and feeding themselves.
What should you assess in patients to prevent DVTs?
Assess lower extremities for signs such as swollen extremity, warmth, or redness.
