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Nursing-Sem 1 > Foundations Exam 3 > Flashcards

Foundations Exam 3 Flashcards

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1
Q

What is the AORN?

A

Association of periOperative Registered Nurses; 1950s

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2
Q

What are some benefits of ambulatory surgery?

A

rapidly metabolizing anesthetics
cost-saving (less time in care setting)
reduce risk of HAIs
minimally invasive

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3
Q

What are the purposes of surgery? (8)

A 
(A Curious Colorful Caterpillar Plays Pretty Rad Tunes)
ablative
constructive
cosmetic
curative
palliative
preventive
reconstructive
transplant
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4
Q

what are the different classifications for surgery?

A

1) seriousness (major, minor)
2) urgency (emergency, urgent, elective)
3) purposes (ablative, palliative, diagnostic, reconstructive, procurement, transplant, cosmetic)

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5
Q

Phases of surgery?

A

preoperative, intra-operative, postoperative,

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6
Q

what is the purpose of assessment during the preoperative phase?

A

to establish “normal” or baseline functioning to use as comparison during post-op phase to help recognize/prevent complications

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7
Q

what should be included in the pre-op assessment?

A

nursing hx (smoking, alcohol, pain, religion)
medical hx (allergies, meds, surgeries)
labs
risk factors

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8
Q

what are some of the risk factors for surgical complications?

A 
age
medical conditions
nutrition
sleep apnea
medications/allergies
immunocompetence
fluid/electrolyte imbalance
pregnancy
personal habits (alcohol, smoking)
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9
Q

what are some specific surgical risk factors associated with age?

A 
skin more prone to ulcers, tears
delayed GI emptying
increased risk for infection
increased risk for confusion/delirium
falls risk
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10
Q

what are some specific surgical risk factors associated with obesity?

A

embolus, atelectasis, pneumonia
poor wound healing (low blood supply)
dehiscence and evisceration

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11
Q

implications of anticoagulants before/during surgery?

A

must d/c at least 48 hours before surgery b/c alter normal clotting and increase risk of hemorrhage

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12
Q

implications of insulin before/during/after surgery?

A

the need for insulin changes post-op b/c stress, IV admin of insulin, and decreased nutritional intake decrease insulin requirements

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13
Q

implications of NSAIDS before/during/after surgery?

A

NSAIDs inhibit platelet aggregation and prolong bleeding times, increasing susceptibility to post-op bleeding

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14
Q

implications of ginseng and surgery?

A

Ginseng increases risk of hypoglycemia in patients on insulin therapy

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15
Q

ASA classes for surgical patients?

A 
I: normally healthy
II: mild symptomatic disease
III: severe disease, not threatening
IV: severe disease, constant threat to life
V: not expected to survive w/o operation
VI: brain dead, awaiting organ harvest
I-III = ambulatory surgery candidate
IV-VI = inpatient surgery only
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16
Q

preoperative teaching includes preparing patient for what?

A

expectations before, during, and after surgery

and physically prepping patient (NPO, jewelry, meds)

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17
Q

what is the nurses role in informed consent?

A

witnessing the signature, making sure patient is competent, making sure it’s signed by the right person, and assuring patient knows their right to refuse

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18
Q

different types of anesthesia?

A

general
conscious sedation
regional
local/topical

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19
Q

primary focus during intra-operative phase?

A

prevent injury/complications related to anesthesia, positioning, surgery, and equipment use

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20
Q

malignant hyperthermia

A

life-threatening complication related to anesthesia (genetic–hx important!)

s/s inc CO2, HR, RR, PVCs, unstable BP, cyanosis, mottling, muscle rigidity, late sign = 106-107 deg hyperthermia

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21
Q

recovery phase I

A

movement from OR to PACU
q15min assessment of airway, LOC, vitals, mobility, sensation, fluid balance, dressing (Aldrete score/post-anesthesia recovery score)

handoff communication
nursing focus on maintaining airway, respiratory, circulation, neurological functions and managing pain

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22
Q

recovery phase II

A

after ambulatory surgery

modified Aldrete score. need 8-10 to be discharged home. PARSAP scoring in addition to Aldrete. Need 18+ to go home.

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23
Q

t/f: never assume pain is incisional

A

true. always check for location, intensity, and character of pain.

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24
Q

pain

A

unpleasant, subjective sensory and emotional response to actual or potential tissue damage

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25
pain control influences what other factors?
QOL, early mobilization, fewer hospitalizations, shorter length of stay, and decreased costs
26
nociception
process by which painful stimulus is transmitted to CNS and perceived as pain
27
the process of pain includes what phases?
transduction, transmission, perception, modulation
28
transduction
conversion of a painful stimuli into an action potential
29
transmission
action potential signals release of 2nd messengers into synapses to further the impulse to spinal cord, brainstem
30
perception
recognition of pain stimulus
31
modulation
body inhibits pain by releasing chemical messengers the send signal back to pain site
32
gate-control theory of pain
two painful stimuli cannot be transmitted at the same time, will compete for transmission, so painful stimuli can be blocked by other somatic stimuli (e.g. toe stubbing, rubbing example)
33
what stimulated the activation of the ANS and parasympatheic nervous system?
ANS: stress (fight/flight) PSNS: continuous, severe, deep pain
34
sympathetic responses to pain
dilate respiratory tubes, increase HR, peripheral vasoconstriction, increase BGC, diaphoresis, increased muscle tension, pupil dilation, decreased GI motility
35
parasympathetic responses to pain
pallor (blood to vital organs), muscle tension (fatigue), decreased HR & BP (vagal stimulation), rapid/irregular breathing (bodys defenses fail under prolonged stress)
36
behavioral responses to pain
body movements: clenched teeth, guarding, bent posture, grimacing, crying, moaning, restlessness, frequent requests for nurse **lack of pain expression does not mean patient is not experiencing pain**
37
types of pain
acute, chronic, chronic episodic, cancer, inferred pathological, idiopathic
38
acute pain
``` protective identifiable cause limited tissue damage, emotional response seen with injury or surgery lasts up to 6 months ```
39
chronic pain
``` lasts longer than 6 mo lasts longer than expected recovery time in response to progressive illness may not have visible injury (neuropathic) no adaptive purpose frequently results in depression ```
40
physiological factors influencing pain
age fatigue genes neurological function
41
social factors influencing pain
attention previous experience family or social support spiritual factors
42
psychological factors influencing pain
anxiety coping style cultural factors (expectations, roles, ideas about healing/suffering, etc.)
43
burning, crushing, piercing, sharp are examples of what kind of words that describe pain?
sensory words
44
agonizing, exhausting, miserable, punishing are examples of what kind of words that describe pain?
affective words
45
what is the goal of pain management?
anticipate and prevent pain, not treat it
46
what are some non-pharmacologic interventions for pain?
cognitive-behavioral physical CAM
47
cutaneous stimulation for pain
TENS | massage
48
what does TENS stand for?
transcutaneous electrical nerve stimulation
49
what are some pharmacologic interventions for pain?
``` analgesics (opioid, non-opioid, adjuvants) PCA (patient-controlled) perineurial local anesthetic infusion topical analgesics local/regional analgesics ```
50
what are some benefits of PCA?
safe (avoids peaks, troughs) patient in control relief does not depend on nurse availability decreases anxiety and medication use
51
describe perineurial local anesthetic infusion
anesthetic agent infused through un-sutured catheter placed at surgical site
52
what are some considerations with local anesthetics?
prolonged use may lead to "caine allergy"
53
what are some considerations for caring for patients with epidural infusions?
``` prevent catheter displacement maintain catheter function prevent infection (q24h tube change) monitor for respiratory depression prevent complications (itching, nausea) maintain urinary/bowel function ```
54
guidelines for use of analgesics
1) know patient's previous response to analgesics 2) select proper med when have multiple orders 3) know accurate dosage 4) assess right time, interval for admin
55
pain relief ladder
1) start with non-opioids such as NSAIDs, acetaminophen, +/- adjuvants 2) if persists/develops to mild-moderate pain, use opioids +/- non-opioids and adjuvants 3) if persists/develops to severe pain, use higher dose of opioids +/- non-opioids and adjuvants
56
cautions with analgesic use
avoid use of multiple opioids, esp. w/ elderly | avoid IM analgesics, esp. in elderly
57
what is used for long-term management of chronic pain?
fentanyl patches, morphine, and hydro-morphone and SR formulatons ATC
58
what is a benefit of IV analgesics?
quicker acting
59
patient barriers to effective pain management
fear of addiction worries about side effects "noble" suffering need to suffer to earn healing
60
provider barriers to effective pain mangement
inadequate pain assessment skills addiction concerns fear of legal repercussions thinks pain is part of aging process (false)
61
differences between physical dependence, addiction, and tolerance
dependence: withdrawal symptoms w/ stop addiction: disease. impaired control, cravings tolerance: over time requires more to achieve same effects
62
palliative care vs. hospice
palliative care helps coordinate care and live life fully hospice is end of life care (quality of life over quantity of time)
63
allodynia
sensation of pain in response to a normally non-painful stimulus
64
analgesia
absence of pain in response to a normally painful stimulus
65
dysthesia
unpleasant but normal sensation, either spontaneous or evoked unpleasant, normal
66
paresthesia
abnormal but not unpleasant sensation, spontaneous or evokes not-unpleasant, abnormal
67
neuroalgesia
pain in distribution of nerve or nerves
68
hyper/hypoalgesia
increased or decreased response to normally painful stimuli
69
pain threshold vs. tolerance
``` threshold = minimal experience of pain tolerance = greatest level of pain ```
70
nociceptive pain state
evidenced by painful stimulus pain localized to area of stimulus damage
71
inflammatory pain state
evidence of inflammation redness, swelling, heat
72
neuropathic pain state
evidence of sensory or nerve damage burning, tingling, shock-like pain, paresthesias or dysthesias
73
dysfunctional/centralized pain state
pain without detectable pathology; evidence of increased amplification and/or decreased inhibition
74
pain mechanisms include...
``` nociceptive transduction peripheral sensitization exotic activity central sensitization central disinhibition ```
75
what to acquire about during nursing assessment for pain?
intensity location quality modifying factors
76
what to observe for during nursing assessment for pain?
``` level of distress movement posture consistency with story vitals TOUCH/physical exam ```
77
pain red flags include...
outside expected location out or proportion with diagnosis "something's not right"
78
multimodal management of pain
``` M = medications I = interventions P = PT S = pSychoSocial ```
79
treatment of nociceptive pain
opioids NSAIDS acetaminophen antidepressants (TCAs)
80
treatment of inflammatory pain
steroids NSAIDs COX2 inhibitors
81
treatment of neuropathic pain
CCBs | sodium channel blockers
82
treatment of dysfunctional/centralized pain
SNRI antidepressants | CCBs

Nursing-Sem 1 (13 decks)

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