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Nursing-Sem 1 > Foundations Exam 3 > Flashcards

Foundations Exam 3 Flashcards

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
Q

pain control influences what other factors?

A

QOL, early mobilization, fewer hospitalizations, shorter length of stay, and decreased costs

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26
Q

nociception

A

process by which painful stimulus is transmitted to CNS and perceived as pain

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27
Q

the process of pain includes what phases?

A

transduction, transmission, perception, modulation

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28
Q

transduction

A

conversion of a painful stimuli into an action potential

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29
Q

transmission

A

action potential signals release of 2nd messengers into synapses to further the impulse to spinal cord, brainstem

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30
Q

perception

A

recognition of pain stimulus

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31
Q

modulation

A

body inhibits pain by releasing chemical messengers the send signal back to pain site

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32
Q

gate-control theory of pain

A

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)

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33
Q

what stimulated the activation of the ANS and parasympatheic nervous system?

A

ANS: stress (fight/flight)
PSNS: continuous, severe, deep pain

34
Q

sympathetic responses to pain

A

dilate respiratory tubes, increase HR, peripheral vasoconstriction, increase BGC, diaphoresis, increased muscle tension, pupil dilation, decreased GI motility

35
Q

parasympathetic responses to pain

A

pallor (blood to vital organs), muscle tension (fatigue), decreased HR & BP (vagal stimulation), rapid/irregular breathing (bodys defenses fail under prolonged stress)

36
Q

behavioral responses to pain

A

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
Q

types of pain

A

acute, chronic, chronic episodic, cancer, inferred pathological, idiopathic

38
Q

acute pain

A 
protective
identifiable cause
limited tissue damage, emotional response
seen with injury or surgery
lasts up to 6 months
39
Q

chronic pain

A 
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
Q

physiological factors influencing pain

A

age
fatigue
genes
neurological function

41
Q

social factors influencing pain

A

attention
previous experience
family or social support
spiritual factors

42
Q

psychological factors influencing pain

A

anxiety
coping style
cultural factors (expectations, roles, ideas about healing/suffering, etc.)

43
Q

burning, crushing, piercing, sharp are examples of what kind of words that describe pain?

A

sensory words

44
Q

agonizing, exhausting, miserable, punishing are examples of what kind of words that describe pain?

A

affective words

45
Q

what is the goal of pain management?

A

anticipate and prevent pain, not treat it

46
Q

what are some non-pharmacologic interventions for pain?

A

cognitive-behavioral
physical
CAM

47
Q

cutaneous stimulation for pain

A

TENS

massage

48
Q

what does TENS stand for?

A

transcutaneous electrical nerve stimulation

49
Q

what are some pharmacologic interventions for pain?

A 
analgesics (opioid, non-opioid, adjuvants)
PCA (patient-controlled)
perineurial local anesthetic infusion
topical analgesics
local/regional analgesics
50
Q

what are some benefits of PCA?

A

safe (avoids peaks, troughs)
patient in control
relief does not depend on nurse availability
decreases anxiety and medication use

51
Q

describe perineurial local anesthetic infusion

A

anesthetic agent infused through un-sutured catheter placed at surgical site

52
Q

what are some considerations with local anesthetics?

A

prolonged use may lead to “caine allergy”

53
Q

what are some considerations for caring for patients with epidural infusions?

A 
prevent catheter displacement
maintain catheter function
prevent infection (q24h tube change)
monitor for respiratory depression
prevent complications (itching, nausea)
maintain urinary/bowel function
54
Q

guidelines for use of analgesics

A

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
Q

pain relief ladder

A

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
Q

cautions with analgesic use

A

avoid use of multiple opioids, esp. w/ elderly

avoid IM analgesics, esp. in elderly

57
Q

what is used for long-term management of chronic pain?

A

fentanyl patches, morphine, and hydro-morphone
and
SR formulatons ATC

58
Q

what is a benefit of IV analgesics?

A

quicker acting

59
Q

patient barriers to effective pain management

A

fear of addiction
worries about side effects
“noble” suffering
need to suffer to earn healing

60
Q

provider barriers to effective pain mangement

A

inadequate pain assessment skills
addiction concerns
fear of legal repercussions
thinks pain is part of aging process (false)

61
Q

differences between physical dependence, addiction, and tolerance

A

dependence: withdrawal symptoms w/ stop
addiction: disease. impaired control, cravings

tolerance: over time requires more to achieve same effects

62
Q

palliative care vs. hospice

A

palliative care helps coordinate care and live life fully

hospice is end of life care (quality of life over quantity of time)

63
Q

allodynia

A

sensation of pain in response to a normally non-painful stimulus

64
Q

analgesia

A

absence of pain in response to a normally painful stimulus

65
Q

dysthesia

A

unpleasant but normal sensation, either spontaneous or evoked

unpleasant, normal

66
Q

paresthesia

A

abnormal but not unpleasant sensation, spontaneous or evokes

not-unpleasant, abnormal

67
Q

neuroalgesia

A

pain in distribution of nerve or nerves

68
Q

hyper/hypoalgesia

A

increased or decreased response to normally painful stimuli

69
Q

pain threshold vs. tolerance

A 
threshold = minimal experience of pain
tolerance = greatest level of pain
70
Q

nociceptive pain state

A

evidenced by painful stimulus

pain localized to area of stimulus damage

71
Q

inflammatory pain state

A

evidence of inflammation

redness, swelling, heat

72
Q

neuropathic pain state

A

evidence of sensory or nerve damage

burning, tingling, shock-like pain, paresthesias or dysthesias

73
Q

dysfunctional/centralized pain state

A

pain without detectable pathology; evidence of increased amplification and/or decreased inhibition

74
Q

pain mechanisms include…

A 
nociceptive transduction
peripheral sensitization
exotic activity
central sensitization
central disinhibition
75
Q

what to acquire about during nursing assessment for pain?

A

intensity
location
quality
modifying factors

76
Q

what to observe for during nursing assessment for pain?

A 
level of distress
movement
posture
consistency with story
vitals
TOUCH/physical exam
77
Q

pain red flags include…

A

outside expected location
out or proportion with diagnosis
“something’s not right”

78
Q

multimodal management of pain

A 
M = medications
I = interventions
P = PT
S = pSychoSocial
79
Q

treatment of nociceptive pain

A

opioids
NSAIDS
acetaminophen
antidepressants (TCAs)

80
Q

treatment of inflammatory pain

A

steroids
NSAIDs
COX2 inhibitors

81
Q

treatment of neuropathic pain

A

CCBs

sodium channel blockers

82
Q

treatment of dysfunctional/centralized pain

A

SNRI antidepressants

CCBs

Nursing-Sem 1 (13 decks)

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