Operative Care

Question 1

key points from pre op

Answer 1

report any out of range H/P, VS or labs to surgeon

Question 2

surgical care improvement plan

Answer 2

measures hospitals must meet (interventions to reduce surgical site infections)

Question 3

minimally invasive/robotic surgery

Answer 3

more expensive and accurate with less blood loss and faster recovery times

Question 4

robotic surgery is preferred for

Answer 4

cholecystectomy, joint, cardiac, splenectomy, spinal

Question 5

anesthesia

Answer 5

induced state of partial/total loss of sensation, occurring with or without loss of consciousness

Question 6

anesthesia is used

Answer 6

to block nerve impulses, supress relfexes, paralysis, muscle relaxation, controlled level of conciousness

Question 7

general anesthesia

Answer 7

reversible loss of consciousness induced by inhibiting neuronal impulses in CNS

Question 8

inhalation of general anesthesia

Answer 8

commonly induces post op N/V

Question 9

IV injection general anesthesia

Answer 9

do not give if you have kidney or liver problem

Question 10

balanced anesthesia for general anesthesia

Answer 10

Combination of IV drugs and inhalation agents

Question 11

examples of balanced anesthesia

Answer 11

Thiopental for induction, nitrous oxide for amnesia, morphine for analgesia, pancuronium for muscle relaxation

Question 12

adjuncts to general anesthetic agents

Answer 12

hypnotics, opioid analgesics, neuromuscular blocking agents

Question 13

local anestheisa

Answer 13

briefly disrupts sensory nerve impulse transmission from a specific body area but pt remains concious

Question 14

local anesthesia is delivered

Answer 14

topically and by local infiltration (lidocaine)

Question 15

regional anesthesia

Answer 15

type of local anesthesia that blocks multiple peripheral nerves in a specific region

Question 16

example of regional anesthesia

Answer 16

field block, nerve block, spinal block, epidural block

Question 17

conscious sedation

Answer 17

IV delivery of sedative, hypnotic, opioid drugs to reduce level of conciousness with patent airway able to respond

Question 18

examples of conscious sedation

Answer 18

Etomidate, diazepam, midazolam, meperidine, fentanyl, alfentanil, and morphine sulfate

Question 19

preventing injury

Answer 19

proper body position, prevent pressure ulcers, prevent obstruction of circulation/resp/nerve conduction

Question 20

interventions for older adults

Answer 20

hold onto aids/glasses, small pillow under head, lift pt, head cap, monitor I/O + blood loss

Question 21

postoperative phase

Answer 21

begins w completion of surgery and transfer to PACU/ICU

Question 22

phase 1 of post op

Answer 22

PACU or ICU till stable

Question 23

Phase 2 of post op

Answer 23

prep for lower level of care

Question 24

phase 3 for post op

Answer 24

at home w no restriction on ADLs

Question 25

PACU recovery room

Answer 25

allows for ongoing eval and stabilization of pt to prevent and treat complications after surgery

Question 26

PACU nurses

Answer 26

skilled in care of patients with multiple probs after surgery and helps w discharge

Question 27

assessment phase

Answer 27

review pre op assessment, pt hx, identify potential surgical comps

Question 28

respiratory assessment

Answer 28

patent airway, adequate gas exchange, o2 delivery device, lungs every 4 hrs, any artificial airways

Question 29

cardiovascular assessment

Answer 29

VS compared with baseline, cardiac monitor, peripheral vascular assessment, antiembolism stockings to prevent DVT, prophylactic drugs

Question 30

nurse must report BP changes that are at 25% higher or lower than baseline because it cause

Answer 30

blood loss, fluid loss, low BP, shock, pain, hemorrhage

Question 31

neuro assessment

Answer 31

LOC, A/O x 4, prevent delirium, motor and sensory assessment with return of SNS

Question 32

fluid electrolyte and acid base balance assessment

Answer 32

I/O, hydration status, color, IV fluids, acid bases, NG tube

Question 33

before oral feedings are given

Answer 33

check bowel sounds and voiding and that no paralytic ileus is present

Question 34

post op IV fluids provide

Answer 34

hydration and electrolytes not nutrients/calories

Question 35

renal assessment

Answer 35

return of urination, retention s/s, report if UO under 30 ml/hr

Question 36

GI assessment

Answer 36

post op N/V, assess peristalsis return, NG drainage, constipation, bowel sounds

Question 37

constipation may be related to

Answer 37

anesthesia, opioid analgesia, decreased movement, decreased oral intake

Question 38

NG tube inserted during surgery to

Answer 38

decompress/drain stomach, GI rest/healing, provide entereal feeding, monitor bleeding and prevent obstructions

Question 39

NG tube drainage must be assessed

Answer 39

every 8 hours

Question 40

oral feedings

Answer 40

allows more needed nutrients and stimulates action of GI tract only if bowel sounds return

Question 41

diets must progress from

Answer 41

clear to full liquids, soft to reg diet

Question 42

affect on nutrition

Answer 42

nutrient loss great, food intake diminished, protein loss for tissue breakdown/blood loss

Question 43

catabolism after surgery

Answer 43

tissue breakdown and loss exceeds tissue buildup

Question 44

negative nitrogen balance

Answer 44

poor nitrogen means poor ingestion of protein as it controls protein metabolism

Question 45

skin assessment

Answer 45

tissue integrity, drainage color/amount/smell, impaired wound healing

Question 46

dehiscence

Answer 46

opening of a wound

Question 47

evisceration

Answer 47

organs pop out of wound opening

Question 48

pain assessment

Answer 48

pain is expected so it should be continuously monitored

Question 49

drug therapy for pain

Answer 49

opioid/non opioid analgesics

Question 50

complimentary therapies to manage pain

Answer 50

position, massage, relaxation, music

Question 51

psychosocial assessment

Answer 51

anxiety, fear, safety, provide reassurance

Question 52

lab assessment includes

Answer 52

electrolytes, CBC, urine/renal tests, serum amylase, blood glucose, urinalysis, ABG

Question 53

"left shift" CBC

Answer 53

immature neutrophils released due to lack of mature WBCs to fight infection

Question 54

patient problems

Answer 54

decreased gas exchange, infection/delayed healing, pain, decreased peristalsis, post op hemorrhage

Question 55

improving gas exchange interventions

Answer 55

O2 sat, sit pt up, O2 therapy, incentive spirometer, cough, deep breathing, ambulation

Question 56

prevent wound infection/delayed healing

Answer 56

dressing, drains, antibiotics, manage dehiscence/evisceration

Question 57

promote peristalsis interventions

Answer 57

monitor abdomen, adequate hydration, increased mobility, metoclopramide

Question 58

prevent post op bleeding

Answer 58

assess underneath patient, drains, recognize warning signs, color, cap refill

Question 59

transition management

Answer 59

safety, fam availability, adherence to plan, activity, drug reconcilition, high protein/iron/zinc diet

Question 60

outcomes

Answer 60

maintain adequate lung expansion/resp function, good wound healing, pain management, peristalsis return