Theory/ Patho Week 1 Flashcards

Question

Classification fo Anaesthesia: Complications of inhalation agents

Answer 1

* Coughing * Laryngospasm * Bronchospasm * Increased secretions * Respiratory depression

Answer 2

- Opioids - Benzodiazapines - Neuromuscular blocking agents - Antiemetics

Answer 3

Controlled hypotension - Decrease amount of expected blood loss by lowering blood pressure during administration of anesthesia Hypothermia - Deliberate lowering of body temperature to decrease metabolism - Reduces demand for O2 and anaesthesia

Answer 4

Cryoanesthesia - Freezing localized area to block pain impulses Hypnoanesthesia - Hypnosis to produce alteration in pain consciousness Acupuncture - Decrease sensation

Answer 5

- Accessibility of operative site - Administration and monitoring of anesthetic agents - Maintenance of airway - Correct skeletal alignment - Prevent pressure on nerves, skin over bony prominences, eyes - Provide for adequate thoracic excursion - Prevent occlusion of arteries and veins - Provide modesty in exposure

Answer 6

Scrubbing, gowning, and gloving - Cleanse hands and arms by scrubbing with detergent and brush Basic aseptic technique - Centre of sterile field in surgical incision - Only sterilized items in sterile field - Face shields - Caps, gloves, aprons, eyewear (as appropriate)

Answer 7

Preparing surgical site - Scrubbing or cleaning around the surgical site with antimicrobial agents Circular motion from clean to dirty area - Hair may be removed with clippers

Answer 8

Reversal of anaesthetic agents | Anaesthesiologist and another perioperative team member accompany client to PACU and report is given

Answer 9

Monitoring ABCs (airway, breathing and circulation Fluid therapy (maintain intravenous lines) Monitoring output from catheters and drains Condition of dressings Level of consciousness Providing pain control

Answer 10

``` Explain all activities from admission as hearing is first sense to return Orientation • Explaining surgery is over • Location • Family/friend notified • Who is caring for client ```

Answer 11

``` Ineffective airway clearance Ineffective breathing pattern Impaired gas exchange Risk for aspiration Potential complication: hypoxemia ```

Answer 12

• Lateral position unless contraindicated • Client allowed in supine with HOB elevated once conscious • Deep breathing encouraged to facilitate gas exchange and promote return to consciousness

Answer 13

``` Decreased cardiac output Deficient fluid volume Ineffective tissue perfusion Excess fluid volume Potential complication: hypovolemic shock ```

Answer 14

Frequent monitoring of vital signs • Compare to baseline Apical‐radial pulse carefully assessed and report irregularities Assess skin colour, temperature, and moisture

Answer 15

Treatment begins with administration of oxygen therapy Volume status assessed • IVF boluses to normalize BP Drug intervention Address and eliminate cause of sympathetic nervous system stimulation • Analgesics, voiding, correction of respiratory problems Rewarming corrects hypothermia‐induced hypertension

Answer 16

Disturbed sensory perception Risk for injury Disturbed thought processes Impaired verbal communication

Answer 17

``` LOC Orientation Ability to follow commands Size, reactivity, and equality of pupils Sensory and motor status ```

Answer 18

Attention on evaluation of respiratory function • Hypoxemia causes post‐operative agitation Sedation may be beneficial for controlling agitation and providing safety Side rails up Secure IV lines and artificial airways Verify presence of ID and allergy bands Monitor physiological status

Answer 19

``` Nursing Diagnoses - Hypothermia - Risk for imbalanced body temperature Nursing Assessment - Vital signs, including temperature Orally, tympanic, or axillary - Assess colour and temperature of skin ```

Answer 20

Passive rewarming raises basal metabolism Active rewarming requires application of warming devices • Blankets, heated aerosols, radiant warmers, forced air warmers, or warm intravenous fluids Monitor body temperature at 15‐minute intervals when using any external warming device Skin care to prevent injuries Oxygen therapy for increasing demand

Answer 21

``` Nursing Assessment - Question about feelings of nausea - Document characteristics of vomitus Nursing Diagnoses - Nausea - Risk for aspiration - Risk for deficient fluid volume ```

Answer 22

- Anitemetic or prokinetic drugs - Oral fluids as tolerated - Suction at bedside - Turn client’s head to side to protect from aspiration - Upright position - Slow, deep breathing

Answer 23

- Difficult to do all required teaching due to short timeframe - Client must be mobile and alert and able to provide a degree of self‐care - Pain, nausea, and vomiting must be controlled - Client must drink, eat and void before discharge

Answer 24

Client must be at or near preoperative functioning Instructions are specific to type of anaesthesia used • Given verbally and reinforced with written directions Client may not drive Follow‐up by phone

Answer 25

* PACU nurse gives report to receiving nurse summarizing operative and post‐operative periods * Receiving nurse assists with transfer onto bed * Vital signs obtained and compared to report

Answer 26

* After transfer, in‐depth assessment done * Initiation of post‐operative orders * Early ambulation for muscle tone, GI and urinary function, stimulation of circulation, and normal respiratory function

Answer 27

``` Ineffective airway clearance Ineffective breathing pattern Impaired gas exchange Potential complication: pneumonia Potential complication: atelectasis ```

Answer 28

``` Deep breathing and cough helps prevent alveolar collapse • Incentive spirometer • Splinting • Diaphragmatic breathing • Change position q2h ```

Answer 29

``` Decreased cardiac output Deficient fluid volume Excess fluid volume Ineffective tissue perfusion Activity intolerance Potential complication: thromboembolism ```

Answer 30

Regular monitoring of BP, HR, pulse, and skin temperature and colour • Compare with preoperative status and post‐operative findings

Answer 31

``` Accurate I&Os Monitor laboratory findings Assessment of infusion rate of fluid replacement and infusion site Adequate mouth care Leg exercises ```

Answer 32

``` Elastic stockings or compressive devices Unfractionated or low‐molecular‐weight heparin Ambulation • Slowly progress • Monitor pulse • Assess for feelings of faintness ```

Answer 33

Impaired urinary elimination | Potential complication: acute urinary retention

Answer 34

Urine examined for quantity and quality • Note color, amount, consistency, and odour Assess in‐dwelling catheters for patency Urine output should be at least 0.5 mL/kg per hour • In Adults approx 30 mL/hr If no catheter, client should be able to void 200 mL following surgery • If no voiding, abdominal contour inspected and bladder palpated and percussed for distention

Answer 35

Position client for normal voiding Reassure client of ability to void Use techniques such as running water, drinking water, pouring water over perineum, ambulation, or use of bedside commode

Answer 36

Nausea Imbalanced nutrition: less than body requirements Potential complication: paralytic ileus Potential complication: hiccoughs

Answer 37

Auscultate abdomen in all four quadrants for presence, frequency, and characteristics of bowel sounds • Can be absent or diminished in immediate post‐ operative period • Return of bowel motility accompanied by flatus

Answer 38

May resume intake upon return of gag reflex NPO until return of bowel sounds for client with abdominal surgery • IVF, NG for decompression Clear liquids, advance as tolerated

Answer 39

``` Regular mouth care when NPO Antiemetics administered for nausea • NG tube if symptoms persist Early and frequent ambulation to prevent abdominal distention Assess client regularly for resumption of normal peristalsis ```

Answer 40

Encourage client to expel flatus and explain expulsion is necessary and desirable Relief of gas pains by frequent ambulation and repositioning Suppositories prn Determine cause of hiccoughs

Answer 41

Risk for infection | Potential complication: impaired wound healing

Answer 42

Knowledge of type of wound, drains, and expected drainage Drainage should change from sanguineous to serosanguineous to serous with decreasing output Wound dehiscence may be preceded by sudden brown, pink, or clear discharge

Answer 43

Note type, amount, colour, and consistency of drainage | Assess affect of position changes on drainage

Answer 44

Notify surgeon of excessive or abnormal drainage and significant changes in vitals Note number and type of drains when changing dressing • Examine incision site • Clean gloves and sterile technique

Answer 45

Acute pain | Anxiety

Answer 46

Observe for behavioral clues Question clients able to verbalize Indications of pain and question about the degree and characteristics of pain Identify location Measure before and after treatment is administered

Answer 47

``` IV narcotics Epidural catheters, PCA, or regional anaesthetic blockade Comfort measures • Touch • Family • Rewarming ```

Answer 48

Analgesic administration timed to ensure effectiveness during activities and comfort Assess nature of pain • Location, intensity, quality Notify physician and request change of medication if order fails to relieve pain or makes client excessively somnolent

Answer 49

Patient- controlled analgesia (PCA and epidural analgesia • Provide immediate analgesia and maintain constant, steady blood level of agent • Self‐administration of pre‐metered doses with PCA Patient controls when they get pain medication Opioid medication that can be by demand or continuous infusion in conjunction with adjunct therapy Requires frequent monitoring

Answer 50

* Epidural is infusion of analgesic through catheter in epidural space to deliver medication directly to opiate receptors in spinal cord * Can be administered with additives such as Marcaine and oral adjunct therapy * Requires frequent monitoring

Answer 51

Risk for imbalanced body temperature Hyperthermia Hypothermia

Answer 52

Frequent temperature assessment Observe for early signs of inflammation and infection

Answer 53

Measure temperature q4h for first 48 hours post‐ operatively Asepsis with wound and IV sites Encourage airway clearance Chest x‐rays and cultures if infection suspected Antipyretics and body‐cooling >39.5° C

Answer 54

Anxiety Ineffective coping Disturbed body image Decisional conflict

Answer 55

Provide adequate support Client must be included in discharge planning and provided with information and support to make informed decisions about continuing care Recognition of alcohol withdrawal syndrome Report any unusual behavior for immediate diagnosis and treatment

Answer 56

Planning for discharge begins in preoperative period ◦ Client is informed and prepared and gradually assumes greater responsibility for self‐care ◦ Client may be referred to Home Care for follow‐ up assessments and treatments Provide information to client and caregivers ◦ Care of wound site and dressings ◦ Action and side effects of drugs and when/how to take them ◦ Dietary restrictions/modifications

Answer 57

``` Symptoms to be reported Where and when to return for follow‐up care Answers to questions or concerns Activity prescriptions or restrictions Written instructions for reinforcement • Document and record instructions ```

Answer 58

* Follow‐up call or visit may assess and evaluate client after discharge * Working with discharge planner or case manager can facilitate transition of care from hospital‐based to community‐based and home care (depending on hospital policy)