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NUR123 Exam 1 > Unit 1: The Surgical Patient > Flashcards

Unit 1: The Surgical Patient Flashcards

(71 cards)

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1
Q

Masks are worn at all times in the restricted zone of the OR

A

True

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2
Q

An advantage of IV anesthesia is that the onset of the anesthesia is pleasant, therefore, it is often used.

A

True

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3
Q

Tachycardia is often the first sign of malignant hyperthermia

A

True

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4
Q

Shock results from hypervolemia

A

False- hypovolemia can cause shock

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5
Q

_______is the most common endocrinopathy.

A

Diabetes

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6
Q

The major purpose of withholding fluids before surgery is to prevent _______.

A

Aspiration

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7
Q

The ___________ phase begins when the patient is transferred onto the OR table and ends with admission to the PACU.

A

Intraoperative

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8
Q

________ is a state of narcosis, analgesia, relaxation, and reflex loss.

A

Anesthesia

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9
Q

Spinal anesthesia produces anesthesia of the lower extremities, _______, and lower abdomen.

A

Perineum

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10
Q

What phases does perioperative nursing include?

A

Preoperative, Intraoperative, Postoperative

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11
Q

What is the preoperative phase?

A

The period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table

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12
Q

What is the intraoperative phase?

A

The period of time from when the patient is transferred to the operating room table to when he or she is admitted to the postanesthesia care unit (PACU)

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13
Q

What is the postoperative phase?

A

The period of time that begins with the admission of the patient to the PACU and ends after a follow-up evaluation in the clinical setting or home

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14
Q

What is first-intention healing?

A

a method of healing in which wound edges are surgically approximated and integumentary continuity is restored without granulation

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15
Q

What is second-intention healing?

A

a method of healing in which wound edges are not surgically approximated and integumentary continuity is restored by the process of granulation

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16
Q

What is third-intention healing?

A

A method of healing in which surgical approximation of wound edges is delayed and integumentary continuity is restored by apposing areas of granulation

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17
Q

What factors would you include in the assessment of a surgical patient?

A 
Fluid & nutritional status
Drug & alcohol use
Respiratory status
Cardiovascular status
Hepatic & Renal function
Endocrine function
Immune function
Medication use
Psychological factors
Spiritual & Cultural beliefs
Presence of genetic disorders
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18
Q

What is the preoperative checklist?

A

A list of elements that must be checked preoperatively, including: patient identification, correct documents, and patient understanding of the procedure

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19
Q

What is the role of the nurse in the informed consent process?

A

To ensure the patient/patient representative is provided the information necessary to enable them to evaluate the surgery before agreeing to it
as well as verifying that the patient signing the document is the patient receiving the operation

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20
Q

What are the routine screening tests for surgical patients?

A 
Bloodwork
Urinalysis
Chest X-Ray
Pulmonary function test
ECG
Pregnancy test
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21
Q

What are some age-related changes that put older adults at risk for surgery?

A

Decreased subcutaneous fat
Poor skin tugor
Tissue fragility
Decreased physiologic reserve

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22
Q

What are factors that place older adults at risk for surgery?

A

Age related changes
medications
medical history

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23
Q

What are the effects of medications taken preoperatively?

A

Medications will cause relaxation, lightheadedness, and drowziness

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24
Q

What are some key points to make during preoperative teaching?

A

the possible need for a ventilator, drainage tubes, etc
instruction for breathing and leg exercises
promote mobility
proper breathing techniques
pain intensity scale

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25
What are characteristics of patients under general anesthesia?
not arousable, even with painful stimuli lose ability to maintain ventilatory function require assistance maintaining a patent airway
26
What is Stage I of general anesthesia?
Beginning Anesthesia: warmth, dizziness, detachment; may hear buzzing or ringing, may sense inability to move extremities
27
What is Stage II of general anesthesia?
Excitement: struggling, shouting, talking, singing, laughing, crying; often avoided if anesthesia is given quickly and smoothly
28
What are the different types of anesthesia?
General anesthesia Local anesthesia Moderate sedation/analgesia Monitored anesthesia care
29
What is Stage III of general anesthesia?
Surgical Anesthesia: reached by continuous administration; pt is unconscious
30
What is Stage IV of general anesthesia?
Medullary Depression: too much anesthesia has been administered; cyanosis; can be fatal
31
What is Local Anesthesia?
Blocks the nerves in the CNS & PNS, can be used alone or in conjunction with other types; topical or local infiltration
32
What is Regional Anesthesia?
A form of local anesthesia where an anesthetic agent is injected around nerve so the area the nerve supplies is anesthetized
33
What are examples of regional anesthesia?
Spinal, epidural, peripheral nerve blocks
34
What is Moderate sedation/analgesia?
Sedation without anesthesiologist; conscious sedation
35
What is monitored anesthesia care?
Potential for a deeper level of sedation where the sedation/analgesia is always monitored by and anesthesiologist
36
What do moderate sedation & monitored anesthesia have in common?
Depress a pt's LOC to a moderate level to enable surgical, diagnostic, or therapeutic procedures to be preformed while ensuring the pt's comfort and cooperation Allows pt to maintain a patent airway, retain protective airway reflexes, respond to verbal and physical stimuli, and recover more rapidly
37
What is emergent surgery?
Life-threatening, needs to be done ASAP
38
What is urgent surgery?
Necessary, but can wait 24 hours
39
What is required surgery?
necessary, but can wait
40
What is elective surgery?
Unnecessary, but will make quality of life better
41
What is optional surgery?
No medical need; cosmetic
42
What are the types of surgical techniques?
Conventional Laparoscopic Robotic Natural orifice
43
What types of bloodwork is completed pre-operatively?
CBC Electrolytes Chem 7 PT, PTT, & Clotting
44
What percentage of surgery is outpatient?
70-90%
45
What is the anesthesiologist's assessment focused on?
Cardiac history respiratory history previous anesthesia experiences current medications
46
Pre-operative checklist criteria
``` Vitals Height & weight consent signed? H&P charted/dated? Diagnostics NPO ID Band Allergies hospital gown jewelry off disposition of valuables meds given pt voided ```
47
What are common pre-op orders?
NPO (usually @ 12a) IVF Medications OK to give
48
What are common pre-op preps?
Skin- cleanse/clip hair | Bowel
49
Prior to the surgery, the patient is nervous and does not understand hte procedure or how it will be preformed; the nurse should...
Have the HCP come and explain & review the procedure with the patient
50
Who's in the OR?
``` Primary surgeon Assistant surgeon Scrub nurse Circulating nurse Anesthesia provider ```
51
SURGICAL TIME OUT prevents
Wrong person wrong procedure wrong site
52
What is malignant hyperthermia?
An inherited complication of general inhalation anesthesia; causes contractillity of muscles leading to extreme hyperthermia
53
What are the sympotms, in order, of MH?
``` Tachycardia* Tachypnea Hypercarbia/hypoxemia Muscle rigidity venticular dysrhythmias Lactic acidosis Extreme hyperthermia ```
54
What is the treatment of MH?
Stop anesthetic Hyperventilate 100% O2 Cool IV dantrolene
55
How do you prevent a patient from MH?
Obtain a family history
56
What criteria is used to evaluate if a PACU pt is ready for discharge?
``` Stable BP Adequate respiratory function Adequate O2 sat Spontaneous movement/movement on command AAOx3 Urine output of > 30 ml/hr absent n/v ```
57
What is the role of the RN during pt admission to PACU?
``` assess pt maintain patent airway maintain cardiovascular stability relieve pain & anxiety Control n/v prep for discharge ```
58
What are possible immediate post-op complications?
``` Respiratory depression laryngospasm aspiration cardiac arrest hypo/hypertension dysrhythmias syncope ```
59
What is the intervention to post-operative respiratory depression?
Verbal stimulation | administer naloxone
60
What is the intervention to post-operative nausea/vomiting?
Administer metaclopromide or promethazone
61
What is the intervention for post-operative hypothermia?
Warming blanket
62
What is the intervention to post-operative pain?
IV push PCA epidural morphine, fentanyl, hydromorphone
63
Identify tasks that can be delgated to UAP
``` vital signs repositioning pt assistance with ambulation collecting UA height & weight ```
64
Describe the use of patient controlled analgesia (PCA) in the post-op period
allows pt to control the administration of their medication w/i predetermined safety limits
65
Describe the use of epidural analgesia in the post-op period
the infusion of opiods or local anesthetic agents into the epidural space
66
What are common post-operative complications?
``` DVT/PE Infection Pneumonia UTI Sepsis Wound dehiscence evisceration ```
67
What is a cataract?
The clouding/opacity of the eye lens
68
What are the assessment findings of cataracts?
painless, blurry vision abnormal color perception dim surroundings
69
What kind of surgery is cataract surgery?
required, outpatient
70
What are complications of cataract surgery?
``` Minimum eye pain Hemorrhage Infection increased intraoccular pressure Toxic anterior segment syndrome ```
71
What are the expected outcomes of cataract surgery?
improved vision better ADL performance minimal to no pain

NUR123 Exam 1 (5 decks)

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