unit 2

Question 1

assess pt duting conscious sedation

Answer 1

monitor airway, LOC, O2 sat, capnography, ECG, and vital signs q 15min

Question 2

malignant hypothermia

Answer 2

1. stop all inhalation anesthetic
2. intubate
3. vent at 100% at highest rate
4. give dantolene
5. terminate surgery is possible
6. check ABGs and treat
7. cool pt/ monitor temp

Question 3

RN interventions during general anestheia

Answer 3

stage 1- close OR door, dim lights, control OR traffic, position pt, keep voices low
stage 2- avoid auditory and physical stimulus, protect extremities, assist w suctioning, stay w pt
stage 3- assist w intubation, place in operative position, prep skin
stage 4- prepare/assist w cardiopulmonary arrest, document occurance

Question 4

7 meds for conscious sedation

Answer 4

etomidate-amidate
diazepam-valium
midazolam-versed
fentanyl-sublimaze
alfentanil-alfenta
propofol-diprivan
morphine

Question 5

insufflation

Answer 5

the practice of injecting gas or air into a cavity before surgery

Question 6

DVT assessment

Answer 6

obese, over 40, cancer, decreased mobility, Hx of VTE, DVT, varicose veins, edema, oral contraceptives, smoke, decreased cardiac output, hip or knee surgery
-sudden swelling in 1 leg, dull ache in calf that worsens w mobility

Question 7

application of pneumatic pressure device

Answer 7

measure legs for proper size, place boots on legs and check compression pressure (35-55), apply preop

Question 8

deep breathing

Answer 8

gentle in and out, hold for 5

Question 9

post coughing

Answer 9

every 1-2 hrs post surgery, expel secrestion, keep lungs clear,allow full aeration, prevent pneumonia and atelactesis

Question 10

day of surgery meds

Answer 10

sedatives, hypnotics, anxiolytics, opoid analgesics, anticholinergic, antibiotic w/n 60 min of surgery

Question 11

informed consent w nonenglish speaker

Answer 11

requires qualified translator and witness

Question 12

lab assessment preop

Answer 12

urinalysis, CBC or HH, clotting studies, electrolytes, BUN and Cr, pregnancy

Question 13

hypokalemia

Answer 13

increased risk for digoxin toxicity, slows recovery from anesthia, increased cardiac irritability

Question 14

hyperkalemia

Answer 14

increased risk for dysrhythmias w anestheia

Question 15

assessment priorities post op

Answer 15

phase 1- airway, vitals, indicators of recovery every 15 min
phase 2- presurgery LOC returned, O2 sat at baseline, vitals stable
phase 3- vitals stable, surgical site bleeding

Question 16

post op hand off report

Answer 16

type and extent of proceedure, anestheia details, allergies, health problems, vitals, fluids, blood loss, complications, communication issues, special requests, resp function, location/type incisions/dressings/drains, I&O

Question 17

time out

Answer 17

verify correct pt, proceedure, position

Question 18

RN informed consent

Answer 18

provide detailed info about proceedure, clarify facts and myths, verify signitures, serve as witness

Question 19

age related changes to consider pre op

Answer 19

chronic illness, malnutrition, more allergies, increased impaired self care, inadequate support system, decrease ability to handle stress of surgery/anestheia, increased risk for cardiac, change in mental status, increased fall risk

Question 20

10 SCIP measures

Answer 20

1. antibiotic wn 60 min
2. proper antibiotic selection
3. antibiotic d/c wn 24 hrs post op
4. cardiac pts w controlled 0600 post op blood glucose
5. hair removal
6. urinary cath removal 1-2 days post op
7. temp management
8. beta-blockers
9. VTE prophylactics ordered
10. VTE pro recieved 24 hrs pre and post surgery

Question 21

diagnostic surgery

Answer 21

determine origin and cause of disorder

Question 22

curative surgery

Answer 22

resolve health problem by repair or removal of cause

Question 23

restorative surgery

Answer 23

improve functionable ability

Question 24

palliative surgery

Answer 24

relieve symptoms of dx processbut not cure

Question 25

elective surgery

Answer 25

correction of nonacute problem

Question 26

urgent surgery

Answer 26

requires prompt intervention, life threatening in 24-48 hrs

Question 27

emergent surgery

Answer 27

immediate intervention due to life threatening consequences

Question 28

subcutaneous infusion indications

Answer 28

1. pain and insulin drug infusions 2. palliative care can't take oral meds, IM to painful, or vascular access not available 3. hypodermoclysis- short-term fluid replacement

Question 29

assess post intraosseous device placement

Answer 29

no longer than 24 hrs, check for fluid accumulation, any signs of decreased circulation in limb

Question 30

3 potential systemic complications of IV therapy

Answer 30

1. circulatory overload 2. speed shock 3. catheter embolism

Question 31

assessing peripheral IV site

Answer 31

begin w insertion site and work up, swelling, redness, hardness, drainage, lightly palpate, integrity of dressing, tubing

Question 32

choosing correct IV site

Answer 32

superfiscial veins of forearm (bascilic, cephalic, and median), no hands on older pts, avoid arm w mastectomies, stroke, fistulas

Question 33

IV fluid orders

Answer 33

type, rate, specific dose to be added to solution

Question 34

IV drug orders

Answer 34

name, dose, route, frequency, time of administration, length of infusion time, purpose

Question 35

cholinergic agonists side effects

Answer 35

stimulate bladder and GI tone, constrict pupils, increase neuromuscular transmission, decrease HR and BP, increase saliva, GI, and bronchial glandular secretions

Question 36

antichoinergic effects

Answer 36

decrease GI motility, saliva, bladder contraction, rigidity and tremmors, dilation of pupils, increase pulse

Question 37

evisceration

Answer 37

get help, cover w warm sterile solution dressing, keep dressings moist, assess for shock, supine w knees bent and head raised 15-20 degrees, vitals, emergent surgery

Question 38

dehiscence

Answer 38

apply sterile dressing, avoid cough, alert surgeon

Question 39

assess post op wounds

Answer 39

dr first dressing change, tissue integrity, type and amt of drainage

Question 40

assess pt w spinal or epidural

Answer 40

cardiac depression, restlessness, excitement, incoherent speech, headache, blurred vision, metalic taste, nausea, tremors, seizures, incresed pulse, RR, BP

Question 41

discharge from PACU

Answer 41

9-10 rating on recovery scale, stable vitals, no overt bleeding, return gag/swallow, can take liquids, urine output

Question 42

post op ed for home discharge

Answer 42

prevention of infection, care and assessment of surgical site, mgt of drains and catheters, nutrition, pain and drug mgt, progressive increase in activity

Question 43

pH and osmolarity w IV site

Answer 43

central line needed w pH 5-9 and osmolarity more than 600

Question 44

IV infiltration

Answer 44

stop infusion and remove catheter, apply sterile dressing, elevate extremity, warm/cold compress, insert new line in opposite extremity, rate infiltration and document

Question 45

central line bundle to reduce infection

Answer 45

use checklist, hand hygiene, maximal barrier precautions, sterile technique, min traffic in room, chlorhexide for skin disinfection, use preferred sites, post-placement care, remove ASAP

Question 46

nonpharmacological pain mgt

Answer 46

positioning, massage, relaxation techniques, diversion, ice

Question 47

actions post PICC placement

Answer 47

meticulous dressing changes, hang bags w sterile technique, vigorous scrub of catherter hub, chest xray