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113 Cards in this Set
- Front
- Back
What are some key points of Pre-op nursing care?
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identify treatment risks, pt teaching, including diagnostic tests, safety, medication administration, nutrition, elimination, metabolic
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What are some intra-op key points of nursing care?
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SAFETY
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What are some key points of post-op nursing care?
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prevention of post-op complications, pain control, wound care, patient teaching
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What are some increased risk factors for complications of perioperative?
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chronic illness, age (young or old), urgency, meds, pulmonary (COPD, asthma), anemia, blood problems, hypertension, seizures, steroids
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What are some interventions for the elderly perioperative?
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think of system related illnesses and how it will affect the pt going to surgery, (example: CV- previous MI = decreased contractility of the heart due to stress of anaethesia OR Pulmonary- COPD risk with oxygen levels with anaesthesia)
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What are some parts of preoperative period?
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assessment: history, age, medications, allergies, past medical history, discharge planning, blood donations if needed
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How long must you be off coumadin before surgery?
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a few days
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What are some meds to consider during pre-op?
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antiarrhythmics, antihypertensives, steroids, anticoagulants, ASA, NSAIDS, Vitamin E, anti seizure, hypoglycemics, herbal, OTC
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What are parts of the physical exam for pre-op?
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CV, respiratory, renal, neurological, musculoskeletal, nutritional status, psychosocial
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What are some assessments for pre-op related to the elderly?
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chronic illness (arthritis, renal, CV, pulmonary, sensory), malnutrition, more allergies, decreased ability for self care, support systems?, ability to tolerate stress? (decreases with aging), increased complications, comorbidity
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What are some diagnostic tests that may be done pre-op?
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CBC, UA, T AND C, PT, PTT, INR, BUN/CR, CXR, PFT, ECG, pregnancy tests, electrolytes
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What is the difference between PT and PTT?
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measures different parts of cascade process
PT= INR and coumading PTT= heparin |
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Why will BUN and Cr be tested pre-op?
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deals with the metabolism and excretion of anaesthetics and meds
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What are some problems/ nursing diagnoses for pre-op?
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knowledge deficit, anxiety, powerlessness
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What must you get before surgery?
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informed signed consent
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Who describes the surgery to the pt?
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surgeon
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When must the consent be signed?
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prior to sedation
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Who signs it?
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the patient if over 18 or emancipated, if under 18 and not emancipated, the legal guardian
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What does the nurse provide pre-op?
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teaching for tests, drains, tubes, exercises, pain management, etc
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What do use for elimination prep if needed?
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enemas, laxatives
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What are some parts of nutrition to remember pre-op?
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NPO, IV, TPN
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What are some parts of skin prep pre-op?
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cleanse, remove hair (based on hospital policy NO shaving, use clippers) shaving causes risk for infection
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What is some info that is in the pre-op checklist?
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ID band, allergy band, consent, History and physical, EKG, CXR, remove jewelry, contacts, nail polish, etc. document last set of vitals and last time pt voided and other info, preop meds given after and time given recorded
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What are some pre-op meds given for?
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to decrease anxiety, promote relaxation, reduce oral secretions, decrease amount of anaesthesia needed, on call, AFTER CONSENT SIGNED
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When do you empty bladder pre-op?
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right before giving meds, then put side rails up and keep pt in bed
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What types of meds are given in the pre-op?
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sedative, opiod analgesic, and anticholinergic
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What does anaesthesia cause?
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partial or total loss of sensation with or without loss of consciousness
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What does anesthesia do?
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block transmission of nerve impulses, suppresses reflexes, and promotoes muscle relaxation
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Where is anesthesia metabolized and excreted?
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metabolized in teh liver and excreted in the kidneys
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What are some points about general anaesthesia?
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reversible, loss of consciousness, CNS depression, amnesia, pain relief, loss of muscle tone and reflexes
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What are routes of general anaesthesia
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inhalation, IV
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4 stages of general anaesthesia
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analgesia sedation, excitement, operative, and DANGER
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What are some ways to inhale general anaesthesia?
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ET tube, gas agents
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What is balanced anaesthesia?
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combinations of inhaled and IV
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Why to use balanced anaesthesia
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safe adn controlled, especially for elderly and high risk patients
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complications from anaesthesia
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sore throat, N/V, overdose, hypoventilation, malignant hypertension
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How is Malignant hyperthermia (MH) acquired?
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usually genetic and it is a skeletal muscle defect triggered by anaesthesia and deals with calcium and muscles
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Why are people NPO before anaesthesia
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prevent aspiration
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What is a genetic disorder that is a skeletal muscle defect and you cannot regulate Ca++ properly?
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malignant hyperthermia
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What are the symptoms of a patient with MH?
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rapid elevation of temp, sudden tachycardia (unexplained), muscle rigidity in jaw and upper chest, hypotension, tachypnea, skin mottling, cyanosis, myoglobinuria (cola colored urine), increased end tidal CO2 and decreased O2 saturation levels, extremely elevated temp
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What is a late sign of MH?
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extremely elevated temp
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Page in book to look for MH
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330
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What can cause tachycardia during surgery?
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blood loss
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How do you treat a pt with MH?
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first thing is to STOP ANAESTHERIA IMMEDIATELY!!!, then give Dantrolene 2-3 mg/kg IV
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After stopping anaesthesia and giving dantrolene, how do you deal with MH?
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maintain airway, give O2 100%, cool pt with iced IV normal saline, apply cooling blanket, lavage stomach, bladder, open body cavity, treat any other symptoms, check ABG and K levels
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What IV of iced IV normal saline do you use for MH?
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15 ml/kg every 15 minutes x 3
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What are some contraindications of regional/local anaesthesia
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severe arthritis or recent back surgery
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Types of regional/local anaesthesia
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topical, local, field block, nerve block, spinal anaesthesia, epidural
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What are some local/regional complications of anaesthesia
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anaphylaxis, incorrect technique, systemic absorption, overdose, toxic reaction
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What is conscious sedation
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IV administration of sedative, hypnotic and opiod to produce a depressed LOC but can maintain airway
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What is needed for conscious sedation
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consent
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What are some meds given for conscious sedation
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valium, versed, fentyl
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What has a rapid recover and usually discharged
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conscious sedation
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What do you give IV for conscious sedation
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sedative, hypnotic, and opiod
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What are some problems with conscious sedation
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injury from positioning, immobilization, and anaesthesia, skin integrity, pg 337, SAFETY, sharps count, sponge count
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How often do you count sharps and sponges?
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at least 3 times each
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What are you at risk for in post op?
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airway, allergic rxn, hypothermia, hypo/hypertension, shock, renal failure, 'lyte imbalance, dysrhythmias, CHF, ileus, urinary retention, DVT, PE, atelectasis/pneumonia, larygeal edema, GI bleed, DIC anemia, wound dehis/evis
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When does post op start?
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close patient and begin reversal of anaesthesia
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What do you check in post op
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LOC, VS, dressing, drains and other tubes, gag and cough reflexes, tsf to room, stable conditions
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What may the pt be like when coming out of anaesthesia
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restless
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What do you do when transferring a pt to room post op
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airway, breathing, LOC, surgical site, VS, IV, other tubes
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What are some post op complications that can occur with the respiratory system
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atelectasis, pneumonia, aspiration
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What do you do post op for respiratory?
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listen to lung sounds, vitals, check for use of accessory muscles, O2 levels, pulse ox, incentive spirometry, turn, cough, deep breathe
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What do you evaluate in respiratory post op?
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pulse ox 95+, clear breath sounds, RR within normal limits, no use of accessory muscles
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What are some post op CV complications
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pulse deficit, dysrhythmia, evidence of bleeding/ hemorrhage/shock, evidence of hypovolemia, IV fluids infusing, labs (BUN, Cr, CBC)
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What will dysrhythmia cause
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risk for decreased CO
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Signs of hypovolemia
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tachycardia, decreased BP, restless, decreased urinary output
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What are some signs of a DVT
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complaints of calf pain, swelling, warmth and tenderness, pulses palpable, can also use venous doppler or Homans sign (not accurate), use TEDs adn sequentials
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Why are pulses palpable with DVT
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in a vein NOT artery
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What are some risk factors for CV?
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obesity, immobility, smoking, cancer, oral contraceptives, trauma to blood vessels
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When should the pt void post op?
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within 8 hours
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What do you monitor in renal post op?
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IV/PO intake adequate, I adn O, prevent renal calculia, prevent UTI
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What can you do to get the pt to pee?
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run water, put in natural position
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How do you check if the bladder is full
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palpate
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What are some parts to assess when dealing with GI post op?
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NPO, check bowel sounds, NG tube care, drain care, N/V, advance diet, suppository, paralytic ileus
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What is a paralytic ileus?
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section of the bowel that has lost peristalsis
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What do you do with a paralytic ileus?
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avoid narcotics and get the pt to ambulate and move
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How long may it take for bowel sounds to return after surgery?
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24-36 hour
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What is good to hear post op
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the client passing gas, means the bowel sounds are back
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What may help increase peristalsis in early post op
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chewing gum
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What are some skin assessments post op?
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wound care, dressing changes, drainage, SSX of infection, SSX of dihiscence/evisceration
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What is eviseration
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part of body sticking out of wound
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What do you want when assessing surgical wound
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want suture line well approximated, staples and sutures intact, no redness, warmth, or drainage
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What are some parts of usual post op care
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wound, nutrition, safety, pain, pulmonary, CV, elimination
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What do you do for pain management in PACU?
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1/2 ordered dose
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What do you check for painwise in post op?
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assessment, severity matches med, interventions to enhance med, PCA, or epidural
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What do opiods do
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block release of NTs in spinal column
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What are some opiods?
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hydrocodone (vicodin, lortab), oxycodone (oxycontin, percodan, percocet), hydromorphine (dilaudid- 8 times more potent than morphine), Fentanyl patch, Demerol (restricted use), ultram
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What is 8 times more potent than morphine
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dilaudid
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What is main goal of intra op/
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SAFETY
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What are some opiod side effects?
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respiratory depression with IV use, constipation with PO/longterm use
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What do you give only IM/PO because of high mortality rate
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Toradol
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What are some parts of follow up care?
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discharge planning, office visit, diet, ADL, activities, shower, meds, SSX infection/report, tell them when to call MD
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In the salem tube, what part never suctions
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blue
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How do you measure an NG/Salem tube?
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ear to nose then nose to sternum
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What do you do before inserting NG tube?
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check nares to see if clear
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How do you insert NG tube
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after checking nares, tilt forward, give water, and ask to swallow as you keep progressing it in
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What is the blue part of salem tube?
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vented to atmospheric air to rpevent the tip of tube from adhering to stomach
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What do you do with suction on NG tube to listen?
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turn off, but be sure to turn it back on
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What are SSX that the NG tube is not tolerated?
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cough and gag/blue
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What do you do if NG tube not tolerated
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withdraw, have the pt breathe a couple times and try again
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What is the best way to check tube placement?
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xray
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What do you do to check placement of NG tube besides xray
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inject air and listen with steth at LUQ or check for gastric return
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What is the purpose of an NG tube?
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gastic decompression (to withdraw/empty and prevent nausea), if overdose (lavage with saline), or to lavage feed
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When can you irrigate an NG tube?
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as long as the pt hasn't had gastric or esophageal surgery. If they have, you need an order to irrigate
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What do you irrigate an NG tube with?
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saline or water
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What must you be very careful not to do with an NG tube if they've had gastic or esophageal surgery?
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not to dislodge it
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What is a Hemavac?
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to promote drainage: must be held lower than suture but NOT dangling
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How does a Hemavac work?
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compressed to allow suction, it will expand, then you empty and measure the output, then squeeze, recap and it's ready for next time
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What is a Jackson Pratt?
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transparent bulb used to drain surgical drainage (PAGE 347)
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How does a Jackson Pratt work?
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same suction as Hemavac: wear gloves
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What may drainage look like right after surgery?
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more bloody in first few hours, then turn to serosanguineous (looks like punch)
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What do you do with a penrose drain?
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safety pin it so it doesn't slip back
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