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116 Cards in this Set
- Front
- Back
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SURGERY IS CLASSIFIED ACCORDING TO WHAT
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PURPOSE, URGENCY, DEGREE OF RISK
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WHAT IS DIAGNOSTIC SURGERY AND GIVE AN EXAMPLE
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THIS TYPE OF SURGERY CONFIRMS A DIAGNOSIS
EX: BIOPSY, EXPLORATORY |
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WHAT IS ABLATIVE SURGERY AND GIVE AN EXAMPLE
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THIS TYPE OF SURGERY IS TO REMOVE A DISEASED PART
EX: CHOLECYSTECTOMY (REMOVAL OF THE GALL BLADDER) |
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WHAT IS PALLIATIVE SURGERY AND GIVE AN EXAMPLE
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THIS TYPE OF SURGERY IS TO REDUCE OR RELIEVE SYMPTOMS
EX: PARTIAL REMOVAL OF CANCER FROM BOWEL FOR MORE COMFORT/RELIEF |
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WHAT IS RECONSTRUCTIVE/CONSTRUCTIVE SURGERY AND GIVE AN EXAMPLE
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THIS TYPE OF SURGERY RESTORES FUNCTION/APPERARANCE
EX: TOTAL KNEE REPLACEMENT |
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WHAT IS TRANSPLANT SURGERY AND GIVE AND EXAMPLE
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THIS TYPE OF SURGERY REPLACES MALFUNCTIONING ORGANS
EX: KIDNEY TRANSPLANT |
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SURGERIES CLASSIFIED ACCORDING TO URGENCY ARE CALLED WHAT? GIVE EXAMPLE
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ELECTIVE OR EMERGENCY
ELECTIVE: CATARACT REMOVAL, HIP REPLACEMENT, COSMETIC EMERGENCY: ABDOMINAL AORTIC ANEURYSM |
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PERIOPERATIVE NURSING CARE
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REFERS TO THE ROLE OF THE NUSE DURING THE PREOPERATIVE, INTRAOPERATIVE, POSTOPERATIVE PHASES OF SURGICAL EXPERIENCE
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PREOPERATIVE PERIOD
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PERIOD WHICH BEGINS WHEN DECISION TO HAVE SURGERY IS MADE AND ENDS WHEN PATIENT ENTERS THE OR. CONSISTS OF ASSESSMENT, PLANNING, PRE-OP EDUCATION TO REDUCE ANXIETY AND COMPLICATIONS
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WHAT IS THE PURPOSE OF THE PATIENT ASSESSMENT DURING THE PREOPERATIVE PERIOD OF SURGERY?
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HELPS IDENTIFY PATIENTS WHO ARE AT HIGH RISK DURING SURGERY
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WHY ARE INFANTS AT HIGH RISK DURING SURGERY?
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SMALL BLOOD VOLUME WHICH COULD LEAD TO FVD, HIGH RISK FOR HYPOTHERMIA, IMMATURE LIVER, KIDNEYS, IMMUNE SYSTEM, DECREASED ABILITY TO METABOLIZE DRUGS, FIGHT INFECTION, AND SEPERATION ANXIETY
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WHY ARE OLDER ADULTS AT INCREASED RISK during SURGERY
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FVD, FVE, F/E IMBALANCES, POOR NUTRITIONAL STATUS SLOWS HEALING, HEARING/VISUAL DEFICITS, MEMORY PROBLEMS MAKE TEACHING DIFFICULT, DIMINISHED RENAL, LIVER AND IMMUNE SYST., PRESENCE OF CHRONIC DISEASES
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INSULIN IN REGARDS TO SURGERY
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INSULIN NEED AFTER SURGERY MAY DECREASE B/C OF NPO STATUS
STRESS AND IV GLUCOSE CAN INCREASE INSULIN NEED HAVE AN APPROPRIATE SLIDING SCALE FOR GLUCOSE MONITORING (MONITOR EVERY 6 HOURS) |
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TRANQUILIZERS - WHAT CAN THEY CAUSE/
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DECREASED BP
INCREASED RISK FOR SHOCK RESPIRATORY DEPRESSION POTENTIATE ANESTHESIA AND NARCOTICS. KAVA AND VALERIAN, ST.JOHNS WORT CAN ALSO POTENTIATE EFFECTS OF ANESTHETICS |
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CORTICOSTEROIDS
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DELAY WOUND HEALING
INCREASE GLUCOSE LEVELS SUPPRESS IMMUNE SYSTEM AND INCREASE RISK FOR INFECTION |
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WHEN TAKING AN ASSESSMENT BEFORE SURGERY, WHAT ARE SOME QUESTIONS YOU SHOULD INCLUDE IN THE NURSING HISTORY?
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ASK ABOUT:
PAST ILLNESS CHRONIC ILLNESS PRIOR CARDIAC/PULMONARY PROBLEMS ALL THESE DISORDERS MAY IMPAIR ABILITY TO WITHSTAND ANESTHESIA AND INCREASE RISK FOR COMPLICATION POSTOP |
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THIS DISORDER INCREASES RISK FOR HEMMORHAGE
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BLEEDING DISORDERS
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THIS DISEASE INCREASES SUSEPTIBILITY TO INFECTION AND MAY IMPAIR HEALING
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DIABETES MELLITUS
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THIS DISORDER DECREASES ABILITY TO ECRETE WASTE PRODUCTS (DRUGS) AND FLUIDS
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RENAL PROBLEMS
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DISEASE OF THIS ORGAN ALTERS ABILITY TO METABOLIZE DRUGS AND IMPAIRS HEALING
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LIVER DISEASE
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WHAT EFFECT DOES OBESITY HAVE ON ANESTHESIA
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PROLONGS ANESTHESIA
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OBESITY EFFECTS SURGERY IN WHAT WAYS?
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PROLONGS ANESTHESIA
LARGER, WEAKER INCISIONS POSSIBLE DEHISCENCE AND EVISERATION |
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DEHISCENCE
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OPENINIG OF SURGICAL WOUNDS
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EVISERATION
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INTERNAL ORGANS PROTRUDE THROUGH INCISION
SURGICAL EMERGENCY |
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ASSESSING FOR ALLERGIES PREOP IS VERY IMPORTANT. IF A PATIENT HAS AN ALLERGY TO ANYTHING, WHERE DO YOU DOCUMENT IT?
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ON ARMBAND, NOTE IN CHART, NOTIFY PHARMACY
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A PATIENT WITH NEGATIVE NITROGEN BALANCE IS LIKELY TO EXPERIENCE WHAT?
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POOR WOUND HEALING AND INFECTION
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IF A PATIENT HAS CANCER AND IS UNDERGOING RECENT RADIATION AND CHEMOTHERAPY FOR CANCER, WHAT PROBLEMS COULD ARISE?
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RADIATION CAUSES DELAYED WOUND HEALING (ELECTIVE SURGERY SHOULD WAIT 4-6 WEEKS AFTER RADIATION). CHEMO DRUGS CAN INCREASE RISK OF INFECTION AND BLEEDING.
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BASIC PREOPERATIVE TESTS INCLUDE WHAT?
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CBC, GLUCOSE, BUN, CREATENINE, ELECTROLYTES (ESPECIALLY POTASSIUM), PT, PTT, AND A URINALYSIS, T&X MATCH, CHEST X-RAY, EKG (OVER 40), PREG. TEST
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WHY WOULD A TYPE AND CROSS MATCH BE DONE?
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IF A TRANSFUSION WOULD NEED TO BE DONE
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NURSING DIAGNOSIS FOR PREOPERATIVE PERIOD
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KNOWLEDGE DEFICIT R/T LACK OF EDUCATION/EXPOSURE TO PERIOPERATIVE EXPERIENCE, RISK FOR INEFFECTIVE AIRWAY CLEARANCE R/T SMOKING HISTORY, ANXIETY R/T FEAR OF UNKNOWN OR SEPARATION FROM FAMILY OR LOSS OF CONTROL DURING ANESTHESIA
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BECAUSE SURGERY CAN BE STRESSFUL, PEOPLE DO NOT ALWAYS UNDERSTAND ALL PREOPERATIVE INSTRUCTIONS. WHAT ARE SOME MEASURES TO BE TAKEN TO AVOID PROBLEMS WITH THIS?
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HAVE A SUPPORT PERSON PRESENT
GIVE A WRITTEN COPY OF ALL INSTRUCTIONS PREOPERATIVE TEACHING TO REDUCE FEAR,ANXIETY AND HELP PT. FEEL MORE IN CONTROL (THIS REDUCES AMT. OF ANESTHESIA AND PAIN MEDS AND POST OP COMPLICATIONS) |
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IF A PREOP PT. IS NPO BEFORE SURGERY, WHAT DOES THIS MEAN?
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THEY CAN'T DRINK OR EAT BUT MAY BRUSH TEETH AND RINSE MOUTH WITHOUT SWALLOWING
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ROUTINE MEDS BEFORE SURGERY - WHAT DO WE DO?
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HOLD UNLESS ORDERED TO BE GIVEN WITH A SIP OF WATER
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JEWELRY, MAKEUP, NAIL POLISH, ETC. WHAT ARE THE RULES FOR THE OR?
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NO MAKEUP, JEWELRY, DENTURES, BRIDGES, NAIL POLISH. WEDDING BAND CAN BE TAPED IN PLACE IF CLIENT DOES NOT WISH TO REMOVE IT. GLASSES AND HEARING AIDS MAY GO WITH PATIENT IF THEY NEED TO BE INVOLVED IN THE PROCEDURE, BUT USUALLY GO WITH THE FAMILY FOR SAFEKEEPING.
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DURING PREOP TEACHING INSTRUCT PT. ON POSTOP EXERCISES THAT WILL DECREASE COMPLICATIONS. GIVE AN EXAMPLE
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TURN, COUGH, AND DEEP BREATHE AT LEAST EVERY 2 HOURS
TEACH HOW TO SPLINT INCISION TO PROMOTE COMFORT INSTRUCT ON USE OF INCENTIVE SPIROMETER LEG EXERCISES EARLY AMBULATION |
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WHY MIGHT COUGHING BE CONTRAINDICATED IN NEUROLOGICAL PROCEEDURES?
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IT INCREASES INTERCRANIAL PRESSURE
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INCENTIVE SPIROMETER IS USED POST OP BECAUSE:
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IT ENCOURAGES FORCED EXPIRATION TO IMPROVE LUNG VOLUME, OXYGEN LEVELS, REINFLATES COLLAPSED ALVEOLI AND REMOVES SECRETIONS PREVENTING POST OP PNEUMONIA
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WHY ARE LEG EXERCISES BENEFICIAL POST OP?
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PROMOTES VENUS RETURN AND PREVENTS CLOT FORMATION IN LOWER EXTREMETIES WHICH COULD LEAD TO PULMONARY EMBOLI.
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EARLY AMBULATION POST OP IS BENEFICIAL. WHY?
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PROMOTES GI MOTILITY, RESPIRATIONS AND LUNG EXPANSION AND IMPROVES CIRCULATION.
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ATC STANDS FOR WHAT
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AROUND THE CLOCK SCHEDULE FOR PAIN MEDS.
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OPIOD ANALGESIC (NARCOTIC), BENZODIAZAPINES (SEDATIVES), HIGHLY ANTICHOLINERGIC MEDS, ANTIANEMICS ARE USE FOR WHAT?
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PRE-OP MEDICATIONS
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WHAT DO PREOP MEDICAITONS DO?
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RELAX PATIENT
DECREASE GI MOTILITY DECREASE BRONCHIAL, SALIVARY SECREATIONS TO PREVENT ASPIRATION HELP PREVENT NAUSEA CAUSE URINARY RETENTION |
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SIDE EFFECT OF PREOP MEDICATIONS
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CONSTIPATION, URINARY RETENTION
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POST OP ROUTINE - WHAT CAN BE EXPECTED?
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PT GOES TO PACU AFTER SURGERY
VS EVERY 15 MINUTES UNTIL STABLE OBSERVATION OF DRESSING FREQUENTLY PT. WILL DANGLE AT BEDSIDE AND GET OUT OF BED ASAP. MAY WEAR TED HOSE, SCD'S, FLOTRONS TO IMPROVE VENUS RETURN THEY WILL BE NPO FOLLOWED BY LIQUID DIET AND GRADUAL RESUMPTION OF REGULAR DIET |
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WHEN SHOULD BASELINE VS BE TAKEN AND WHY?
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PRIOR TO PRE-OP MEDS
SERVES AS A BASELINE FOR POST-OP VITAL SIGNS |
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INFORMED CONSENT DOCUMENTS WHAT?
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PATIENT UNDERSTANDS WHO WILL PERFORM PROCEEDURE, WHY PROCEEDURE IS BEING DONE, STEPS INVOLVED, RISKS, EXPECTED RESULTS.
THE PT. SHOULD ALSO BE AWARE OF ALTERNATIVE TREATEMENTS AVAILABLE PRIOR TO GIVING CONSENT. |
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WHO IS RESPONSIBLE FOR OBTAINING CONSENT?
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SURGEON
NURSE IS A WITNESS AND ENSURES PT. UNDERSTANDS. NURSE SHOULD NOTIFY SURGEON IF PT. IS UNINFORMED. |
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WHAT STATE MUST A PATIENT BE IN ORDER TO SIGN CONSENT?
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CONSCIOUS
COMPETENT NOT CONFUSED NOT SEDATED PATIENT HAS THE RIGHT TO REFUSE OR LATER WITHDRAW CONSENT (FOLLOW INSTITUTION POLICY) |
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MEMBERS OF SURGICAL TEAM ARE SURGEON, ORFA, ANESTHESIOLOGIST, CRNA. WHAT ARE THE JOBS OF ORFA?
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ORFA - OPERATING ROOM SURGICAL ASSISTANT. CAN BE MD, NURSE, PA, SURGICAL TECH. RESPONSIBILITIES ARE HOLDING RETRACTORS, SUCTIONING, CUTTING, SUTURING, AND DRESSING WONDS.
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WHAT IS THE ROLE OF THE ANESTHESIOLOGIST/CRNA
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MAINTAINS HOMEOSTASIS/AIRWAY
ADMINISTERS ANESTHETIC DRUGS INDUCES AND MAINTAINS ANESTHESIA ADMINISTERS OTHER DRUGS TO MAINTAIN HOMEOSTASIS ENDS ANESTHESIA AND REVERSES CONTINUES TO MONITOR AIRWAY IN PACU |
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WHAT ARE SOME DUTIES OF THE HOLDING AREA NURSE?
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MANAGES PT. CARE BEFORE SURGERY
MAY START IV FLUIDS, INSERT FOLEY OR NG TUBE SUPPORT PT. EMOTIONALLY REASSESS PT. AND REVIEW CHART FOR DOCUMENTATION |
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SCRUB NURSE/TECH
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SETS UP STERILE FIELD
ASSISTS WITH DRAPING PASSES STERILE INSTRUMENTS/SUPPLIES RESPONSIBLE FOR MAINTAINING ACCURATE COUNT OF SPONGES, SHARPES, INSTRUMENTS (ALONG WITH CIRCULATING NURSE) |
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CIRCULATING NURSE
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MUST BE RN
ASSESSES PT/CHART PRE-OP DOES NOT DON STERILE GOWN/GLOVES SETS UP OR AND SUPPLIES HELPS TRANSFER PT TO OR TABLE AND POSITION FOR SURGERY ASSISTS WITH INDUCTION, SCRUBS SURGICAL SITE, APPLIES STERILE DRAPES MONITORS TRAFFIC IN ROOM MONITORS URINE OUTPUT/BLOOD LOSS MONITORS THAT STERILE TECH USED RECORD/DOC.SPONGE,SHARPS, AND INSTRUMENT COUNT |
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DEFINE ANESTHESIA
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ARTIFICALLY INDUCED STATE OF PARTIAL OR TOTAL LOSS OF SENSATION, OCCURING WITH OR WITHOUT LOSS OF CONSCIOUSNESS
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PURPOSE OF ANESTHESIA
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BLOCKS TRANSMISSION OF NERVE IMPULSES, SUPPRESS REFLEXE, PROMOTE MUSCULAR RELAXATION
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TYPES OF ANESTHESIA
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GENERAL, LOCAL, REGIONAL, HYPNOSIS, HYPNOANESTHESIA, CRYOTHERMIA, AND ACUPNCTURE.
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GENERAL ANESTHESIA
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REVERSABLE STATE IN WHICH PATIENT LOSES CONSCIOUSNESS AS A RESULT OF INHIBITION OF NEURONAL IMPULSES IN THE BRAIN. MULTIPLE AGENTS DEPRESS CNS, CAUSING ANALGESIA,AMNESIA, UNCONSCIOUSNESS, LOSS OF MUSCLE TONE AND REFLEXES
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METHODS OF ADMINSTERING GENERAL ANESTHESIA
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INHALATION
IV |
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INHALATION METHOD OF ADMINISTERING ANESTHESIA AND SIDE EFFECTS IF ANY?
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ADMINISTERED THROUGH ENDOTRACHEAL TUBE OR FACE MASK.
FEW SIDE EFFECTS PATIENT MAY EXP. POSTOP N/V |
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NITROUS OXIDE, HALOTHANE, ISOFLURANE ARE EXAMPLES OF WHICH TYPE OF ANESTHESIA?
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GENERAL INHALED
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IV ADMINISTRATION OF ANESTHESIA PRO'S AND CON'S
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RAPID, PLEASANT INDUCTION
LOW INCIDENCE OF POSTOP N/V CONTRAINDICATED IN PT. WITH RENAL AND HEPATIC DISEASE INCREASED RISK FOR CARDIAC/RESP. DEPRESSION HIGHLY LIPID SOLUBLE AND RETAINED IN FAT CELLS WHICH PROLONGS TIME IT TAKES TO ELIMINATE THE DRUGS. |
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BARBITUATES SUCH AS: THIOPENTAL, PENTOTHAL, METHOHEXOTAL BREVITAL, AND NON BARBITUATES SUCH AS: KETAMINE OR KETALAR DISOPROFOL OR DIPRIVAN ARE ANESTHETICS THAT DO WHAT?
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TRANQUILIZE AND PRODUCE SLEEP BEFORE AND DURING SURGERY.
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OPIODS SUCH AS FENTANYL AND SUBLIMAZE ARE ADMINISTERED TO DO WHAT?
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THEY ARE ADJUNCTS TO ANESTHESIA ADMINISTERED TO INHIBIT THE ASCENDING PAIN PATHWAYS IN THE CNS AND BIND TO PAIN RECEPTOR SITES SO THAT THE PATIENT DOES NOT EXPERIENCE PAIN DURING SURGERY.
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HYPONTICS SUCH AS BENZODIAZAPINES VERSED, VALIUM, ATIVAN ARE USED DURING GENERAL ANESTHESIA AS WELL AS PROCEDURES REQUIRING ONLY CONSCIOUS SEDATION. WHY?
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THEY DECREASE ANXIETY AND PRODUCE SEDATION AND AMNESIA.
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NEUROMUSCULAR BLOCKERS SUCH AS PAVULON, TRARIUM, NURCURON ARE USED FOR WHAT? WHAT CAUTIONS NEED TO BE TAKEN?
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RELAX THE SKELETAL MUSCLES AND REFLEXES.
ARTIFICAL AIRWAY MUST BE PRESENT BECAUSE THE DRUGS WILL SUPRESS THE PT. REFLEX TO BREATHE AND BREATHING WILL BE CONTROLLED BY A RESPIRATOR. |
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WHAT DO REGIONAL ANESTHETICS DO?
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TEMPORARILY INTERRUPT TRANSMISSION OF SENSORY NERVE IMPULSES FROM SPECIFIC REGIONS.
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TELL ME ABOUT REGIONAL ANESTHETICS.
IN WHAT SITUATIONS MIGHT THEY BE USED? |
NO LOSS OF CONSCIOUSNESS
GAG AND COUGH REFLEX INTACT USU. SUPPLEMENTED W/ SEDATIVES, OPIOD ANALGESICS, AND HYPNOTICS USED WHEN GEN ANESTHESIA IS CONTRAINDICATED B/C OF PRE-EXIST. MED COONDITIONS MAY ALSO BE USED IN EMERGENCY SURGERY WHEN PT. HAS RECENTLY EATEN TO PREVENT ASPIRATION |
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OINTMENT, SPRAY, TRANSDERMAL PATCHES, LOCAL INFILTRATION SUCH AS PROCAINE, NOVOCAINE, LIDOCAINE, XYLOCAINE, MARCAINE ARE WHAT TYPE OF ANESTHESIA?
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LOCAL ANESTHESIA
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WHAT IS A FIELD BLOCK AND WHEN IS IT USED?
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IT'S AN ANESTHETIC AGENT INJECTED AROUND THE OPERATIVE FIELD. USED WHEN DENTAL WORK IS DONE OR WHEN A LACERATION IS SUTURED.
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NERVE BLOCK
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INJECTION OF ANESTHETIC INTO OR AROUND A NERVE SUPPLYING THE INVOLVED AREA TO PREVENT PAIN.
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SPINAL OR INTRATHECAL BLOCK
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INJECTION OF ANASTHETIC AGENT INTO SUBARACHNOID SPACE
USEFUL IN ABD AND PELVIC SURGERY |
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WHY IS IT IMPORTANT FOR PT. TO LIE FLAT FOR 8 HRS. AFTER SPINAL ANESTHESIA?
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LOSS OF CEREBRAL SPINAL FLUID DURING THE PROCEDURE CAN CAUSE POST OP HEADACHES.
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EPIDURAL ANESTHESIA. WHAT IS IT AND WHEN IS IT DONE?
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ANESTHESIA INJECTED INTO EPIDURAL SPACE.
USED IN HYSTERECTOMIES, VAGINAL DELIVERIES, C-SECTIONS, TOTAL HIP AND KNEE REPLLACEMENTS. |
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BENEFITS TO EPIDURAL ANESTHESIA
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DECREASED CARDIOPULMONARY COMPLICATIONS
EPIDURAL CATHETER CAN BE LEFT IN PLACE FOR POST-OP ANALGESIC ADMINISTRATION FOR PAIN CONTROL. |
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WHAT KIND OF DRUGS ARE USED IN CONSCIOUS SEDATION? AND WHAT ARE THE EFFECTS?
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IV PUSH ANALGESICS AND ANTI ANXIETY MEDS SUCH AS:
VALIUM, VERSED, DEMEROL, MORPHIINE DULL OR REDUCE INTENSITY OF PAIN OR AWARENESS OF PAIN DURING A PROCEDURE WITHOUT LOSS OF REFLEXES. |
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CONSCIOUS SEDATION IS USED WITH WHAT TYPES OF PROCEDURES?
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ENDOSCOPIES AND CARDIAC CATHETERIZATION.
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WHEN DOES THE POST OP PERIOD BEGIN AND END AND WHAT ARE THE 2 PHASES
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BEGINS ON ADMISSION TO PACU AND ENDS WHEN HEALING IS COMPLETE.
2 PHASES: RECOVERY AND CONVALESCENCE |
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HOW LONG IS RECOVERY IN AMBULATORY SURGERY SETTING? WHERE DOES CONVALESCENCE TAKE PLACE?
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RECOVERY 1-2 HOURS
CONVALESCENCE TAKES PLACE AT HOME |
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IN THE HOSPITAL RECOVERY LASTS HOW LONG? HOW LONG DOES CONVALESCENCE TAKE?
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RECOVERY LASTS A FEW HOURS, CONVALESCENCE TAKES 1 OR MORE DAYS.
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HOW LONG DO SURGICAL WOUNDS TAKE TO HEAL COMPLETELY?
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APROX 1 YEAR
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WHAT TAKES PLACE IN PACU?
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PT. GOES THERE TO RECOVER FROM ANESTHESIA
FAMILY USUALLY NOT ALLOWED PT. MAY STILL HAVE DRAINS TUBES, O2, ENDOTRACHEAL TUBE IN PLACE LOC MAY BE ALTERED RN IN PACU IS GIVEN REPORT BY SURGICAL TEAM MEMBER |
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WHAT MIGHT THE REPORT GIVEN TO NURSE IN PACU CONTAIN?
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PATIENT STATUS
TYPE AND EXTENT OF SURGERY TYPE OF ANESTHESIA PT. TOELRANCE, ALLERGIES, VS TYPE AND AMT. OF IV AND MEDS GIVEN ESTIMATED BLOOD LOSS COMPLICATIONS LOCATION OF INCISIONS, DRAINS PT. PRIMARY LANGUAGE SENSORY DEFICITS RESPRIATORY,RENAL,CARDIAC STATUS BEFORE AND DURING SURGERY RISK FACTORS UNUSUAL POSITIONING DURING SURGERY THAT MAY CONTRIBUTE TO POST OP COMPLICAITONS |
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INITIAL POST-OP ASSESSMENT FOCUSES ON WHAT?
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A-B-C'S: AIRWAY, BREATHING, CIRCULATION
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LEAVE ENDOTRACHEAL TUBE IN PLACE UNTIL PT. CAN SPIT IT OUT. WHEN PT CAN SPIT IT OUT, THIS IS INDICATIVE OF?
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GAG REFLEX HAS RETURNED.
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GEN. ANESTHESIA MAY CONTINUE TO CAUSE RESP. DEPRESSION. WHAT NEEDS TO BE MONITORED AFTER GENERAL ANESTHESIA
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PULSE OX, SYMMETRY OF CHEST WALL MOVEMENT, BREATH SOUNDS, MUCOUS MEMBRANES, WATCH FOR SLOW SHALLOW BREATHS
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POST OP PATIENTS ARE AT RISK FOR WHAT TYPE OF COMPLICATIONS?
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CARDIOVASCULAR DUE TO BLOOD LOSS
SIDE EFFECTS OF ANESTHESIA ELECTROLYTE IMBALANCES |
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IN THE PACU, PATIENTS ARE PLACED ON CONTINUOUS EKG MONITORING FOR RHYTHM/RATE DISTURBANCES. VITALS ARE TAKEN HOW OFTEN?
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EVERY 15 MINUTES
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WHAT IS DONE IN THE PACU TO MONITOR SURGICAL INCISIONS?
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OBSERVE FOR BLOOD LOSS, WHICH MAY OCCUR INTERNALLY WITHIN SURGICAL WOUND SITE
ASSESS THE OPERATIVE SITE FOR SWELLING AND DISTENSION MONITOR SKIN COLOR AND TEMP, LIPS, NAILBEDS, MUCOUS MEMRANES |
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WHAT IS THE FIRST SIGN OF HEMORRHAGE
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RESTLESSNESS AND ANXIETY, FOLLOWED BY A FALL IN B/P, INCREASED HEART AND RESP RATE, A THREADY PULSE, COOL, CLAMMY, PALE SKIN AND DECREASED URINARY OUTPUT BELOW THE MINIMAL 30ML/HR
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TEMPERATURE CONTROL R/T ANESTHESIA
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ANESTHESIA DECREASES METABOLISM
FALL IN TEMP=PT. SHIVERS HYPOTHERMIA=TEMP<98.6 |
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PT NEUROLOGICAL STATUS AFTER ANESTHESIA
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CHECK LOC
PT SHOULD BE DROWSY BUT RESPOND TO VERBAL COMMANDS CHECK PUPILLARY AND GAG REFLEXES ATTEMPT TO WAKE PT AND ORIENT THEM TO PERSON,PLACE, TIME |
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MOST ANESTHETICS AND ANAGESIC DRUGS HAVE ANTICHOLINERGIC SIDE EFFECTS THAT CAN LEAD TO URINARY RETENTION. URINE OUTPUT AFTER ANESTHESIA SHOULD BE:
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IF THEY HAVE A FOLEY:SHOULD HAVE MIN 30ML/HOUR
IF NO FOLEY: CK FOR BLADDER DISTENTION Q2 HR. PT SHOULD VOID Q 6-8 HR. |
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BE SURE TO MAINTAIN PT NPO STATUS UNTIL WHAT?
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BOWEL SOUNDS RETURN
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MONITOR DRESSING OF SURGICAL SITE BY DOING WHAT?
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MONITOR AMOUNT, COLOR, ODOR, CONSISTANCY OF DRAINAGE
NEVER REMOVE ORIGINAL SURGICAL DRESSING UNLESS ORDERED ESTIMATE DRAINAGE AMT. BY HOW MANY GAUZE PADS WERE SATURAED |
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HOW SHOULD A PATIENT BE POSITIONED TO PREVENT OCCLUSION OF AIRWAY AT THE PHARYNX?
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POSITION PT ON THEIR SIDE WITH THEIR HEAD ELEVATED AND NECK SLIGHTLY EXTENDED
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ROUTINE POST-OP CARE CONSISTS OF WHAT?
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VITALS Q15 MINUTES
POSITION ON SIDE W/ HEAD AND NECK SLIGHTLY ELEVATED SUCTION ARTIFICAL AIRWAY AND ORAL CAVITY PRN ENCOURAGE PT TO TURN,COUGH,DEEP BREATHE O2 ADMINISTERED TO HELP CLEAR ANESTHETIC GASES. |
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REPORT SIGNS OF HEMORRHAGE STAT. AND DO WHAT?
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MAY NEED TO INCREASE IVF
BLANKETS TO INCREASE WARMTH AWAKEN AND ORIENT PT. GIVE PAIN MED AS ORDERED OR ENCOURAGE PT TO USE PCA |
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TRANSFER PT TO POST OP FLOOR WHEN?
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WHEN THEY MEET CRITERIA FOR DISCHARGE
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CRITERIA FOR DISCHARGE
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ABLE TO MAINTAIN PATENT AIRWAY
HAVE STABLE VITALS SATISFACTORY LOC URINARY OUTPUT OF 30CC/HR REPORT FROM PACU TO FLOOR NURSE AND PT TRANSPORTED TO ROOM. |
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RESPONSIBILITIES OF POST-OP NURSE
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PREPARE PT ROOM
RECIEVE PT. ASSESS ABC'S CHECK VS, DRSG, LOC IMMEDIATELY AND AS ORDERED (USU Q 3 MIN, Q 1 HR, Q 4 HR) HAVE PT TURN,COUGH,DB Q 2 HR USE INCENTIVE SPIROMETER (PREVENTS PNEUM. AND ATELECTASIS) HAVE PT EXERCISE LEGS,GET OOB ASAP, SCD'S TED HOSE WHILE IN BED (OFF Q 8 HRS FOR 1 HR) |
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HAVE PT GET OOB ASAP. EARLY AMBULATION DOES WHAT?
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INCREASES LUNG EXPANSION
INCREASES PERISTALSIS HELPS PREVENT DVT |
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ILEUS, PARALTIC OR ADYNAMIC ILEUS IS WHAT
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ABSENCE OF PERASTALSIS THAT MAY DEVELOP AFTER SURGERY
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WHAT IS THE TREATMENT FOR A PT WITH ABSENCE OF PERISTALSIS?
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CHECK ABDOMINAL DISTENSION (CAN USE A TAPE MEASURE)
MAKE PT NPO DR MAY ORDER NASOGASTRIC TUBE TO DECOMPRESS GI TRACT ENCOURAGE AMBULATION |
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SINGULTUS
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HICCUPS- MAY BE CAUSED BY ABD DISTENSION
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WHEN PT IS NPO, WHAT ARE SOME NURSING INTERVENTIONS TO ALLEVIATE DISCOMFORT OF DRY MOUTH?
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MOISTURIZER TO LIPS
GLYCERINE SWABS ADMINISTER PAIN MEDS AND ANTIANEMICS FOR NAUSEA REPOSITIONING PROVIDE RESTFUL ENVIRONMENT |
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COMPLETE CLOSURE OF AN INCISION REQUIRES HOW MANY DAYS?
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7-10
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IT IS NORMAL TO HAVE MODERATE PAIN FOR HOW MANY DAYS POST OP?
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3-5. AFTER THAT, SHOULD BE DECREASING DAILY
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WHAT IS DEHISCENCE?
WHEN COULD THIS OCCUR? |
SEPERATION OF SURGICAL INCISION. CAN OCCUR ANY TIME WITHIN 3 DAYS-2 WEEKS. IT CAN INVOLVE A SMALL AREA OR THE ENTIRE INCISION.
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EVISCERATION
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PROTRUSION OF INTERNAL ORGANS THROUGH THE SURGICAL INCISION. IT'S A SURGICAL EMERGENCY.
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WHAT NURSING INTERVENTIONS CAN BE DONE WITH EVISCERATION
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COVER WOUD WITH SALINE SOAKED GAUZE
HAVE PT LIE FLAT WITH KNEES FLEXED TO DECREASE ABD TENSION BE SURE PT IS MADE AND REMAINS NPO NOTIFY SURGEON |
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PATIENTS CAN DEVELOP PULMONARY EMBOLI AS A RESULT OF______ SECONDARY TO ________.
PT. WITH PULM. EMBOLI WILL COMPLAIN OF CHEST PAIN AND EXPERIENCE_______,______,_________, AND THE EFFECTS OF HYPOXIA, WHICH ARE_____ AND ________ |
DVT, BED REST IMMOBILITY
TACHYPNEA, TACHYCARDIA, HYPOTENSION, DIAPHORESIS ANXIETY, CONFUSION |
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WITH PNEUMONIA, PATIENTS EXPERIENCE WHAT?
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DYSPNEA, TACHYCARDIA, AND THE EFFECTS OF HYPOXIA. THEY WILL ALSO AHVE A PRODUCTIVE COUGH, FEVER, ELEVATION OF WBC'S AND ADVENTITOUS LUNG SOUNDS SUCH AS CRACKLES AND RHONCI.
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ANTICHOLINERGIC SIDE EFFECTS OF PAIN MEDS AND OTHER MEDS SUCH AS ANTIEMETICS CAN PUT THE PT AT RISK FOR WHAT?
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URINARY RETENTION AND CONSTIPATION
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NASOGASTRIC TUBES CAN BE USED FOR WHAT?
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NUTRITION
DECOMPRESS GI TRACT DRAIN SECRETIONS RELIEVE ABD DISTENSION |
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IF A SINGLE LUMEN NG TUBE IS USED THE SUCTION IS ALWAYS______?
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INTERMITTENT
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WHEN A DOUBLE LUMEN OR SALEM SUMP TUBE IS USED, CONTINUOUS SUCTION IS USED. IT IS IMPORTANT TO KEEP THE AIR VENT_______THAN THE STOMACH TO PREVENT_______
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HIGHER, REFLUX
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