Med Surge - Test 1 P. 15-20

Front 1

-in RUQ we have a gall bladder.. How do you know that a pt is not complaining about a stomach?

Back 1

Someone who has stomach burn describes it as a burning sensation (acid in stomach refluxing up against the esophagus and the nerve endings in the esophagus are inflamed.

The gall bladder is located in the RUQ but the pain will occur where????


in the left up shoulder or between your shoulder blades, it follows the nerves track. Usually, this comes from eating a fatty food..and the bile cant be excreted and the bile sits there and it produces inflammation and swells.

Front 2

-burning sensation is _________inflammation

Back 2

nerve

Front 3

-a pain that’s related to the bowel itself (sharp, intense, deep) but is considered visceral. Bowel pain comes in waves. It’s a wave because it’s a peristalsis wave.

what s/s can it cause a person to have?

Back 3

It can cause a person to become hypertensive, pale, diaphoretic

-the pt is complaining a wave type pain – think bowel.

Front 4

-for testicular pain, they complain of the inability to urinate..they don’t really get UTIs. Testicular pain is a sudden onset of extreme sharp pain, a little burning, unable to touch the testicle because its very tender, testicular pain radiates up.

Back 4

ouch!

Front 5

-ovarian pain in a woman can be insidious (low key, dull pain but it can be sharp, ovarian cysts are common in women. It starts off as a dull achiness but as the cyst grows so does the intensity of the pain. It’s a constant dull pain that grows with intensity.

Back 5

ouch!

Front 6

-appendix is RLQ, but the pain starts right by the umbilicus, as the pain becomes inflamed it will focus to the RLQ

Back 6

rebound pain

Front 7

For narcotic overdose we can give……. NARCAN!!

what kind of drug is this?

how is it given? and what is the dosage?

Back 7

An Opioid (Narcotic) antagonist




0.4mg – 2mg IVP

Front 8

Narcan

what are the 2 other names?

Back 8

AKA: Naloxone Hydrochloride

Front 9

Narcan

0.4mg – 2mg IVP
-usually given slowly. if given too fast, what can it result in?

Back 9

nausea, vomiting, tremors, sweating, increased BP, & tachycardia.

Front 10

Narcan
-be cautious when administering to who? why?

Back 10

Be cautious with someone who uses cocaine because you can induce a seizure in the pt

Front 11

Narcan
-the nurse makes the assessment of when the pt has too much narcotic, like:

Back 11

-(hypotension, low sao2, mentation state change, low RR)

Front 12

Intra op care

What is the nurses prime responsibility in the OR?

Back 12

to ensure patient safety and all aspects of care to the pt are monitored for safe practices

Front 13

Intra op care
Roles of the circulating nurse
Responsible for all of the activities within their assigned OR
examples:

Back 13

•Assist with set-up for the procedure
•Checks equipment (suction, lights, monitor system, videos)
•Primary RN who communicates with the pt (they come out to you in your holding area.. Day surgery or room in H) this is the person the pt 1st makes eye contact with.
•Positions patient on the OR table –this is the person who keeps the patient calm, last person the pt sees before anesthesia hits them ..they scrub pts skin area to insert foley catheter. They assist anesthesiologist if the tech is not there.

Front 14

Intra op care

During the procedure circulating nurse:

Back 14

•Monitors traffic in the room
•Assess urine and blood loss amounts (urine coming out of foley and blood loss)
•Communicates with surgeon, anesthesiologist (the surgeon gets phone calls during surgery it is the circulating nurse holds the phone till the surgeon is able to talk)
•Provides supplies, medications, blood products,
–sets up equipment, transports specimens, labeling, pathology
•Documents care, events, interventions

Front 15

Intra op care
Roles of the Scrub nurse

Back 15

-makes sure the sterile field is not broken
-responsible for working with the surgeon
-their job is anticipating where they are going to go next. They are 2 steps ahead of the surgeon
-they also see things go wrong
-Sets up the sterile field and sterile instruments to be used in the procedure
-Provides surgeon with instruments

Front 16

Intra op care
Roles of the Scrub nurse

Back 16

-Needs to anticipate what will be needed and have it ready
-MUST understand anatomy and physiology of the body
-Maintain accurate sponge and needle count throughout procedure, and equipment count
-Accounts for all instruments
-Accounts for all irrigation fluid used in pt during procedure

Front 17

Positioning of the patient (Lithotomy, Prine, Supine, Trendelenberg)

Lying on the back; having the face upward

Back 17

supine

Front 18

Positioning of the patient (Lithotomy, Prine, Supine, Trendelenberg)

A supine position with the patient inclined at an angle of 45 degrees; so that the pelvis is higher than the head, used during and after operations in the pelvis or for shock

Back 18

Trendelenberg

Front 19

Positioning of the patient (Lithotomy, Prine, Supine, Trendelenberg)

Lying with the front or face downward

Back 19

Prone

Front 20

Positioning of the patient (Lithotomy, Prine, Supine, Trendelenberg)

Position in which the patient is on their back with the hips and knees flexed and the thighs apart. The position is often used for vaginal examinations and childbirth.

Back 20

Lithotomy -

Front 21

- whose responsibility is it to correct positioning during surgery?

Back 21

circulating nurse and surgeons

Front 22

Risk for Perioperative Positioning Injury
Interventions include:

Back 22

•Proper body position
•Risk for pressure ulcer formation
•Prevention of obstruction of circulation (tissue on tissue compression), respiration, and nerve conduction secondary to pressure
•padding-arms protected to prevent damage to tissue

Front 23

Impaired Skin Integrity and Impaired Tissue Integrity
Interventions include:

Back 23

•Plastic adhesive drape
•Skin closures, sutures and staples, nonabsorbable sutures
•Insertion of drains
•Application of dressing –if you see drainage, circle it and put the time to see how much saturation is coming out. Seroma- serous tumor that gets caught between skin layers and it’s just serous fluid that’s trapped.
•Transfer of client from the operating room table to a stretcher

Front 24

Anesthesia
The word anesthesia means

Back 24

“negative sensation”

Front 25

Anesthesia defined:

Back 25

Anesthesia is an artificially induced state of partial or total loss of sensation, occurring with or without loss of consciousness.

Front 26

Anesthesia

-the purpose of anesthesia is to do what?
block what:
suppress what:
promote what:

Back 26

to block nerve impulse transmission,

suppress reflexes,

promote muscle relaxation,

and in some cases achieve a controlled level of unconsciousness

Front 27

General anesthesia –defined

Back 27

Reversible loss of consciousness is induced by inhibiting neuronal impulses in several areas of the central nervous system.

Front 28

General anesthesia

-is this state achieved by one or two agents?

what does it depress?

Back 28

State can be achieved by a single agent or a combination of agents
----- Drug competes with acetylcholine at cholinergic receptor sites on the skeletal muscle and the body can’t respond to the stimulus
--Whenever you see ‘curonium’ think general anesthesia.



it depresses the central nervous system, resulting in analgesia, amnesia, and unconsciousness, with loss of muscle tone and reflexes.

Front 29

General anesthesia

the pt is unconscious and unaware

true or false

Back 29

true

Front 30

General anesthesia

you are not able to swallow so we have to protect airway and assist with respiration

true or false

Back 30

true

Front 31

what are they stages of general anesthesia?

Back 31

•Stage 1: analgesia
•Stage 2: excitement
•Stage 3: operative
•Stage 4: danger

Front 32

Types of general anesthesia:

Inhalation:

Back 32

•intake and excretion of anesthetic gas or vapor to the lungs through a mask –inhaling vapors

Front 33

Types of general anesthesia:

Intravenous injection:

Back 33

-barbiturates, ketamine, and propofol through the blood –induction route

Front 34

Types of general anesthesia:

Adjuncts to general anesthetic agents: 3

Back 34

hypnotics,

opioid analgesics,

neuromuscular blocking agents (blocks Ach from activiting nicotinic receptors, allowing muscle relaxation)

Front 35

Types of general anesthesia:

Balanced Anesthesia:
what is it a combination of:

Back 35

Combination of intravenous drugs and inhalation agents used to obtain specific effects

Front 36

Types of general anesthesia:

Balanced Anesthesia:
-combination is used to provide what??

Back 36

hypnosis,
amnesia,
analgesia,
muscle relaxation,
reduced reflexes

with minimal disturbance of physiologic function

Front 37

Example: thiopental for induction, nitrous oxide for amnesia, morphine for analgesia, and pancuronium for muscle relaxation

is an example for what

Back 37

balanced anesthesia

Front 38

Complications from general anesthesia

biggest concern:

Back 38

Malignant hyperthermia:

Front 39

General anesthesia:

Malignant hyperthermia
-how is it treated?

Back 39

possible treatment with dantrolene genetically mediated problem. It’s not known if the pt has this. It’s a muscle link

Front 40

Complications from general anesthesia

Overdose can occur by a combo of

Back 40

paralytics and analgesics

Front 41

Complications from general anesthesia

Unrecognized hypoventilation

whose responsbility is this to monitor?

what happens to the pt that results in this?

Back 41

–the anesthesiologists responsibility to monitor.


Pt is not getting enough oxygen and the carbon dioxide level accumulates/builds up

Front 42

Complications from general anesthesia

Complications of specific anesthetic agents

Back 42

allergic reaction, suppression of cerebellum and respiratory center

Front 43

Complications from general anesthesia

Complications of intubation
-this occurs when?

Back 43

once the pt receives the paralyzing agent, the diaphragm is no longer moving, therefore not breathing and they can’t take in oxygen and the oxygen level that’s circulating will drop.


A bag valve mask is available until the endotracheal tube is inserted.

Front 44

-Local or Regional Anesthesia - combing the anesthesia to:

Back 44

1 area of the pts body.

Front 45

Local or Regional Anesthesia

-sensory nerve impulse transmission from........

Back 45

a specific body area or region is briefly disrupted w/o the patient losing consciousness

Front 46

Local or Regional Anesthesia

what happens to motor function:

Back 46

Motor function may be affected

Front 47

Local or Regional Anesthesia

Client remains conscious and able to follow instructions.

true or false

Back 47

true

Front 48

Local or Regional Anesthesia

Gag and cough reflexes remain intact.

true

Back 48

not for general anesthesia

Front 49

Local or Regional Anesthesia

what supplements are often used to reduce anxiety?

Back 49

Sedatives, opioid analgesics, or hypnotics are often used as supplements to reduce anxiety.

Front 50

what kind of anesthesia:


Ex: dental work, stitches

Back 50

---it’s in 1 place

local or regional anesthesia

-Local anesthetics work by blocking the generation and conduction of the impulse through nerve fiber (they block ions)
-The blockage of Na is the main mechanism that produces the anesthesia affect
-Blocking sodium ion blocks pain receptor

Front 51

Complications from local or regional anesthesia

4

Back 51

•Anaphylaxis –the worst

•Incorrect delivery technique – u don’t give it, you assist with it. if the surgeon hasn’t properly cleaned it, you can suddenly step in and give them the cleansing solution

•Systemic absorption – the nurse observes for CNS stimulation followed by CNS and cardiac depression which are signs of systemic toxic reaction

•Overdosage -numbness and tingling in pts body

Front 52

Treatment of complications from anesthesia

Back 52

•Establish an open airway.
•Give oxygen.
•Notify the surgeon.
•Fast-acting barbiturate is usual treatment. (ativan goes a long way)

Front 53

Treatment of complications from anesthesia

if toxic reaction is untreated, what can occur?

Back 53

unconsciousness, hypotension, apnea, cardiac arrest, and death may result.

Front 54

Local Anesthesia


-how is it delivered? 2 ways

Back 54

topically (skin or mucous membranes)

and by local infiltration (injected directly into the tissue around an incision or wound) ---Local infiltration can use a 27 or 30 g needle

Front 55

Regional anesthesia is a type of local anesthesia that blocks what?

when is it used?

Back 55

multiple peripheral nerves in a specific body region.



can be used when general anesthesia cannot be used.

Front 56

types of regional anesthesia

–Field block: injections that go where?

3 examples

Back 56

a series of injections around the operative field


(ex: chest procedure, hernia repair, dental surgery)

Front 57

types of regional anesthesia

–Nerve block : injection where?

what is 2 examples:

Back 57

into or around one nerve or group of nerves in the involved area.

(ex: limb surgery or to relieve chronic pain)

Front 58

types of regional anesthesia

–Spinal anesthesia
-going into where?
-injection into where?

what is an example: 4

Back 58

(going into circulating spinal fluid): injection of an anesthetic agent into the cerebrospinal fluid

(ex: lower abdominal, pelvic, hip, knee surgery)

Front 59

types of regional anesthesia


–Epidural anesthesia:
3 examples

Back 59

(ex: vaginal, perineal, hip and lower extremity surgeries)

Front 60

circulating nurse, scrub nurse, or surgeon

Responsible for all of the activities within their assigned OR

Back 60

circulating nurse

Front 61

circulating nurse, scrub nurse, or surgeon

Assist with set-up for the procedure

Back 61

circulating nurse

Front 62

circulating nurse, scrub nurse, or surgeon

Checks equipment (suction, lights, monitor system, videos)

Back 62

circulating nurse

Front 63

circulating nurse, scrub nurse, or surgeon

Primary RN who communicates with the pt (they come out to you in your holding area.. Day surgery or room in H) this is the person the pt 1st makes eye contact with.

Back 63

circulating nurse

Front 64

circulating nurse, scrub nurse, or surgeon

Positions patient on the OR table

Back 64

circulating nurse

Front 65

circulating nurse, scrub nurse, or surgeon

this is the person who keeps the patient calm, last person the pt sees before anesthesia hits them ..they scrub pts skin area to insert foley catheter. They assist anesthesiologist if the tech is not there.

Back 65

circulating nurse

Front 66

circulating nurse, scrub nurse, or surgeon

Monitors traffic in the room

Back 66

circulating nurse

Front 67

circulating nurse, scrub nurse, or surgeon

Assess urine and blood loss amounts (urine coming out of foley and blood loss)

Back 67

circulating nurse

Front 68

circulating nurse, scrub nurse, or surgeon

Communicates with surgeon, anesthesiologist (the surgeon gets phone calls during surgery, this person holds the phone till the surgeon is able to talk)

Back 68

circulating nurse

Front 69

circulating nurse, scrub nurse, or surgeon

Provides supplies, medications, blood products,

Back 69

circulating nurse

Front 70

circulating nurse, scrub nurse, or surgeon


Sets up equipment, transports specimens, labeling, pathology

Back 70

circulating nurse:

Front 71

circulating nurse, scrub nurse, or surgeon

Documents care, events, interventions

Back 71

circulating nurse:

Front 72

circulating nurse, scrub nurse, or surgeon

Makes sure the sterile field is not broken

Back 72

Scrub nurse

Front 73

circulating nurse, scrub nurse, or surgeon

Responsible for working with the surgeon

Back 73

Scrub nurse

Front 74

circulating nurse, scrub nurse, or surgeon

Their job is anticipating where they are going to go next. They are 2 steps ahead of the surgeon

Back 74

Scrub nurse

Front 75

circulating nurse, scrub nurse, or surgeon

They also see things go wrong

Back 75

Scrub nurse

Front 76

circulating nurse, scrub nurse, or surgeon

Sets up the sterile field and sterile instruments to be used in the procedure

Back 76

Scrub nurse

Front 77

circulating nurse, scrub nurse, or surgeon

Provides surgeon with instruments

Back 77

Scrub nurse

Front 78

circulating nurse, scrub nurse, or surgeon

Needs to anticipate what will be needed and have it ready

Back 78

Scrub nurse

Front 79

circulating nurse, scrub nurse, or surgeon

MUST understand anatomy and physiology of the body

Back 79

Scrub nurse

Front 80

circulating nurse, scrub nurse, or surgeon

Maintain accurate sponge and needle count throughout procedure, and equipment count

Back 80

Scrub nurse

Front 81

circulating nurse, scrub nurse, or surgeon

Accounts for all instruments

Back 81

Scrub nurse

Front 82

circulating nurse, scrub nurse, or surgeon

Accounts for all irrigation fluid used in pt during procedure

Back 82

Scrub nurse