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376 Cards in this Set

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Association of Operating Room Nurses (AORN)
first nursing organization to develop structure, process, and outcome standards defined by ANA.
The standards of perioperative nursing include?
administrative practice; clinical practice; professional performance; quality improvement
client outcomes
AORN has since been changed to?
Association of Perioperative Registered Nurses
What is ambulatory surgery?
outpatient surgery, short-stay surgery, or same-day surgery
Describe PS-1 (Physical Status)?
a normal healthy client
Describe PS-2?
a client with a mild systemic disease; a 48 yo smoker needing an EDG
Describe PS-III?
a client with a severe systemic disease that limits activity but is not incapacitating;
43 yo asthmatic 280 lb needs EDG
Describe PS-IV?
a client with a severe systemic disease that is a constant threat to life; 54 yo renal dialysis pt needing colonoscopy
Describe PS-V?
a moribund client who is not expected to survive 24 hours with/without the operation; ejected MVA victim needing cranial, abdominal, and thoracic injury
Describe PS-VI?
a client declared brain dead whose organs are being removed for donor purpose
Describe E?
Emergency operation
What are the characteristics of a PS-1 which is a normal healthy client?
No physiological, biological, organic disturbance
ex: 24 yo male needing repair of facial laceration
What are the characteristics of a PS-II which is a client with a mild systemic disease?
Cardiovascular disease with minimal restriction on activity
What are the characteristics of a PS-III which is a client with severe systemic disease that limits activity but is not incapacitating
Hypertension, obesity, diabetes mellitus
What are the characteristics of a PS-IV which is a client with a severe systemic disease that is a constant threat to life?
CV or pulmonary disease that limits activity; severe diabetes with systemic complications; history of myocardial infarction, angina pectoris, or poorly controlled HTN
What are the characteristics of a PS-V which is a moribund client not expected to survive 24 hours with/without operation?
Severe cardiac, pulmonary, renal, hepatic, or endocrine dysfunction
What are the characteristics of a PS-VI which is a client declared brain dead whose organs are being removed for donor purpose?
clients may have a wide variety of dysfunctions that are being managed to optimize blood flow to the heart and organs (e.g., aggressive fluid replacement and blood pressure medications)
What are the characteristics of E which is emergency operation?
Surgery is done as a last recourse of resuscitative effort; major multisystem or cerebral trauma, ruptured aneurysm, or large pulmonary embolus
Assessment for surgical procedures are (18 fond campers)?
alcohol ingestion
allergies
client expectations
culture
diagnostic screening
emotional health
family support
medical history
medication history
nursing history
occupation
perceptions of surgery
physical exam
preoperative pain
previous surgeries
risk factors
smoking habits
substance abuse and use
How does CHF affect surgical candidate?
(medical history)
there might be a further decline in cardiac function which can be thwarted
by giving IV at a slower rate or by giving a diuretic after blood transfusion
Name 6 risk factors of surgical procedures?
(pinafo)
pregnancy
immunocompetence
nutrition
age
fluid and electrolyte imbal.
obesity
What are two major risk factors for infants undergoing surgery?
maintaining normal circulatory blood volume which makes it difficult to meet increased oxygen demands...also dehydration or overhydration depending on rate fluids are replaced
Name surgical care aspects of child's surgical care?
(seaaaa pasted)
(a, risk factors, age)
seizure treatment
excessive blood loss
airway management
agitation
age-appropriate medications
age-appropriate equipment
pain
anesthesia recovery
seizure treatment
temperature alterations
emergence delirium
dehydration vs overhydration
How many calories per day does a patient require following surgery? (a, risk factors, nutrition)
1500 kcal/day, esp. vitamins A and C, and zinc which facilitate wound healing
How does malnutrition in a surgical patient affect healing? (a, risk factors, nutrition)
anesthesia tolerance poor
nitrogen balance negative
blood clotting mechanisms
delayed
infection
wound healing poor
multiple organ failure
(potential for poor)
How does obesity (bariatric) affect surgical risks? (a, risk factors, obesity)
reduces ventilatory and cardiac function
What diseases are common in obese patients?
CAOD
hypertension
diabetes mellitus
CHF
What conditions are commonly seen in bariatric patients?
(a, risk factors, obesity)
embolus
atelectasis
pneumonia
How does obesity affect wound healing?
fatty tissue structure contains a poor blood supply which slows delivery of nutrients, antibodies, and enzymes; thick adipose layer also hard to suture and susceptible to dehiscence
Complications from previous surgeries include? (a, previous surgeries)
motion sickness and
nausea and vomiting
which increase the risk for aspiration
The patient's perception and understanding of surgery may induce? (a, P&U)
fear
True or False? All meds (herbal too) are discontinued postoperatively unless doctor orders? (a, medications)
true
It is critical to assess what type of allergies in surgical patients? (a, allergies)
latex
food
contact (ex. tape, ointments, solutions)
What postoperative care is important to smokers and ALL
preop teaching programs?
(a, smoking habits)
deep breathing exercises which include:
"huff" coughing diaphragmatic breathing incentive spirometry positive expiratory pressure
therapy
turning
leg exercises
How does alcohol affect surgical healing? (a, alcohol ingestion)
increases anesthetic needs due to cross-tolerance;
poor wound healing due to malnourishment; at risk for liver disease, portal hypertension, esophageal varices; delirium tremens
Review of emotional health of surgical patient may reveal that patient feels?
fear, anxiousness and powerlessness
How does self-concept affect surgical outome? (a, self-concept)
hinders ability to adapt to stress of surgery and aggravates feelings of guilt or inadequacy
What types of surgery can affect body image, mainly sexuality? (a, emotional health)
breast removal
colostomies
ureterostomies
hysterectomy
prostate gland removal
When assessing emotional health of surgical patient, determine? (3)
self-concept
body image
coping resources
What is the body's physiological response to surgical stress?
activation of endocrine system results in release of hormones and catecholamines (epinephrine, NE) which increases blood pressure, heart rate, and respiration; platelet aggregation also occurs
Physical exam for surgery should include?
general survey
head and neck
integument
thorax and lungs
heart and vascular system
abdomen
neurological status
The surgical nursing assessment should complement?
surgeon's and anesthesia provider's assessment
The surgical nursing assessment should include the following? (hav light nn)
head
abdomen
vascular
lungs
integument
general survey
heart
thorax
neck
neurological
The surgical nurse should take baseline preoperative vital signs and compare with post-operative vital signs?
to rule out fluid and electrolyte imbalance
When assessing head and neck, the nurse should inspect soft palate and nasal sinuses for?
dehydration
Palpate for cervical lymph node enlargement to rule out possibility of?
local or systemic infection
Inspect jugular veins for distention to?
rule out excess fluid buildup in circulatory system or failure of heart to contract efficiently
Note oral mucosa, identifying
loose or capped teeth as they may be?
dislodged during endotracheal intubation.
Inspect skin before surgical procedure to?
discern increased risk of skin tears after lying for hours or sliding on OR table.
If surgical nurse auscultates wheezing preoperatively, the patient may be at risk for further airway narrowing due to?
certain anesthetics which cause laryngeal muscle spasm...notify doctor.
Acceptable capillary fill occurs in?
less than 2 seconds
Assess abdomen for?
size
shape
symmetry
distention
regular bowel movements?
color and consistency of
stools
If client is to receive spinal anesthesia, nurse should assess?
gross motor function and strength preoperatively. Nurse needs to be aware that client will only return to pre-op strength.
What is a complete blood count?
peripheral venous sample of blood measuring
rbc's
wbc's
hgb
hct
What conditions might a CBC reveal? (bio)
blood volume low
infection
oxygenation problems
(surgeon may order replacement)
Normal rbc count in men?
4.7 - 6.1 million/mm3
Normal rbc in women?
4.2 - 5.4 million/mm3
Normal hemoglobin in men?
14 - 18 g/100 ml
Normal hemoglobin in women?
12 - 16 g/100 ml
Normal hematocrit in men?
42% - 52%
Normal hematocrit in women?
37% - 47%
Normal white blood count in adults and children older than 2 years?
5,000 - 10,000 /mm3
Serum electrolytes include?
bicarbonate (HCO3-)
chloride (Cl)
potassium (K)
sodium (Na)
Normal range for bicarbonate (HC03-)?
21 - 28 mEq/L
Normal range for chloride (Cl)?
98 - 106 mEq/L
(chloride is feverish)
Normal range for potassium (K)?
3.5 - 5.0 mEq/L
Normal range for sodium (Na)?
136 - 145 mEq/L
Imbalanced serum electrolytes may indicate need for?
IV fluid replacement preoperatively. Use peripheral venous sample of blood
Coagulation studies include?
APTT - activated partial
thromboplastin time
INR - International
Normalized Ratio
Platelets
PT - prothrombin time
(These values reveal clients at risk for bleeding tendencies and thrombus formation)
Normal PT level?
11 - 12.5 seconds
Normal INR level?
0.76 - 1.27
Normal APTT level?
30-40 seconds
Normal platelet level?
150,000 - 400,000 /mm3
Serum creatinine measures?
ability of kidneys to excrete creatinine, by-product of muscle metabolism, assesses renal function
An elevated creatinine can indicate?
renal failure
Normal serum creatinine level for men?
0.6 - 1.2 mg/100 ml
Normal serum creatinine level for women?
0.5 - 1.1 mg/100 ml
Normal blood urea nitrogen (BUN level)?
10 - 20 mg/100 ml
BUN measures?
ability of kidneys to excrete urea and nitrogen indicates renal function
An elevated BUN may indicate?
dehydrated client; preop IV fluid replacement may be needed
(normal BUN 7-20 mg/dl
Normal fasting glucose level?
70 - 105 mg/100 ml
A glucose check may be acquired by?
finger stick or peripheral blood sample; treat abnormal levels pre-op and post-op
Common diagnostic studies for hepatic disease?
coagulation studies
liver enzymes (ex: AST)
alkaline phosphatase
Common diagnostic studies for diuretics include?
BUN
creatinine
CBC
CXR
ECG
Common diagnostic studies for steroids include?
electrolytes
glucose
Common diagnostic studies for anticoagulants include?
coagulation studies
Common diagnostic studies for cardiovascular disease include?
BUN
CBC
CXR
creatinine
ECG
Common diagnostic studies for pulmonary disease include?
CBC
CXR
ECG
Common diagnostic studies for CNS disease are?
BUN
creatinine
ECG
electrolytes
glucose
WBC count
Common nursing diagnoses relevant to surgical client?
(18)
acute pain
anxiety
deficient knowledge (specify)
delayed surgical recovery
disturbed body image
disturbed sleep pattern
fear
impaired physical mobility
impaired skin integrity
ineffective airway clearance
ineffective breathing pattern
ineffective coping
powerlessness
risk for deficient fluid
volume
risk for imbalanced body temp
risk for infection
risk for latex allergy
risk for perioperative-
positioning injury
response
Critical thinking assessment for surgical clients include?
(5)
coping skills
physical exam
pre-op dx tests
previous surgical experience
risks

client's previous experience
with surgery
physical exam focused on
client's history and
planned surgery
results of preoperative
diagnostic tests
Critical thinking planning for surgical clients include?
(4)
pre-op instructions for
client and family
consult other hcp's
provide coping therapies
risk reduction therapies
Planning phase of the nursing process includes? (3)
continuity of care
goals and outcomes
setting priorities
In the PLANNING phase, OUTCOMES established for each goal of care provide?
MEASURABLE behavioral evidence; OUTCOMES ARE MEASURABLE
In the PLANNING phase, setting PRIORITIES requires?
clinical judgment to prioritizing nursing diagnoses and interventions based on the assessed unique needs of each client.
In the PLANNING phase, CONTINUITY OF CARE for surgical patients mean?
guiding the patient pre-op and post-op
In the IMPLEMENTATION process for surgical intervention, the nurse provides?
a complete understanding of surgery and prepares client physically and psychologically
IMPLEMENTATION for surgical clients involves? (6)
acute care
health promotion
informed consent
physical preparation
preoperative teaching
preparation on day of surgery
It's the __________ responsibility to explain the surgical procedure and obtain the informed consent.
physician's
Health promotion activities during preop phase focus on?
health maintenance
prevention of complications
support of possible rehab
needs postop
A nurse pre-warns (reduces anxiety) client that he may have a sore throat following surgery due to? (preoperative teaching)
endotracheal tube
A nurse pre-warns (reduces anxiety) client that he may have sensations of blurred vision postop due to? (preoperative teaching)
ointment being placed in client's eyes to prevent corneal damage
Understanding of the surgical experience includes the following? (8 preoperative teaching)
Client cites:
feelings regarding surgery
postop activity resumption
pain relief measures
postop monitoring & therapies
postop unit & location of
family during surgery &
recovery
reasons for preop instruct.
surgical procedures & postop
treatment
time of surgery
When giving preop instructions concerning breathing, the nurse should?
explain
demonstrate
guide
assess
help
allow pt practice
return to re-evaluate
patient's success
Equipment needed when demonstrating post-op exercises are?
pillow or wrapped blanket
incentive spirometer
positive expiratory pressure
(PEP) device and nose clip
The pillow used when demonstrating postop exercises is used to?
splint surgical incisions during coughing
When assessing client's risk for postop respiratory complications, review medical history for?
chest wall movement
abnormalities
chronic pulmonary conditions
ex: emphysema, asthma
history of smoking
presence of reduced hgb
Why does general anesthesia predispose client to respiratory problems?
because lungs are not fully
inflated during surgery..
cough reflex is suppressed..
mucus collects in airway
passages
Postop, patient may have trouble coughing and deep breathing because?
there is reduced lung volume due to general anesthetic
Postop, patient is at greater risk to develop?
respiratory complications if other chronic lung conditions are present
Smoking damages?
*action of cilia in pulmonary mucous membranes decreases which increases mucus secretions which are retained and predisposes client to infection (pneumonia)
*causes collapse of alveoli (atelectasis) which reduces gas exchange and causes intolerance of anesthesia
Reduced hemoglobin level can lead to?
inadequate oxygenation
Preop, nurse should get a baseline chest expansion measurement to?
compare postop measurement with
Older clients, active cancer patients, and clients immobilized for more than 3 days are most at risk for?
DVTs or thrombus formation
Signs of thrombus formation may include?
localized tenderness along
distribution of venous
system
swollen calf or thigh
calf swelling more than 3 cm
compared with other leg
pitting edema
collateral superficial veins
For thrombus formation to occur, there must be simultaneous? This event may occur following general anesthesia.
hypercoagulability
vein trauma
venous stasis
True or false? Positive Homan's sign indicates DVT?
False
When teaching diaphragmatic breathing, have client hold slow, deep breath for?
3 counts
When giving preop instructions concerning breathing, the nurse should?
explain
demonstrate
guide
assess
help
allow pt practice
return to re-evaluate
patient's success
Equipment needed when demonstrating post-op exercises are?
pillow or wrapped blanket
incentive spirometer
positive expiratory pressure
(PEP) device and nose clip
The pillow used when demonstrating postop exercises is used to?
splint surgical incisions during coughing
When assessing client's risk for postop respiratory complications, review medical history for?
chest wall movement
abnormalities
chronic pulmonary conditions
ex: emphysema, asthma
history of smoking
presence of reduced hgb
Why does general anesthesia predispose client to respiratory problems?
because lungs are not fully
inflated during surgery..
cough reflex is suppressed..
mucus collects in airway
passages
Postop, patient may have trouble coughing and deep breathing because?
there is reduced lung volume due to general anesthetic
Postop, patient is at greater risk to develop?
respiratory complications if other chronic lung conditions are present
Smoking damages?
ciliary clearance
increases mucus secretions
Reduced hemoglobin level can lead to?
inadequate oxygenation
Preop, nurse should get a baseline chest expansion measurement to?
compare postop measurement with
Older clients, active cancer patients, and clients immobilized for more than 3 days are most at risk for?
DVTs or thrombus formation
Signs of thrombus formation may include?
localized tenderness along
distribution of venous
system
swollen calf or thigh
calf swelling more than 3 cm
compared with other leg
pitting edema
collateral superficial veins
For thrombus formation to occur, there must be simultaneous? This event may occur following general anesthesia.
hypercoagulability
vein trauma
venous stasis
True or false? Positive Homan's sign indicates DVT?
False
When teaching diaphragmatic breathing, have client hold slow, deep breath for?
3 counts, exhale slowly, and repeat 3 to 5 times...patient to take 10 slow, deep breaths every hr while awake during postop period until mobile
To perform incentive spirometry or positive expiratory pressure therapy, have patient sit in which position?
semi-Fowler's or high Fowler's position
"Huff" coughing or forced expiratory technique when using PEP therapy accomplishes what?
promotes bronchial hygiene by increased expectoration of secretions
When done appropriately ((with fingers (splint/support) or pillow over incision)), controlled coughing exercises will cause incisional injury? True of false
False
Practicing turning exercises
preop?
reduces risk of vascular and pulmonary complications
Preop leg exercises are done by?
rotating each ankle alternating with dorsiflexion and plantar flexion of both feet in supine position
If in pain, patient may request pain medication 30 minutes before postop exercises. True or false?
true
A client may receive the following preop to relieve anxiety and promote sleep?
Restoril (temazepam)-
sedative-hypnotic
Xanax (alprazolam)-anxiolytic
Routine procedures surgical nurse provides in preparation for a day of surgery are? (10)
administering preop meds documentation
eliminating wrong site and
wrong procedure surgery
hair and cosmetics
hygiene
latex sensitivity/allergy
performing special procedures
preparing bowel and bladder
removal of prosthesis
vital signs
safeguarding valuables
If patient has been NPO before surgery, mouth may be dry. Nurse may offer?
mouthwash and toothpaste and
water and instruct patient
not to swallow
preop meds which may cause
drowsiness
An indwelling catheter may be placed in the pre-op client just before surgery if?
surgery is long
incision is in lower abdomen
Essential documentation that must be in chart before client goes to OR?
pertinent laboratory results
preoperative checklist
current client documentation
Preop or "on call" meds are given AFTER consent form signed and are used to treat?
amount of anesthesia
required
anxiety
risk of n & v and resultant
aspiration
respiratory tract secretions
Products that may contain latex and which surgical candidate may be allergic to include?
adhesive tape
disposable electrodes
endotracheal tube cuffs
gloves
IV tubing
protection sheets
rubber stoppers on bottles
and vials
syringes
ventilator equipment
Localized signs and symptoms of latex allergy?
urticaria
anything from flat or raised
red patches to
vesicular, scaling, or
bleeding eruptions
acute dermatitis
rhinitis and/or rhinorrhea
Life threatening symptoms of latex allergy include?
bronchospasm
edema
focal or generalized
urticaria
mucus hypersecretion
(compromises respiratory
status)
vasodilation compounded
by increased capillary
permeability leading to
circulatory collapse and
death
Define "Time Out"?
conducted just before surgery whereby all team members are present and client is again identified along with indelibly marked side and site of surgery
The qualification of a circulating nurse MUST be?
an RN
In the nursing process, EVALUATION for surgery includes?
Ask if the client's
expectations are being
met.
Evaluate the client's
knowledge of surgical
procedure and planned
postop care
Have the client demonstrate
postop exercises
Observe behaviors or
nonverbal expressions of
anxiety or fear
What does the circulating nurse do?
Assists surgeon & surgical
team by operating non-
sterile equipment,
provides additional
supplies, verifies sponge
and instrument counts and
maintains accurate and
complete written records
Assists with endotracheal
intubation and blood
administration
Establishes & implements
intraop plan of care
Evaluates the care
Monitors sterile technique
and safe OR
Provides for continuity of
care postop
Reviews preop assessment
The qualifications of a scrub nurse may be?
RN
licensed practical nurse
surgical technician
What does the scrub nurse do?
maintains sterile field
during surgical procedure
assists with applying sterile
drapes
hands surgeon instruments
counts sponges and instru-
ments
Four types of anesthesia used in the OR are?
conscious
general
local
regional
Define general anesthesia?
an immobile, quiet client who doesn't recall surgical procedure
The 3 phases of anesthesia?
emergence
induction
maintenance
General anesthesia is called for when?
analgesia
control of ANS
immobility
muscle relaxation
Define induction?
includes administration of agents and endotracheal intubation
Define maintenance?
includes positioning the client
Define emergence?
anesthetics are decreased and client begins to awaken
Define palliative surgery?
reduces intensity of disease; performed to relieve symptoms of a disease process, but does not cure; makes the client more comfortable
ex: colostomy
nerve root resection
tumor debulking
ileostomy
Define cosmetic surgery?
reconstructs the skin and underlying structures; can be elective, urgent, or emergent; performed primarily to alter or enhance personal appearance
ex: liposuction
revision of scars
rhinoplasty
blepharoplasty
Surgical procedures are categorized according to? (5)
anatomic location
degree of risk
extent of surgery
reason for surgery
urgency of procedure
Reasons for surgery include?
(5)
cosmetic
curative
diagnostic
palliative
restorative
Urgency of surgery? (3)
elective
emergent
urgent
Degree of risk of surgery?
minor
major
Extent of surgery?
radical
simple
Define diagnostic surgery?
performed to determine the origin and cause of a disorder or the cell type for cancer
ex: breast biopsy
exploratory laparotomy
arthroscopy
Define curative surgery?
performed to resolve a health problem by repairing or removing the cause
ex: laparascopic
cholecystectomy
mastectomy
hysterectomy
Define restorative/reconstructive surgery?
restores function; performed to improve a client's functional ability
ex: total knee replacement
finger reimplantation
Define elective surgery?
planned for correction of a nonacute problem
ex: cataract removal
<hernia repair>
hemorrhoidectomy
total joint replacement
Define urgent?
<necessary, but not necessarily emergency> requires prompt intervention; may be life threatening if treatment is delayed more than 24-48 hrs
ex: acute cholecystitis
bladder obstruction
bone fracture
eye injury
intestinal obstruction
kidney or ureteral
stones
<removal of gallbladder>
Define emergent?
NOW! requires immediate intervention because of life-threatening consequences
ex: AAA
appendectomy
compound fracture
gunshot or stab wound
<repair of perforated
appendix>
severe bleeding
Define minor surgery?
procedure without significant risk; often done with local anesthesia
ex:
cataract extraction
implantation of a venous
access device (VAD)
incision and drainage
(I&D)
muscle biopsy
Define major surgery?
procedure of greater risk, usually longer and more extensive than a minor procedure
ex: CAB
colon resection
lymph node dissection
mitral valve replacement
pancreas transplant
Define simple surgery?
only the most overtly affected areas involved in the surgery
ex: simple/partial
mastectomy
Define radical surgery?
extensive surgery beyond the area obviously involved; is directed at finding a root cause
ex: radical hysterectomy
radical prostatectomy
A diabetic client may need a more extensive bowel preparation because?
of decreased intestinal motility
Problems from anesthesia occur most commonly in what body system?
cardiovascular due to hemodynamic changes and response to anesthesia possibly resulting in MI
<Surgical risk factors of the aged's cardiovascular system include?>
<decreased cardiac output
decreased peripheral
circulation
increased blood pressure>
<Nursing interventions and rationales for the aged's cardiovascular system are?>
<1) Determine normal activity levels and note when the client tires...knowing limits helps prevent fatigue

2) Monitor vital signs, peripheral pulses, and capillary refill....having baseline data helps detect deviations>
<Surgical risk factors of the aged's respiratory system include?>
<reduced vital capacity
loss of lung elasticity
decreased oxygenation of
blood>
<Nursing interventions and rationales for the aged's respiratory system are?>
<1) teach coughing and deep breathing exercises...
pulmonary exercises help prevent pulmonary complications

2) monitor respirations and breathing effort...having baseline data helps detect deviations>
<Surgical risk factors of the aged's renal/urinary system include?>
<decline in glomerular
filtration rate
decreased blood flow to
kidneys
nocturia common
reduced ability to excrete
waste products>
<Nursing interventions and rationales for aged's renal
and urinary system are?>
<1) assess overall hydration and monitor I & O...ongoing assessment helps detect fluid and electrolyte imbalances and decreased renal function

2) assist frequently with toileting needs, especially at night....frequent toileting helps prevent incontinence and falls>
Risk factors of the aged's neurologic system include?
<decreased ability to adjust
to changes in surroundings
sensory deficits
slower reaction time>
<Nursing interventions and rationales for the aged's neurological system are?>
<1) orient client to surroundings

2) allow extra time for teaching client

3) provide for client's safety
...an individualized preop teaching plan is developed on the basis of the client's orientation and neurologic deficits and safety measures help prevent falls and injury>
<Risk factors of the aged's musculoskeletal system are?>
<Increased incidence of deformities related to osteoporosis or arthritis>
<Nursing interventions and rationales of the aged's musculoskeletal system are?>
<1) assess the client's mobility...interventions help prevent complications of immobility

2) teach turning and positioning; encourage ambulation; place on fall precautions, if indicated
...safety measures help prevent injury>
Name 7 routine preop meds?
anticoagulants
antidiabetic
antidysrhythmics
antihypertensives
antiseizure
corticosteroids
glaucoma
Nursing interventions for preop antidysrhthmic meds?
obtain baseline ECG
assess peripheral circulation
Nursing interventions for preop antihypertensives?
assess for hypotension during transfer and turning
Nursing interventions for preop corticosteroids?
continue steroid therapy
during surgery
assess for signs of
hyperglycemia
assess for subtle signs of
infection and bleeding
monitor wound healing,
support incision area
with binders, and splint
wound when client is
turning, coughing, and
deep breathing
Nursing interventions for preop anticoagulants?
monitor coagulation studies
monitor signs of bleeding
gradually d/c 24-48 hours
before surgery
have an antidote for warfarin
ready;
ex: vitamin K for heparin
protamine sulfate for
warfarin sodium
Nursing interventions for
antiseizure meds?
assess for seizures
pad siderails of bed
place suction equipment
at bedside
Nursing interventions for glaucoma meds?
check with physician about
d/c'ing Humorsol at least 2
weeks before surgery
monitor respiratory status
and cardiac output
assess for increased intra-
ocular pressure
Nursing interventions for antidiabetic agent?
monitor serum glucose levels
administer antibiotics and other intermittent meds in NS
instead of dextrose , or as facility prescribes
Define autologous donations?
patient donates 2-4 units of own blood up to 5 weeks before surgery, hgb greater than 11 g/dl, and doctor's recommendation;
last donation can't be made within 72 hours before surgery
Define directed blood donation?
family and friends donate blood exclusively for patient
Red blood cell stimulation can be accomplished with?
epoetin alpha
ex: Epogen
Procrit
supplemental iron
folic acid
vitamin B12
vitamin C
Specific considerations when planning care for the older preop client includes?
Increased, decreased or
impairment of........
allergies
cardiopulmonary complications
chronic illness
fall with injury
malnutrition
mental status
self-care abilities
surgery and anesthesia stress
support systems
Define oliguria?
scant amount of urine
Surgery increases metabolic rate and depletes which vitamins and electrolytes needed for wound healing and blood clotting?
B vitamins
vitamin C
potassium
How can a surgical nurse detect poor nutritional status?
brittle nails
muscle wasting
dry or flaky skin
hair changes (dull, sparse,
dry)
decreased skin turgor
orthostatic hypotension
decreased serum protein
levels
abnormal serum electrolyte
values
Define procurement for transplant?
removes an organ
Define constructive surgery?
restores function of congenital anomalies
<Anesthesia is an induced state of partial or total loss of consciousness. The purpose is to?>
<*block nerve impulse
transmission
*suppress reflexes
*promote muscle relaxation
*sometimes achieve a
controlled level of
unconciousness>
<What happens to general anesthesia in the body?>
<*most are metabolized by the liver
*excreted by the kidneys
*interactions can occur
with other drugs that the
patient has received>
<Define general anesthesia?>
<a reversible loss of consciousness induced by inhibiting neuronal impulses in several areas of the CNS>
<General anesthesia results in?>
<*analgesia (pain relief or suppression)
*amnesia (memory loss of the surgery)
*unconsciousness and loss of muscle tone and reflexes>
<General anesthesia is used in surgery for?>
<head
neck
upper torso
abdomen>
<Stages of general anesthesia are?>
<Stage 1 analgesia & sedation
Stage 2 excitement, delirium
Stage 3 operative level
Stage 4 DANGER>
<Define Stage 1 of general anesthesia?>
<analgesia & sedation is a dizzy and drowsy feeling;
hearing is exaggerated>
<Define Stage 2 of general
anesthesia?>
<excitement and delirium; loss of consciousness to loss of eyelid reflex; irregular breathing, involuntary movements, vomiting or laryngospasm may occur>
<Define Stage 3 of general anesthesia?>
<operative level; loss of reflexes, depressing of vital functions; sensations are lost; patient can't hear; jaw relaxed>
<Define Stage 4 of general anesthesia?>
<DANGER; respiratory failure, cardiac arrest, possible>
Nursing interventions and rationales for Stage I are?
keep discussions to a minimum (hearing exaggerated);
position with safety belts;
close OR doors, dim lights,
control traffic
Nursing interventions and rationales for Stage II are?
avoid auditory and physical stimuli; protect extremities; assist anesthesiologist or CRNA with suctioning as needed
Nursing interventions and rationales for Stage III are?
assist anesthesiologist or CRNA with intubation; scrub patient skin over operative site
Nursing interventions and rationales for Stage IV are?
prepare for and assist in treatment of cardiac and/or pulmonary arrest; document occurrence in client's chart
<Administration of general anesthesia by inhalation does what?>
<causes shivering after surgery because of effects on hypothalamus;
blankets won't stop shivering, but will give comfort>
<Define nitrous oxide?>
the most commonly used agent and is usually given with oxygen; it's a colorless and odorless gas that provides analgesia>
<Explain IV anesthetic agents?>
<injected through an IV line and into diluted into blood; it remains at high enough levels in brain, kidney, and liver>
<Name 3 types of IV anesthetic injections?>
<barbituates
ketamine (ketalar)
propofol (diprivan)>
<How are IV anesthetic barbituates used in surgery?>
<acts on CNS; most common one is thiopental sodium (Pentothal); acts within 30 seconds; monitor vital signs continuously as it depresses breathing and cardiac function>
<How are IV anesthetic ketamine (ketalar) used in surgery?>
<a dissociative anesthetic agent (one that promotes a feeling of separation of dissociation from the environment) rapid onset of trancelike, analgesic state; often used for diagnostic and short surgical procedures);
emergence reactions are common during recovery (24hrs); may help to give patient small doses of diazepam (Valium)>
<How is Propofol (diprivan)
used in surgery?>
<a short-acting; minimal n&v; hypnosis occurs in less than 1 minute; drug eliminated rapidly and client responsive within 8 minutes after infusion ends>
<Adjuncts to general anesthesia are?>
<hypnotics
opioid analgesics
neuromuscular blocking
agents>
<How are hypnotics used as adjuncts to general anesthesia?>
<may be used as part of IV conscious sedation for short diagnostic procedures; higher doses of medazolam can induce general anesthesia; may be used during surgery along with regional or local anesthesia>
<Name hypnotics used as adjuncts to general anesthesia?>
<benzodiazepines such as:
midazolam (Versed)
lorazepam (Ativan,
Novolorazepam)
diazepam (Valium, Vivol,
Novo-Dipam)
<What are the effects of hypnotics as adjuncts to general anesthesia?>
<amnesic
hypnotic
muscle relaxant
sedative>
<Adverse effects of hypnotics as adjuncts to general anesthesia include?>
<apnea (temporary cessation
of breathing)
oversedation
respiratory depression>
<Name opiods used as adjuncts to general anesthesia?>
<fentanyl (Sublimaze)
sufentanil (Sufenta)
meperidine (Demerol)
morphinen sulfate (Statex)>
<How are opioids used as adjuncts to general anesthesia?>
<reduced dosages are used for older clients, clients with a circulatory problem (ex: heart failure) and debilitated clients)>
<What are the effects of opiods as adjuncts to general anesthesia?>
<*provides pain relief AFTER
surgery
*DEPRESSES RESPIRATION>
<What is the potency relationship between Fentanyl and Morphine?>
<Fentanyl is 75 to 125 times more potent than Morphine>
<Define balanced anesthesia?>
<a combination of IV drugs and inhalation agents used to obtain specific effects>
<What is balanced anesthesia used for?> (haamr)
<to provide:
amnesia
analgesia
hypnosis
muscle relaxation
reduced reflexes with
minimal disturbance of
physiologic function>
<When is balanced anesthesia most advantageous?>
<provides safe and controlled anesthetic delivery, especially for older and high-risk clients>
<What are some balanced anesthesia combinations?>
<*thiopental for induction
*nitrous oxide for amnesia
*morphine for analgesia
*pancuronium for muscle
relaxation>
<What systems are affected by general anesthesia?>
<cardiac
GI
kidney
muscles
respiratory
skin: incision>
<Undesirable outcomes of surgery include?>
<*bleeding
*fluid and electrolytes are
out of balance which is due
to large amounts of IV
fluids
*inflammation process>
<How does positioning put the patient at risk perioperatively?>
<*Poor body positioning puts patient at risk for pressure ulcer formation.
*Good body positioning can prevent obstruction of circulation, respiration, and nerve conduction.>
<Common surgical positions include?>
< dorsal recum. (mostcommon)
*jackknife
*lateral
*lithotomy (mostcommon)
*prone (mostcommon)
*supine
*trendelenburg>
How is padding used when positioning patients for surgery?
Circulating nurse pads, coordintes transfer to OR bed, assessing skin integrity, and adds extra padding as needed.
Factors influencing TIMING of repositioning of patient by circulating nurse on OR table?
age and size
anesthetic delivery
pain on movement if client
conscious
surgical site
Factors influencing ACTUAL position of repositioning of patient by circulating nurse
include?
age, size, and weight
any pulmonary, skeletal, or
muscular limitations, such
as arthritis, joint
replacements, or emphysema
specific procedure being
performed
surgeon's request
<Surgical patient's skin can be impaired. Nursing interventions for this include?>
(3 at skin level
1 at body level)
<*plastic adhesive drape
*skin closures, sutures,
staples, nonabsorbable
sutures
*insertion of drains
*application of dressing
*transfer of client from the
operating room table to a
stretcher>
Define absorbable sutures?
*digested over time by body enzymes
*catgut, plain gut and chromic gut are types of natural absorbable sutures
*natural and synthetic absorbable sutures are absorbed in about 2 weeks
Define nonabsorbable sutures?
become encapsulated in tissue during healing process and remain in tissue unless removed;
made of silk, cotton, steel, nylon, polyester
<The incision line is considered normal if?>
<after 5 to 10 days, there is a healing ridge; ineffective wound healing can be seen at this time
ex: dehiscence of wound>
<Other than decreased O2 sat and increased respiratory, what will be a sign of respiratory problems?>
<restlessness>
<When should postop education begin?>
<before surgery>
<If there is a drop in O2 sat, what should be checked first?>
<make sure airway is clear...there may be trouble with secretions following surgery>
<Which herbs affect the heart rate or blood pressure?> (he b ggg b's)
<black cohosh
bloodroot
ephedra
garlic
ginseng
goldenseal
hawthorn>
<Which two lab test are done on everyone before ANY surgery?>
hematocrit
hemoglobin
<What is the nurse's role in informed consent?>
<*patient advocate
*make sure they know what
is happening to them and
witness their signature>
<What is the typical amount of time patient is NPO?>
<6-8 hrs;
doctor will specify which meds to continue with a sip of water;
also NPO requires cessation of smoking as it stimulates gastric secretions>
<What type of meds are normally continued when a patient is NPO?>
<cardiac
respiratory
seizures
hypertension
diabetic>
But don't assume!
<Who takes the patient to PACU (recovery)> and what MUST they have with them?
<circulating nurse
anesthesia provider>
they must have a verbal report of the patient's condition with them
<In PACU, what is the significance of the patient snoring or making a stridor sound (high pitched crowing sound)?>
(crow's making a MES)
<both are signs of airway obstruction because of mucus, spasm, or edema>
<What is the Homan's sign?>
<an indicator of deep venous thrombosis; the sign is present where pain in the calf is produced by passive dorsiflexion of the foot; the test has fallen into disfavor because of the risk of precipating a pulmonary embolism>
<How might the purpose of surgery impact the anxiety of the patient?>
<anxiety may increase if it's diagnostic or curative surgery>
<The preop assessment screens for increased risk of complications when?>
<both in surgery and postop>
<Which herbs have an effect on blood clotting?>
<feverfew
garlic
motherwort>
<Every member of the health care team needs to correctly identify the surgical patient by?>
<*asking pt's name and
verifying the id bracelet
*making sure the correct
procedure is done
*investigating any
discrepancy and notifying
the surgeon and the
anesthesia provider
*allergies
*autologous blood (is it in
the hospital?)
*advance directives, labs>
<The preop chart review should include?>
<documentation
preop procedures
orders
consent form
allergies
height and weight
laboratory
diagnostic tests
abnormal reports
special needs and concerns>
<All jewelry must be removed, but if a ring is too tight, it may be?>
<taped down>
PACU is another name for?
Recovery
<What is the most important area to assess for a postop patient?>
<respiration>
<How are vital signs measured postop?>
<*every 15 minutes for one
hour
*every 30 minutes for one
hour
*every 1 hour twice
*every 2 hours for 8 hours
*every 4 hours for 1-2 days>

<then it's every 4 hours when pt gets to floor unless a condition arises>
One of the reasons for assessing lung sounds after surgery might be?
the ET tube has moved down into the right mainstem bronchus, preventing left lung expansion...lung sounds on left will be absent or decreased and only right chest wall rises and falls with breathing
Postop, stridor and snoring are signs of?
airway obstruction resulting from tracheal or laryngeal spasm or edema, mucus in airway, blockage of airway from edema or tongue relaxation
When postop, the order of return to consciousness after general anesthesia will be?
1. muscular irritability
2. restlessness and delirium
3. recognition of pain
4. ability to reason and
control behavior
When postop, the order of return of motor and sensory functioning after local or regional anesthesia will be?
1. sense of touch
2. sense of pain
3. sense of warmth
4. sense of cold
5. ability to move
<Fluid and electrolyte imbalances occur more often in?>
<older or debilitated clients and patients with diabetes mellitus, Crohn's disease, or heart failure>
<Intake and output documentation postop includes?>
<IV fluid intake
vomitus
urine
NG tube drainage
both intake and output from OR AND PACU must be assessed to complete the 24 hour intake and output record>
What IV solution is used as fluid replacement in PACU?
isotonic solutions
ex: lactated Ringer's as
well as
5% dextrose with
lactated Ringer's
A typical IV solution for the client being admitted to the nursing unit is?
5% dextrose with 0.45% normal saline (D50.45%NS)
How is the surgical patient's acid-base balance affected?
*through metabolic changes during surgery
*losses of acids or bases in drainage

Ex: NG tube drainage or vomitus causes a loss of hydrochloric acid and leads to alkalosis
When assessing intake and output of postop patient, the urine output should be close to total intake for a 24 hour period. Report less than _________ to physician.
30 mL/hr (240 mL per 8 hr nursing shift)
How long may peristalsis be decreased following surgery?
about 24 hours and may persist several days following GI surgery
<What is the NG tube used for during surgery?>
<*decompresses and drains stomach
*promotes GI rest
*allows lower GI tract to heal
*provides enteral feeding route
*may be used to monitor any gastric bleeding
*may prevent intestinal obstruction>
What is the normal color of NG drainage fluid?
greenish yellow
Red drainage from NG tube indicates?
active bleeding
Brown drainage with a "coffee-ground" appearance indicates?
old bleeding
NG tube complications might be?
*nares discomfort
*fluid and electrolyte imbalance (esp when using water instead of NS)
*aspiration
<True or false? After gastric surgery, don't move or irrigate tube without an order from the physician.>
<true>
It may take up to ___________
before scar is truly strengthened.
2 years
Define sanguineous?
bloody
Define serous?
serum-like or yellow
Define dehiscence?
partial or complete separation of outer wound layers?
Define evisceration?
total separation of all wound layers and protrusion of internal organs through open wound
To prevent aspiration by patient in PACU, place patient in which position?
side-lying
<In order to leave PACU, patient's circulation should be at?>
<plus or minus 20% preanesthesia level>
<In order to leave PACU, patient's oxygen saturation should be at?>
<92% on RA>
<In order to leave PACU, patient's consciousness level should be?>
<fully awake>
Penrose is a ________ _________type of drain.
open system
drains directly onto dressing
and skin around incision
Hemovac and Jackson Pratt are ___________ _________ types of drains
closed system or self-contained systems;
wounds drain directly through a tube via gravity
and vacuum;
these drains are sutured in place with a suture that seals the area when drain is removed
When watching for symptoms of DVT's, hand massage calf.
True or false
False
Montgomery straps may be used when?
frequent dressing changes are anticipated; helps prevent skin irritation from frequent tape removal
Encourage patient to ambulate same day postop if possible to help prevent?
pulmonary complications
The best practices in postop skin care for older adults is? (6)
*improve perfusion to the wound to promote wound healing
*conserve client's energy
*place client on safety program to prevent falls
*maintain strict aseptic technique
*maintain client's psychosocial health
*protect fragile skin
Perfusion to wounds postop can be promoted by? (3)
hydration
airway patent and provide
adequate oxygenation
keep O2sat on pulse oximetry
greater than 93%
Conservation of client's energy postop can be achieved by?
sleeping in dark, quiet room
pain and sleep medications
rest periods
control room temperature
assist ADL's
Postop, follow strict aseptic techniques for all breaks in skin, for example, in the following areas?
IV and other catheters
indwelling urethral catheter
wound
Postop, the client's psychosocial health can be achieved by?
preventing unnecessary
stressors
allowing client liberal
visitation of supportive
others
enable client to use
individual successful
coping mechanisms
keep client well groomed
and bathed
Postop, protect fragile skin by?
minimize use of tape on skin
use hypoallergenic tape or
Montgomery straps
change dressings as soon as
they become wet
lift client during transfer
or repositioning
Drains may be placed in the wound or in separate small incision to provide exit route for?
air
blood
bile
*also help prevent deep infections and abscess formation
Postop, how does the nurse care for a Penrose drain?
change the damp or soiled
dressing and carefully
clean under and around
Penrose drain
place absorbent pads DISTAL
to drain to prevent skin
irritation and wound
contamination
The nurse cares for the Jackson-Pratt and Hemovac drains by?
*emptying the reservoir and recording the amount and color of drainage during every nursing shift or more often if prescribed
*after emptying and compressing reservoir, secure drain to patient's
gown
Postoop, antibiotics may be administered from _________ to _________ hours to fight infection.
24 to 72 hours
Postop, read physician's order to irrigate the wound with what types of solutions?
sterile saline
hydrogen peroxide
povidone-iodine
acetic acid
Postop, one to three times daily, physician's order may require wet to dry dressing change by packing wound with solution-soaked gauze with the following types of solutions?
neomycin
gentamicin
iodoform
povidon-iodine
saline
ascetic acid
Wet to dry dressing changes promote healing from within the wound. True or false
true
Define debridement?
removal
ex: debridement of infected
tissue as wound heals
If dehiscence occurs, what should nurse do?
apply sterile nonadherent (Telfa) or saline dressing and notify physician
Define evisceration?
*a wound opening with protrusion of internal organs or viscera
*a surgical emergency
*one nurse tends to client while another nurse notifies surgeon immediately
*NG tube may be necessary
*prepare for surgery to close wound
*anesthesia required
*stay or retention sutures of wire or nylon are used instead of standard sutures or staples
The nurse can help relieve pain postop by?
positioning
massage
relaxation techniques
diversion
drug therapy as prescribed
by physician
If opioids or analgesics are prescribed in PACU, continue to assess the patient for?
hypotension
respiratory depression
(hypoventilation)
__________analgesics are given during first 24 to 48 hours after surgery for pain?
opioid
Common opioid analgesics given during first 24 to 48
hours after surgery for pain
include?
neperidine (Demerol)
morphine (Statex)
hydromorphone (Dilaudid)
ketorolac (Toradol)
codeine
butorphanol (Stadol)
oxycodone with aspirin
(Percodan)
oxycodone with acetaminophen
(Tylox, Percocet)
PCA analgesics may include?
morphine
meperidine
hydromorphone
<The effects of drugs, anesthetic agents, or manipulation during surgery can cause?>
<urine retention so assess for bladder distention>
<Postop, when assessing I & O, be sure to include other sources of output than urine such as?>
<sweat
vomitus
diarrhea
*report urine output of less than 30 mL/hr>
<GI complications of postop surgical patients include?>
<abdominal distention
paralytic ileus (paralysis of
intestinal smooth muscle)
n & v
urinary retention
UTI>
Define paralytic ileus?
paralysis of intestinal smooth muscles with distention of abdomen;
nausea and vomiting, abdominal pain;
inability to pass stool or gas;
may occur after abdominal surgery, during an episode
of peritonitis, or after
administration of some drugs...especially narcotics
<How often should the PACU nurse assess for bleeding or other drainage from dressings, drains, casts, and plastic bandages?>
<on admission to PACU and hourly thereafter>
Postop, the nurse should assess drained material from NG tube every _____ hrs?
8 hrs
If a post-op client has impaired gas exchange, interventions should include?
*airway maintenance
*positioning client in side-lying position or turning head to side to prevent aspiration
*encouraging breathing exercises
*encouraging mobilization ASAP to help remove secretions and promote lung expansion
<Pain assessment is started by who?>
<postanesthesia care unit nurse>
Post-op, when does pain usually reach its peak?
second day after surgery
<How often should the PACU nurse assess for bleeding or other drainage from dressings, drains, casts, and plastic bandages?>
<on admission to PACU and hourly thereafter>
Postop, the nurse should assess drained material from NG tube every _____ hrs?
8 hrs
If a post-op client has impaired gas exchange, interventions should include?
*airway maintenance
*positioning client in side-lying position or turning head to side to prevent aspiration
*encouraging breathing exercises
*encouraging mmobilization ASAP to help remove secretions and promote lung expansion
<Pain assessment is started by who?>
<postanesthesia care unit nurse>
<Post-op, when does pain usually reach its peak?>
<second day after surgery>
<How often should the PACU nurse assess for bleeding or other drainage from dressings, drains, casts, and plastic bandages?>
<on admission to PACU and hourly thereafter>
Postop, the nurse should assess drained material from NG tube every _____ hrs?
8 hrs
If a post-op client has impaired gas exchange, interventions should include?
*airway maintenance
*positioning client in side-lying position or turning head to side to prevent aspiration
*encouraging breathing exercises
*encouraging mmobilization ASAP to help remove secretions and promote lung expansion
<Pain assessment is started by who?>
<postanesthesia care unit nurse>
<Post-op, when does pain usually reach its peak?>
<second day after surgery....because anesthesia has worn off and patient awake and active>
<Postop, patient is at risk for hypoxemia. Nursing interventions include?
<maintenance of airway patency
and breathing pattern
prevention of hypothermia
maintenance of oxygen therapy
as prescribed>
<Postop, the nurse needs to teach the patient the following?>
<infection prevention
dressing care
nutrition
pain medication management
progressive increase in
activity level
use of proper body
mechanics>
<Nursing interventions for impaired skin integrity include?>
<assess surgical area
FIRST dressing change usually
performed by surgeon
assess drains
treat wound infections with
irrigations and antibiotics
assess wound for dehiscence
and possible surgical
management by physician>
<Possible nursing diagnosis for post-surgical patient?>
<impaired physical mobility
impaired skin integrity
disturbed body image>
How does pain have an adverse effect on healing?
impede return of normal
pulmonary function
modify certain aspects of
stress response to injury
alter hemodynamic values and
cv function
can produce immobility and
contribute to
thromboembolic complication
can slow a patient's recovery
from surgery and contribute
to increased morbidity
<How do painkillers and anesthesia promote healing?>
(last page)
<fewer pulmonary complications
occur
inhibits stress response if
injury or surgery involves
lower part of body>
<Implement the following postop care for surgical clients to prevent CIRCULATORY stasis.>
<leg exercises
TED stockings
early ambulation
positioning
anticoagulants
fluid intake>
<Implement the following postop care for surgical clients to prevent RESPIRATORY function.>
<positioning and turning
suctioning
deep breathing
(incentive spirometer)
coughing
comfort
early ambulation
oral hygiene
oxygen>
<Implement the following postop care for surgical clients to promote temperature regulation.>
<warmed blankets
monitoring for hypothermia
and malignant hyperthemia
assessment for signs of
infection>
<Implement the following postop care for surgical clients to promote rest and comfort>
<analgesics
PCA
pain assessment>
<Implement the following postop care for surgical clients to assess neurologic function>
<orientation to environment
level of consciousness>
<Implement the following postop care for surgical clients to prevent CIRCULATORY stasis.>
<leg exercises
TED stockings
early ambulation
positioning
anticoagulants
fluid intake>
<Implement the following postop care for surgical clients to prevent RESPIRATORY function.>
<positioning and turning
suctioning
deep breathing
(incentive spirometer)
coughing
comfort
early ambulation
oral hygiene
oxygen>
<Implement the following postop care for surgical clients to promote temperature regulation.>
<warmed blankets
monitoring for hypothermia
and malignant hyperthemia
assessment for signs of
infection>
<Implement the following postop care for surgical clients to promote rest and comfort>
<analgesics
PCA
pain assessment>
<Implement the following postop care for surgical clients to assess neurologic function>
<orientation to environment
level of consciousness>
<Implement the following postop care for surgical clients to maintain fluid and electrolyte balance.>
<IV therapy
oral intake when
appropriate>
<Implement the following postop care for surgical clients to promote elimination and adequate
nutrition>
<gradual progression of
dietary intake
ambulation and exercise
adequate fluid and food
intake
give fiber and medications
that promote elimination
control of nausea and pain>
<Implement the following postop care for surgical clients to promote urinary
elimination>
<normal positioning
frequent assessment
assessment of bladder
distention
I & O>
<Effects of age on CARDIOVASCULAR system include?>
<decreased elasticity of
arterial walls
low PNS and SNS tone
decreased peripheral
circulation>
<How age increases CARDIOVASCULAR surgery risks?>
<reduces cardiac reserve
postop hemorrhage
increases b.p.
shock
delayed wound healing
postop confusion>
<Effects of age on RESPIRATORY system?>
<rib cage stiffens
loss of elasticity in lung
tissue
reduced blood flow
decreased ciliary action
increased residual lung
volume>
<How age increases RESPIRATORY surgery risks?>
<reduced vital capacity
reduced blood oxygenation
aspiration
atelectasis
difficulty maintaining
airway
difficult intubation>
<Effects of age on RENAL system.>
reduced bladder capacity
decreased bladder muscle
tone
decreased glomerular
filtration rate
<How age increases RENAL surgery risks?>
<frequent voiding
incomplete bladder emptying
incontinence
UTI
prolonged response to
anesthesia and drugs>
<How age affects neurological status?>
<cerebral atheroclerosis
decreased total sensation
decreased basal metabolic
rate
increased pain tolerance
impaired thermoregulation>
<How age increases NEUROLOGICAL surgery risks?>
<less able to respond to
early warning signs
CVA
hypothermia>
<The effects of age on METABOLIC rate?>
<decreased reaction time
decreased metabolic rate
decreased RBC & Hgb>
<How age affects METABOLIC (balance of nutrients) surgical risks?>
<confusion following
anesthesia
dysrhythmias
delayed wound healing
wound dehiscence or evisceration>
<Surgical patient should be NPO for ______hours?>
<6-8 hours>
<To prepare skin for surgery?>
<shower using antiseptic
solution
shaving (may be contro-
versial)>
<To prepare the intestines for surgery>
<administer enema and
laxative to prevent
injury to colon and
reduce number of
intestinal bacteria>
Define efferent?
carrying away from a central organ or section, as efferent nerves, which conduct impulses from brain or spinal cord to periphery