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376 Cards in this Set
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Association of Operating Room Nurses (AORN)
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first nursing organization to develop structure, process, and outcome standards defined by ANA.
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The standards of perioperative nursing include?
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administrative practice; clinical practice; professional performance; quality improvement
client outcomes |
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AORN has since been changed to?
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Association of Perioperative Registered Nurses
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What is ambulatory surgery?
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outpatient surgery, short-stay surgery, or same-day surgery
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Describe PS-1 (Physical Status)?
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a normal healthy client
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Describe PS-2?
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a client with a mild systemic disease; a 48 yo smoker needing an EDG
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Describe PS-III?
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a client with a severe systemic disease that limits activity but is not incapacitating;
43 yo asthmatic 280 lb needs EDG |
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Describe PS-IV?
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a client with a severe systemic disease that is a constant threat to life; 54 yo renal dialysis pt needing colonoscopy
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Describe PS-V?
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a moribund client who is not expected to survive 24 hours with/without the operation; ejected MVA victim needing cranial, abdominal, and thoracic injury
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Describe PS-VI?
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a client declared brain dead whose organs are being removed for donor purpose
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Describe E?
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Emergency operation
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What are the characteristics of a PS-1 which is a normal healthy client?
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No physiological, biological, organic disturbance
ex: 24 yo male needing repair of facial laceration |
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What are the characteristics of a PS-II which is a client with a mild systemic disease?
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Cardiovascular disease with minimal restriction on activity
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What are the characteristics of a PS-III which is a client with severe systemic disease that limits activity but is not incapacitating
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Hypertension, obesity, diabetes mellitus
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What are the characteristics of a PS-IV which is a client with a severe systemic disease that is a constant threat to life?
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CV or pulmonary disease that limits activity; severe diabetes with systemic complications; history of myocardial infarction, angina pectoris, or poorly controlled HTN
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What are the characteristics of a PS-V which is a moribund client not expected to survive 24 hours with/without operation?
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Severe cardiac, pulmonary, renal, hepatic, or endocrine dysfunction
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What are the characteristics of a PS-VI which is a client declared brain dead whose organs are being removed for donor purpose?
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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)
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What are the characteristics of E which is emergency operation?
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Surgery is done as a last recourse of resuscitative effort; major multisystem or cerebral trauma, ruptured aneurysm, or large pulmonary embolus
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Assessment for surgical procedures are (18 fond campers)?
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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 |
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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 |
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Name 6 risk factors of surgical procedures?
(pinafo) |
pregnancy
immunocompetence nutrition age fluid and electrolyte imbal. obesity |
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What are two major risk factors for infants undergoing surgery?
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maintaining normal circulatory blood volume which makes it difficult to meet increased oxygen demands...also dehydration or overhydration depending on rate fluids are replaced
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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 |
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How many calories per day does a patient require following surgery? (a, risk factors, nutrition)
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1500 kcal/day, esp. vitamins A and C, and zinc which facilitate wound healing
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How does malnutrition in a surgical patient affect healing? (a, risk factors, nutrition)
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anesthesia tolerance poor
nitrogen balance negative blood clotting mechanisms delayed infection wound healing poor multiple organ failure (potential for poor) |
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How does obesity (bariatric) affect surgical risks? (a, risk factors, obesity)
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reduces ventilatory and cardiac function
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What diseases are common in obese patients?
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CAOD
hypertension diabetes mellitus CHF |
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What conditions are commonly seen in bariatric patients?
(a, risk factors, obesity) |
embolus
atelectasis pneumonia |
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How does obesity affect wound healing?
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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
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Complications from previous surgeries include? (a, previous surgeries)
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motion sickness and
nausea and vomiting which increase the risk for aspiration |
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The patient's perception and understanding of surgery may induce? (a, P&U)
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fear
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True or False? All meds (herbal too) are discontinued postoperatively unless doctor orders? (a, medications)
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true
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It is critical to assess what type of allergies in surgical patients? (a, allergies)
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latex
food contact (ex. tape, ointments, solutions) |
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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 |
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How does alcohol affect surgical healing? (a, alcohol ingestion)
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increases anesthetic needs due to cross-tolerance;
poor wound healing due to malnourishment; at risk for liver disease, portal hypertension, esophageal varices; delirium tremens |
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Review of emotional health of surgical patient may reveal that patient feels?
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fear, anxiousness and powerlessness
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How does self-concept affect surgical outome? (a, self-concept)
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hinders ability to adapt to stress of surgery and aggravates feelings of guilt or inadequacy
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What types of surgery can affect body image, mainly sexuality? (a, emotional health)
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breast removal
colostomies ureterostomies hysterectomy prostate gland removal |
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When assessing emotional health of surgical patient, determine? (3)
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self-concept
body image coping resources |
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What is the body's physiological response to surgical stress?
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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
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Physical exam for surgery should include?
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general survey
head and neck integument thorax and lungs heart and vascular system abdomen neurological status |
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The surgical nursing assessment should complement?
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surgeon's and anesthesia provider's assessment
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The surgical nursing assessment should include the following? (hav light nn)
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head
abdomen vascular lungs integument general survey heart thorax neck neurological |
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The surgical nurse should take baseline preoperative vital signs and compare with post-operative vital signs?
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to rule out fluid and electrolyte imbalance
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When assessing head and neck, the nurse should inspect soft palate and nasal sinuses for?
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dehydration
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Palpate for cervical lymph node enlargement to rule out possibility of?
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local or systemic infection
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Inspect jugular veins for distention to?
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rule out excess fluid buildup in circulatory system or failure of heart to contract efficiently
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Note oral mucosa, identifying
loose or capped teeth as they may be? |
dislodged during endotracheal intubation.
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Inspect skin before surgical procedure to?
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discern increased risk of skin tears after lying for hours or sliding on OR table.
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If surgical nurse auscultates wheezing preoperatively, the patient may be at risk for further airway narrowing due to?
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certain anesthetics which cause laryngeal muscle spasm...notify doctor.
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Acceptable capillary fill occurs in?
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less than 2 seconds
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Assess abdomen for?
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size
shape symmetry distention regular bowel movements? color and consistency of stools |
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If client is to receive spinal anesthesia, nurse should assess?
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gross motor function and strength preoperatively. Nurse needs to be aware that client will only return to pre-op strength.
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What is a complete blood count?
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peripheral venous sample of blood measuring
rbc's wbc's hgb hct |
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What conditions might a CBC reveal? (bio)
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blood volume low
infection oxygenation problems (surgeon may order replacement) |
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Normal rbc count in men?
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4.7 - 6.1 million/mm3
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Normal rbc in women?
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4.2 - 5.4 million/mm3
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Normal hemoglobin in men?
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14 - 18 g/100 ml
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Normal hemoglobin in women?
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12 - 16 g/100 ml
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Normal hematocrit in men?
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42% - 52%
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Normal hematocrit in women?
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37% - 47%
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Normal white blood count in adults and children older than 2 years?
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5,000 - 10,000 /mm3
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Serum electrolytes include?
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bicarbonate (HCO3-)
chloride (Cl) potassium (K) sodium (Na) |
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Normal range for bicarbonate (HC03-)?
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21 - 28 mEq/L
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Normal range for chloride (Cl)?
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98 - 106 mEq/L
(chloride is feverish) |
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Normal range for potassium (K)?
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3.5 - 5.0 mEq/L
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Normal range for sodium (Na)?
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136 - 145 mEq/L
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Imbalanced serum electrolytes may indicate need for?
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IV fluid replacement preoperatively. Use peripheral venous sample of blood
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Coagulation studies include?
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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) |
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Normal PT level?
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11 - 12.5 seconds
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Normal INR level?
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0.76 - 1.27
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Normal APTT level?
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30-40 seconds
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Normal platelet level?
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150,000 - 400,000 /mm3
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Serum creatinine measures?
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ability of kidneys to excrete creatinine, by-product of muscle metabolism, assesses renal function
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An elevated creatinine can indicate?
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renal failure
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Normal serum creatinine level for men?
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0.6 - 1.2 mg/100 ml
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Normal serum creatinine level for women?
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0.5 - 1.1 mg/100 ml
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Normal blood urea nitrogen (BUN level)?
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10 - 20 mg/100 ml
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BUN measures?
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ability of kidneys to excrete urea and nitrogen indicates renal function
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An elevated BUN may indicate?
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dehydrated client; preop IV fluid replacement may be needed
(normal BUN 7-20 mg/dl |
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Normal fasting glucose level?
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70 - 105 mg/100 ml
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A glucose check may be acquired by?
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finger stick or peripheral blood sample; treat abnormal levels pre-op and post-op
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Common diagnostic studies for hepatic disease?
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coagulation studies
liver enzymes (ex: AST) alkaline phosphatase |
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Common diagnostic studies for diuretics include?
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BUN
creatinine CBC CXR ECG |
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Common diagnostic studies for steroids include?
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electrolytes
glucose |
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Common diagnostic studies for anticoagulants include?
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coagulation studies
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Common diagnostic studies for cardiovascular disease include?
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BUN
CBC CXR creatinine ECG |
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Common diagnostic studies for pulmonary disease include?
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CBC
CXR ECG |
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Common diagnostic studies for CNS disease are?
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BUN
creatinine ECG electrolytes glucose WBC count |
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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 |
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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 |
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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 |
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Planning phase of the nursing process includes? (3)
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continuity of care
goals and outcomes setting priorities |
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In the PLANNING phase, OUTCOMES established for each goal of care provide?
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MEASURABLE behavioral evidence; OUTCOMES ARE MEASURABLE
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In the PLANNING phase, setting PRIORITIES requires?
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clinical judgment to prioritizing nursing diagnoses and interventions based on the assessed unique needs of each client.
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In the PLANNING phase, CONTINUITY OF CARE for surgical patients mean?
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guiding the patient pre-op and post-op
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In the IMPLEMENTATION process for surgical intervention, the nurse provides?
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a complete understanding of surgery and prepares client physically and psychologically
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IMPLEMENTATION for surgical clients involves? (6)
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acute care
health promotion informed consent physical preparation preoperative teaching preparation on day of surgery |
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It's the __________ responsibility to explain the surgical procedure and obtain the informed consent.
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physician's
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Health promotion activities during preop phase focus on?
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health maintenance
prevention of complications support of possible rehab needs postop |
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A nurse pre-warns (reduces anxiety) client that he may have a sore throat following surgery due to? (preoperative teaching)
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endotracheal tube
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A nurse pre-warns (reduces anxiety) client that he may have sensations of blurred vision postop due to? (preoperative teaching)
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ointment being placed in client's eyes to prevent corneal damage
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Understanding of the surgical experience includes the following? (8 preoperative teaching)
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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 |
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When giving preop instructions concerning breathing, the nurse should?
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explain
demonstrate guide assess help allow pt practice return to re-evaluate patient's success |
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Equipment needed when demonstrating post-op exercises are?
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pillow or wrapped blanket
incentive spirometer positive expiratory pressure (PEP) device and nose clip |
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The pillow used when demonstrating postop exercises is used to?
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splint surgical incisions during coughing
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When assessing client's risk for postop respiratory complications, review medical history for?
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chest wall movement
abnormalities chronic pulmonary conditions ex: emphysema, asthma history of smoking presence of reduced hgb |
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Why does general anesthesia predispose client to respiratory problems?
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because lungs are not fully
inflated during surgery.. cough reflex is suppressed.. mucus collects in airway passages |
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Postop, patient may have trouble coughing and deep breathing because?
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there is reduced lung volume due to general anesthetic
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Postop, patient is at greater risk to develop?
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respiratory complications if other chronic lung conditions are present
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Smoking damages?
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*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 |
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Reduced hemoglobin level can lead to?
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inadequate oxygenation
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Preop, nurse should get a baseline chest expansion measurement to?
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compare postop measurement with
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Older clients, active cancer patients, and clients immobilized for more than 3 days are most at risk for?
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DVTs or thrombus formation
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Signs of thrombus formation may include?
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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 |
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For thrombus formation to occur, there must be simultaneous? This event may occur following general anesthesia.
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hypercoagulability
vein trauma venous stasis |
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True or false? Positive Homan's sign indicates DVT?
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False
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When teaching diaphragmatic breathing, have client hold slow, deep breath for?
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3 counts
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When giving preop instructions concerning breathing, the nurse should?
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explain
demonstrate guide assess help allow pt practice return to re-evaluate patient's success |
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Equipment needed when demonstrating post-op exercises are?
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pillow or wrapped blanket
incentive spirometer positive expiratory pressure (PEP) device and nose clip |
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The pillow used when demonstrating postop exercises is used to?
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splint surgical incisions during coughing
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When assessing client's risk for postop respiratory complications, review medical history for?
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chest wall movement
abnormalities chronic pulmonary conditions ex: emphysema, asthma history of smoking presence of reduced hgb |
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Why does general anesthesia predispose client to respiratory problems?
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because lungs are not fully
inflated during surgery.. cough reflex is suppressed.. mucus collects in airway passages |
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Postop, patient may have trouble coughing and deep breathing because?
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there is reduced lung volume due to general anesthetic
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Postop, patient is at greater risk to develop?
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respiratory complications if other chronic lung conditions are present
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Smoking damages?
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ciliary clearance
increases mucus secretions |
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Reduced hemoglobin level can lead to?
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inadequate oxygenation
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Preop, nurse should get a baseline chest expansion measurement to?
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compare postop measurement with
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Older clients, active cancer patients, and clients immobilized for more than 3 days are most at risk for?
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DVTs or thrombus formation
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Signs of thrombus formation may include?
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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 |
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For thrombus formation to occur, there must be simultaneous? This event may occur following general anesthesia.
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hypercoagulability
vein trauma venous stasis |
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True or false? Positive Homan's sign indicates DVT?
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False
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When teaching diaphragmatic breathing, have client hold slow, deep breath for?
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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
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To perform incentive spirometry or positive expiratory pressure therapy, have patient sit in which position?
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semi-Fowler's or high Fowler's position
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"Huff" coughing or forced expiratory technique when using PEP therapy accomplishes what?
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promotes bronchial hygiene by increased expectoration of secretions
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When done appropriately ((with fingers (splint/support) or pillow over incision)), controlled coughing exercises will cause incisional injury? True of false
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False
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Practicing turning exercises
preop? |
reduces risk of vascular and pulmonary complications
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Preop leg exercises are done by?
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rotating each ankle alternating with dorsiflexion and plantar flexion of both feet in supine position
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If in pain, patient may request pain medication 30 minutes before postop exercises. True or false?
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true
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A client may receive the following preop to relieve anxiety and promote sleep?
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Restoril (temazepam)-
sedative-hypnotic Xanax (alprazolam)-anxiolytic |
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Routine procedures surgical nurse provides in preparation for a day of surgery are? (10)
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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 |
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If patient has been NPO before surgery, mouth may be dry. Nurse may offer?
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mouthwash and toothpaste and
water and instruct patient not to swallow preop meds which may cause drowsiness |
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An indwelling catheter may be placed in the pre-op client just before surgery if?
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surgery is long
incision is in lower abdomen |
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Essential documentation that must be in chart before client goes to OR?
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pertinent laboratory results
preoperative checklist current client documentation |
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Preop or "on call" meds are given AFTER consent form signed and are used to treat?
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amount of anesthesia
required anxiety risk of n & v and resultant aspiration respiratory tract secretions |
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Products that may contain latex and which surgical candidate may be allergic to include?
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adhesive tape
disposable electrodes endotracheal tube cuffs gloves IV tubing protection sheets rubber stoppers on bottles and vials syringes ventilator equipment |
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Localized signs and symptoms of latex allergy?
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urticaria
anything from flat or raised red patches to vesicular, scaling, or bleeding eruptions acute dermatitis rhinitis and/or rhinorrhea |
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Life threatening symptoms of latex allergy include?
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bronchospasm
edema focal or generalized urticaria mucus hypersecretion (compromises respiratory status) vasodilation compounded by increased capillary permeability leading to circulatory collapse and death |
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Define "Time Out"?
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conducted just before surgery whereby all team members are present and client is again identified along with indelibly marked side and site of surgery
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The qualification of a circulating nurse MUST be?
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an RN
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In the nursing process, EVALUATION for surgery includes?
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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 |
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What does the circulating nurse do?
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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 |
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The qualifications of a scrub nurse may be?
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RN
licensed practical nurse surgical technician |
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What does the scrub nurse do?
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maintains sterile field
during surgical procedure assists with applying sterile drapes hands surgeon instruments counts sponges and instru- ments |
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Four types of anesthesia used in the OR are?
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conscious
general local regional |
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Define general anesthesia?
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an immobile, quiet client who doesn't recall surgical procedure
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The 3 phases of anesthesia?
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emergence
induction maintenance |
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General anesthesia is called for when?
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analgesia
control of ANS immobility muscle relaxation |
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Define induction?
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includes administration of agents and endotracheal intubation
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Define maintenance?
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includes positioning the client
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Define emergence?
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anesthetics are decreased and client begins to awaken
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Define palliative surgery?
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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 |
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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 |
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Surgical procedures are categorized according to? (5)
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anatomic location
degree of risk extent of surgery reason for surgery urgency of procedure |
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Reasons for surgery include?
(5) |
cosmetic
curative diagnostic palliative restorative |
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Urgency of surgery? (3)
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elective
emergent urgent |
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Degree of risk of surgery?
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minor
major |
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Extent of surgery?
|
radical
simple |
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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 |
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Define curative surgery?
|
performed to resolve a health problem by repairing or removing the cause
ex: laparascopic cholecystectomy mastectomy hysterectomy |
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Define restorative/reconstructive surgery?
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restores function; performed to improve a client's functional ability
ex: total knee replacement finger reimplantation |
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Define elective surgery?
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planned for correction of a nonacute problem
ex: cataract removal <hernia repair> hemorrhoidectomy total joint replacement |
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Define urgent?
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<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> |
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Define emergent?
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NOW! requires immediate intervention because of life-threatening consequences
ex: AAA appendectomy compound fracture gunshot or stab wound <repair of perforated appendix> severe bleeding |
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Define minor surgery?
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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 |
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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
|
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Problems from anesthesia occur most commonly in what body system?
|
cardiovascular due to hemodynamic changes and response to anesthesia possibly resulting in MI
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<Surgical risk factors of the aged's cardiovascular system include?>
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<decreased cardiac output
decreased peripheral circulation increased blood pressure> |
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<Nursing interventions and rationales for the aged's cardiovascular system are?>
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<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> |
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<Surgical risk factors of the aged's respiratory system include?>
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<reduced vital capacity
loss of lung elasticity decreased oxygenation of blood> |
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<Nursing interventions and rationales for the aged's respiratory system are?>
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<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> |
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<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> |
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<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?>
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<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>
|
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<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
|