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67 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What does PACU stand for?
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Postanesthesia Care Unit
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What happens during Phase I of PACU?
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This is the immediate recovery phase, pt is monitored.
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What happens during Phase II of PACU?
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The patient is prepared for self care or care in the hospital or an extended care setting.
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What happens during Phase III of PACU?
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The patient is prepared for discharge.
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Whose responsibility is it to transfer the patient from the OR to the PACU?
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The anesthesiologist or anesthetist.
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What happens during a hypopharyngeal obstruction? Why does this happen?
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The lower jaw and tongue fall backward and the air passages become obstructed. The patient is unconscious after surgery and the relaxation caused by anesthesia extends to the muscles of the pharynx.
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How is hypopharyngeal obstruction treated?
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By tilting the head back and pushing forward on the angle of the lower jaw (as if to push the lower teeth in front of the upper teeth. This maneuver pulls the tongue forward and opens the air passages.
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How much blood can be lost during surgery before replacement is indicated?
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Up to 500 mL
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What two factors contribute to main causes of shock?
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hypovolemia and decreased intravascular volume
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Pallor, cool/moist skin, rapid breathing, cyanosis, rapid/weak/thready pulse, low BP, narrowing BP, and concentrated urine are all classic signs of what?
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Hypovolemic shock
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After surgery a patient exhibits the following behaviors: apprehensiveness, restlessness, is thirsty, has cold/moist skin and is pale. They have an increasing pulse rate, dropping temperature and rapid/deep respirations. What is happening to them?
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They are experiencing an extreme blood loss!
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What unusual symptoms might the patient experience during extreme blood loss?
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They might see spots, hear a ringing and feel weak.
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What is the shock position?
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Flat on back, legs elevated at a 20-degree angle, knees kept straight
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Who is at most risk for postoperative nausea and vomitting (PONV)?
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Females, nonsmokers, those with a history of PONV or motion sickness and patients undergoing surgical procedures lasting longer than 2 hours.
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True or False: Postoperative confusion and delirium affect as many as 25% of older patients.
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False: 51%
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True or False: An older patient is displaying signs of confusion and restlessness. This is most likely due to their reaction to medicaitons/anesthesia.
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False: Hypoxia, blood loss and electrolyte imbalances can all present with signs of confusion and restlessness. Exclusion of all other causes of confusion must precede the assumption tha tthe confusion is related to age, circumstances, and medications.
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Urine output must be at least __ mL per hour in order for the patient to be considered ready to be discharged from the PACU.
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30 mL/hour
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What is the Aldrete scoring system and what does a score of less than 7 mean?
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It is a PACU scoring system that determines the patients general condition and readiness to transfer from the PACU. A score of less then 7 means the pt is not ready to leave the PACU.
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After the patient is transfered from PACU to the clinical unit, how often are vitals recorded?
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Every 15 minutes for the first hour and then every 30 minutes for the next 2 hours. Then every 4 hours.
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True or False: Pulmonary complications are amoung the most frequent and serious problems encountered by surgical patients.
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True! (For once)
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What lung condition is characterized by decreased breath sounds over the affected area, crackles, and cough?
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Atelectasis
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What lung condition is characterized by chills, fever, tachycardia, and tachypnea?
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Pneumonia
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What is subacute hypoxemia?
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When oxygen saturations are a constant low level although breathing appears normal.
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What is episodic hypoxemia?
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When the patient suddenly has a symptomatic low pulse ox.
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How often should the nurse encourage the patient to turn and take deep breaths?
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At least every 2 hours
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How often should an incentive spirometer be used?
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10 times per hour while awake
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(How many times per hour?)
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True or False: Pain control has no effect on cardiovascular insufficiency and incidence of infection.
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False: Cardiovascular insufficiency occurs three times more frequently, and the incidence of infection is five times more greater in people with poor postoperative pain control.
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How do epidural infusions and intrapleural anesthesia affect the sensory and motor functions of the intercostal muscles?
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They provide sensory anesthesia without affecting motor function to the intercostal muscles.
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How long after surgery is IV replacement therapy used for?
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Up to 24 hrs or until the patient is stable and tolerating liquids.
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After surgery, about how many mL per 8-hour shift is expected? What do you do if it is lower?
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240 mL or greater is expected. Call the MD if it is less than that.
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True or False: It is recommended that patients have a pillow under their knees or dangle their legs off the edge of the bed for long periods of time to promote pressure relief.
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False: Patients should avoid positions that compromise venous return, such as raising the bed's knee gatch, placing a pillow under the knees, sitting for long periiods, and dangling the legs with pressure at the back of the knees.
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Why is orthostatic hypotension common after surgery?
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Because of changes in circulating blood volume and bed rest.
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Why are wound drains used?
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To allow the escape of blood and serous fluids that could otherwise serve as a culture medium for bacteria.
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What are the 3 phases of surgical wound healing?
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Inflammatory, Proliferative and Maturation (You should know this from last semester slackers!!!)
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An infected wound with granulation tissue being formed or with edges that have not been approximated is most likely undergoing what type of healing? First-intention, Second-intention or third intention?
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Second-intention
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Deep wounds that have not been sutured early or break down and result in deeper and wider scars, are said to undergone what type of wound healing? First, Second, or Third intention.
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Third-intention
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True or False: The correct way to apply tape is to place the tape at the center of the dressing and then press the tape down on both sides, applying tension evenly away from the midline.
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True!
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Why would a postoperative patient who is NPO complain of fullness or pain in the abdomen?
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Even though nothing is given by mouth, swallowed air and gastrointestinal secretions enter the stomach and intestines; if not propelled by peristalsis, they collect in the intestines, producing distention and causing the patient to complain of fullness or pain in the abdomen.
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What intervention can the nurse do if a postoperative patient is voiding, but not able to empty his bladder fully?
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The nurse can get an order for intermittent catheterization for every 4-6 hours until the patient can void spontaneously and the postvoid residual is less than 100mL.
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True or False: If a postoperative patient is not able to void, an indwelling catheter should be inserted and left in for a few days.
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False: Straight intermittent catheterization is preferred over indwelling catheterization because the risk of infection is increased with an indwelling catheter.
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In reference to wound classification, what is a clean-contaminated wound?
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One that is clean, but has entry into respiratory, alimentary, genitourinary or oropharyngeal tracts without unusual contamination.
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In reference to wound classificaiton, what is a contaminated wound?
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A wound that is open, new, and has gross spillage from the GI track, or has entry into genitourinary or bilary tract when urine or bile is infected.
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In reference to wound classificaiton, what is a dirty wound?
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A tramatic wound that has:
-delayed repair -devitalized tissue -foreign bodies -fecal contamination -acute inflammation and purulent(puss) drainage encountered during the procedure |
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How are surgical wounds classified?
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According to their degree of contamination.
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Why are more than half of wound infections diagnosed after discharge?
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Because wound infection may not be evident until at least postoperative day 5. Most patients are discharged before that time.
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What bacteria accounts for more than half of wound infections?
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Staphylococcus Aureus
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What special precautions are needed if it is determined that the wound infection was caused by beta-hemolytic streptococcus or clostridium?
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Strict infection control practices are needed to prevent the spread of infection to others.
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The disruption of a surgical incision is termed wound _____.
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Dehiscence
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The protrusion of wound contents is termed?
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Evisceration
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A patient reporting a gush of bloody serosanguineous peritoneal fluid comming from a wound has most likely just experience a (choose one) wound dehiscence or wound evisceration?
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A wound dehiscence. If the patient had reported that "something gave way" and pain and vomiting may follow.
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What can be used to help prevent evisceration?
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An abdominal binder.
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Low ____ prevents the return of interstitial fluid to the venous system, decreasing intravascular fluid.
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serum albumin
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Low serum albumin can cause an increased risk of shock. Why?
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Because it causes you to have a low intravascular volume!
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When postoperatively does dehiscence occur most frequently?
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Between the 5th and 12th postoperative days.
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Why would a nurse refer a preoperative client with marked dental caries to a dietitian?
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Because carious teeth can be caused by poor eating habits. If they patients hopes to successfully recover from surgery, they need to be nutritionally sufficient.
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In terms of preoperative nutrition, how much time in needed for objective evidence of the effectiveness of nutritional therapy to be evident? (ie how long before surgery do you have to eat well to be in good balance for surgery)
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2-3 weeks
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How long must you wait after consuming a light meal, before you are considered safe from aspiration risks?
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6 hours
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How long must you wait after consuming a regular meal containing fat or meat, before you are considered safe from aspiration risks?
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8 hours
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What is a low residue diet?
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A diet that consists of food and drink that will leave minimal solid material in the large intestine after digestion.
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What foods/drinks are avoided on a low residue diet?
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Milk products, seeds, nuts, raw or dried fruits and vegitables.
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What is the purpose of a low residue diet?
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To decrease colonic contents.
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A person preparing to undergo gastrointestinal tract surgery would want to eat a low residue diet for how long before surgery, to minimize feces left in the bowel?
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2-3 days
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Vitamin ____ is necessary for collagen formation.
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C
*C for collagen |
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Vitamin__ is necessary for blood clotting.
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K
*K for Klotting |
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____ is necessary for tissue growth, bone formation, skin integrity, cell-mediated immunity, and generalized host defense.
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Zinc
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To prevent excessive muscle protein from being used for energy, adequate nourishment should be delivered to the client within ___ days of not eating/drinking.
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3
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Other than bowel sounds, what is another sign of peristalsis?
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The passing of flatus (gas) from the rectum.
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