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90 Cards in this Set
- Front
- Back
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surgical procedures are classified according to
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seriousness
urgency purpose |
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moribund
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the client would not survive without the surgery
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after surgery, a client requires at least ___ kcal/day to maintain energy reserves
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1500
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What 2 populations are at risk when having surgery?
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very old and very young
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Being argumentative and hostile with the nurse probably indicates a patient is __
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anxious about the upcoming surgery
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__ temperature preop will probably cause the surgery to be rescheduled
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elevated
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Acceptable capillary refill occurs in less than __ seconds.
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2
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ambulatory surgery...
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*same day
*short stay *outpatient Becoming more and more common. PS I-II can do ambulatory and stable III. |
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Surgery is classified by
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seriousness, urgency, and purpose.
Indicates level of care pt requires from RN |
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Risk factors to be assessed
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Age - infants (blood volume balance is important, very old are detereorating all over)
Nutrition- at least 1500kcal post op Obesity- aka bariatric. dehiscence is a risk Immunocompotence F/E imbalance- Na, H2o retained, K lost Pregnancy - only on an emergency basis. |
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If the patient does not have any info of the procedure pre op, the nurse needs to ________
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confer with the physician, and the physician needs to explain the procedure to the patient. This is his/her job, NOT the nurses.
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Allergies need to be delineated from _____
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unpleasant side effects. For example, nausea is a side effect, confusion and hypotension is an allergy.
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Physical Examination should include
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*General Survey - baseline vitals, height, weight, etc.
*Head/Neck- palpate the lymph nodes to ck for infection. ck mucosa for hydration, capped teeth, etc. *Integument- *thorax/lungs- Physician notified wheezing or anything abnormal. *Heart and vascular system- cap refill should be <2sec Abdomen- preop bowel sounds are a useful baseline |
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The patient who uses ____ infusion may have a lower ___ the day of surgery.
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autologous, H and H
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The periop. care plan is reviewed and modified during what periods?
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intraop and post op
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Care is enhanced if education is provided___
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before, during, and after discharge.
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Including __ in the education is advised.
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family members
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___ is minimized when proper education is provided.
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Anxiety. Ex. educating a pt on blurry vision they may experience when they wake from surgery.
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Name and describe 6 post op excercises.
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diaphramic breathing- q hr til mobile.
Incentive spirometry- # of breaths not to exceed 10-12 per minute. baseline breath should be goal. positive expiratory pressure and huff- book controlled coughing- cough 2-3x q 2h while awake Turning- turn q 2hr while awake Leg excercises - foot circles, alternate dorsiflexion and plantar flexion of foot |
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Physical prep preop includes
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*maintain normal FE balance
*reduction of risk of infection *Prevention of incontinence- consec. enemas can lead to f/e imbalances. Void right before leaving for OR if possible. No more than 3 consecutive enemas at most facilities. *Promotion of rest and comfort |
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Prep day of surgery
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*Hygeine
*Hair and cosmetics-no makeup, hair back, preferably no jewelry on *REmoval of prostheses- Provide for privacy as patient removes things like wigs, toupess, etc. This may be embarrassing. *Safeguarding valuables *Prepping bowel and bladder *Vitals *Documentation |
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What does perioperative nursing emphasize?
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safety and education
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Surgical procedures are categorized by:
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reason, urgency, risk, anatomic location, extent of surgery required.
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What are the five reasons, and an example of each
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diagnostic- ex breast biopsy
curative - ex mastectomy restorative - ex knee replacement paliative- tumor reduction cosmetic- lipo |
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The extent of surgery is either __ or __
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simple - where only the affected areas are 'cut on'
radical- extensive surgery beyond area is involved. directed at finding root cause |
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Diagnostic surgery is generally very __ for the pt.
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stressful
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A pt. experiencing delirium tremors may be having___ ___
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alcohol withdrawals
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Risk for MI is higher in pts with ___
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existing cardiac problems.
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Pts. allergic shellfish will probably have a reaction to ___ , same with bananas and ___
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iodine, latex
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Autologous blood donation
Direct blood donation |
- pt. donates own blood up to 5 wks before surgery. they must have a hemoglobin level of at least 11, be infection free, and be OK'd by dr. to do this
- is rare, but a friend, if a match may donate for the pt. |
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ALL pts. must have ___ planning.
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discharge
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What does surgery do to vitamin stores necessary for wound healing?
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depletes them, therefore check for indications of poor hydration and nutritional status.
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Labs need to be obtained __ preop
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24-28 hrs
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T/F a chest xray is given to all pts. preop
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False. Usually healthy young pts. do not get a chest xray preop
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Informed consent includes:
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reason for surgery, who will be performing surgery, risks
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Does surgery provide an exception to a pts advanced directives or living will.
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NO! a dnr status does not apply during surgery. the team will attempt to save the pts. should complications arise.
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NPO status usually begins __ before surgery
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6-8 hrs. Emphasize importance of adherence.
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Which drugs are usually allowed w a sip of water before surgery ?
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cardiac drugs, resp., seizure drugs, and some antidepressants. Again, it depends on the pt. but these are usually given.
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What is the first step in preventing surgical wound infection?
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skin prep
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Shaving the site before surgery is a __ subject. Why?
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controversial. It is believed that it allows more microbes to enter the skin and cause infection.
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Educating a patient on drains:
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*used routinely but may cause discomfort
*should not be pulled or kinked |
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What is an effective method of teaching?
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discussing, demonstration, and return demonstration
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Excercises should be done___ in the recovery phase __ reps each, and q __ hrs post op for the first __ hrs.
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early, 5-10, 1-2, 48
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Explain to the pt. she may be __ for the excercises.
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awaken.
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What must the pt. doing incentive spirometry be able to do?
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form a seal around mouthpiece, inhale spontaneously and hold for 3-5 seconods for effective lung expansion
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what does coughing prevent?
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actelectasis and pnemonia
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a __ can be a folded bath blanket or pillow
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splint
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Should wraps and surgical stockings be removed at least once a day to inspect skin?
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yes
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Clients have ranked ____ as the most important part of periop. teaching
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psychosocial support
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WHAT DOES THE Anesthesiologist monitor ?
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level of anesthesia, cardiopulmonary functioning, vitals, and I and O
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Whta does the holding area nurse do ?
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maintains an atmosphere of comfort, privacy, and confidentiality.
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Who ensures all supplies are gathered and fully functioning?
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the circulating nurse. (s)he also monitors room traffic, assesses urine and blood loss, ensures sterile field is maintained, communicates with family members, and documents.
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What does the scrub nurse do?
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sets up sterile field, drapes pt, hands sterile supplies to surgeon or other staff,
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When are counts performed?
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before surgery, during the time things are added, when personnel is relieved, and immediately before skin closure.
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What is the optimal room temp for an OR?
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68-73 F
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the surgical suite is divided into what 3 areas?
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restricted, semirestricted, and unrestricted
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When should surgical staff bathe/shower?
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a few hours before changing into OR attire
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a hospital aquired infection is known as ___
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nosocomial
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true false. Staff is allowed to change into their clean surgical attire at home.
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False. They must change inthe locker rooms at the hospital.
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T/F. The scrub makes the hands and forearms sterile.
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F. It reduces the # of microorganisms.
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4 Stages of Gen. Anesthesia
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1. analgesia, sedation, relaxation- hearing is eggagerated, dizzy, drowsy
2. excitement/delirium- LOC, loss of eyelid reflex, increased movement, involuntary control, and vomitting may occur. Stay with patient. 3. Operative/surgical- generalized muscle relaxation. pt. cannot hear and sensations are lost. intubation and skin scrub occur. 4. danger - eyes are fixed and dilated. |
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Emergence
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recovery from anesthesia
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Which agents cause shivering?
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volitale, due to the action on the hypothalamus
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__ is the most commonly used barbituate.
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penothal
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__ is a dissociative agent
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Ketamine
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T/F all opoids depress respiratioon
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True
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T/F Balanced anesthesia is good for older and high risk clients
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True
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Elevated temp of 111 or over is a sign of ___
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malignant hyperthermia
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what is the drug of choice to treat malignant hyperthermia ?
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Dantrolene Na
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Correct ID of the pt. is the responsibility of who?
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the whole healthcare team
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T/F it is OK to leave the pt unattended if only for a short period.
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False.
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How must the pt. be ID'd ?
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2 ways. For example, what is your name, and when is your bday?
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What should be assessed immediately upon entering pacu?
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airway patency, gas exchange
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continuously monitor __ while in pacu
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o2 sat
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Resp rate less than __ indicates drug depression
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10
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Stridor is...
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a high pitched snoring sound, indicates airway obstruction
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Report BP changes __ greater than or less than baseline
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25%
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T/f. a common reaction post of is nausea and vomiting
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True
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NG tube drainage formula:
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drainage in collection device - amount of irrigant= true drainage
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the normal color of NG drainage is __
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greenish yellow
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Wound healing is not truly complete until __
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up to 2 yrs. typically 6mos to 2 yrs.
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T/f serosanguineous drainage beyond 5th day of surgery is cause for concern.
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True. This is a sign of dehiscence and the surgeon should be notified.
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__ use is a risk factor for the seperation of wounds.
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steroid use, diabetes, obesity
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t/f drainage is normal and expected with closed drainage systems.
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False. Only with open drainage systems.
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left shift
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Is an indication of infection. YOu will see an increase if immature neutrophils. aka bandemia
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how should pts immediately be positioned in pacu ?
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side lying to prevent aspiration
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skin sutures and staples are normally removed ___ days after surgery.
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6 to 8
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When evisceration occurs....
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call for help. this is an emergency. cover the wound with moist warm sterile saline. do not attempt to put the organ back into the body. take vitals often until physician arrives.
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the teaching plan for pts. who had surgery and are now going home includes:
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prevention of infection
assessment and care of wound diet therapy pain management drug therapy progressive increase in activity |
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in the event of a dehiscence or evisceration, pts should lie in what position >?
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supine
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