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32 Cards in this Set

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What teaching should you give a client regarding autologous blood donations as preparation for surgery?
advise client that they can donate their own blood up to 5 weeks before surgery if they meet the
following requirements:
They are infection free.
They have a hemoglobin level greater than 11/gdL (110g/L).
They have a physician's recommendation.
If they have a cardiac condition they will need additional clearance from their cardiologist.
To prepare I would advise:
The physician may order an iron supplement before the first donation.
The autologous donations can be made as often as every 3 days as long as the criteria for the donation
is met.
The last donation cannot be made 72 hours prior to surgery.
What drainage would you expect from a Jackson Pratt drain in the first 24 hours? In 72 hours?
The drainage would be sanguineous (bloody) in the first 24 hours and then serosanguineous to serous
(serum-like or yellow) in 72 hours.
What should an incision appearance and drainage look like in the first 24 hours? In a week?
During the first 24 hours the incised tissue regains blood supply and begin to bing together. After a
week , Fibrin and a thin layer of epithelial cells seal the incision. Then the epithelial cells continue to
grow in the Fibrin and collagen begin to fill the wound gaps and the process continues for up to
3 weeks.
Who can sign an informed consent?
The client or legal gaurdian
What is the focus of your assessment for a client post spinal anesthesia?
Motor and sensory assessment should be the focus.
What are the nursing interventions for a client after spinal anesthesia? When can the client leave PACU?
Evaluate motor function by asking the client to move each extremity. Assess the strength of each limb
and compare results on both side. The client will remain in PACU until sensory function and voluntary
motor movement of the legs have returned.
What should be the priority (numero uno) assessment after surgery with general anesthesia?
Respiratory function/assessment.
What should be part of your circulatory assessment after any type of surgery?
Assess blood pressure, pulse, and heart sounds.
What are some side effects of the aminoglycosides?

And name a common aminoglycoside:
Ototoxicity (vestibular and cochlear) , nephrotoxicity,
hypomagnesemia, muscle paralysis (high parenteral doses), and hypersensitivity reactions.
Common aminoglycosides: Gentamicin, neomycin, streptomycin, and tobramycin.
If a person is allergic to Penicillin, what other class of medications might they react to?
Cephalosporins.
Describe the type of client that would be at highest risk for complications such as DVT, PE or pneumonia
after surgery.
Older or debilitated clients and in clients with health problems such as diabetes mellitus.
What would be the reason for a client needing Epogen (Procrit) prior to surgery?
Low hemoglobin
count from pre-op labs because it stimulates erythropoiesis which is the production of RBC's.
What instructions would you give the client who has started on PCA?
I would teach the client how to use the device and to report side effects such as dizziness, nausea,
vomitting, and inability to void.
When should you tell a client who is Postop to use the PCA or if he does not have a PCA, when should you tell him to ask for the pain medication?
As soon as he experiences pain.
What abnormal labs going into surgery would place a client at greater risk for SOB or
respiratory problems after surgery?
Abnormal results of: Chloride can cause respiratory alkalosis; Carbon Dioxide can cause chronic pulmonary disease;
and Hemoglobin can also cause chronic pulmonary disease.
What abnormal labs going into surgery would place a client at greater risk for arrhythmias during or after surgery?
High potassium levels.
What are nursing interventions for a client suspected of malignant hyperthermia?
Stop all inhalation anesthetic agents and succinycholine.

If no ET tube, intubate immediately.

Ventilate client w/ 100% oxygen w/ highest possible flow rate.

Administer dantrolene sodium via IV at a dose of 2 to 3 mg/kg.

If possible, terminate surgery. If termination is not possible then continue the surgery using anesthetic agents that do not trigger it.
Assess ABG's and serum chemistries for metabolic acidosis and hyperkalemia.
If metabolic acidosis is evident by ABG analysis, administer sodium bicarbonate via IV If hyperkalemia is present, administer 10 units of insulin in 50 mL of 20% dextrose via IV

Use active cooling techniques like iced saline, cooling blanket over torso, and/or lavage open cavaties w/
sterile, iced saline.
Monitor core body temperature to assess effectiveness of interventions and prevent hypothermia.

Monitor cardiac rhythm via ECG to assess for dysrhythmias.

Insert Foley to monitor urine output.

Treat dysrhythmias that do not resolve on correction of hyperthermia and hyperkalemia w/ agents other than channel blockers.

Maintain urine output above 2 mL/kg/hr via intake of IV fluids.

Monitor urine for presence of blood or myoglobin.

Osmotic or loop diuretics if urine output falls below 2 mL/kg/hr.

Transfer the client to ICU when stable
What does REACT stand for in the PACU?
respiration, energy, airway, circulation, temperature
When will you know when to remove the airway of someone in PACU?
After client regains gag and cough reflex and meets guidelines for exubation (ie. ability to raise and hold
the head up and evidence of thoracic breathing).
What are nursing interventions for a client with an NG tube?
Record the color, consistency, and amount of drainage every 8 hours.
Assess for complications w/ NG tube:
Fluid and electrolyte imbalances, aspiration, and nares discomfort.
Check tube placement every 4-8 hours and before instilling liquid into tube.
What is the purpose of drains post surgically?
To allow excess bleeding and fluid to be removed from the body.
What breathing exercises are most effective after surgery?

Describe the proper use of the IS and what are proper breathing exercises?
Deep diaphragmatic breathing, expansion breating,
and splinting incision.

Client must be able to seal lips around mouthpiece, then inhale spontaneously and hold his or her breath for 3-5
seconds. Client should note mL achieved and create goals according to client ability.
What helps reduce nausea and vomiting in the immediate post op period?
By having the client in a
side-lying position before raising the head of the bed.
What classes of medications place clients at greater risk for complications intraoperatively or postoperatively and why?
Opioids due to risk for respiratory depression and hypotension.
What classes of medications place clients at greater risk for bleeding postoperatively?
NSAIDS
What symptoms would a person display who has experienced an excessive blood loss during surgery?
Losing large amounts of blood suddenly can create two problems: Blood pressure falls because the amount
of fluid left in the blood vessels is insufficient, and the body's oxygen supply is drastically reduced because
the number of oxygen-carrying red blood cells has diminished so quickly.
What would your nursing interventions be for a client suspected of hemmorhage post operatively?
Stop the bleeding and monitor vitals, labs and O2 stats.
A patient signed an informed consent yesterday, but on the day of surgery is having second thoughts about the
surgery. What would you do?
Do not continue with the surgery until after talking with client and
reviewing fears and apprehensions. The surgery cannot continue without client's consent.
A client preoperatively tells you that he is used to drinking at least 6 beers a day and drank two beers this AM
prior to coming into the hospital. What would you do with this information?
Alert the doctor immediately because
alcohol can alter the client's responses to anesthesia and pain medications.
A client has a long history of asthma. What would you give priority to in your assessment
pre and post operatively?
Respiratory function and O2 Stats as well as watching for reduced tissue
oxygenation
What interventions will help to prevent postoperative complications such DVT?
The use of TED or Jobst
stockings, elastic ace wraps, or pneumatic compression devices. Also, teaching about post-op
leg exercises when appropriate.
What interventions will help to prevent postoperative complications such as pneumonia?
Using breathing
exercises and the incentive spirometer. Also, coughing and splinting.