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49 Cards in this Set
- Front
- Back
What is routinely checked after surgery that is affected by hemorrhage?
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Hemoglobin and Hematocrit
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What are the normal hemoglobin levels?
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F: 12-16 g/dl
M: 14-18 g/dl |
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What are the normal hematocrit levels?
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F: 37-47%
M: 42-54% |
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What is the normal range for bicarbonate in blood?
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22-26 mEq/L
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What is the normal range for CO2 in venous blood?
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22-30 mEq/L
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What is the normal range for O2 saturation?
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95-98%
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What is ABLATIVE surgery?
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removal of a diseased part
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What is PALLIATIVE surgery?
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reduces intensity of a disease
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What are the three levels of surgery regarding urgency?
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1. Elective (optional), 2. Urgent (must be done soon), 3. Emergent (must be done immediately)
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What are the purposes of anesthesia?
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Block nerve impulse, suppress reflex, relax muscles, achieve a controlled level of unconsciousness
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When is sterile technique used?
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In any procedure that compromises skin integrity or that involves contact with mucus membranes
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What are the four stages of anesthesia?
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1. Analgesia and sedation 2. Excitement, delirium 3. Operative level 4. DANGER, code
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What is the main concern for a patient that has been administered Pentothal?
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Respiratory and cardiac depression, VS are to be monitored until drug is eliminated
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What is the main safety concern for a patient under the influence of Ketamine?
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Possible fall, safety measures or Valium is used to control effects
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What are important concerns for a patient under the influence of Ativan or Valium?
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Respiratory depression, apnea
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Which opioid should not be used for elderly patients?
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Demerol. Alternatives: Fentanyl, morphine
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What is a high concern for patients on opioids?
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Respiratory depression
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What are three common neg side effects in surgery?
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1. Bleeding 2. Fluid & electrolyte imbalance (due to the large amount of IV fluids administered) 3. Inflammation
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What are some red flags in a patient's history when heading into surgery?
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ALLERGIES, Hypo/hyperthermia, hypo/hypertension, Hypovolemic shock, Renal failure, Electrolyte imbalances, Dysrhythmias, Chronic heart failure, Paralytic ileus, Acute urinary retention, DVT, Pulmonary embolism, Atelectasis, Pneumonia, Laryngeal edema, GI bleeding, Anemia
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What is the normal range for PT (prothrombin time) and what is its significance?
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11-12.5 seconds, how quickly a clot is formed on a wound, used to measure the effects of anticoagulants (Heparin, Coumadin)
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What are post surgery vital signs compared with?
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pre surgery vital signs (baseline)
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What are main areas of post op assessment?
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Vital signs (esp. respirations), Integrity of surgical area (any bleeding?), Neuro, Comfort level, IV fluid status (30cc/hr is standard), I&O, once stabilized assess for readiness for discharge
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In post op, how often are vital signs monitored?
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every 15mins x 4
every 30mins x 4 every 1hr x 2 every 4hr x 24-48hr |
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How would you prevent dehiscence of a wound?
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Move patient carefully, instruct them to move carefully, use a pillow for pressure support of a wound in case of coughing
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Describe two general types of drains.
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1. Gravity - fluid flows freely from surgical site (Penrose, T-tube)
2. Closed wound drainage systems - fluid is extracted by means of a pump (Hemovac, Jackson-Pratt) |
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What are Montgomery straps?
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Used for frequent dressing changes, prevent skin irritation from frequent tape removal
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What are some factors that contribute to poor wound healing and infection?
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Malnutrition, inhibited circulation
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What are some special considerations for an obese patient undergoing surgery?
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- Decreased ventilatory and cardiac function
- Poor wound healing due to low blood circulation in fatty tissue - Greater chance of evisceration (external exposure of organs through incision) |
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What are the physiologic reasons for surgical complications in patients with COPD or that smoke?
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- Cilia and membranes hypoactive
- Lining of airways hypertrophied - Alveoli less compliant |
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What are some surgical complications in patients with diabetes, heart disease, liver and renal disease?
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- Diabetes - impaired wound healing, glucose levels
- Heart disease - anesthetics depress cardiac function, healing requires increased cardiac output - Liver/Renal - elimination and excretion of drugs |
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What is the normal pH of blood?
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7.35-7.45
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What would a urine output of less than 30cc/hr indicate?
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Kidney complications
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Post op GI and excretory assessments?
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- Abdominal distention
- Paralytic ileus - Nausea and vomiting (very common) - Urinary retention - Urinary tract infection |
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How often should NG drainage be assessed?
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every 8hr...do not alter NG tube without order from surgeon
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How many days after surgery will ineffective wound healing be able to be observed?
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5-10 days
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When does pain level usually reach peak after surgery?
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2nd day (patient more active, alert)
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What are some interventions for impaired gas exchange?
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- Airway maintenance
- Position patient on side or turn head to prevent aspiration - Breathing exercises - Encourage mobilization asap |
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What are the reasons for a drain?
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- Provides exit route for air, blood, and bile
- Prevents deep infections and abscess formation |
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A couple treatments for potential or present wound infection?
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Antibiotics, irrigation
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Some teaching points in avoiding infection after discharge?
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- Regular dressing care
- Proper nutrition - Meds - Progressive increase in activity level - Use of proper body mechanics |
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Some diagnoses for post op?
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- Impaired physical mobility
- Impaired skin integrity - Disturbed body image |
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When setting priorities for treatment what is the standard reference?
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Maslow
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Treatments that prevent DVT?
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- Leg excercises
- TED stockings - Early ambulation - Positioning - Anticoagulants - Fluid intake |
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What is the greatest risk after surgery for an infant?
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Dehydration (hypothermia is also a large risk)
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What are some important factors to consider when gathering data preop?
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- Age
- Current meds, drugs - Medical history, CARDIAC and PULMONARY - Previous surgery and anesthesia (complications?) - Blood donations - Discharge planning |
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What are some preop lab assessments?
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- Urinalysis
- Blood type and crossmatch - H&H - PT - Electrolyte levels - Pregnancy test - Chest x-ray - EKG |
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What is the nurse's role regarding teaching preop?
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1. Clarify facts and dispel myths the client or family may have about surgery
2. Tell the patient what to expect for post op |
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The client is to be NPO for __ to __ hrs before surgery.
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6-8
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Name some herbs that affect BP.
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Garlic, Motherwort, Feverfew (important not to overlook in preop assessment)
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