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50 Cards in this Set

  • Front
  • Back
What are the advantages of pre-op teaching?
1
What areas are addressed in pre-op teaching?
1
What is the purpose of pre-op labs?
Hemoglobin - ability to oxygenate
Hematocrit - fluid overload or loss
Glucose & A1C- impaired glucose metabolism
WBC—infectious process
Platelets & coagulation profile (PT, PTT)—clotting
CO2—respiratory status
Electrolytes especially K, Na, Cl; BUN, Creatinine
What diagnostic tests are done pre-op and why?
1
Which medications are given preoperatively and why?
1
What meds may be discontinued preoperatively and why?
1
What is the primary focus of care during immediate post-op care?
1
What are the criteria for discharge from PACU?
1
What are the special precautions associated with spinal anesthesia?
1
Why is oxygen given postoperatively?
1
What is the role of the nurse during the continuing post-op period?(assessment)
General appearance
Level of consciousness
Emotional Status
Quantity of respirations
Skin color & Temp
Discomfort/pain
Nausea/vomiting
Type of IV fluid & flow rate
Dressing site
Drainage on dressing or bed linen
Urinary output (catheter or self)
Ability to move all extremities
What are the parameters for VS in the PACU post-op period
Q 5 minute Vital Signs (P, R, BP, p02) until discharged to the clinical floor
What are the parameters for VS once D/C'd to floor during post-op period?
VS (P, R, BP):
15 min for 1st hour
30 min for next 2 hours
Every hour for next 4 hours
How is pain managed in the post-operative client?
1
How is pain medication administered in the post-operative client?
1
How is pain medication timed in the post-operative client?
1
What are the drug choices for pain management in the post-operative client?
1
What are the side effects for comonly used pain meds in the post-operative client?
1
List some common post-op complications.
Shock
Pulmonary Emboli
Pneumonia
Atelectasis
Urinary Retention
Dehiscence & Evisceration
Gastric Dilation & Paralytic Ileus
What is the treatment for post-op hemorrage (blood loss)?
early recognition!!
Bedrest: supine; Elevate feet 12 inches; Extra blankets; NPO; & aggressive IV Fluids (eg.1 liter over 10 min) +
List nursing interventions for urinary retention.
Assess amount in bladder: Bladder Scanner, Order to catheterize if large volume retained, Assure adequate fluid replacement: may increase IV fluid to 2500-3000 ml / 24 hours
Monitor I & O;
List nursing interventions for DVT.
1
How do you assess for a DVT in a post-op pt?
1
List nursing interventions for pulmonary embolis in the post op pt.
TREAT:
IMMEDIATELY notify physician;
Bedrest with head elevated; O2 and pulse ox;
Monitor symptoms and vital signs;
With MD order, give prescribed: fluids,
anticoagulants, analgesics
How do you assess for a PE in a post-op pt?
ASSESS for Signs/Symptoms of:
Sudden dyspnea
Chest pain (steady; worsen with exertion; does not go away)
Cough, blood-tinged sputum
Tachypnea, shallow
Tachycardia and/or dysrhythmia
Diaphoresis and/or clammy skin
Anxiety & restlessness
Light-headed and/or disoriented
Cyanosis
List nursing interventions for atelectasis in the post-op pt.
TREAT:
Head elevated;
oxygen order; CTDB Q2 hrs;
incentive spirometer;
hydration ;ambulate
How do you assess for atelectasis in a post-op pt?
ASSESS for Sign/Symptoms of:
Difficulty breathing (dyspnea)
Rapid, shallow breathing
Cough
Anxiety & restlessness
Lung sound Assessment
Diminished breath sounds over area
List nursing interventions for pnuemonia in the post op pt.
TREAT:
Head elevated;
TCDB Q 2hrs;
Incentive Spirometer
Oxygen order;
Hydrate (Encourage increased fluid intake-to liquefy secretions; proper disposal of tissues. Ambulate (chest expansion & deep breaths)
How do you assess for pnuemonia in a post-op pt?
ASSESS for Signs/Symptoms of:
Hyperthermia (T up)
Tachypnea and tachycardia (P up & BP up)
Chills
Productive cough
Dyspnea and chest pain
Lung Sound Assessment;
Crackles "popping open" of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration
Wheezes (a continuous, coarse, whistling sound produced in the airway)
How do you assess for urinary retention in a post-op pt?
ASSESS for Signs/Symptoms of:
Bladder distention (palpate)
If voiding only small , frequent amounts, Pain in the suprapubic area
How do you assess for a paralytic ileus in a post op pt?
ASSESS for Signs/Symptoms of:
Inspect: abdominal distention
Auscultate: no bowel sounds (listen for 5 minutes in each quadrant)
Percuss: decreased tympany & increased resonance
No bowel movement or flatulence
Excessive belching; maybe nausea
How do you treat a paralytic ileus in a post op pt?
NPO: food or drink should be avoided until peristaltic sound auscultated in all 4 quadrants
Intestinal decompression (Nasogastric tube to low intermittent suction)
IV Fluids
Auscultate for bowel sound Q 4 hrs
Define paralytic ileus.
disruption of the normal propulsive ability of the GI tract; typically after abdominal surgery; the intestinal content of that portion of the bowel is unable to move forward
Define pulmonary embolis.
a dislodged blood clot (thrombi -> emboli); lodges in pulmonary artery; high risk in DVT patient
Define atelectasis.
Complete or partial collapse of lung; from mucus in the airways after surgery.
Unlike pneumothorax, which is air between the chest wall and lung, atelectasis develops when the alveoli become deflated.
Who is at increased risk for atelectasis?
Confinement to bed, with infrequent change of position;
Obesity, which can elevate the diaphragm and hamper the ability to inhale fully
What is a normal urine output amount?
30ml per hour.
What are common post-op discharge teaching needs?
1
What should accompany all aspects of discharge teaching?
1
Define Dehiscence and Evisceration.
Dehiscence: separation of wound edges
Evisceration: intestines or organs protrude
Identify lab and diagnostic tests used with infectious disorders and state their purpose and expected results.
1
What is the best preventive measure used with transmission of infectious organisms?
Handwashing
What is the key clinical manifestation of an infection?
1
How does the prodromal stage of an infection differ from the acute stage, including symptoms?
1
What clients are at higher risk to contract an infection?
1
What clinical manifestations (symptoms) are seen in the older adult with an infection?
1
What pharmacologic agents are used in the treatment of infection, including side effects and possible toxicities?
1
What is a nosocomial infection and what is the incidence by location?
1
What are characteristics of inflammatory vascular response?
1
Which diagnostic test(s) is (are) used to measure/monitor the inflammatory status of a client?
1