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148 Cards in this Set
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Perioperative nursing
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includes nuring care given before, during and after sx
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postoperative care
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care after sx
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preoperative care
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care before sx
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intraoperative care
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care during sx
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outpatient
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minor sx, enter hosp, have sx and leave same day
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What are surgical procedures classified under?
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seriousness, urgency and purpose of sx
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What are the 6 main risk factors used to anticipate care?
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age 60+, impaired preop cog. funct, smoker, BMI > 27, hx or cancer, midline abd incision site
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what do normal tissue repair and resistance to infection depend on?
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adequate nutrition
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how many kilocalories a day does a pt need to maintain energy reserves?
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1500
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Major surgery
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involves extensive reconstruction or alteration in body parts, poses great risks to well-being
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minor sx
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involves minimal alteration in body parts, often designed to correct deformities, invloves min risks
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urgency elective
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performed on basis of cts choice, may not be necessary for health
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urgent
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necessary for cts health, may prevent additional problems from developing, not nec. emergency
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Emergency
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must be done immediately to save life or preserve function of body parts
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Purpose diagnostic
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surgical exploration that allows physician to confirm dx, may involve removal of tissue for further testing
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Ablative
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excision or removal of diseased body part
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palliative
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relieves or reduces intensity of disease symptoms, will not produce cure
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reconstructive/restorative
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restores function or appearance to traumatized of malfunctioning tissues
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procurement for transplant
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removal of organs and/or tissues from a person pronoun. brain dead for transpl. into another person
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constructive
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restores function lost or reduced as a result of congenital anormalies
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cosmetic
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performed to improve personal appearance
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How long should sx be delayed after radiology treatments?
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4-6wks
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How does the body respond to sx?
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as a form of trauma
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why does a pregnant person make sx more complex?
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uterus displaces abd organs and distorts landmarks
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When do anesthetic and medication cause fetal abnormalities?
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first trimester
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What is the major responsibility or a perioperative nurse?
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safe, consistent, effective nursing care during all phases of treatment
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when does preoperative teaching start so its most effective?
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when you first assess cts and families readiness and ability to learn
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what is one of our principal roles as a perioperative nurse.
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ct. advocate
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how can a latex allergy manifest?
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contact dermitis, contact uticaria, hay fever
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What is a smoker more at risk for after sx than a non-smoker is?
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pulmonary complications
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Does past hx of sx and how they went affect a ct?
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yes
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How do bleeding disorder increas the risks of sx?
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increase risk of hemorrhage
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How does DM increase the risks of sx?
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ups susceptibility to infection, impair wound healing, cause CNS malfunction,
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How does heart disease increase the risks of sx?
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stress causes uped demands on heart to maintain cardiac output,
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What does general anesthesia do to the heart?
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depresses cardiac function
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how does a URI increase the risks of sx?
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increases risk of resp. complication during anesthesia
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How does liver disease increase risk of sx?
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alters metabolism and elimination or drugs, impairs wound healing and clotting time
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How does fever increase risk of sx?
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predisposes ct to fluid and electrolyte imbalances and may indicate an infection
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How does chronic resp disease increase risk of sx?
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reduces cts means to compensate for acid-base alterations, anesthesia reduces resp functi
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How do immunological disorders increase risk of sx?
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increase risk of infection and delay wound healing
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How does abuse of street drugs increase risk of sx?
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may have underlying disease
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How does chronic pain increase risk of sx?
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have higher tolerance may need higher doses to control pain
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What do antibiotics do?
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potentiate action of anesthetic agents, can cause mild resp depression
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What do antidysrhythmics react with sx ct?
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reduce cardiac contractility and impari cardiac conduction during anesthesia
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How do anticoagulants affect pts who are having sx?
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alter normal clotting factors and increase risk oh hemmorrage.
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When should anticoagulants be d/cd prior to sx?
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at least 48 hours
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What type of drug is aspirin?
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anticoagulants
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anticonvulsants and sx?
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long-term use of certain anticonvulsants can alter metabolism or anesthetic agents
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antihypertensives and sx?
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cause bradycardia, hypotension ad impaired circulation
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corticosteroids and sx?
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cause adrenal atrophy which reduces bodies ability to handle stress
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insulin and sx?
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diabetics need is down during sx
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diuretics and sx
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potentiate electrolyte imbalances
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Nonsteroidal antiinflammatory drugs
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inhibit platelet aggregation and my prolong bleeding time,
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symptoms of a fearful ct?
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asks alot of questions, be very quiet, seem uneasy when strangers enter room, actively seek company
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Why may asian cts remain quiet?
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out of respect
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What reaveals level of hydration?
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condition of oral mucous membranes
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What do you always do if ct has heart disease?
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assess apical pulse
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How long may bowel sounds be diminished if general anesthesia is used?
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up to several days
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Can a cts LOC change the result of general anesthesia?
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yes
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What does spinal or epidural anesthesia cause?
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temporary paralysis of lower extremities
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When does the plan of care begin?
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preoperative phase
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When is a plan of care modified?
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intraoperative and postoperative phases
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What does a low HgB indicate?
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anemia
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What does a hight HgB indicate?
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polycythemia
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Normal HgB for female?
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12-16
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Normal HgB for male
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14-18
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Normal Hct for female?
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37-47%
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Normal hct for male?
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42-52%
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Low hct indicate?
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fluid overload
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high hct indicate?
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dehydration
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Normal whaite blood cell ct?
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5000-10000
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normal platelet count
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150000-400000
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If the ct has signed all the forms to allow sx, can he/she still decline?
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yes
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What does ct education do?
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relieves anxiety, increases self-esteem, speeds up recovery, reduces med costs, decreases amt of perceived pain
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teaching and ventilary function?
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improves ability and willingness to ambulate and resume ADLS
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teaching and physical functional capacity?
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increases understanding and willingness to ambulate and resume ADLS
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When is preoperative teaching started to be most useful?
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the week before admission and reinforced immed b4 sx
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What is the most effective form of teaching for surgical cts?
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planned to cover entire sx experience
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What happpens during the use of general anesthetic?
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muscles relax and gastic contents can reflux into the esophagus
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Does anesthesia affect the gag reflex?
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eliminates it
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What is one of the cts greatest fears about sx?
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pain
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PCA
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patient controlled anesthesia
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What does diaphragmatic breathing do?
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improves lung expansion and o2 delivery w/o using excess energy
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What does deep breathing do in regards to anesthesia?
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clear any gases from the airways
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What can help to facilitate deep breathing?
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incentive spirometer
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What do leg exercises and turning do?
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improve blood flow to the extremities and thus reduce venous stasis
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is rest essential for normal healing?
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yes
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What is the favorite site of microorganism to grow and multiply?
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skin
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what does an empty bowel reduce?
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risk of injury to the intestinges and minimizeds contamination of the operative wound
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What type of undergarments can a ct wear when having sx?
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none
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Should a pt wear makeup during sx? why or why not?
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no, cant assess mucous membranes to determine the cts level of oxygenation, circulation fluid balance
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Jewelry in sx?
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no, wedding rings can be taped
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two roles of nurses in OR?
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circulating nurse, scrub nurse
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role of circulating nurse
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cares for ct while in OR, comp. other preoperative assess, est. and implement the intraoperative plan of care provides contin of care after sx
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which nurse helps the anesthesiologist?
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circulating
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Which nurse operates nonsterile equip
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circulating nurse
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Which nurse maintains written records?
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circulating nurse
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What type of nurse is a circulating nurse?
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must be an RN
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PSCU
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presurgical care unit
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what does the scrub nurse do?
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resp for maintaining sterile field, adhere to strict sx sepsis, applies drapes, and hands surgeon instraments
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What kind of nurse does a scrub nurse have to be?
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may be an RN, LPN, or surgical technician
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What minimizes risk of or irritation and small cuts when shaving?
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clippers
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Who transfers ct to operating room?
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circulating nurse
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General anesthesia
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all sensation and consciousness are lost, muscles relax, reflexes lost, amnesia experienced
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When is GA used?
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major procedures, some minor procedures for children
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Regional anesthesia
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loss of sensation in an area of body
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How is Regional anesthesia given?
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infiltration and local app
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Examples of regional anesthesia?
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nerve, spinal, epidural and caudal blocks
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Local anesthesia
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loss of sensation at desired site by inhib peripheral nerve conduction
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When is local anesthesia usually used?
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during minor procedures or ambulatory sx
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Conscious sedation
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brings ct into decreased consciousness
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What are some advantages to conscious sedation?
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adequate sedating, deminished anxiety, pain relief, mood alteration rapid recovery
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two phases of postoperative course
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recovery period and convalescence
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Where does convalescence occur for ambulatory sx pt?
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at home
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How long is recovery for ambulatory pt?
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1-2 hours
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Where are pts transferred immediately after sx?
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PACU
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How often do you do assessments in PACU?
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every 15 min
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Phase 2 environment in ambulatory pts?
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promotes the cts and families comfort and well-being until discharge
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If pt is not ambulatory pt where do they go after recovery phase?
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postoperative nursing unit
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what do you do during convalescence?
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consider goals of care est. earlier
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In convalescence what is the direction of your nursing care?
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towards pts smooth transition home
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How often are assessments taken when pt is in postop nsg unit?
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15-30 min first, than hourly , and then per physicians order
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Normal Pulse ox?
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92-100
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How long does risk for hemorrage last after sx?
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several days
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In a postoperative nsg unit is a sudden change of consciousness normal?
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no
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what may a rash indicate?
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drug sensitivity or allergy
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what do abrasions or petechiae show?
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inadequate padding during positioning or restraining
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What is the critical time for wound healing?
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24-72 hours
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What can exert physical stress on a wound?
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coughing, vomiting, movement
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What is evisceration?
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wound seperates below fascia
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Is evisceration a medical emergency?
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yes
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What do you put over an eviscerated site?
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gauze soaked with sterile normal saline
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When does a wound normally become infected?
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3-6 days after sx
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How long can spinal anesthesia prevent ct from feeling bladder fullness?
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12-24 hrs
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How long can you expect to have bloody urine from a pt who has had urinary sx?
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12-24 hrs
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When can pain be perceived?
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before full consciousness is regained
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When should normal bowel sounds return after sx?
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about 24 hours
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goal during recovery?
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returning ct to normal physiological funct
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When do goals become more long term?
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when ct is in surgical nursing unit
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What are the priorities when pt is in PACU?
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center on physiological needs
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When should you begin deep breathing exercised?
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as soon as ct can
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What do you observe for with external hemorrage?
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increased bloody drainage on dsgs and through drains
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What do you observe fro with internal hemorrage?
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swollen and tight operative site, hematoma
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What is the cts only source of fluid intake after sx?
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IV
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What is important to maintaining alertness?
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orientation to environment
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Do you chg the surgical dsg first w/o an order?
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no
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When do cts have the most surgical pain?
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24-48 hours
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What can make cts depressed during recovery?
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slow recovery
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