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194 Cards in this Set
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This type of surgery is usually same day and the patient may not be admitted as an inpatient and go home the same day. |
Outpatient surgery |
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What are some of the Pros of outpatient surgery |
Not separated from comfort, allows them to have the security of family and friends. |
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What are some things to think about with outpatient surgery? Keep in mind? |
This is a same day surgery, sometimes patients dont expect to have this surgery and life goes on without them, they may not have family members who can come be with them during the process, maybe they are old and the spouse cant come. |
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In this type of surgery the patient is already admitted to the hospital.` |
Inpatient surgery |
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What other places are surgery's being done? |
In surgi-centers Physicians office |
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This type of surgery usually doesnt require immediate action. Examples of it are a cataract removal and hernial repairs.
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Elective surgery |
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This type of surgery usually requires surgery verily quickly and some examples of this type of surgery are, intestinal obstruction, kidney stones, and bone fractures |
Urgent Surgery |
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This type of surgery is high priority and needs to be done right away. Examples of this type of surgery are: Gunshot, stab wound, severe bleeding, abdominal aortic aneurysm, compound fracture |
EMERGENT Surgery |
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This type of surgery usually is done with local anesthesia and some examples of this surgery are: incision and drainage, implantation of a venous access device, muscle biopsy. |
Minor Risk Surgery Again these are usually not long procedures and dont require a lot of anesthesia or for the patient to be put under which places them at a less of a risk for complications. |
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This type of surgery is longer and more invasive than minor surgery. Some examples of this surgery are: Mitral valve replacement, pancreas transplant, and lymph node dissection. |
Major risk surgery: Again requires patient to be under anesthesia for longer periods of time with more exposure. |
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This type of surgery is performed to determine the origin and cause of a disorder or the cell type of cancer. |
Explorative Surgery |
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This surgery involves taking out the tumor or curing the patient of that specific issue or problem. EX: cholecystectomy and appedndectomy |
Curative/ Ablative |
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In this type of surgery the dr goes in and trieds to remove as much of the tumor as they can to help relieve symptoms of a disease. NOT A CURE! |
Palliative surgery |
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This type of surgery is done to help people feel better about themselves |
Cosmetic. |
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This type of surgery is when the Dr will cut straight through the patient. Opens them up. |
Traditional surgery |
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This type of surgery is done without cutting the patient open, they will have 3/4 stab wounds and recovery time is 2 weeks. During this surgery they are at risk for being cut open depending on what is found. |
Laproscopic Surgery Use of scopes and lazers |
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This type of surgery increases the patients ability to function. EX: Total knee replacement. |
Restorative |
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What are the main goals of preoperative nursing? |
SAFETY ADVOCACY Patient Education |
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Decision to perform surgery-------> transportation of patient to OR What period is this? |
Pre-operative period
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In OR---------> transfer to post-anesthesia care unit (PACU) What period is this |
Intra-operative period |
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Admission to PACU------------> Recovery time----> anesthesia/ stress of surgery----->then back up to floor.
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Post-operative period. |
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Major responsibilities for perioperative nursing? |
Safety Consistency of process Effectiveness |
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______ _____ _______ is critical to the outcome, education and intervention before surgery to decrease anxiety |
Readiness for surgery |
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This needs to be obtained before surgery. |
Informed consent |
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The informed consent gives the patient ____________ |
Details about surgery and whats involved. |
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The patient must be informed of these 6 things. |
1. Need for procedure, what is involved 2. Risks of having and not having procedure 3. Benefits and expected results 4. Alternative treatments(what else can we do) 5. Right to refuse or withdraw consent. 6. Risks associated w/ anesthesia |
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What is the nurses responsibility with informed consent, what do we do? |
We validate, we clarify and we reinforce the infor the pt received from the surgeon or other members of the medical team. We witness the signature and sign after witnessing. |
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We must have these 3 separate consents before surgery |
Consent for surgical procedure Consent for anethesia Consent for blood and blod products |
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Why do we do informed consents? Who does it protect? |
One way to ensure patient safety Protects the pt from unwanted procedures Protects surgeon and facility from lawsuit. |
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It patient is unable to sign the consent who signs the consent? |
Medical power or attorney or the parent if they are under 18 |
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You want to make sure the patient is ______ when receiving informed consent and that this ______ can alter this. |
That patient is coherent and that pain med can alter coherence. |
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What do we do to ensure that the correct site is located?
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By marking the site and having the patient involved or mark the site as well. |
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What is this called? Dr asks patient what we are doing today, has the patient explain and has the patient mark the surgical site. This all happens before the ER and name, DOB, and procedure are discussed as well. |
This is called time out and most facilities have adopted this procedure. |
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Why does age play a factor with surgery? |
Age: the older you are the more dangerous surgery is and the more at risk you are. |
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What are some things that happen when you age? |
Chronic Illness increases Decrease in muscle mass Decrease in water retention = dehydration |
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This affects the ability of anesthesia to work properly.
Which is why it should be included in the medical history assessment. |
Tobacco |
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This changes the way they react to narcotics and also alters the response to anesthesia and pain. |
Alcohol So again important to ask during the per op phase assessment in medical history |
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We must treat this before the patient goes to surgery. |
Infection, asking if the patient has had or has a infection is critical, dont want them to go to surgery with infection. |
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Why must we know if the patient has a latex allergy? |
To prevent complications |
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Why do we want to know about prior surgeries during the preoperative assessment? |
So that we know if there are any complications, reactions or if they tolerated the surgery well, it not so that we can know what to do. |
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Why do we want to know about the patients experience to anesthesia. |
Have they had anesthesia before? Nausea? Vomiting? Sufficient pain control? |
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Why do we want to know who the patients support team is? |
WE want to know who will be helping take care of them after surgery. Who will be there with them before surgery, providing comfort. |
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We want to know about the patients cardiac history and its relation to surgery |
The patient has a greater chance for a MI during surgery for patients who have heart problems. |
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Cardiac problems that increase risk during surgery are: (there are 6) This is why we want a cardiac history. |
Coronary artery disease Angina MI w/in 6 months prior surgery HF Hypertension Dysrhythmias |
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Patients that have cardiac issues withstand ______ changes and & alter response to _______
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hemodynamic Anethesia |
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Loss of lung elasticity reduces ________ excretion |
Anesthesia
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Who usually has respiratory issues? |
Problems occur with older patients, chronic respiratory problems, and smokers. |
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Smoking causes _______ and ______ gas exchange and causes intolerance to _______ |
Atelectasis Decreases Anesthesia |
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Asthma, chronic bronchitis, and emphysema cause Decrease in _______, decrease in _______, and decrease in __________ ___________ |
elasticity gas exchange tissue oxygenation |
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F, purulent sputum, dysuria, cloudy or foul smelling urine, any red swollen, draining IV or wound site. These are signs of what? |
Signs of infection |
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What is the protocol if they patient cannot sign their name for the informed consent. |
Can sign with a X but must be witnessed by two. |
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What is an advanced directive |
Legal instructions about pts wishes that are to be followed. |
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True or False Surgeries provide an exception to a pts advanced directive or living will. |
False, they do not provide an exception. |
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When do you prepare for discharge? |
Right away, we need to know what they may need after surgery, who is their support group? Do they have an help. |
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shortened stays require adequate _________ _________ |
discharge planning |
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What emotional considerations should you consider before surgery? |
How much fear and anxiety do they have? |
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Anesthesia can cause what kind of emotional response? |
Can cause fear if they had a bad experience in the past. |
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By _________ the pt and family members we can help decrease __________ |
teaching Anxiety |
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We want to explore the pts ___________ & __________ of their disease process and surgery to decrease ___________ |
knowledge & understanding to decrease anxiety. |
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We want to report a _______ in prothrombin time (lab) |
Increase |
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We want to report these 2 labs, what are they? |
international normalized ration INR Activated partial thromboplastin time |
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We want to make sure our patient is not _______ (lab/diagnostic test) |
Pregnant, pregnancy test |
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We want to make sure that this electrolyte level is not high or low. |
Potassium (hypo or hyperkalemia) |
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What clinical changes do we want to report to the physician before surgery? |
Change in mental status Vomiting Rash Recent administration of an anticoagulant drug. |
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Dehydration, polycythemia, chronic pulmonary disease, and CHF can cause a Increase in this lab |
Hemoglobin
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Blood loss, anemia, and renal failure show a decrease in these labs |
Hemoglobin and Hematocrit |
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Dehydration, polycthemia, and high altitude cause a increase in this lab |
Hematocrit |
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In the preop area this is done for the patient |
IV Gown EKG BP check Talk about consents, verify surgical site, what to expect, teaching checklist, other surgeries may push back time. |
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How can we prepare for post op before surgery?
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Talk to them, tell them what to expect after surgery, they will be assess again, they will be checked out and they should expect that. There might be tubes or drains in place. IV is needed for meds, VS will be done Q15mins so prepare them for that. |
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To help reduce post op pulmonary issues we should teach our patient how to use this and how to decrease pain when doing this. |
Incentive spirometry and how to splint their incision to decrease pain when coughing. |
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The pt should be NPO for ___ to ___ hrs before surgery, if patient is dehydrated this is ok to use. |
8-12 hours IV is okay to help keep the patient hydrated |
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What meds are okay to take before surgery? How much water? |
Some meds are ok for seizures, cardiac diseases, respiratory disease and hypertension, only with a sip of water. |
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DM patients are usually given this type of INSULIN before surgery |
Intermediate or long acting depending on BG level |
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Anticholinegic drugs are given preop to do what? |
Decrease fluids |
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H2 blockers and PPI's are given before surgery to |
Decrease acid to help with GI surgery |
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Why are prophylactic antibiotics given before surgery? |
To prevent infection. |
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What can we do to prevent DVT, PE, and VTE |
Ted hose pneumatic compression devices Leg exercises |
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This person of the operating team takes care of the patient before coming into the OR. |
Holding area nurse |
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This person of the operating team is responsible for documenting, providing supplies, ensure patient safety and is responsible for coordinating all activities within that particular OR. |
Circulating nurse |
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This person of the operating team helps with sterile table set up, hands instruments and helps with sterile field. |
Scrub nurse. |
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Scrub attire is clean not sterile. True or False? |
True, the scrub material is clean and the actual scrub does not make the hands and forearms sterile. |
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What is the process for scrubbing into surgery. The step |
1st scrub up to elbows, make sure your hands are held up, put on gown, keep hands inside of gown, someone ties the gown loosely and then put on gloves |
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This type of anesthesia uses gases and or IV meds to put the patient under. |
General |
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This type of anesthesia uses lidocaine, only to the area where surgery is happening. |
Regional |
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In this type of anesthesia, the patient is somewhat awake but not aware and forgets about the procedure. |
Conscious sedation |
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General anesthesia can cause ______ & _______ |
Vomiting and restlessness during emergence *Emergence means recovery from anesthesia* |
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When they do general anesthesia, why do they combine an IV and inhalation drug? |
Provides safe and controlled anesthesia which is especially good for older and high risk patients. |
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How would you treat shivering an cyanosis as a side effect of general anesthesia? |
Blankets and provide O2 |
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If the patient is vomiting after general anesthesia, what can you do as a nurse? |
make sure suction equipment is available and use to prevent aspiration. |
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What is malignant hyperthermia? |
Acute life threatening complication of certain drugs used for general anesthesia. |
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This causes a increase in Ca+ in muscle cells and a Increase muscle metabolism. Increase Ca+ and increase of K+ as well as a increase metabolic rate lead to acidosis, cardiac dysrhythmias and increase body temp. |
Malignant hyperthermia |
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Manifestations of the cardiac system with malignant hyperthermia. |
Sinus tachycardia tachycardia dysrhythmias hypotension |
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Other manifestations of malignant hyperthermia. (pulmonary, Muscle, Skin, Urine?) |
Pulmonary: cyanosis, decrease in 02 sat., tachypnea Muscle: muscle rigidity Skin: skin mottling (patchy) Urine: myogobinuria (muscle protein in urine.) |
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Spinal, epidural, nerve block and field blocks are what types of anesthesia? |
Regional anesthesia |
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Injection of the local anesthetic agent into or around one nerve or group of nerves in the involved area, commonly used for limb surgery or to relieve chronic pain. |
Nerve block |
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Injection of anesthetic agent into CSF in the subarachnoid space. Used for lower abd, pelvic, hip, or knee surgery. |
Spinal |
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Injection of an agent into epidural space used for anorectal, vaginal, perineal, hip and lower extremity surgeries |
Epidural |
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What are some complications of local or regional anesthesia? |
Complications r/t sensitivity of agent, incorrect delivery technique, system absorption and over dose, CNS stimulation followed by cardiac depression = systemic toxic reaction. |
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Some S&S of complications of Regional anesthesia include: |
Restlessness, excitement, incoherent speech, HA, blurred vision, metallic taste, N, V, tremors, seizures, increase pulse, RR, and BP. |
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What is the first thing you would do if someone is showing signs & symptoms of complications r/t regional anesthesia. 1. give epinephrin 2. call dr 3. establish an open airway 4. Give O2 |
1st, establish an open airway, give O2 then give epinephrin and notify dr. *epinephrin is given to prevent cardiac arrest* |
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Edema, inflammation, abscess formation, tissue necrosis and gangrene are signs of.... |
Complications r/t local anesthesia |
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What is conscious sedation used for? |
Endoscopy, cardiac catheterization, closed fracture, reduction, cardioversion and other special but SHORT procedures. |
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What do you want to monitor the patient for who has had moderate sedation? |
LOC, airway, capnography, O2 sats, ECG, VS q15-20mins until pt is awak and oriented and when VS return to normal baseline levels. |
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Patient is expected to be sleepy and not arousable several hours after moderate sedation. True or False |
False, patient will be sleepy but they should be arousable. |
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When performing MIS, sometimes air or gas is injected into the area, what is this called and why do they do it? |
Air and gas is injected to help separate the organs to prevent accidental injury to other organs while doing surgery. |
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The ______ or _____ can contribute to complications and pt discomfort when doing MIS. |
Gas or Air |
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What are the pros of using lasers for surgery? |
Cuts tissue more cleanly, rapidly clots blood vessels or tissue. |
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This type of wound closure is used on long lacerations and requires a special tool for removal |
Staples * These is no increase in inflammatory response vs suturs |
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This type of wound closure is used on the dermis for superficial wounds, or used to close laparoscopic wounds. |
Steri-strips * sometimes the dr will suture the underlying layer of the skin but on top of skin will use steri strips which is common with laparoscopic surgery. |
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This type of wound closure can be self dissolving, and requires manual removal. |
Sutures Body enzymes break up the dissolving sutures. |
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This type of sutures are used for large abdomen wounds, helps tighten the abdomen over time. |
Retention sutures. |
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This type of wound closure is not the easiest or prettiest but is the only way for it to heal. |
Secondary. |
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What are the main things we want to check right away when the patient is admitted to the PACU |
ABC- AIRWAY Fluids- I&O Incisions/tubes pain management LOC |
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The pt is in PACU for at least _______, DC to floor when adequate score on the ______ _______ . |
1 hour Recovery scale ex aldreti score |
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The patients ______ _____ must be stable and they should have no overt ________ and have a return of _______ & _______ ________ before returning to their floor or being discharged |
Vtial signs Bleeding Cough and Gag reflux |
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When having a patient coming into the PACU what should you have ready for them? |
Bed ready VS equipment in the room IV pole |
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This must be done when a patient is coming into the PACU |
Both the PACU RN and anesthesiologist do a hand off report. |
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If the patients O2 saturation drops below 95% what should you do? |
Call the surgeon and or anesthesiologist provider |
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If the patients O2 saturation drops by 10 percentage points and you are certain its an accurate measure what should you do? |
Call the rapid response team! |
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Rapid shallow breaths could indicate what?
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Shock, cardiac problems, increased metabolic rate or PAIN |
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How do you know if there is an excessive anesthetic effect on the patient |
Using accessory muscles, airway obstruction or paralysis which could result in hypoxia |
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Listen for _____ & ______ these occur with airway obstruction. |
Snoring and stridor |
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How does a airway obstruction happen? |
Could result from tracheal or layngeal spasm or edema, mucus in the airway, or blockage of the airway from edema or tongue relaxation. |
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Muscle weakness can impair _______ _______ |
Gas exchange |
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What are signs and symptoms of impaired gas exchange. |
Inability to maintain a head lift, weak hand grips, and abdomen breathing pattern. |
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You should check the patients lungs every _____ ____ in the first 24 hrs then every _____ ____ |
4 hours 8 hours |
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How often should you do VS in the PACU? |
Q15mins |
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You want to report a BP change that are _____ to ____ point difference, systolic or diastolic to the Anesthesiologist or to the surgeon. |
15 to 20 points off |
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What are some Signs of possible cardiac depression? |
Decrease BP, Pulse pressure and abnormal heart sounds. FVD, shock hemorrhage or the effects of drugs. |
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Bradycardia could happen because of the ______ _________ or hypothermia. |
Anesthesia effect |
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A increased pulse rate indicates what? |
Shock, hemorrhage, pain |
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Why do you want to do a peripheral vascular assessment post op? |
Anesthesia and positioning during surgery may impair peripheral circulation and contribute to VTE, and DVT. |
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What interventions could you do to prevent DVT and VTE? |
Compare distal pulses on both fee for quality of pulsation, observe the color and temp of extremities, evaluate sensation, determine speed of cap refill |
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You want to do a Focus assessment post up based on _____ of ________. |
Type of surgery |
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This is one of the best indicators to tell if your patient is in pain |
Vital signs |
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How often should you do vital signs. Why do we do vital signs? |
Q15 MINS X4 ---->Q30 MINS X2------->Q1HR X4 We do vitals so often because it is often teh first sign of complications. |
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How often do you want to do a Neuro assessment? |
Q4-8HR or as indicated by the Dr |
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General anesthesia depresses all ______ ______ ______. Whereas regional anesthesia alters the motor and sensory function of only part of the body |
Voluntary motor function. |
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Motor and sensory assessment are very important after _______ or _______ anesthesia. Evaluate motor function by asking the pt to move each extremity |
Epidural or Spinal |
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What is a way to assess the patients neuro capabilities? |
Assess push and pulls, compare sides. |
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Why do we want to know the type and amount of blood or fluid given during surgery? |
How much given affects the patients fluid and electrolyte balance after surgery. |
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Imbalances in fluid, electrolyte, and acid and base often occur in _______ patients. |
Older *also those who have health problems. DM, Debilitated, crohns, HF.* |
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Record any intake or output, including IV fluid intake, _______, urine, ______ _______ and NG drainage. |
Vomitus Wound drainage |
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You must know the total I&O from both the _____ and ____ to assess fluid balance accurately and to complete the 24hr I&O record |
OR and PACU |
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You want to consider _______ _______ loss such as sweat when reviewing total output. |
insensible loss |
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NG drainage or vomit cause a loss of ______ ____ and leads to metabolic alkalosis |
hydrochloric acid |
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Postoperative _____ and _____ are the most common reactions after surgery |
Nausea and vomiting |
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Patients with a history of ______ ______ are more likely to develop Nausea and Vomiting after surgery. |
Motion sickness |
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Obese patients may be at risk because ________ are retained and fat cells and remain in the body ________ |
Anesthetics Longer |
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Abdomen surgery and use of opiod analgesics Decrease ____ _____ |
intestinal peristalsis |
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Patients often have ______ _______ when HOB is raised after surgery. |
Increased N * Have pt be in side laying position before raising HOB SLOWLY!* |
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What is the best indicator of intestinal activity? |
Stool and Flatus |
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S&S of a paralytic illeus |
Few or absent bowel sounds, ABD discomfort, Vomiting, no passage of Flatus or Stool |
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What is the most common NG tube used after surgery? |
Salem pump, continuous suction on low. |
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After surgery do not or move, or irrigate the ____ _____ unless prescribed by the dr. |
NG Tube |
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What assessment techniques can you do to assess if the patient is retaining urine? |
inspection, palpation, percussion of Lower abdomen for bladder distention or use a bladder scanner. |
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Urine retention is NOT common after surgery. True or False |
FALSE urine retention is common early after surgery and requires intervention such as a straight catheterization to empty bladder. *common because of preoperative drugs, anesthetic agents, or manipulation during surgery. |
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you want to report a urine output __________ to the physician |
<30ml (240ml/8hr shift) |
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This is a high priority after surgery and is worst during the first 48 hours |
Pain |
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When treating pain you want to be worried about ______ _______ |
effects of narcotics *narcotics depress the respiratory system. |
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When in between medication doses what can you do for pain? |
Positioning, massage, relaxation/ diversion, TV |
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We dont want to medicate pain before it starts, we want to medicate when the patient feels the pain so that we can get a baseline. True or False? |
False Medicate before pain becomes severe or before it starts. |
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When assessing his/her pain discomfort and need for med, consider the _____, ____, and ______ of the surgical procedure. |
Type, extent length |
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What are some physical signs of pain? |
Increased HR Increased BP Increased RR Profuse sweating |
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What are some emotional signs of pain? |
Restlessness Confusion (older pt) Wincing Moaning Crying |
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What are ways to relieve vomiting and N. |
oral care afterwards Elevate HOB Anti-emetics small frequent amounts of food |
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We want our patient up and moving _______ |
ASAP |
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What are the nutrition guidelines? |
Begin with clear liquids, advance per orders. *before giving anything to the patient make sure cough and gag reflex are working!* |
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changes in these specific lab tests during the 1st 24 - 48hrs could indicate blood and fluid loss and the body's reaction to the surgical process. |
CBC H&H Electrolytes |
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Infection increases what specific lab value |
Immature neutrophils Called the Left shift |
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We want to monitor SpO2 with Pulse ox every _____ _____ or more often according to the pts condition |
9 hours |
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This after surgery increases o2 demand and induces hypoxemia. |
Hypothermia |
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How can we prevent and manage hypothermia |
Warm blankets, manage with O2 therapy. |
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If the patient cannot be in the SEMI-FOWLERS position to improved o2 what can you do? |
Turn them on their side to increase o2 |
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What are S&S of hypoxia |
restlessness, pallor, dyspnea, diaphoresis, bounding pulse |
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Interventions for hypoxia |
Raise HOB, o2, suction, pain management. |
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How can we prevent aspiration? |
Make sure to check cough and gag reflex. Slowly advance diet, start with clear liquids. Have pt sit up to swallow. |
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What can we do to prevent pneumonia? |
Turn Cough Deep Breathe Incentive spirometer. |
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What can we do to prevent atelectasis? Atelectasis- lungs dont expand at the bottom |
Turn cough deep breathe Incentive spirometer SVN Mobility |
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How often should the pt use the Incentive spirometer, cough, and deep breathe? |
q1-2hrs |
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If patient is unable to clear secretions, it requires _____ or ______ _______. |
Oral or nasal suctioning *provide oral care after* |
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Why do we encourage movement after surgery? |
Helps with removal of secretions decreases chances of VTE, or DVT |
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If the patient cannot ambulate what can you do to help them with movement? |
Assist with turning q2hrs, and ensure that breathing exercises and leg exercises are being performed |
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We want to offer pain meds _____ to _____ mins prior to movement |
30-45 mins |
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RBC Value for Males |
4.7-6.1 million |
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RBC value for F |
4.2-5.4 |
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Hemoglobin values for Male |
14-18 |
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Hemoglobin values for Female |
12-16 |
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Hematocrit Values for Male |
42-52% |
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Hematocrit Values for Femal |
37-47 |
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WBC values |
5,000-10,000 |
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Iron levels for Female |
60-160 |
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Iron levels for Males |
80-180 |
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platelet count value |
150,000-400,000 |