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Chap 18-20 MedSurg
| Question | Answer |
|---|---|
| Diagnosis: | Determination of the presence and/or extent of pathology (e.g., lymph node biopsy, bronchoscopy) |
| Cure: | Elimination or repair of pathology (e.g., removal of a ruptured appendix, benign ovarian cyst) |
| Palliation: | Alleviation of symptoms without cure (e.g., cutting a nerve root [rhizotomy] to remove symptoms of pain, creating a colostomy to bypass an inoperable bowel obstruction) |
| Prevention: | Examples include removal of a mole before it becomes malignant or removal of the colon in a patient with familial polyposis to prevent cancer |
| Exploration: | Surgical examination to determine the nature or extent of a disease (e.g., laparotomy) |
| Cosmetic improvement: | Examples include repairing a burn scar or breast reconstruction after a mastectomy |
| Signs & Symptoms of malignant hyperthermia | Tachycardia, tachypnea, hypercarbia, and ventricular dysrthythmias |
| hemoptysis | coughing blood |
| What type of teaching:patients want to know what they will see, hear, smell, and feel during the surgery. For example, you may tell them that the OR will be cold, but they can ask for a warm blanket; | sensory information |
| What type of teaching:desire to know the general flow of what is going to happen;the patient’s transfer to the holding area, visits by the nurse and ACP before transfer to the OR, and waking up in the PACU. | process information |
| What type of teaching:desired details are more specific;IV line will be started while the patient is in the holding area, and the surgeon will mark the operative area with an indelible marker to verify site and side. | procedural information |
| What 3 conditions must be met for consent to be valid | Adequate disclosure, Understanding and comprehension, Voluntarily given consent |
| Define malignant hyperthermia | a rare,heriditary metabolic disease characterized by hyperthermia with rigidity of skeletal muscles and can result in death. |
| -ectomy | Excision or removal of ex. Appendectomy |
| -lysis | Destruction of ex. Electrolysis |
| -orrhaphy | Repair or suture of ex. Herniorrhaphy |
| -oscopy | Looking into ex. Endoscopy |
| -ostomy | Creation of opening into ex. Colostomy |
| -otomy | Cutting into or incision of ex. Tracheotomy |
| -plasty | Repair or reconstruction of ex.Mammoplasty |
| Semirestricted areas | Must wear surgical attire and cover all head and facial hair only authorized people |
| Restricted areas | Operating rooms Scrub sink areas Clean core Surgical attire, head covers, and masks required |
| members of what community may refuse blood transfusions | Jehovah’s Witness |
| What community considers the left hand unclean, so you should use the right hand to administer forms, drugs, and treatments | Muslims |
| What is the procedure of scrubbing | your fingers and hands should be scrubbed first with progression to the forearms and elbows |
| What is the Universal Protocol | Preventing wrong site, wrong procedure, and wrong surgery |
| Name the 5 most common positions in which the patient may be placed for surgry | supine, prone, lateral, lithotomy, and sitting |
| Which position allows easy access for back surgery. | prone position |
| What does PNDS stand for | Perioperative nursing data set |
| Name 4 classifications of anesthesia | general anesthesia, regional anesthesia, local anesthesia, and MAC |
| What anesthesia is used with procedures performed outside of the OR | Local or regional anesthesia with MAC |
| Who can administer local or regional anesthesia with MAC | Only registered nurses who receive education and training in MAC |
| Define adjuncts | Drugs added to an inhalation anesthetic other than an IV induction agent |
| What are some adjuncts used | opioids, benzodiazepines, neuromuscular blocking agents (muscle relaxants), and antiemetics |
| Ketamine (Ketalar) is a commonly administered dissociative anesthetic for what type of patient | in asthmatic patients undergoing surgery because it promotes bronchodilation and in trauma patients requiring surgery because it increases heart rate and helps maintain cardiac output. |
| What adjunct causes:Sedation and analgesia, Induction and maintenance intraoperatively, Pain management postoperatively, Respiratory depression | Opioids |
| What adjunct causes:Premedication for amnesia Induction of anesthesia Monitored anesthesia care | Benzodiazepines |
| What adjunct causes:Facilitate endotracheal intubation Relaxation/paralysis of skeletal muscles Interrupt transmission of nerve impulses at neuromuscular junction | Neuromuscular blocking agents |
| What adjunct causes:Classified as depolarizing or nondepolarizing muscle relaxants Duration of effects may be longer than the procedure. Reversal agents may not be effective in eliminating residual effects. | Neuromuscular blocking agents |
| What adjunct prevent nausea and vomiting associated with anesthesia | Antiemetics |
| What is the treatment for Malignant hyperthermia | prompt administration of dantrolene (Dantrium) |
| What classification of anesthesia allows patient to respond normally | Minimal Sedation |
| What classification of anesthesia allows airway and cardiovascular functions to stay maintained | Moderate sedation/analgesia (conscious sedation) |
| What classification of anesthesia causes patient not to be easily aroused | Deep sedation/analgesia |
| What classification of anesthesia requires patient assisted ventilation | Anesthesia |
| Which adjunct drug can cause drug-related respirator depression | Opioids |
| Decreased SaO2 recorded by pulse oximetry is a late sign of.... | drug-related respirator depression by opioids |
| Assessment in RR rate and depth is critical with the use of which adjunct | Opioids |
| A patient given ________adjunct should be carefully observed for airway patency & adequacy of RR muscle movement | Neuromuscular blocking agents |
| Changes in body temp greatly alter metabolism & effectiveness of _____(which ajunct) | Neuromuscular blocking agents |
| Who is at highest risk for N&V when antiemetics are use prophylactically | Female nonsmoker with a history of motion sickness |
| RPP | rapid postanesthesia care unit progression |
| Phase I Initial Assessment Priority care: | Monitoring and managing respiratory and circulatory function, pain, temperature, and surgical site |
| What can result from fluid overload, left ventricular failure, or prolonged airway obstruction, sepsis, or aspiration | Pulmonary edema |
| Pulmonary edema can be characterized by.... | crackles, decreased compliance, or infiltrates on x-ray |
| wheezing, dyspnea, use of accessory muscles, hypoxemia, tachypnea are S&S of... | Bronchospasm |
| After anesthesia how often should you change the patient’s position | every 1-2 hrs |
| Presence of hypoxemia may be reflected by... | rapid breathing, gasping, apprehension, restlessness, and rapid, thready pulse. |
| The most common cause of hypotension in the PACU is..... | unreplaced fluid and blood loss, which may lead to hypovolemic shock. |
| Urine output of at least _______ is generally considered indicative of adequate renal function. | 0.5 mL/kg/hr |
| What should be suspected in any patient complaining of tachypnea, dyspnea, and tachycardia, particularly when the patient is already receiving oxygen therapy. | Pulmonary embolism |
| Other manifestations of Pulmonary embolism may include ..... | agitation, chest pain, hypotension, hemoptysis, dysrhythmias, and heart failure. |
| Hypotension accompanied by a rapid pulse and cold, clammy, pale skin may indicate | hypovolemic shock and requires immediate treatment |
| Notify ACP if systolic BP or HR is.... | Systolic <90 mm Hg or >160 mm Hg Pulse <60 or >120 beats per minute |
| Treatment of hypotension should always begin with..... | oxygen therapy to promote oxygenation of hypoperfused organs. |
| What is the most significant general nursing measure to prevent postoperative complications | Early ambulation |
| define singultus | Hiccoughs |
| What Endocrine disorders need to be checked with ACP | DM, Hyper/hypothyroidism, Addison's |
| Name 3 Benzodiazepines | midazolam(Versed) diazepam(Valium) lorazepam(Ativan) |
| Name 7 Opioids | morphine sulfate, meperidine(Demerol) fentanyl(Sublimaze) methadone(Dolophine) sufentanil(Sufenta) alfentanil(Alfenta) remifentanil(Ultiva) |
| Name 6 antiemetics | ondansetron(Zofran) metoclopramide(Reglan) prochlorperazine(Compazine) promethazine(Phenergan) |
Created by:
mromerobr
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