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68WM6 Ph 2 Test 3
Surgical Nursing and Meds
| Question | Answer |
|---|---|
| If client has not followed preop instructions what should you do? | Notify physician immediately |
| List the points that should be included in incentive spirometer patient teaching? | -Have patient sit upright head elevated 45 degrees -Instruct 2-3 normal breaths and then insert mouthpiece -Inhale and hold for 3-5 seconds -Exhale slowly and fully -10 times during each waking hour for the first 5 days after surgery(except meals) |
| A witness is attesting to patient's understanding the surgical risks? | No! The witness is witnessing the patient's signature. |
| What is an important consideration when a patient is receiving Spinal Anesthesia | Proper patient position is vital to prevent unintentional migration of the block |
| Who must monitor a the consciously sedated patient | An RN |
| Who counts the sponges, needles, and instruments? | Both the scrub nurse and the circulating nurse |
| How often are vital signs checked in the post-anesthesia care unit (PACU)? | Minimum every 15 minutes |
| What vital signs are most important to monitor in the recovery of a patient with spinal anesthesia? | Respiratory rate and blood pressure |
| What potential postoperative complications may occur in the immediate post –op phase? | Aspiration, Nausea and vomiting, Hypothermia/ hyperthermia, Hypoxia, Laryngospasm, Hemorrhage, Hypovolemic shock, Unresolved pain, Increase / Decrease IV input |
| Pain medication should be timed in relation to? | Activities, such as dressing changes or ambulation |
| Because a surgical patient's condition may change rapidly during the immediate postoperative recovery, the nurse should monitor the patient's status at least every______ minutes. | 15 |
| List 4 possible comfort measures for the patient with nausea and vomiting. | Maintain clean environment, Provide frequent oral hygiene, Encourage sips of liquids at frequent intervals, Administer medications as ordered |
| Name examples of open wound injuries? | Abrasions, Lacerations, Avulsion, Amputations, Punctures, Bite |
| What are the phases of wound healing? | Hemostasis, Inflammatory, Reconstruction, Maturation |
| In which phase is collagen formed from fibroblasts to promote healing? | Reconstruction phase |
| What are the types of wound healing? | Primary Intention, Secondary Intention, Tertiary (Delayed Primary) Intention |
| Which wound complication is a surgical emergency? | Evisceration |
| What supplies do you need to do a dry sterile dressing change? | Gloves, gauze, tape, basin, NSS or SW, 30-60 ml syringe, pad |
| What types of wounds may require a wet to dry dressing? | Abdominal evisceration, Dehiscence, Infected open wounds, Pressure ulcers, Diabetic foot ulcers |
| Give two examples of a closed drainage system? | Jackson-Pratt, Hemovac |
| How do you evaluate wound healing? | Reduced size, Depth, Increase in granulation tissue, Free of signs and symptoms, Relief of pain |
| Before starting a client on antibacterial therapy, the nurse should assess what? | Hypersensitivity |
| A client with a fungal infection is taking fluconazole (Diflucan). The nurse explains that although this drug is generally well tolerated, possible adverse effects include? | gastrointestinal upset and dizziness |
| Before administering an antiviral medication the nurse should question the client about their? | use of OTC or herbal medications |
| The hospitalized client has received an excessive dose of morphine sulfate. What drugs should the nurse ensure is available on the nursing unit for use as an antidote? | Naloxone because it is an antidote for opioids such as morphine sulfate. |
| What reversal agent is used to counter act the effects of Benzodiazapines such as Valium or Versed? | Romazicon (Flumazenil) |
| Types of general anesthetics? | Etomidate, Propofol, Fentanyl, Ketamine |
| Types of regional anesthetics | Bupivicaine, Lidocaine, Tetracaine, Procaine |
| Regional anesthetics via infiltration route? | Nerve Block Spinal anesthesia, Epidural anesthesia, Intravenous Regional anesthesia |
| Common agents used to achieve moderate sedation? | Opioids (Demerol or Morphine), Sedatives/Benzodiazapines (Valium, Versed, or Fentanyl), or Combinations of Opioids and Sedatives |
| What is the desired effect of regional anesthesia? | To produce anesthesia that results in loss of sensation to an area of the body. |
| The nursing interventions in the immediate postoperative phase? | A-Airway B-Breathing C-Circulation C-Consciousness S-System review |
| The nurse should teach the pt that the purpose of the spirometer is for? | promoting lung expansion |
| Post op pt who smoke are at increased risk for? | Infection |
| When coughing and deep breathing, the pt should be sitting because? | this facilitates the expansion of the thorax |
| Pt admitted to unit from PACU after abdom surgery. There is 1.5 cm diameter spot of serosanguineous drainage on the dressing. What should the nurse do? | Note the amount of drainage and continue to monitor. |
| Nurse is checking a pt 2 hours after he returns from surgery. What assessment finding would require immediate attention? | Pt vomits and the emesis is coffee-colored. |
| Define ablation? | amputation or excision of any body part or removal of a growth or harmful substance |
| Define atelectasis? | an abnormal condition characterized by the collapse of lung |
| Define cachexia? | ill health, malnutrition, and wasting as a result of chronic disease |
| Define conscious sedation? | the administration of drugs that depress the CNS or provide analgesia to relieve anxiety or provide amnesia during surgical diagnostic procedures |
| Define dehiscence? | the separation of a surgical incision or rupture of a wound closure |
| Define extubate? | remove endotracheal tube from airway |
| Define exudate? | substances such as perspiration, pus, serum |
| Define palliative? | therapy to relieve or reduce uncomfortable symptoms without cure |
| Define paralytic ileus? | a decrease in or absence of intentinal peristalsis |
| Define perioperative? | refers to the nurse's role during the surgical process (pre, intra, and post op) |
| Define singultus? | hiccup |
| Define catabolism? | tissue breakdown |
| Define primary intention? | healing that begins during the inflammatory phase of healing; in surgery this is usually during closure of the wound |
| Define sanguineous? | composed of or pertaining to blood |
| Define serosanguineous? | thin and red, composed of serum and blood |
| Define serous? | thin and watery, composed of the serum portion of blood |
| What is a T-tube? | a drainage tube in the bile duct to maintain a free flow of bile until edema subsides; uses gravity to drain into a closed drainage system |
| Define tertiary intention? | AKA delayed primary intention; the doc leaves a contaminated wound open and closes it later after the infection is controlled; results in deeper, larger scar |
| What is palliative care? | extends the principles of hospice care to a broader population that can also benefit from the increased comfort care earlier in their illness or disease process |
| What is curative treatment? | aggressive care in which the goal and intent is curing the disease and prolongeding life at all cost |
| What is respite care? | a period of relief from responsibilities of caring for a patient |
| Define titrate? | slowly increase the amount of drug to find the therapeutic dose |
| Define adjuvant? | additional drug or treatment that is added to assist in the action of the primary pain treatment |
| Define the hemostasis phase of wound healing? | termination of bleeding |
| Define the inflammatory phase of wound healing? | initial increase in blood elements water flow out of blood vessel and into vascular space |
| Define the reconstruction phase of wound healing? | collagen formation occurs |
| Define the maturation phase of wound healing? | 3rd week to 2 years post injury |
| How long are retention sutures left in for? | 14 days or more, much longer than normal sutures |
| When are most sutures and staples removed? | 7-10 days based on healing |
| What are the types of wound drainage? | Serous, Sanguineous, Serosanguineous, Purulent |
| How much wound drainage in 24 hours is considered abnormal? | more than 300 ml |
| Name a type of open wound drain? | Penrose drain |
| What should be documented when wound dressings are changed? | Location, Size (Length x Width x Depth), Drainage Type and Amount, Odor, Neurovascular Status, Peripheral Vascular Status - depending on site of injury |
| What nursing diagnosis is available for wound care? | -Potential for infection related to alteration in skin integrity; -Alteration in comfort related to injury; -Knowledge deficit related wound care |
| What are some potential wound complications? | Abscess, Adhesion, Cellulitis, Dehiscence, Evisceration, Extravasations, Hematoma |
| What should be suspected if the pt states "something has given way”? | Dehiscence |
| Factors that effect wound healing? | Extent of the Injury, Type of Injury, Age, Nutritional Status, Obesity, Impaired Oxygenation, Smoking, Drugs, Diabetes Mellitus, Radiation, Wound Stress |
| What is the primary reason to irrigate a pt's wound? | removing debris from the wound |
| What is the best indicator that a wound has become infected? | purulent drainage is coming from the wound area |
| The first step in packing a wound is? | assess its size, shape, and depth |
| The purpose of a wet-to-dry dressing is? | to mechanically debride a wound |
| Define debridement? | prevent infection and promote healing |
| Before surgery, when would a thorough history and physical be indicated? | when the surgery is not urgent |
| When is pre-op teaching usually done? | 1-2 days prior to surgery |
| What benefits of turning should be taught to the pre-op pt? | improves venous return, respiratory function, and gastrointestinal peristalsis |
| How often should deep breathing exercises be performed post-op? | 5-10 times per hour |
| How often should the incentive spirometry device be used post-op? | 10 times per hour for the first 5 days after surgery; excluding meal times |
| What is the purpose of the incentive spirometer? | used to encourage deep breathing & prevent atelectasis |
| What are leg exercises used to prevent? | circulatory problems and "gas pains" |
| What are the three stages of general anesthesia? | Induction phase, Maintenance phase, Emergence phase |
| What are some anesthesia reversal agents? | Naloxone, Romazicon/Flumazenil, Anticholinesterases (neostigmine, edrophonium, pyridostigmine) |
| Where is spinal anesthesia administered? | delivered to the subarachnoid space |
| What is the most significant complication of spinal anesthesia? | headache |
| Where is the epidural administered? | delivered to the epidural space located between the Dura and overlying connective tissue |
| Types of peripheral anesthesia? | Nerve block, Infiltration, Topical |
| Type of procedure that does not require complete anesthesia? | bronchoscopy, pulmonary biopsy |
| What important change should be documented on the immediately post-op pt? | when oxygen supplimentation is discontinued and O2 saturation at that time |
| Spinal anesthesia risks? | Migration, Vasodilation/ decrease in BP, Respiratory paralysis |
| Nursing Management During the Later Postoperative Period? | Prevent postoperative respiratory problems, Circulation (Prevent venous stasis), Incision Care, Pain Management |
| When does the recovery period begin? | when the patient arrives in the hospital room or a post-surgical unit, extends until after discharge from the hospital, and ends when full activity is resumed |
| What are some signs and symptems of pulmonary embolism? | Sharp, stabbing chest pain; Cyanosis; Anxiety; Profuse diaphoresis; Rapid, irregular pulse; and Dyspnea, tachypnea |
| What are the 5 categories of NSAIDs? | Salicylates(Aspirin, Aspirin products); Acetic Acid derivatives(Clinioril, Toradol); COX 2 inhibitors(Celebrex); Enolic Acid derivatives(Mobic, Feldene); Propionic Acid derivatives(Ibuprofen, Naproxen) |
| What common medication is NOT considered an NSAID? | Acetaminophen-Tylenol |
| How are non-opioid analgesics excreted? | through the liver and kidney |
| What mechanism do non-opioid analgesics use to work in the body? | blocks peripheral pain impulses by inhibiting the enzyme that is necessary for prostaglandin synthesis |
| List some classifications of opioid analgesics? | Meperidine; Methadone; Morphine |
| Types of pre-op meds? | Phenobarbital (Barbituate); Diazepam or Valium (Benzodiazepine); Chloral Hydrate; Hydroxyzine |
| What is the desired effect of general anesthesia? | to produce anesthesia to where the patient does not recall the surgical procedure |
Created by:
princess3734
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