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68WM6 Ph 2 Test 3

Surgical Nursing and Meds

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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