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MED SURG TEST 1
| Question | Answer |
|---|---|
| preoperative(Pre-op) | begins with patient decides to have surgery; consents; needs clearance before surgery--> includes labs, MR, etc. |
| intraoperative | OR--> PACU |
| postoperative(post-op) | PACU; goes up to unit or goes to recovery room and then home; this phase lasts until pt is healed; depends on type of surgery(inpt or outpt) |
| reasons for surgery | diagnostic; curative; restorative; palliative; cosmetic |
| diagnostic reason for surgery | biopsy, laparotomy |
| curative reason for surgery | appendectomy |
| restorative reason for surgery | total knee repair |
| palliative reason for surgery | relieve symptoms |
| cosmetic reason for surgery | rhinoplasty; usually done on outpt basis |
| causes of surgery-related stress | fears- death; scared; pain; problem going under; being able to do anything on own; being disabled; how getting around; embarassment |
| surgical risk factors | infection; rxn to anesthesia; death; wrong site surgery; do everything we can to reduce these |
| patient assessment before surgery/history and physical | establish baseline |
| general early preop car: therapeutic communication | client and fam teaching; pre-op, post-op(tubes, tubes, tubes); pre-op prep; make sure they understand the enviro of coming out of surgery |
| health teaching before surgery | deep breathing and coughing; incentive spirometer; lower extremity exercises; positioning; pain meds; PCA pump/pain rating scales |
| lower extremity exercises surgery | movement to prevent venous stasis/blood clots |
| positioning surgery | understanding the position during surgery to understand soreness may occur after surgery |
| pain meds and surgery | available afterwards; important to understand may not be given on regu basis; pain assessments will be done/evaluated; given PRN; pts need to be their own advocate |
| PCA(patient controlled analgesia) pump | IV fluids; provide another level of control over pain; understand that it is individualized; family needs to know they should not be taking control only pt; not used with elderly, causes a lot of elderly pts to be confused |
| pre-op chart review | ensure all documentation, preop procedures and orders are complete; pre-surg check list; check consent forms & others for complete; doc allergies, height and weight; ensure all labs/tests are on chart; doc/report abnormal results, special needs & concerns |
| pre surgical check list | allergies; iso precaut; side/site ID; labs/tests; vitals; NPO since; wt/ht; last period; pts belongings secured/removed; blood type and cross match; antimicrobial prophylaxis guideline checked & faxed to pharm; IV am prior; site prep; equipment to OR w pt |
| pre op pt prep surgical checklist | NPO after midnight(MN); verify consent; ID, allergy, blood bands; ht/wt/allergies |
| pre op informed consent surgeons role | responsible for obtaining signed consent before sedation and/or surgery; if nurse feels pt is not adequately informed--> contact and request to see the pt for further clarification |
| pre op informed consent nurses role | clarify facts presented by physician and address questions and concerns that the pt or family may have about surgery; not responsible for providing details about surgical procedure; can serve as witness to signature but not that the pt is informed; |
| informed consent implies that | person has sufficient info to understand nature and reason for surgery; who will perform surgery and who will be present; options and risks assoc with each option; risks with procedure; potential outcomes and risk assoc with anesthesia |
| holding area prior to surgery | never leave pt alone; greets pt; preop checklist; verify consent forms; ask pt what surg procedure is being done; assess emo status, gives support, answers ?; start IV/epidural; ID pt(2); fam ok here; if specific site, pt and nurse initial site |
| preop pt prep | skin, prep, IVs, fluids; remove contacts, dentures, hearing aids, makeup, nail polish, jewlery(wedding band) |
| incentive spirometer purpose | encourages pt to take deep breaths; promote complete lung expansion and to prevent pulm problems i.e. atelectasis; pneumo; uses visual feedback to encourage pt |
| incentive spirometer steps | Seal lips tightly around mouthpiece; Inhale spontaneously; Hold breath for 3- 5 sec for effective lung expansion; AARC recs 5 to 10 breaths per session every hr while awake; Pain meds before helps pt achieve deep breathing by reducing pain, splinting |
| incentive spirometer goals | can be set according to pts ability and type; Post-op capacity ½ to ¾ of pre op volume is acceptable due to post op pain |
| sequential compressions devices(SCDs) | to promote venous return and prevent DVTs |
| preop labs | CBC, PT, PTT, U/A,BMP; CXR, void; pre-op meds/VS; document |
| preop pt prep drugs(if ordered) | antibiotics(on call); sedatives, histamine H2-receptor; antagonists; analgesics |
| the older surgical pt sensory impairments | hypotension; hypothermia; hypoxemia r/t anasthesia; less adipose tissue; very cold in OR plus meds; pts on HTN meds--> could bottom out post op |
| the older surgical pt positioning complications r/t | arthritis; decubiti/pressure ulcers; decreased subcu fat and reduced circ; twice as long to position, takes a team |
| drugs for care of the surgical pt | neuromuscular blocking agents; anticholinergics; GI stimulants; sedatives/hypnotics; antianxiety agents; lots of drugs; cocktail during preop to prevent post op complications |
| nursing dx and interventions pre op | deficient knowledge of surgery; fear; disturbed sleep pattern; ineffective coping; anticipatory grieving |
| sociocultural affiliation effect on surgical experience of client | support; social network |
| team members not scrubbed | circ nurse; anesthesiologist--> wear cover scrub jackets with long sleeves and protective eyewear; shoe covers |
| scrubbing up for surgery | 3-5 min with broad spec ab; hands held higher than elbows; thoroughly drying; hands above wasit alcohol based; circ rn helps surgeon gown up; checks for tears; team wears sterile fluid resist gown, sterile gloves, eye protect or face shields |
| wrong patient errors JC | 17% |
| wrong procedure JC | 8% |
| wrong side JC | 56% |
| other wrong site JC | 19% |
| time out before surgery begings | surgical team pauses to communicate about the specific pt and procedure; correct pt, med record, side/site, pt position, agreed procedure, right implants, correct equip, atbs; know advance directive |
| circulating nurse | coordinates and oversees pt care in OR; sets up OR; flow; assists surg; sterile tech; docs events and findings; sponge count; communicates with fam |
| scrub nurse | sets up sterile fields; drapes pt; hands supplies/equip and instruments to surgeon; sponge, sharps, instrument count; amount of irrig fluid and drugs used b4 and after surgery |
| specialty nurses in surgery | assess, maintain and recommend DME supplies used in that specialty |
| major safety concerns of the operative experience | positioning; equipment; maintain asepsis; assisting in wound closure |
| geriatic positioning considerations | dry skin, loss of tugor and elasticity; disposed to hematomas, handle carefully; poor nutritional status; osteoporosis; arthritic changes; limited ROM; venostasis; resp problems(thicker, less elastic alveoli; COPD, asthma) |
| obese positioning considerations | HTN, CV disease, diabetes, decreased periph circ; strain on joints and ligaments; trendelenberg-increased venous return; risk of aspiration |
| malnourished positioning considerations | more susceptible to infection; thin, poor skin tugor; susceptible to venostasis and thrombus formation; prone and trendelenburg not tolerated well |
| supine position | foam headrest, foam donut, pillow; most common position; arms at sides, palms turned towards patient or on armboards: palms turned down; never beyond ROM or >90 degrees |
| trendelenburg position | modification of supine; exposure of lower ab/pelvic cavity; arms on armboards or at sides; when pt is hypotensive--> want head down |
| trendelenburg contraindicated | increased intracranial pressure; increased intraocular pressure(glaucoma); increased thoracic pressure |
| reverse trendelenburg position | padded footboard; head up, feet down; arms on armboards or at sides; consider venous pooling |
| lithotomy position | many potential problems; legs suspended, pt on back; consider back pain, joint replacements, ROM; arms with armboards <90 degrees; or tucked at sides--> WATCH fingers; prevent neuro damage; raise and lower legs simultaneously; can cause HTN |
| neurological damage with lithotomy position | most common- femoral nerve from acute flexion; fem or obturator from personnel or instruments; saphenous, tibial, common perineal from the stirrups |
| fracture table position | unaffected leg is raised; abducted and supported in a padded leg rest |
| general anesthesia | loss of all sensation; reversible loss of consciousness induced by inhibiting neuronal impulses in several areas of the CNS; involves a single agent or a combo of agents; combo of inhalation and IV injection is best for older adults and high risk pts |
| regional anesthesia | temporary interruption of nerve impulses to and from a specific body area |
| concious sedation | client still has ability to retain pt airway and respond to commands |
| older pts and anesthesia | general not always the best because of the effects it may have on the rest of the body; higher risk for resp problems; wake up slower; higher risk for atelctasis or pneumo; diminished or absent bowel sounds; cant feed until these are heard |
| anesthesia chosen based on pt's | fears; health issues; previous response to anesthesia; type of surgery |
| purpose of anesthesia | block nerve trans; promote muscle relaxation and suppress reflexes |
| complications from general anesthesia | overdose; unrecognized hypoventilation; complications of specific anesthetic agents; complications of intubation |
| overdose of anesthetic | if pts metabolism and drum elim slower than expected(liver or kidney); toxicity; important to obtain accurate history about the pts ht, wt, liver and kidney function to determine the anesthetic type and dose |
| unrecognized hypoventilation | failure to exchange gases adequately may lead to cardiac arrest, perm brain damage and death |
| complications of intubation | broken/injured teeth caps; swollen lip, vocal cord trauma; surgeon needs to be in OR during intub in case a trach is needed |
| malignant hyperthermia clinical manisfestations | tachycardia; dysrhythmias; muscle rigidity; hypotension; tachypnea; skin mottling; cyanosis; elevated temp >111.2; potentially fatal |
| malignant hyperthermia genetics | autosomal dominant; more common in young males; if known pts history pt can have a muscle biopsy to determine whether they are at risk; survival dependent on early diagnosis and actions of the surgical team |
| treatment of malignant hyperthermia | possible with dantrolene, a skeletal muscle relaxant |
| spinal anesthesia | non invansive; non generalized; wont have as many resp and GI issues as you have with generalized |
| neuro side effects/complications of gen anesthetic agents | excessive sedation- delayed awakening |
| respiratory side effects/complications of gen anesthetic agents | laryngospasm, hypoxia, hypercarbia |
| cardio side effects/complications of gen anesthetic agents | hypotension; tachycardia; arrhythmias; fluid/electrolytes imbalances |
| other side effects/complications of gen anesthetic agents | restlessness; N/V |
| CNS side effects/complications of REGIONAL anesthetic agents | stimulation- hyperactivity, excitement, seizures, followed by CNS depression |
| cardio side effects/complications of REGIONAL anesthetic agents | hypotension; arrhythmias |
| spinal side effects/complications of REGIONAL anesthetic agents | headache, urinary retention |
| nursing diagnosis intraoperative phase | risk for aspiration; ineffective protection; impaired skin integrity;risk for perioperative positioning injury; risk for imabalanced body temp; ineffective tissue perfusion; risk for deficient fluid volume |
| nursing responsibilities of care of the intraoperative client | nurse anesthetist observes for adverse effects intraoperatively; circ nurse runs the room; scrub nurse works with the dr |
| PACU(postanesthesia care unit) | allows for ongoing evaluation and stabilization of pts to anticipate, prevent, and treat complications after surgery; circ nurse and anesthesia provider give PACU nurse a verbal hand off report |
| upon admission to PACU pt should be immediately placed in | side lying position with head to side |
| admitted to PACU | assess airway and gas exchanged; cont monitor spO2 >95%; RR <10= shock, acidosism pain; all wrpas/bandages assessed for bleeding, drainage and then hourly thereafter; |
| all post op pts at risk for | pnemo, shock, cardiac/ resp arrest; dvt; hemmorrhage |
| PACU nursing assessment- respiratory | pt airway; rate, pattern and depth of breathing; accessory muscle use; snoring and stridor |
| PACU nursing assessment- cardio | vital signs; heart sounds; cardiac monitoring |
| PACU nursing assessment- neuro | cerebral functioning; motor and sensory |
| PACU nursing assessment- others | I &O; hydration status; IV fluids; acid-based balance; renal urinary retention, other output sources; N/V and <peristalsis |
| NG tube inserted during surgery to | decompress and drain the stomach; promote GI rest; allow the lower GI tract to heal; provide an enteral feeding route; monitor any gastric bleeding; prevent intestinal obstruction; assess drained material every 8 hr; do not move or irrigate tube w/o order |
| PACU nursing functions | respiratory; LOC, TPR, O2 sat; BP, output; examine surgical area for bleeding; discharge from PACU--> vital signs every 15 min x4; then every 30 min, 2 hrs and then 4 hrs x 24-48 hrs |
| post op risks | airway obstruction; shock; cardiac arrest; resp arrest; DVT; GI bleeding; pain |
| pre-op diet | NPO |
| post op diet | nutrition withheld until bowel sounds and no N/V; diet progresses slowly- ice chips, H2O, clear, full liquids, regular; by drs orders only |
| nutritional modifications to promote optimal wellness in surgical pts | protein and calories for healing; low-fat, high fiber diets contraindicated; failure to use GI tract for > 4 or 5 days can result in atrophy of intestinal mucosa leading to risk for infection |
| nursing diagnosis for post-op pt | acute pain; risk for infection; risk for imbalanced fluid volume; nausea; ineffective protection; delayed surgical recovery |
| impaired gas exchange interventions | airway maintenance; positioning the pt in a side lying position or turning head to side to prevent aspiration; encourage breathing exercises; encourage mobilizations as soon as possible |
| impaired skin integrity interventions | nursing assessment of the surgical area; dressings-first change usually done by surgeon; drains- provide exit route for air, blood, and bile as well as help prevent deep infections and abscess formation during healing |
| ineffective wound healing can be seen | between 5th and 10th days after surgery; dehiscence or evisceration |
| dehiscence | a partial or complete separation of the outer wound layers |
| evisceration | a total separation of all wound layers and protrusion of internal organs through the open wound |
| factors that influence perception of pain | age, gender, sociocultural, genetics |
| nociceptive pain | somatic pain; visceral pain; normal processing of pain; sharp, burning; somatic- dull, aching; visceral- diffuse, cramping, stabbing |
| neuropathic pain | abnormal pain processing; results from nerve injury; burning shooting stabbing pins and needles ; shocklike, burning, fiery, numbness |
| pharm and comp/alt therapies for acute pain | non-opoid analgesics; NSAIDS, opoid analgesics; adjuvant analgesics; positioning; massage; relax and diversion techniques |
| chronic pain | onset is gradual; longer than 3 months duration; persistent, mild to severe in intestiny; accompanied by depression, fatigue, decrease in function |
| prevention, treatment of opoid side effects | constipation, N/V, sedation/confusion; respiratory depression |
| QSEN competencies | patient-centered care; teamwork and collaboration; evidence-based practice; quality improvement; safety; informatics |
| what percentage of adults in the USA are over age 65? | 13%; fastest growing population is >85 |
| gerontology | broad term use to define the study of aging |
| generalist RN Prep in geriatics | 2.2 million practicing RNs; <1% are certified in gerontological nursing; 34% of BSN programs have a required course in geriatics |
| psychosocial changes of aging | retirement; social isolation; sexuality; housing and environment; death; longer you live the more losses you have to cope with; high percentage of older adults are depressed; a lot of older adults are negative (cant change what is);often overlooked |
| young old | 65 to 74 |
| middle old | 75 to 84 |
| old old | 85 to 99 |
| elite old | ages 100 or older; fast growing segment |
| fraility | a clinical syndrome; unitentional weight loss; weakness; exhaustion; slowed physical activity including walking; risk for adverse outcomes |
| physiological changes of older adult | perception of well-being defines quality of life; older pts concept of health revolves around how they perceive their ability to function; nurses need to be cognizant of normal age-related changes; not all physio changes are patho |
| ageism | discrimination based on age; age discrimination employee act of ADEA 1967; stereotyping and prejudice against older persons |
| stereotyping of older dults | disabled; sick, senile, senseless, sexless, physically unattractive, rigid, unfriendly, confused and forgetful; refrain from "elderspeak" |
| age-related physio changes | atrophic gastritis; decreased ADH response; decreased hepatic metabolism; decreased muscle mass; decreased body water; decreased cerebral blood flow |
| atrophic gastritis--> | B12 deficiency--> dementia |
| decreased ADH response--> | increased dehydration risk |
| decreased hepatic metabolism--> | drug toxicity/polypharmacy |
| decreased muscle mass--> | digitalis toxicity/polyparm |
| decreased body water--> | increased dehydration risk |
| decreased cerebral blood flow--> | syncope--> falls |
| health concerns of the older adult | SPICES; nutrition; mobility; safety; stress and loss; polypharm; mental/behavioral health; neglect and abuse |
| SPICES | Sleep disorders; Problems with eating, feeding; Incontinence; Confusion; Evidence of falls; Skin breakdown |
| caring for older adults is COMPLEX | the array and number of chronic illnesses facing older adults is only expected to increase with longevity |
| caring for older adults is CHALLENGING | given the demand for skilled health care providers in geriatrics which far exceeds the capcity of current geriatric nurses and other health professionals |
| causes of older adult malnutrition | diminished sense of taste and smell; tooth loss and poorly fitting dentures; economics; inappropriate or imbalanced nutrition; logistics, access; loneliness |
| malnutrition: symptoms | lethargy; generalized weakness; an unintentional weight loss of more than 5% of body weight in 1 month |
| nursing nutritional assessment of older adults: SCALES | Saddness or mood changes; Cholesterol, high; Albumin, low; Loss of gain of weight; Eating problems; Shopping and food prep problems |
| dysphagia-behaviors | difficulty or discomfort swallowing; sensation is something is stuck in the throat; coughing with intake of food, fluids; excessive throat clearing; gurgling voice, drooling, food or fluid coming out of nose when swallowing; pocketing of food in the mouth |
| nutrition imbalance over 65 years | initially subject to weight gain and obesity-intake remains the same, but expenditure decreases |
| nutrition imbalance older old | are subject to weight loss and malnutrition, decreased intake |
| "at risk" older adults | adults with advanced age and/or complex illness should be considered at increased risk to develop adverse response and complications related to medications, treatments, geriatric syndromes |
| at risk older adults assessed for | functional, cognitive status; pain; geriatric syndromes including presence of urinary incontinence, pressure ulcers, delirium, fall risk |
| older adults and the acute care setting poses riskf or adverse events | delirium, dehydration, malnutrition, health-care associate infections, urinary incontinence, falls |
| older adults and restorative care: types of ongoing care | continues recovery from acute illness; addresses chronic conditions that affect daily functioning |
| older adults and restorative care: goal | to regain or improve prior level of independence, ADLs, instrumental ADLs; discharge planning starts the minute they are admited |
| consequences of malnutrition | infection; pressure ulcers; anemia; impaired cognition; hip fractures; most are reversible; poor healing skin conditions |
| nursing diagnoses for older adult nutrition | swallowing, impaired; self-care deficit, feeding; deficient fluid volume; nutrition imabalnce less or more; failure to thrive, adult; dentition |
| goals for older adult nutrition | pt will demonstrate improved ability to swallow within the next 48 hrs AEB ability to clear throat after intake; pt will be able to swllow without chocking within the next 3 meals offered; |
| nursing interventions for older adult nutrition | determine food pref; remove unpleasant stimuli; maintain good oral hygiene, correct temp of foods; arrange meal when fam visits; pain relieved; small frequent meals; consider meds; community dining |
| benefits of regular exercise | decreased risk for falls; increased mobility; increased quality of sleep; reduced/maintained weight; improved well-being and self-esteem; fewer depression symptoms; improved longevity; reduced risk for diabetes and cardiovascular disease |
| safety risks for older adults in hospital | risk for falls and injury; skin breakdown; dehydration; delirium; HAIs; becoming incontinent; polypharm |
| factors that increase accident likelihood | presbyopia; reduced sense of touch; decreased reaction time; periphral neuropathy; arthritis |
| fall prevention and safety | home modification; exercise; greater predictor of falls/history of falls; tai chi |
| frequent sources of stress older adults | rapid enviro changes; changes in lifestyle; acute or chronic illness; loss of significant others; financial hardships; relocation stress syndrome |
| drug use and misuse | polypharm; may not be able to tolerate standard dosage of drugs; physio changes from aging can affect absorption, distribution, metabolism, and excretion of drugs from the body; start low and go slow |
| how to assess decisional capacity | is pt able to ID problems recognize options, make decisions, and provide the rationale supporting the decisions; mini mental status exam(MMSE) |
| mild cognitive impairment | state of cog functioning that is below defined norms; does not meet criteria for dementia; memory complaint by another person; measurable memory impairment via standard assess tests; norm overall thinking and cognitive functioning; ability to perform ADLs |
| The 3 D's | dementia, depression and delirium |
| dementia | irreversible, progressive, mental, cognitive deterioration; loss of memory, orientation, attention, language judgement and reasoning; personality changes, agitation, delusion, hallucinations may result |
| depression | reversible; 20% of older adults; cognitive impairment; cerebral dysfunction; treatment generally includes drug therapy and psychotherapy |
| delirium | reversible confused state usually related to physio cause; acute; fluctuation in mood, cognition; disorentation; hallucinations; often seen among older adults in an unfamiliar setting |
| four types of dementia | alzheimers; vascular; diffuse lewy body disease, frontotemporal |
| alzheimers disease | loss of memoryl agnosia; apraxia |
| agnosia | dont recognize objects and persons |
| apraxia | inability to perform familiar tasts |
| vascular dementia | causes- thromboemboli, ischemia, hemmorrhage to brain abrupt onset; symptoms similar to stroke(CVA) |
| diffuse lewy body disease | auditory/visual hallucinations; fluctuating cognition; parkinsonian motor symptoms appear early in disease; increased sensitivity to antipsychotics(haldol) |
| frontotemporal dementia | slow progression; incontinence early symptom; poor hygiene; repetitive behaviors; lack of social tact; lack of sexual inhibition |
| elder mistreatment | neglect; physical abuse; emotional abuse; financial abuse |
| restraints | device or drug that prohibits pt from moving freely; always prescribed by health care provider; ethical concern |
| nursing diagnoses for older adult | confusion, fatigue, immobility, self-care deficit; powerlessness; risk for falls |
| nursing outcomes/goals | adequate nutrition; provide safe care-prevent falls, safe med admin; mental/behavioral health; encourage independence, self care |
| the older population is growing and diversifying | the older pop is very ethnically diverse and is growing; by 2030, 25% of older pop will be minorities |
| localized pain | pain confined to the site of origin |
| projected pain | pain along a specific nerve or nerves |
| radiating pain | diffuse pain around the site of origin that is not well localized |
| referred pain | pain received in an area distant from the site of painful stimuli |
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