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255 EXAM 3
opp care: renal exam 3
| Question | Answer |
|---|---|
| Preoperative | Before surgery |
| Intraoperative | During surgery |
| Postoperative | After surgery |
| Elective surgery | choose to have it |
| Emergent surgery | Emergency like a rupture |
| Cure surgery | cure the pt. like taking a tumor out |
| Palliation surgery | relieve symptoms |
| Prevention surgery | to prevent; genetic testing showed breast cancer so get a mastectomy |
| Cosmetic surgery | Changing appearance |
| Impatient | stays in hospital for a cupule days |
| Outpatient/Ambulatory | same day surgery is the same day out |
| Inpatient and outpatient depends on: Type of? Patient? Prior medical? | Type of surgery, Patient situation, Prior medical history |
| Allergies to latex include? | Bananas, Avadacods, strawberry's all from sheard protein |
| Nursing interventions for DVT? | SCD, ROM, Ted hoes |
| Nursing interventions for Respiratory complications like pneumonia and aspiration? | Turn cough deep breath, high flowers, gag reflex intact, IS, early ambulation, huff cough |
| Nursing interventions for GI complications like N/V/C? | early ambulation, start with clear liquids ->full liquids ->bland foods -> fluids (flush Anastasia) |
| Nursing interventions for infections? | Proflactic antibiotics |
| Opioids can dec what vital signs? | Respiratory and BP |
| Anti depressants can dec? | Respiratory drive |
| Antihypertensives can dec? | |
| Insulin/Oral hypoglycemic can dec? | Glucose levels |
| Anti plattlets/ anti coagulants can inc risk for? | bleeding |
| NSAIDS can inc risk for? | Bleeding |
| G Herbs like Garlic, ginkgo, ginger can inc risk for? | bleeding |
| Vitiamin E acts as a blood thinner and inc risk for? | bleeding |
| Immunodeficiency inc risk for? | infection |
| Obesity due to need inc of Anesthesia are more at rick for? | bleeding |
| Malnourished needs protein for? | Wound healing |
| A 73 year old pt had open abdominal surgery, why are they at a higher rick for developing pneumonia? | it hurts to take a deep breath, they need a pillow to splint |
| Why should every patient be prescribed ABX before a surgery? | to dec risk of infection |
| Why do NURSES begin post op teaching in pre op period? | so pts know what to expect after surgery and they are more likley to follow through with it |
| What to teach patient about mobility before surgery? | early ambulation after the surgery |
| What to teach patient about monitoring before surgery? | VS every 15-30 min after the surgery |
| What to teach patient about pain management before surgery? | Pain scale, pts pick a reasonable number to get to after surgery to feel better |
| What to teach patient about dietary modifications before surgery? | Explain NPO, bowl sounds and gag reflex must be intact as getting back to advanced diet after the surgery |
| What to teach patient about skin/items prep before surgery? | Antimicrobial cleanser, no makeup/nails/jewelry/hearing aids/glasses/contacts/dentures (document) |
| Why must a patient be started on PO pain management prior to discharge? | Can't go home on IV, PO meds need to make sure they work with no reactions |
| Why can't pts eat right after surgery? | stomach is asleep due to anesthesia making the organs paralyzed for the surgery |
| What is the NURSE role in obtaining informed surgical consent? | watch them write the signature; if already signed go back and ask them if they signed it themselves |
| informed consent can not be signed until what has been discussed? | Procedure, risk vs benefit, Alternative options |
| What are examples of things that need to be consented? | Surgery, blood, anesthesia |
| What if the pt has questions or does not understand the procedure? | call the DR back to the room; NURSE can not answer procedural surgery questions |
| What is included in the pre op check list? | Chart review, vitals, labs, diagnostics, consents signed, site marking, skin prep, NPO time, Pre void, consent called, pre meds, type and match, safety bands, gown, disposition of valuables |
| Unrestricted zones | common area like front desk |
| Semi restricted zone | area surrounding the surgical suite |
| Restricted zone | surgical suite and where procedure takes place |
| What must be worn in the surgical suite and semi restricted areas? | Scrubs, cap, shoe covers, mask |
| What should the environment of the operating room be like? | filtered and controlled air, positive air pressure temp and humidity controlled by being cold, sterile areas |
| Circulating RN | documents and gets extra suplys |
| Surgery/scrub tech | sets up sterile field, counts, and hands supplies |
| Surgons Assistants | MD, PA, RN all helps the surgeon as needed |
| Anesthesiologist or CRNA | gives anesthesia |
| Potential complications during surgery? | Pressure ulcers, skin tears, Muscle soreness (air from being open) |
| TIME OUT (last check) | Right pt, procedure, site, prep op orders and paper work complete, supply count |
| Local Anesthesia | blocks and numbs body part but still conscious |
| Moderate to deep sedation | sedated but conscious; can still answer questions |
| Monitored anesthesia care | sedated but not to deep |
| General Anesthesia | Full loss of sensation and consciousness |
| Adjunctive Drug Therapy Opioids is for? | Pain |
| Adjunctive Drug Therapy antiemetics used for? | Nausea |
| Adjunctive Drug Therapy Benzodiazepines used for? | Anxiety |
| Adjunctive Drug Therapy Neuromuscular blocking agents used for? | Muscle relation and paralysis |
| Intra op modified drug doses because? | organs don't work as well |
| intra op pressure injures occurs because of? | mobility and circulation |
| Intra op Hypothermia happens because of? | having trouble regulating temp; temp is already lowered from the anesthesia and the OR temp |
| Pain assessment may have to include a? | Face scale because pain goes unreported because pts assume it is a normal part of aging |
| What should you monitor when giving opioids? | Dec BP, respiratory dive, bowl sounds, and constipation |
| What can dec the risk of post op constipation? | Inc fluids, fiber, early ambulation, stool softener |
| Anaphylactic Reactions | Throat closing Hypotension, tachycardia, bronchospasm, pulmonary edema, common with latex allergies |
| Malignant Hyperthermia | Adverse to anesthesia, hot and ridget, tense muscles, inc temp, inc HR, inc RR, cardiac arrest. treat fever and give muscle relaxants |
| Benefits to minimally invasive surgery for blood loss? | minimal |
| Benefits to minimally invasive surgery for incision size ? | smaller/puncture holes |
| Benefits to minimally invasive surgery for pain level? | decreased |
| Benefits to minimally invasive surgery for recovery? | quicker |
| Benefits to minimally invasive surgery for hospital | shorter |
| PACU is the immediate recovery area, what should the nurse do? | head to toe, VS every 15 min, I&O |
| Out patient and inpatient PACU | Outpatient: PACU then home Inpatient: PACU then inpatient floor |
| What precautions should be implemented for a post op patient? | Fall, bleeding, aspiration |
| Why are IV fluids typically prescribed for post op patients? | to flush out anesthesia, inc BP, prevent constipation |
| when patient returns from the PACU and you asses the patient they need to go to the bathroom, what is the SAFEST option? | bed pan or urinal |
| what are expected of VS after the surgery? | all dec |
| What are the GI post op concerns? | N/V and bowl sounds |
| What are the GU post op concerns? | output, urinary retention. (if they don't pee within 8hr call the MD) |
| If the patient's temp is elevated the nurse should be concerned about? | infection, malignant hyperthermia |
| What can be the cause of sore throat during post op finding? | intabution |
| What can be the cause of shoulder pain during post op finding? | trapped air, tell them to lay back down before sitting back up |
| What can be the cause of stomach cramping during post op finding? | gas trapped air, constipation from pain meds |
| What can be the cause of full bladder during post op finding? | urinary retention, might need a catheter |
| What is the discharge criteria? | stable, weaned from O2, no excesses bleeding or drainage, free from nausea, tolerated diet, pain managed with PO meds for q2-24 hr, measured first void, teaching and follow up care |
Created by:
mmarino2