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Med Surg Final2

Perioperative, Bowel Obstruction, HA

What is the overall goal of the preoperative assessment? Identify risk factors and plan care to ensure pt safety throughout the surgical experience
You would expect a patient with bowel obstruction to have these signs and symptoms: N/V, poorly localized abdominal pain, abdominal distention, inability to pass flatus, obstipation, S&S of hypovolemia, abd tenderness, abd rigidity, high-pitched or absent bowel sounds, slight increased temperature
A pt is at risk for bowel obstruction Surgical adhesions, hernias, tumors, carcinoma, volvulus, diverticular disease, neuromuscular or vascular disorder
How would you care for a pt with bowel obstruction? Prevent fluid and electrolytedeficiencies, watch for early recognition of deterioration in pt condition, obtain pt hx & physical exam, determine location, duration, intensity, and frequency of abd pain, **TOO MUCH TO TYPE =( CHECK PG 1033, SORRY!!**
List 2 Nursing dx for bowel obstruction 1) Acute pain r/t abd distention and ^ peristalsis 2) Deficient fluid vol. r/t decrease in intestinal fluid absorption, 3rd space fluid shifts into the bowel lumen & peritoneal cavity, NG suction, and vomiting
List a nutritional nursing dx for bowel obstruction 3)Imbalanced nutrition: less than body requirements r/t intestinal obstruction and vomiting
When will your pt need surgery for a bowel obstruction? If the obstruction does not improve within 24 hours or if the pts condition deteriorates.
Your pt is told surgery is needed to correct their bowel obstruction, what type of surgery should your pt expect? A colonoscopy can be used to remove the obstruction or surgery may be done to resect the obstructed segemnt of bowel and connect the remaining healthy bowel back together (anastomosis). A colostomy may be required
A pt with tension-type headaches may describe their pain as this: No nausea, no vomiting, have a sensitivity to light, occurs intermittently, pain may feel like a weight in or on the head or feel like a band squeezing the head
Symptoms of a migraine headache can be described as: Unilateral (sometimes bilateral) throbbing pain, triggering event or factor, temple pain, strong family hx, manifestations associated with neurologic and autonomic nervous system dysfunction, between 20-30yrs of age,
A pt with cluster headaches describes their headache as: Sharp and stabbing pain w/a pulse, can occur 8x a day, pain is located around the eye, radiates temple, forehead, check, nose or gums. Swelling around the eye, tearing, facial flushing/pallor, nasal congestion, constriction of pupil, agitated,restlessness
Preop Assessment includes: Psycho & physio factos, physical & nutritional assessment, establish basline data, identify surgical site/side, rx, OTC, herbs used, & cultural & ethnic factors affecting surgery, determine pt allergies, hx, immunity, & pt info received about surgery, doc
What is malignant hyperthermia? A rare disorder characterized by hyperthermia with rigidity of skeletal muscles that can result in death; usually occurs under general anesthesia, but may manifest in recovery period as well. *High body temp, muscle rigidity*
What is a PCA? A Patient-controlled analgesia pump used for pain control
What does the PCA do? Maintain a constant, steady blood level of the analgesic agent for pain. Its self administered by a pump in predetermined doses via IV, oral, epidural, or transdermal.
What teaching should you do before your patient goes into surgery? Let them know what to expect and how to help. Meds that will be used, what to do before going into surgery, what nursing will be done before, during, and after surgery, what to tell family (where to meet pt), answer any questions. (pg 341-343)
What is the nursing assessment for a post-op pt? Assess: neurologic status, pain, color, skin appearance, urinary status, airway, breathing, circulation, baseline VS, position for airway maintenance, comfort, and safety, check IV infusion, position call light within reach, emotional condition (T. 20-9)
What is informed consent? An active, shared decision-making process between the health care provider and the recipient of care that must be signed before any major procedure and must be witnessed.
What is the physician's responsibility with informed consent? The physician is responsible for obtaining the patient's consent for surgical treatment after explaining the procedure and answering any questions.
What is the nurse's responsibility with informed consent? The nurse may be responsible for being a witness to the patients signature, being an advocate for the pt, verifying the pt understands the info in the consent form, implications of consent, that the consent is voluntary, and the pts questions are answered
Created by: Keller_KI