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Adult Health Test 1
Care of the Surgical Patient
| Question | Answer |
|---|---|
| Surgery Assessment History: | Age, Drugs & substances use, Current meds, including herbals, Med Hx, Prior surgical and anesthesia Hx, Allergies (shellfish, latex, etc), Knowledge/understanding of surgery, support systems. |
| Why is it important to find out about herbals? | It is important to find out about herbals because they can affect anesthesia and how a pt responds to the surgery, so can drugs. |
| Surgical Physical Assessment | Complete a set of vitals signs, focus on problem areas identified in Hx, Focus on all body Sx affected by the surgical procedure (i.e. make sure there is no infection), Establish baselines |
| Laboratory, Radiology, and Other information you need for surgery? | Urinalysis (infections), Type and cross (poss. blood loss), CBC (hemoglobin and Hematocrit), clotting studies (PT, INR, aPTT), Electrolytes, Serum creatinine, Pregnancy test, Chest x-ray, ECG, cardiology consult |
| Why do you get the electrolytes lab work? | Potassium controls your heart rate Normal is 3.5-5 |
| Serum creatinine lab work is done because _____ ? | kidneys, worried about drug metabolism |
| Pregnancy test is done for whom? | anyone of childbearing age, uterus no longer in body don't have to or if sensation of period for 1yr. |
| 30% of surgery ralted deaths are due to ____? | heart problems |
| What do we report to the Dr and anesthesia provider/surgeon? | Only report Abnormalities |
| What implies that the client has been given sufficient information about the surgery? | Informed Consent |
| T/F Nature of and reason for surgery is apart of the informed consent? | True |
| Is it important for the client to know who is going to preform the surgery? | Yes |
| T/F it is not important to tell the patient of all of the available options and risks? | False it is important to give them all available options and risks |
| T/F Risks of planned surgery is apart of informed consent? | True |
| T/F Informed consent involves informing the pt of risks of anesthesia | True |
| The nurse's role in informed consent? | You as a nurse, are not responsible for providing, detailed info about the surgical procedure.. You ensure that the consent form is signed and you serve as a witness to the signature. |
| Why NPO prior to surgery? | 6-8hrs prior to surgery, gastric secretions bad during surgery. |
| Home Medications (do they need to stop taking a specific meds? Or do they need to take meds with only enough meds to get the pill down) | Steroids can cause problems because they delay wound healing; consult surgeon or anesthesia for instructions, Diabetes, Cardiac disease, Glaucoma, Anticonvulsants, Antihypertensives, Anticoagulants, Antidepresssants, Corticosteroids. |
| Do you take a shower scrub prior to surgery in Preoperative preparation? | Yes |
| Postoperative Excercises are for ____? | preventive measures |
| Dive by Enemas and Shavingflow the surgerons directive When? | During the postoperative Excercises |
| Is Pain Mangment important in the poat op patient? | YES!!! |
| Atogolous blood | Client donatesown blood, infection free, 5 wks in dvance to the last 72 hrs prior to surgery |
| Directed blood | Family or friends donat blood exclusively for cl use. blood types must be compatible, blood must be disease/infection free |
| Preoperative Verification Process includes | discharge planning, |
| All clients, regardless of how minor the procedue or how often they ave had surgery,should have _____? | Discharge planning |
| Discharge planning includes: | Cl home environment (do they have stairs-knee repacement), self-care capabilities, support systems, postoperatve needs (walker, crutches, etc) |
| Food in the stomach puts the pt at risk for what? | aspiration into the lungs. 50% of deaths are a result of aspirated gastric juices |
| intraopeative client surgical team | Surgeon, Surgial Assistants (another surgeon, nurs, tech assistant, etc), Anesthesia, circulating nurse (usually RN), Scrub nurse (assistant is usually called this even if you aren't a nurse), Surgical Tech, other personal |
| Surgical Suite layout | There are three areas and three zones |
| The 3 areas of the surgical layout | Holding (preop phase, family allowed), Surgical suite (authorized personal only, should have scrubs and hat, mask has to be on in the OR) and the PACU (out of surgery, family members can be here. |
| The 3 zones of the surgical layout | Unrestricted PACU, Semirestriced (tech there), Restricted (OR room) |
| What is defined as an induced state of partial or total loss of sensation, occurring with or without loss of consciousness | Anesthesia |
| Types of Anesthsiologist | Genral, Local, Regional |
| General Anesthesia - loss of conciousness | Inhalation, intravenous, balanced-most are a combo of the two |
| Local Anesthesia | Topical anesthesia (skin cream, eye drops, spray), Local infiltration-numb area around it, Strict locals do not require NPO status |
| Field block (dental surgery-around a nerve), Nerve block (shoulder surgery), Spinal anestheisa (vaginal historectamie), Epidural anesthesia (c sections) | Regional Anesthesia |
| Anesthsiologist is chosen based on | based on surgery and complication possibilities |
| Complications of anesthesia | Maliganat Hyperthermia |
| Is an acute, life-threatening complication | Maliganant Hyperthermia |
| When skeleatl muscle is exposed to the agent, calcium levels and muscle metabolism increase if a pt has | Malignant hyperthermia |
| ____ leads to acidosis, cardiac dysrhythmias, and high body temp, HTN, Skin mottling, Myoglobinuria, Cyanosis, tachycardia | Malignant hyperthermia |
| Drug of choice for malignant hyperthermia is | Dantrolene sodium (direct acting that acts directly on skeletal muscle itself) |
| Family Hx of _____ is present usually | Malignant hyperthermia |
| The 4 JCAHO Patient Safety goals | Eliminate: Wrong-site, Wrong-patient, Wrong-procedure, Wrong-surgery |
| Preoperative verification process consitist of: | Checklist and positioning |
| Checklist is to confirm that appropriate documents are available such as... | consent form, Hx & P.E., Imaging studies, and Do all of the above match? |
| This is done for procedures involving R/L multiple structure, or multiple levels | Operative Site Marking |
| It is a line indicating site of incision, surgeon's initials, and/or the word "Yes" (Yes, dotted line used, initials surgical surgery) | Operative Site Marking |
| Immediately before starting a procedure final verification of correct patient, procedure, and site (everyone must agree or we do not go any further) | "Time-OUT" |
| When does the postoperative phase begin? | at the completion of surgery ends with discharge of the client to home or nursing floor. |
| PACU Nurses are: | RN, requires in-depth knowledge of anesthesia, pharmacology, pain management, and surgical procedures, Skilled in assessment and must make quick decisions if emergencies or complications occur, ACLS (Advanced life support Adult) Also Neonatal Certified |
| Typical PACU Cubical consists of | Oxygen, Suction equipment, Cardio monitors, Airway equipment, ER meds |
| Physical Assessment occurs with in 1 min and it consists of: | Level of consciousness; temperature; Pulse; Respiration (most important); BP; and Surgical area for bleeding |
| REspiration is the most important and you want to look for what? | Airway Patency-are they breathing, breath sounds, movements; Gas exchange; Breath Sounds-symmetry; Chest wall; Snoring/Stridor |
| BP Trends to lookf for | Compare to baseline; Usually 15-20 difference |
| BP things to look for: | Trends; Cardiac monitoring-EKG interpretation; Peripheral vascular assessment-distal pulses of bilateral feet and radial pulses |
| It is important to assess the surgical area for ... | Bleeding |
| Complications to look for post operatively | Hypobolymic, Anestia reduces BP, Hyperthermia, Increased Heart Rate-Shock, pt bleeding somewhere, be sure to check dressings and drians |
| Opioid and Non-opioid Analgesics and Patient-controlled analgesia are all examples of | pain management |
| Cerebral function-Level of consciousness and awareneess-open your eyes, take a deep breath, squeeze my hand; orinted to person place and time | Neurological Assessment |
| General motor function "can you lift your left leg"; Regional Motor and sensory function are what type of assessment | Neurological-Motor and Sensory |
| Urine Retention-Inspect, palpate, percuss; Intermittent (straight) catherterization; Indwelling foley (color, clarity, amount (Report <30 ml/hr) | Renal Assessment |
| It is important to monitor fluid and electrolytes and acid base balance so you do an assessment of them. What is it you are monitoring? | Intake (IV fluids (LR D5LR), PO fluids, Blood administration) and Output (Bloodloss (intraoperative and drains/dressing in PACU), Vomitus, Urine, NG drainage) |
| Immediate postop (Nausea and Vomiting-suction; NG Tubes) Later (Paralytic ileus-no bowel sounds/absence of sounds; constipation) | Gastrointestianl Assessment |
| Not immediate postop, Do not remove bandages, Incesion assesment after surgeon removes bandages are example of what | Skin assessment |
| Incesion should look like what | Redness a little pink ok, warmth, swelling, tenderness/pain, Drainage (sangous, serious, purulent); Edges are well peroximated |
| Drainage-amount, color, consistency, odor are all things a nurse should monitor when changing what | Dressings |
| T/F The drainage progression should be monitored by outlining it with a pen | True-think how you can measure it some how. Quarter size. etc |
| What are the 3 types of drains? | Gravity-type; Closed-suction; and Provide exit for air, blood, and vile |
| Gravity-type drains consits of | Penrose and T-Tube |
| closed-suction drians consists of | Hemovac, Jackson-Pratt |
| Partial or complete separation of outer wound layers "splitting open" | Dehiscence |
| What do you do when a wond dehiscence? | Cover with sterile non-adherent dressing and notify surgeon. Obesity is a risk factor. DM and smokers are also a risk factor. Don't heal well |
| total separation of all wound layers and protrusion of internal organs | Evisceration |
| What do you do when a wound eviscerates | Surgical Emergency, call for help and notify surgeon immediately |
| Can positions during surgery cause pain? | Yes |
| Pain signs | Grimicing, increased heart rate, moaning, etc |
| Analgesics-->Opioids | Controled substances, Demerol, morphine, Percodan, percocet |
| Analgesics-->Non-opioids | Toradol, motrin |
| Complication of Opioids | Respiratory depression (HTN, N&V, constipation) Antidote =Narcan (0.1-2 mg IV, SC, and IM; repeat q 2-3 mins PRN) |
| Patient-controned Analgesia (PCA) is done Via IV infusion. What are examples of meds? | Morphine-Drug of choice, Meperidine, hydromorphone (5-7x more potent than morphine); Fentanyl (100x more portent than morphine) |
| Used to get patient comfortable | Loading dose |
| amount with each push | Bolus dose |
| time from one dose to another | lockout time |
| continuous infusion | basal rate |
| hourly limit | max/hr |
| sets up the sterile field (Figure 21-3), drapes the client, and hands sterile supplies, sterile equipment, and instruments to the surgeon and the assistant. | scrub nurse |
| assists the OR team in the transfer to the operating bed. The nurse positions the client, protecting bony areas with extra padding while providing comfort and reassurance. May also assist with anethsia | Circulating nurse |
| general anesthesia is administered by what two routes? | Inhalationa and IV injections |
| What 5 assessment must be made on admittance to PACU? What is most important? | Assessment of Level of consciousness, temperature, pulse, respiartion (most important) and BP |
| Pain medication in the PACU is usually given via which route? | Pain medication in the PACU is usually given intravenously in small doses |
| Post Anestiesia Care Unit abbreviated by | PACU |
| What is the most serious complication of opioid analgesics? What are some other complications? | Respiratory depression, hypotension, nausea, vomiting, and constipation |
| What medication is used to reverse the acute effects of opioid depression? | An opioid antagonist, such as naloxone (Narcan), may be need to reverese the acute effects of opioid depression |
Created by:
cgwayland