phase 2 test 3 'operative patient care/wound management'
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Define Anesthesia | loss of sensation, w/o pain
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| Embolus | free-floating blood clot
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| Infarct | blood clot that blocks an artery
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| Informed Consent | educate pt about and they understand the procedure, why they need it, and agree
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| Intraoperative | care during surgery
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| Perioperative | care throughout entire surgical procedure
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| Preoperative | care prior to surgery
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| Thrombus | deep blood clot that stays in one spot
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| M6 responsible for getting informed consent? | no, but is responsible for making sure it's signed
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| Pre-Operative Patient Care | review peroperative lab and diagnostic studies
review the client's health history and prep for surgery
assess physical needs
assess psychological needs
assess cultural needs
client followed physician's orders
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| Pre-Operative Patient Teaching Done | 1-2 days prior to surgery
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| What is taught in pre-operative patient teaching? | leg position
use of side rails
splinting
frequency
coughing exercises
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| Turning Improves: | venous return
respiratory function
gastrointestinal peristalsis
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| What coughing exercises do | removal of retained mucus from resp tract
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| Deep Breathing Exercises __________ | helps expand collapsed lungs and prevent postoperative pneumonia and atelectasis
done 5-10 times/hr
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| Incentive Spirometry | used to encourage deep breathing and prevent atelectasis
instruct in proper technique
10 times/day during each waking hour for first 5 days
*except immediately before and after meals
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| Leg Exercises | helps prevent circulatory problems
'gas pains'
must be individualized
repeat 1-2 times hour
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| Early Ambulation | helps patient breathe deeply
stimulates circulation
urine retention
constipation
abdominal distention
appetite
sleep
helps people feel less helpless
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| Pain Management | normal part of surgical experience
area of major concern for patient and family
ordered by physician and admin by nurse
usually prn
pt ask for meds before severe
bowel sounds in 4 quads before admin
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| LPN can give IV morphine push? | NO!!!!!
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| Antiembolism Stockings | Homan's sign
apply stockings in supine position
abdominal surgeries most at risk
pitting edema
peripheral cyanosis
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| Sequential Compression Devices | place sleeve under pt's leg with fuller portion at top
ensure there are no wrinkles or creases
attach tubing to SCD after both sleeves applied
assess client periodically
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| Preparing Patient for Surgery | prepare pt's chart using surgical checklist/preoperative checklist
assure completion of SF 522
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| SF 522 | Request for Administration of Anesthesia and for Performance of Operations and other Procedures
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| GI Preparation | NPO after midnight
bowel cleanser may be ordered
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| Skin Preparation | shower hair removal
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| Morning of Surgery | complete morning care
visit with family
record vital signs
check proper ID band is on pt
check preoperative consent forms are signed and medical records are in order
recheck accuracy of surgical checklist
administer preoperative meds
pt's safety
s
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| Intra-Operative Nursing Care Includes | ID pt verbally, nonverbally
personal contact
awareness of the potential for harm
recognition of susceptibility to injury
strict adherence to principles of positioning and asepsis
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| 3 Types of Anesthesia | general
regional
local
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| Half Life | amount of time required for 1/2 of medication to be metabolized
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| Amnesia | not remembering
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| Analgesia | pain relievers
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| Autonomic Stability | sympathetic and parasympathetic medications to control VS
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| Muscle Relaxation | calm and rested, muscles not tensed
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| Anesthesia Made Possible in _____ | 1840s
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| General Anesthesia | used for major procedures
results in - immobile, quiet person, unable to recall procedure
Admin by inhalation agents or IV anesthestics
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| 3 Stages of General Anesthesia | induction
maintenance
emergence
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| Adverse Effects of General Anesthesia | malignant hyperthermia
uncommon but potentially fatal
signs: rapid rise in temp, tachycardia, tachypnea, muscle rigidity
increased risk: children, adolescents and those with skeletal or muscular abnormalities
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| Clinical Uses of Moderate Sedation | procedures requiring moderate (conscious) sedation
preoperative sedation
doesn't necessarily cause complete loss of consciousness
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| Reversal Agents for Moderate Sedation | naloxone - narcotics
romazicon/flumazenil - benzodiazepines
anticholinesterases - reverses effects of neuromuscular blocking agents
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| Local or Regional Anesthesia | loss of sensation in a specific area of body
no loss of consciousness
usually patient is sedated
2 major categories: central, peripheral
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| Central Anesthesia | spinal
epidural
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| Peripheral Anesthesia | nerve block
infiltration anesthesia
topical anesthesia
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| Spinal Anesthesia | intrathecal/subarachnoid
anesthetic agent is delivered to the subarachonoid space
proper patient position
significant complication from SAB is headache
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| Epidural | local anesthetic delivered to the epidural space located between dura and overlying connective tissue
commonly used in labor and delivery
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| Nerve Block | done under ultrasound by anethesiolgist
can be single shot or infusion
post-op pain
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| Infiltration Anesthesia | put into specific and numbs area around 1 tiny nerve, vasoconstriction
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| Topical Anesthesia | eye drops
hemmorroid cream
cytocanespry
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| Intra-Operative Patient Care in Moderate/Conscious Sedation | reduce fear and anxiety
quick recovery
requires careful monitoring
routinely used for procedures that don't require complete anesthesia
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| Common Agents used in Moderate Sedation | opioids
sedatives/benzodiazepines
combinations of medications
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| Monitoring Patient Receiving Conscious Sedation | identify baseline information and risk factors
continuous monitoring by RN during procedure
post procedure assessment: discharge instructions
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| Members of Surgical Team | surgeon
anesthesiologist
anesthetist
scrub nurse
circulating nurse
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| Surgical Risk Factors and Potential Complications | infection - catheters, drains, surgical wound
burns
hypothermia
hyperthermia
bleeding/hemorrhage
pressure sores
trauma injuries
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| Immediate Post-operative Phase | airway
breathing
consciousness
circulation
system review
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| How Often Vital Signs Take in PACU | minimum every 15 minutes
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| Spinal Anesthesia Used For | lower abdominal
pelvic procedures
lower extremity procedures
urology procedures
surgical obsterics
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| Risks for Spinal Anesthesia | migration: drug, amount, pt position
vasodilation/decrease in BP
respiratory paralysis
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| Post Anesthesia Patient Care for Spinal Anesthesia | monitor vitals 3-5 minutes
level of consciousness
level of anesthesia
physical assessment
proper position
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| Most Important VS for PT of Spinal Anesthesia | respiratory rate and BP
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| Potential Postoperative Complications | N/V
aspiration
hypothermia/hyperthermia
laryngospasm
hypoxia
hemorrhage
pain
hypovolemic shock
decreased/absent urine output
increase/decrease IV input
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| Documentation of Postoperative Phase Assessment | ID patient
time patient arrived
LOC
safety measures
VS
type of anesthesia given
type of procedure
meds pre/post-op
surgeon
output
IV's
drains
dressing
discharge/exudate
wound packs
EBL
pain rating
O2 Sat
nursing staff sig & initials
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| Ways to Prevent Postoperative Respiratory Problems | mobility
secretion clearance
deep breathing and coughing exercises
splint
analgesics
breath sounds
incentive spirometer
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| Circulation in the Later Postoperative Period | move legs frequently and do leg exercises
don't use pillows under knees
avoid pressure to lower extremities
use antiembolism stockings
ambulate as ordered
heparin
SCD
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| Incision Care in Later Postoperative Period | observe for drainage-reinforce if necessary
accurate measurement of drainage
dehiscence
evisceration - 3 days - 2 weeks post op
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| When to give pain medications in post-op patient | every 3-4 hours as needed before pain becomes severe
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| Devices that can be used to control pain | PCA
TENS
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| Length of Time Patient Needs to Recuperate from Surgery Depends on | physical and mental prep
type and magnitude of surgical procedure
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| When prep for discharge begins | during the preoperative period
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| The major goals of nursing managements are prevention and detection of complications | prevent injury
regain independence
patient education
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| Pain medication should be timed in relation to? | activities
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| Recovery Period | begins when the pt arrives in the hospital room or a postsurgical unit and full activity is resumed
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| Define Pulmonary Embolism | obstruction of 1+ arterioles originating in venous system
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| S&S of PE | sharp, stabbing chest pain
cyanosis
anxiety
profuse diaphoresis
rapid, irregular pulse
dyspnea, tachypnea
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| Nursing Interventions for PE | administer O2
have pt sit in upright position
reassure and comfort pt
monitor VS, EKG, ABGs
administer analgesics as ordered
initiation of thrombolytic therapy
notify charge nurse STAT
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| Define Pneumonia | inflammation of alveoli as a result of an infectious process or foreign material
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| Causes of Pneumonia | aspiration
infection
depressed cough reflex
dehydration
immobilization
increased secretions from anesthesia
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| S&S of Pneumonia | elevated temperature
chills
crackles or wheezes on auscultation
dyspnea
chest pain
productive cough
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| Nursing Interventions for Pneumonia | semi-fowler's
admin O2
maintain nutritional and fluid status
encourage turning, coughing, deep breathing
frequent oral hygiene
teach proper disposal of tissue and sputum
provide for rest & comfort
provide emotional support
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| How to Manage/Minimize Risk of Phlebitis/Thromosis | leg exercises every 2 hours or more frequently
elastic stockings or bandages (remove at least 1-2 times per day)
asses skin temp, color, and capillary refill
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| Hiccups | singultus
caused by uncontrolled contraction of diaphragm and rapid closure of the glottis
place gentle pressure over eyelids
rebreathe into a paper bag
administer medications as ordered
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| Nursing Concerns and Interventions - Nutrition | monitor I&O
maintain IV fluids
assess for dehydration and wight loss
provide oral hygiene before and after meals
monitor diet tolerance
encourage pt to sit upright for meals
encourage family participation as necessary
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| Nursing Concerns and Interventions - Nausea and Vomiting | maintain clean environment
provide frequent oral hygiene
encourage sips of liquids at frequent intervals
administer medications as ordered
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| Types of Open Wounds | abrasions
avulsions
lacerations
amputations
punctures
bite
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| Type of Closed Wounds | contusion
crush injury
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| Crush Injuries Seen Most in | farming accidents
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| Phases of Wound Healing | hemostasis
inflammatory
reconstruction
maturation
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| Hemostasis | termination of bleeding
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| Inflammation | initial increase in blood elements water flow out of blood vessel and into vascular space
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| Reconstruction | collagen formation occurs
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| Maturation | 3rd week to 2 years post injury
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| Types of Primary Would Healing | primary intention
secondary intention
tertiary (delayed primary) intention
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| Wound Complications | abscess
adhesion
cellulitis
dehiscence
evisceration
extravasations
hematoma
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| Bleeding can be caused by ________ | slipped suture
dislodged clot
coagulation problem
trauma
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| S&S of Internal Bleeding | dressing may remain dry
increase thirst
restlessness
rapid, thready pulse
decreased BP
decreased urinary output
cool clammy skin
abdomen rigid and distended
hypovolemic shock
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| Difference Between Dehiscence and Evisceration | evisceration organs protrude through surgical opening
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| S&S of Infection | purulent (pus) drainage
fever
tenderness
pain
edema
elevated WBC
positive wound culture
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| Factors that Impair Wound Healing | extent of injury
type of injury
age
nutritional status
obesity
impaired oxygenation
smoking
drugs
diabetes mellitus
radiation
wound stress
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| Sutures Remain in Usually _____ | 7-10 days
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| Serous Drainage | clear
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| Sanguineous | red with clear streaks
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| Serosanguineous | pink, watery
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| Purulent | brown, yellow, green
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| Open Drains | drainage passes through an open-ended tube into a receptacle or out onto the dressing
Penrose drain
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| Closed/Suction Drains | self-contained suction units
more efficient than open drains
creating vacuum or negative pressure
prevents environmental contaminants
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| Jackon-Pratt Drain | used when small amounts (100-200 mL) of drainage anticipated
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| Hemovac Drain | system used for larger amounts (up to 500 mL) of drainage
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| Antibiotic | treatment of bacterial infection
slow/retards growth of bacteria
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| Bactericidal | kills bacteria
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| Bacteriostatic | slows/retards growth of bacteria
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| Colonization | bacteria grows and multiplies in a wound
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| Definitive Theory | know what bacteria it is and what will work against it
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| Empiric Therapy | physician decides on what treatment to use without C&S
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| Prophylactic Antibiotic Therapy | treating prior to procedure to prevent infection
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| Subtherapeutic | not getting adequate dosage, etc
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| Superinfection | infection that occurs when antibiotics knock down natural flora
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| Syngeristic Effect | 2+ drugs work together in order to achieve greater effect than individually
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| Gram Positive | stain purple
thick cell wall
outer capsule
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| Gram Negative | stain red
complex cell wall structure
more difficult to treat
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| Sulfonamides | primary bacteriostatic
interferes with PABA
often used to treat UTI and burns
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| Examples of Sulfonamides | sulfisoxasole
sulfamethizole
mafenide (Sulfamylon) - burns
silver sulfadiazine (Silvadene)
trimethoprim and sulfamethoxazole (Bactrim)
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| Adverse Reactions of Sulfonamides | Agranulocytosis
Thrombocytopenia
Aplastic anemia
Anoxeria
N/V/D
Abdominal pain
Stomatitis – inflammation of the mouth
Crystalluria – crystle formation in urine
Leukopenia
Uticaria, pruritus
Steven-Johnson Syndrome
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| Interactions of Sulfonamides | Increased action of anticoagulants
Bone marrow suppression with administration of methotrexate
Decreased metabolism of oral hypoglycemic drugs (Orinase)
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| PT and Family Teaching for Sulfonamides | Take as prescribed
Take drug on an empty stomach
Take with full glass of water
Complete the full course
Drink at least 8-10 oz. glasses of water a day
Keep all follow-up appointments
*Sulfasalazine may cause skin or urine to turn orange - yellow col
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| Classifications and Examples of Penicillins | Natural – penicillin G and V
Penicillinase resistant – dicloxacillin
Aminopenicillins – ampicillin, amoxicillin
Extended-spectrum – piperacillin
B-Lactamase Inhibitor – Augmentin, Unasyn
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| Uses of Penicillins | UTI’s
intra-abdominal infections, meningitis
gonorrhea, syphilis
respiratory infections
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| Adverse Reactions of Penicillins | Mild nausea
Vomiting
Diarrhea
Sore tongue or mouth (glostitis)
Fever
Pain at injection site
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| PT Allergic to Penicillin Most Likely Also Allergic to | cephalosporins
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| Pseudomembranous Colitis | causative org. C syphlasil, abd cramping & pain, bloody stool
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| Interactions of Penicillins | May interfere with effectiveness of birth control pills
Decrease effectiveness when administered with tetracyclines
May increase bleeding risk when taken with anticoagulants
Penicillins should be given 1 hour before or 2 hours after meals
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| Patient and Family Teaching for Penicillin | Similar to Sulfonamides
To reduce risk of superinfection, take yogurt or buttermilk (keep flora in gut)
Women should consider additional contraceptive measures
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| Generation of Cephlosporins best against gram positive. Gram negative | first
third
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| First-Generation of Cephalosporins | cefadroxil (Duricef)
cefazolin (Ancef)
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| Second-Generation of Cephalosporins | cefaclor (Ceclor, Ceclor CD)
cefotetan (Cefotan)
cefoxitin (Mefoxin)
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| Third-Generation of Cephalosporins | cefixime (Suprax)
cefoperazone (Cefobid)
ceftriaxone (Rocephin)
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| Adverse Reactions of Cephalosporins | N/V/D
Pruritis, urticaria
HA
Dizziness
Stevens-Johnson syndrome
Nephrotoxicity
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| Interactions of Cephalosporins | Risk of nephrotoxicity (increased toxic levels in kidneys) increases when administered with aminoglycosides
May increase bleeding risk when taken with anticoagulants
Most cephalosporins may be taken without regard to food
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| PT and Family Teaching of Cephalosporins | Similar to penicillins
Avoid drinking alcohol when taking and for 3 - 7 days after completing therapy
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| Use of Tetracyclines and Macrolides | cholera, Rocky Mountain spotted fever, typhus and some skin and soft tissue infection (acne) in which penicillin is contraindicated
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| Adverse Reactions of Tetracyclines and Macrolides | N/V/D
Epigastric distress
Stomatitis
photosensitivity
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| Contraindications of Tetracyclines and Macrolides | children under 9
pregnant
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| Interactions of Tetracyclines and Macrolides | Antacids impair absorption
Increase effects of anticoagulants and digoxin
Decreases effectiveness of oral contraceptives
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| PT and Family Teaching of Tetracyclines and Macrolides | given on an empty stomach with few exceptions and are not to be taken with dairy products
Avoid exposure to the sun or any type of tanning
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| Fluoroquinolones | ciprofloxacin (Cipro)
levofloxacin (Levaquin)
gatifloxacin (Tequin)
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| Uses of Fluoroquinolones and Aminoglycosides | Lower respiratory infections
Skin infections
UTI’s
STD’s
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| Adverse Reactions of Fluoroquinolones and Aminoglycosides | Nausea
Diarrhea
HA
Abdominal pain or discomfort
Dizziness
Photosensitivity
Superinfection / pseudomembranous colitis
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| Interactions of Fluoroquinolones and Aminoglycosides | taken with cimetidine may interfere with elimination
risk of seizures when taken with NSAID’s
nephrotoxicity if admin with a cephalosporin
risk of ototoxicity if admin with a loop diuretic
risk of neurotoxicity if admin soon after general anesthetics
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| Adverse Reactions of Fluoroquinolones and Aminoglycosides | Nephrotoxicity (chephlosporins)
Ototoxicity – can cause damage to cranial nerve VII, early det. may be reversed
Neurotoxicity
N/V
Anorexia
Rash
Urticaria
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| PT and Family Teaching of Fluoroquinolones and Aminoglycosides | same as other anti-infectives
tendinitis, such as pain or soreness in the leg, shoulder, or back of heel
ringing in the ears or difficulty hearing, numbness or tingling, and change in urine output. May be permament
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| Aminoglycosides | gentamicin (Garamycin)
neomycin (Mycifradin)
streptomycin
tobramycin (Nebcin)
blocking a step in protein synthesis
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| Uses of Aminoglycosides | gram negative organisms
Poorly absorbed, useful in suppressing GI bacteria
Bowel prep
Hepatic coma – liver starts to fail and amonia levels increase
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| ____________and aminoglycosides chemically inactivate each other and should not be physically mixed | penicillins
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| Erythromycin may ________ hepatic metabolism of other drugs | decrease
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| Extended-spectrum penicillins and some ___________ may increase the risk of bleeding with anticoagulants, thrombolytic agents, antiplatelet agents | cephalosporins
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| ________________absorption is decreased by antacids, bismuth subsalicylate, iron salts, sucralfate, and zinc salts | Fluoroquinolone
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| Systemic Antifungals | amphtericin B cholesteryl sulfate (Amphotec)
fluconazole (Diflucan)
ketoconazole (Nizoral)
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| Topical Antifungals | butenafine (Lotrimin Ultra)
clotrimazole (Lotrimin)
ketoconazole (Nizoral)
miconazole (Lotrimin AF, Maximum Strength Desenex / Monistat–Derm)
nystatin (Mycostatin)
terbinafine (Lamisil AT)
tolnaftate (Tinactin)
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| Systemic Adverse Reactions of Antifungals | headache
N/V/D
hypokalemia
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| Topical/Local Adverse Reactions of Antifungals | burning, itching, local hypersensitivity reactions
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| PT and Family Teaching for Antifungals | Proper use of medication form.
Continue medication as directed for full course of therapy, even if feeling better.
Report increased skin irritation or lack of therapeutic response
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| acyclovir | Zoyirax
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| amantadine | Symmetrel
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| ribavarin | Virazole
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| Helminthiasis | invasion of the body by worms
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| Uses of Antihelmintics | pinworms
roundworms
hookworms
whipworms
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| mebendazole | Vermox
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| pyrantel | Antiminth
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| Common Antimalarials | hydroxychloroquine (Plaquenil)
quinine (quinine sulfate)
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| How long antimalarials should be taken prior to exposure to area. After returning. | 2 weeks
4 weeks
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| 5 Categories of Non-Opioid Analgesics | salicylates - Aspirin
acetic acid derivatives - Toradol
COX 2 inhibitors - Celebrex
enolic acid derivatives - Mobic, Feldene
propionic acid derivatives - Naproxen, Ibuprofen
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| Acetaminophen - Tylenol is/is not considered an NSAID | is not
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| How Non-Opioids Work | inhibiting the enzyme that's necessary for prostaglandin synthesis
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| Therapeutic Dose for Salicylates | 10-20
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| Opioid Analgesics | originated from opium poppy plant
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| Classifications of Opioid Analgesics | memeridine-like drugs - Demerol, Fentanyl
methadone-like drugs - Darvon
morphine-like drugs - Morphine, Codeine, oxycodone
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| Opioid Antagonists Reversal Agents | Naloxone (Narcan)
Naltrexone (ReVia)
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| Reversal Agent for Benzodiazapines | Romazicon (Flumazenil)
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| Preoperative Medications | reduces anxiety, the amount of anesthetic used and respiratory tract secretions
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| Types of Anesthesia Medications | general - Etomidate, Propofol, Fentanyl, Ketamine
regional - Bupivicaine, Lidocaine, Tetracaine, Procaine
moderate sedation - Demerol, Morphine, sedatives/Benzodiazapines, combinations
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| Steps in Suture Removals | 1. verify orders
2. ID pt
3. explain procedure
4. wash hands
5. expose incision
6. discard old dressing
7. wash hands
8. open kit
9. clean/sterile gloves
10. remove staple/suture
11. report unexpected outcomes
12. document
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| Responsibilities of the Circulating Nurse | prepare OR
arrange supplies
sends for PT
visits PT pre-op
performs/confirms assess
checks med. record
assists in trans
pos. PT on table
places conduct. pad
counts instruments
assist scrub nurse
prepare PT skin
assists in arranging table
cont.
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| Responsibilities of Scrub Nurse | hand scrub
sterile gloves and gown
arranges supplies
checks instruments
counts instruments w/ circ. nurse
gowns and gloves surgeons
maintain sterile field
corrects aseptic tech
observes progress
hands instruments
ID and handle specimens
maintai
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