TEST 1 CHP 17 SURGICAL CARE
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| ANESTHESIOLOGIST |
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| ANESTETIC |
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| COSMETIC SURGERY | done to correct serious defects that affect appearance, but it is often done simply bc the patient wants to change a physical feature.
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| CURATIVE SURGERY | done to remove diseased tissue or to correct defects. ex- to correct cleft lip, arthritic joints, and hernias.reconstruction procedure: repair of damaged tissue. constructive procedure: repair of congenitally malformed structures.
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| DEHISCENCE | reopening of the surgical wound.
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| DIAGNOSTIC SURGERY | involves the removal and study of tissue to make an accurate diagnosis; ex: biopsy of a skin lesion or a lump int he breast tissue
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| EVISCERATION | organs protrude through the open wound
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| EXPLORATORY SURGERY | more extensive procedure than biopsy. usually requires opening a body cavity to diagnose and to find out the extent of a desease process. ex: exploratory laparotomy (opening abdomen to search for unexplained pain)
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| HYPOTHERMIA | S
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| NURSE ANESTHETIST | S
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| PALLIATIVE SURGERY | relieves symptoms or improves fcn without correcting the basic problem. ex: removal of a malignant tumor in colon even though the cancer is widespread in the entire body
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| SANGUINEOUS | bright red drainage from a wound
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| SEROSANGUINOUS | pinkish drainage as the blood in the drainage decreases
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| SEROUS | straw-colored or clear drainage, as it thins out and becomes lighter.
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| ablation | removal of tissue
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| what are the variables that affect surgical outcome? (6) | age, nutritional status, fluid balance, medical diagnoses, drugs, and habits
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| t/f Older adults who are in good health are likely to do just as well in surgery as younger people. | TRUE
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| Why do older adults respond differently to drugs than younger adults? | Bc of age-related changes in the liver and kidney function and drug interaction.
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| How do you prevent surgical risks in older adults? | Control chronic conditions, carefully evaluation drug therapy, and keep them well hydrated and nourished before surgery. (that is why emergency situations carry more risk for older ppl)
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| How does an overweight patients nutritional status affect surgical procedures? | Bc they are in surgery longer. effective breathing exercises are limited by the excess wt. adipose tissue has poor blood supply so the healing process is slower. anesthesia remain longer in adipose tissue - takes longer to recover.
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| How does an underweight patients nutritional status affect surgical procedures? | malnourished pts are at risk for poor wound healing and infection.
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| How do physicians monitor F&E pre-op? | Physicians order lab tests to measure serum electrolytes before surgery and any imbalances can be corrected preop.
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| which habits alert the nurse to the possibility of specific perioperative comp. | smoking and alcohol use. smoking increases the risk of pulmonary comp. due to more copious/tenacious secretions and less effective ciliary activities. Alcohol increase drug tolerance so higher levels of anesthesia may have to be used.
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| Alcohol damages liver which can cause what.. | Impairment to metabolize drugs, anesthesia agents. also liver disease puts pt at increase risk of bleeding.
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| Goals of a Pre-operative nursing care | to inform the patient of what to expect, reduce patient anxiety, and decrease the risk of
during and after surgery.
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| lab tests that may be performed pre-operatively | blood and urine, blood grouping and crossmatching, chest radiography, pulmonary function tests, electrocardiography (ECG)
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| outpatient surgery: it is especially important to obtain some information in advance why.. | bc the time available for a comprehensive assessment will be limited.
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| What must a patient sign before surgery? | consent form
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| What is a consent form? | It states that the patient has been informed about the procedure to be done, the alternative treatments, and the risks involved and that the patient agrees to the procedure.
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| What is the physician's responsibility regarding the procedure informed consent? | the physician must explain the procedure and the risks to the patient; the nurse must obtain and witness the patient's signature on the form if agency policy allows.if the pt has doubt or questions, contact the physician
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| Bc the consent form is a legal document, the patient state of awareness must be: | fully alert and aware of what it contains when signing it.
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| what do you do to prep the bowel in abdomen or digestive tract surgeries? | give an enema or laxative to empty the bowel, or instruct the pt to do this at home before being admitted to the hospital
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| three reasons to do bowel preparations | 1. to reduce risk of contamination of fecal matter during operation. 2. helps prevent against distention until normal bowel function returns. 3. avoids constipation and straining in postop period
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| skin prep includes: | scrubbing and removing hair from a wide margin around the planned surgical site. typically pt are required to wash site with antiseptic soap the evening before surgery and again in the morning. nurse scrubs skin shortly b4 op. and hair is clipped ifneeded
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| t/f Most anesthesiologists and nurse an. prefer that dentures be left in during surgery. | TRUE
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| Wristbands include what vital information: | name, allergies, and blood type
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| Hearing aides are often ______ for surgery. | left in place
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| define "on call" for drug dosing | means the physician will let you know when to give the specific order of drug
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| three preoperative meds are: | anticholinergic to decrease sectretions, antiemetic to control nausea and vomiting, and an opioid to decrease anxiety and promote sedation
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| Regional anesthesia is achieved by using local anesthetics that block the conduction of nerve impulses in a specific area. list local anesth: | lidocaine hcl (Xylocaine), bupivicaine hcl (Marcaine HCL), tetracaine (Pontocaine) and ropivacaine (Naropin). (dental work, eye surgery,cosmetic surg,repair of lacerations,childbirth. lc are agents of choice for older adults.pt does NOT lose consciousnss
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| which poses as a worse threat to resp, cardiac, and gi complications.. general anest or spinal/epidural anesthesia? | general anesthesia
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| one complication from spinal anesthesia | postspinal headache
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| what is ps headache caused from? | leaking of cerebrospinal fluid at the puncture site. can be severe lasting several weeks. RELIEF: lying flat
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| alternative method to relieve postspinal HA | blood patch. can be repeated if needed. successful patch relieves the HA immediately.
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| What should you do until mobility is reached after regional anesthesia? | passive ROM to prevent thrombus formation (clot).
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| t/f motor skills return before sensory skills with regional anest. | true. at that time, pt is at risk of injury from trauma or pressure bc movement is possible but pain is not perceived.
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| complications of local anesthesia: | toxic effects caused by overdose (S&S excitement and cns stimulation followed by depression of cns and cv syst), local tissue damage, allergic responses.
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| t/f Abscesses and necrosis developing at the injection site is said to be caused by poor technique rather than by the agent | TRUE
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| General anesthesia acts on the cns causing loss of consciousness, sensation, reflexes, pain perception, and memory. Combination drugs are used for this why? | Bc multiple drugs will prevent excessive CNS depression. this is called balanced anesthesia, allowing lower dosages of each drug, reducing the risks of adverse effects.
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| route of general anest.? | usually through inhalation or intravenous infusion.
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| inhalation agents are: | isoflurane (Forane), sevoflurant (Ultane), enflurane (Ethrane), desflurane (Suprane), methoxyflurane (Penthrane), and nitrous oxide
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| how is endotrachealtube placed | short-acting iv agent used to cause rapid loc, tube is inserted to permit admin. of inhalation anesthesia and control mech ventilation. cuff on the tube is inflated to prevent leakage and aspiration of gastric contents while unconscious.
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| intravenous agents are: | thiopental sodium (Pentothal), methohexital sodium (brevital sodium), propofol (Diprivan), midazolam (Versed), etomidate (Amidate) etc.
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| Muscle relaxants prevent what during the operation? | movements of the muscles
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| opiods help with what, postop? | pain management
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| benzodiazepines are used for : | to induce and maintain anesthesia, for conscious sedation, and to sedate pts during local or regional anesthesia.
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| what is malignant hyperthermia | occurs in response to certain drugs like when succinylcholine is used with general anesthetic agents. characteristics: increasing body temp and metabolic rate, tachycardia, hypotension, cyanosis, and muscle rigidity.
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| what to do with malignant hyperthermia? | when occurs, surgery is interrupted and measures are taken to cool the pt (iced iv solution) 100% o2 given, & lasix, sodium bicarbonate and diuretics.
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| What is hypothermia? | body temp is lower than normal. sometimes, deliberately to reduce the metabolic rate and need for o2. cooling or freezing of a local area to block pain impulses is called cryoanesthesia.
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| conscious sedation | iv drugs are used to reduce pain intensity without loss of REFLEXES.
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| PACU definition | postanesthesia care unit or "recovery room"
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| post op complications are related to: | drugs used before and during procedure, or to immobility during and after the procedure.
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| In immediate recover periods, the most likely complications are: | hypoxia and shock. however, wound infection is not seen until several days later.
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| Causes for hypovolemia and shock: | low blood volume from bleeding, dehydration without adequeate fluid replacement or fluid losses through wounds and suction.
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| Hypoxia | inadequate oxygenation of body tissues. @ risk in immediate postop phase for several reasons
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| how does hypoxia occur | gen.anes. depresses resps causing breathing efforts to be initially inadequate. 2nd: when unconsious, the tongue may block airway. 3rd:vomitus/saliva can enter airway due to no swallow reflex. 4th: laryngospasm or bronchospasms (narrow & obstruct airway)
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| drug effects and imobility place the surgical pt at risk for ___ and ___ especially ____ adults. | pneumonia; atelectasis; older and obese, those with chronic pulmonary disease, and those who have undergone chest or abdominal surgery.
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| hypostatic pneumonia | an infection of the lungs associated with immobility
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| to detect shock, the pts vs are monitored every__ to ___ minutes in the PACU. | 5-15
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| S&S of impending shock are: | rapid thready pulse, restlessness, decreasing bp, decreasing urine output
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| t/f an increasing pulse usually precedes a falling blood pressure | TRUE
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| An increased pulse rate is usually a good indicator for what? | poor oxygenation!!!!!!
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| what happens if opioids are given too early in the postoperative phase? | the combined effect with anesthesia may lead to shock. howeverrrrr severe pain also may cause shock.
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| always chart times that the patient regains both movement AND&& sensation after a spinal anesthesia.. t/f | TRUE. also assess for bladder distention since the pt cannot feel pressure yet
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| To move the patient out of the recovery room six things must be met: | 1. VS are stable 2. Resp. and Circulatory fcns are adequate 3. patient has minimal pain 4. patient is awake or can be wakened easily 5. complications are absent or are under control 6. the gag reflex is present.
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| One common source of discomfort is singultus aka... | hiccups
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| signs and symptoms of infection in a wound develop usually around what post op days? | 3rd to 5th day or as late as one week after the operation
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| Classic signs of wound infection are.. | pain, fever, redness, swelling, and purulent drainage. fever is expected the first two days after surgery due to normal inflammation in the healing process.
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| is 100.4 (38c) temperature back 3 days after surgery? | Yes.. if it lasts longer than 2 days or is higher than 100.4, it may be signs of infection.
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| Is redness around the wound bad? | Yes and no. If the redness is increasing to outer tissues more andmore, this is not normal.
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| how often do you document respiratory status? | 1st 24hrs: every hour. then, once or twice a shift after that.
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| S&S of pneumonia.. | fatigue, dyspnea, fever, cough, purulent or bloody sputum, and "wet" breath sounds. pulse rate usually increases. breath sounds absent in areas of atelectasis.
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| what is the most important preventative measure against pneumonia and atelectasis? | frequent position changes, q2h initially, and deep-breathing exercises. first day: assisted out of bed. beginning 2nd day: ambulated several time x day.
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| Deep breathing and coughing are used why | DEEP BREATHING: inflates lungs fully COUGHING: removed secretions. help pt do this every HOUR
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| how to deep breath | deep breath through nose and gradually blow out through the mouth. after several deep breaths, a cough should be attempted to bring up secretions.
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| this is used to promote lung expansion | incentive spirometer
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| coughing is contraindicated for who? | surgery patients from hernias and cataracts as well as brain surgery
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| how to treat pneumonia | rest, oxygen, and antibiotics
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| cathaterization is usually done after how many hours of non-voiding after surgery? | 6-8hrs post-op
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