258 revision 4

Question 1

how long before bowel surgery should you cease NSAIDs?

Answer 1

7 days

Question 2

how does bowel surgery affect long-acting insulin dose?

Answer 2

take half the usual dose before the procedure

Question 3

why is it important to monitor potassium in mechanical bowel prep?

Answer 3

hyperkalaemia can lead to cardiac arrhythmias/arrest

Question 4

what to watch for after bowel procedure?

Answer 4

rectal bleeding/signs of perforation (malaise, abdo distension, tenesmus)
patient may experience abdo cramps when peristalsis resumes because of air in bowel from procedure

Question 5

surgical fasting times

Answer 5

clear liquids up to 2 hours before

solids up to 4 hours before

Question 6

what are ERAs?

Answer 6

advance recovery protocols - 300 - 400ml of special drink up to two hours before surgery

Question 7

what assessments should a nurse be performing post-op?

Answer 7

ABCDE (primary assessment) 
FGH (secondary assessment) 
F is for fluids/full set of vital signs
G is for glucose/give comfort
H is for head to toe assessment

Question 8

how often should a full set of vital signs be taken in the immediate post-op stage?

Answer 8

every 15 minutes for 1 hour, every 30 minutes for 2 hours and then every 4 hours for 24 hours.

Question 9

what are the medication risks of the peri-op stage?

Answer 9

Anaesthetics can cause increased levels of some drugs in the body due to decreased blood flow to the liver. Some drugs can interact with some anaesthetic agents

risk assessment: full medication history

Question 10

why is there risk of post-op endocrine system complications? how would we assess for them?

Answer 10

Surgery/anaesthetics are a stress on the body negative nitrogen balance. Anaesthetics suppress the immune system and pain effects the endocrine system

Question 11

why is there risk of post-op integumentary system complications? how would we assess for them?

Answer 11

anaesthetics decrease ability to maintain homeostasis and body temp

body weight will contribute to this

keep normothermic

Question 12

why is there risk of post-op urinary system complications? how would we assess for them?

Answer 12

anaesthetics can alter urinary function

urinalysis
renal function: UEC (urea, electrolyte, creatinine)

Question 13

why is there risk of post-op nervous system complications? how would we assess for them?

Answer 13

anaesthetics lead to an altered LOC

orientation / GCS

Question 14

why is there risk of post-op respiratory system complications? how would we assess for them?

Answer 14

anaesthetics depress respiratory function

respiratory assessment

Question 15

what is the difference between pain threshold and pain tolerance?

Answer 15

threshold: level at which pain is felt

pain tolerance: level at which it becomes unbearable

Question 16

what increases pain tolerance

Answer 16

medications
distraction techniques
coping techniques
sleep and rest
empathy

Question 17

what lowers pain tolerance?

Answer 17

anxiety
anger
depression 
fatigue
isolation
inability to communicate effectively
previous pain experiences

Question 18

goal of treatment in chronic pain?

Answer 18

minimise pain-related disabilities rather than cure pain

Question 19

adjunctive treatments for neuropathic pain?

Answer 19

tricyclics, tramadol, ketamine, local anaesthetics

Question 20

referred pain from angina?

Answer 20

left arm

Question 21

referred pain from liver/gall bladder?

Answer 21

pain in right shoulder

Question 22

referred pain from kidney stones?

Answer 22

pain in groin