Adult Health I: Final Exam (Weeks 1-3)

Question 1

Pre-Op

What components are apart of a preoperative assessment?

Week 1: Pre/Post-Operation Care and Medication Calculation

Answer 1

• Complete vital signs (Report abnormals)
• Focused asessment on reported problem areas
• Assessing and reporting signs and symptoms of infection
• Assessing and reporting cautionary conditions and contraindications to surgery
• Labs, Imaging and ECGs
• Psychosocial assessment

Question 2

Pre-Op

What are interventions for pre-operative patients?

Week 1: Pre/Post-Operation Care and Medication Calculation

Answer 2

• NPO
• Administer appropriate drugs
• Ensure intestinal preparation (if indicated)
• Perform skin prep
• Prepare patient for tubes/drains and vascular access
• Minimize anxiety
• Plan for pain management
• Teach about indentification/prevention of CV complications
• Teach about post-op interventions

Question 3

Pre-op

What are things that should be reviewed for pre-operative patients?

Week 1: Pre/Post-Operation Care and Medication Calculation

Answer 3

• Recording vital signs within 1-2 hours of procedure
• Record height and weight fot proper dosage for anesthetic agents
• Check for completed consent forms
• Removal of dentures, prosthetic devices, hairpins, clips and hearing aids (All accessories)
• Empty patient’s bladder
• Bed in lowest position
• Answer questions and offer reassurance

Question 4

Post-Op

What are components in a post-operative assessment?

Week 1: Pre/Post-Operation Care and Medication Calculation

Answer 4

• Airway and breathing
• Mental status
• Incision site(s)
• Vital signs
• IV fluids and connections, foley, NGT, monitor
• Pain assessment and management

Question 5

Post-Op

What are interventions for post-operative complications in patients?

Week 1: Pre/Post-Operation Care and Medication Calculation

Answer 5

Post-Op Nausea and Vomiting
* Ondansetron, Dimenhydrinate, Scopolamine

Decreased/Diminished Peristalsis (< 24 hours)
* Monitor bowel signs

Hypoxemia
* Airway maintenance, oxygen saturation, positioning, oxygen therapy, breathing, exercise, early ambulation, q 2 turns, antiembolism stockings, peumatic compression device

Wound Infection/Delayed Healting
* Change dressin when appropriate, Drug therapy
* Asess for infection, drains/drainage

Pain
* Non-pharmaceutical therapies, drug therapy

Venous Thromboembolism
* Antiembolitic stockings, early ambulation

Question 6

Post-Op

What are post-operative complications?

Week 1: Pre/Post-Operation Care and Medication Calculation

Answer 6

• Nausea/Vomiting
• Decreased Peristalsis
• Hypoxia
• Wound Infection/Delayed Healing
• Pain
• VTE

Question 7

Post-Op

What is the difference between dehiscence and evisceration?

Week 1: Pre/Post-Operation Care and Medication Calculation

Answer 7

Dehiscence is the splitting open of a wound.

Evisceration is the protrusion of internal organs through the open wound.

Question 8

Post-Op

When a dressing on a post-op patient is damp with drainage and you have not recieved direction from the wound care nurse/surgeon, what do you do?

Week 1: Pre/Post-Operation Care and Medication Calculation

Answer 8

Reinforce the dressing

Question 9

Pre-Op

Which labratory test should be anticipated before surgery?

Week 1: Pre/Post-Operation Care and Medication Calculation

Answer 9

Urinalysis, Electrolyte Levels, Clotting Studies, Serum Creatinine

Question 10

Post-Op

What are interventions for wound complications?

Week 1: Pre/Post-Operation Care and Medication Calculation

Answer 10

Dishiscence
* Apply sterile nonadherent/saline dressing to the wound
* Notify the surgeon
* Instruct patient to lie supine, bend the knees and avoid coughing

Evisceration
* This is a surgical emergency
* Notify the surgeon
* Apply sterile saline soaked guaze
* Instruct patient to lie supine, bend knees, avoid coughing
* Review Emergency care of the patient

Question 11

ABGs

What are the Arterial Blood Gases and their values?

Week 2: ABGs and Trach Care

Answer 11

Pa02: 80-100 mg Hg
pH: 7.35-7.45
PaCO2 (respiratory): 35-45
HC03 (metabolic): 22-26

Question 12

ABGs

What are the values, causes and treatments of respiratory alkalosis and metabolic alkalosis?

Week 2: ABGs and Trach Care

Answer 12

Respiratory Acidosis
* ph below 7.35 and CO2 above 45

Respiratory Alkalosis
* ph above 7.45 and CO2 below 35)

RO ME (Respiratory Opposite; Both in different directions)

Question 13

ABGs

What are the values, causes and treatments of metabolic acidosis and metabolic alkalosis?

Week 2: ABGs and Trach Care

Answer 13

Metabolic Acidosis
* ph below 7.35 and HCO3 below 22

Metabolic Alkalosis
* ph above 7.45 and HCO3 above 26

RO ME (Metabolic Equal; Both in the same direction)

Question 14

Trach Care

What are some complications that can come with a tracheostomty?

Week 2: AGBs and Trach Care

Answer 14

• Dislodgement
• Obstruction
• Subcutaneous emphysema (rare!)
• Skin breakdown
• Infection
• Bleeding

Question 15

Trach Care (2 questions)

What interventions could we apply to trach care to prevent complications?

Week 2: ABGs and Trach Care

Remember what complications can arise

Answer 15

Dislodgement → Maintain extra trach and obturator at bedside
Obstruction → Suctioning, Ensue placement and patency, Aspiration percautions
Subcutaneous Emphysema → ???
Skin Breakdown → Stoma cleaning/care
Infection → Stoma cleaning/care, Frequent oral care
Bleeding → Monitor cuff pressures (14-20 mmHg)

Question 16

Trach Care

What is included in stoma care?

Week 2: ABGs and Trach Care

Answer 16

• Cleaning the area (NS)
• Providing gauze to collect secretions around the area
• Clean multiple times throughout the day and
• Change/clean inner cannula once a day
• Change commercial ties once a week

Question 17

Trach Care

What are things to remember when suctioning a patient?

Week 2: ABGs and Trach Care

Answer 17

• This is a STERILE PROCEDURE
• Preoxygenate to 100% O2 for 3 breaths before suction
• SOB and Coughing are expected
• Insert until resistance and back up an inch
• NO SUCTION GOING IN
• DO NOT SUCTION LONGER THAT 10-15 SECONDS
• Reoxygenate for 1-5 minutes after to baseline

Question 18

Trach Care

What are the complications and interventions of suctioning?

Week 2: ABGs and Trach Care

Answer 18

Hypoxia → Proper oxygenation (before and after), limited suction time, correct catheter size
Mucosal Trauma → No suction against resistance, 80-120 mmHg pressure, limited suctioning time
Infection → sterile procedure
Vagal stimulation/Bronchospasm → limited suction time
Cardiac Dyshrythmias → related to hypoxia

Question 19

Trach Care

What are nutritional concerns with a tracheostomy?

Week 2: ABGs and Trach Care

Answer 19

ASPIRATION
* Elevate HOB for 30 minutes after eating
* May need to be placed on enteral feeding

Question 20

Trach Care

What is one thing to note about psychosocial care for patients with a tracheostomy?

Week 2: ABGs and Trach Care

Answer 20

Communication!
* Encourage writing or other communication tools
* Be patient
* Involve speech therapy

Question 21

Asthma

What are common types of triggers for asthma?

Week 3: Non-infectious Respitory Illnesses

Answer 21

• Allergens
• Cold/Poor Air
• Exercise
• Resp. Illness
• Irritants (smoke, strong orders, dust)
• Microorganisms
• GERD
• Stress

Question 22

Asthma

What assessment history would you need to gather?

Week 3: Non-infectious Respitory Illnesses

Answer 22

• Family Hx
• Smoking
• Triggers
• Frequency

Question 23

Asthma

What are symptoms that are specific to asthma?

Week 3: Non-infectious Respitory Illnesses

Answer 23

• Coughing
• Chest Tightness
• Retractions (suprasternal notch and intercostal space)
• Wheezing
• Barrel Chest from prolonged asthma

Question 24

Asthma

What are different diagnostic tests for asthma?

Week 3: Non-infectious Respitory Illnesses

Answer 24

Arterial Blood Gases
Pulmonary Funtion Tests (PFTs)

Question 25

Asthma

What are interventions used for asthma?

Week 3: Non-infectious Respitory Illnesses

Answer 25

• Avoiding triggers or premedicating beforehand
• Review action plan and peak flow
• Teach proper use of inhalers/nebulizes, emphasizing the use of spacers
• Oxygen therapy in case of hypoxia or acute attack
• Medications: Bronchodilators and Anti-inflammatory Agents

Question 26

COPD

Which two diseases are within COPD?

Week 3: Non-infectious Respitory Illnesses

Answer 26

Chronic Bronchitis: Inflammation of the airway with thick mucus

Emphysema: Air trapped in the alveoli causing hyperinflation of the lungs

Both are associated with smoking

Question 27

COPD

What are symptoms of COPD?

Week 3: Non-infectious Respitory Illnesses

Answer 27

• Orthopnea
• Fatigue
• Weight loss
• Sputum (Bronchitis)
• Chronic acidiosis (Emphysema)
• Barrel Chest (Emphysema)
• Nail Clubbing, Cyanosis and Hypoxia if severe

Question 28

COPD

What are diagnostic tests for COPD?

Week 3: Non-infectious Respitory Illnesses

Answer 28

ABGs
Sputum Sample
CBC (due to high Hgb)
Chest X-Ray
CT
PFT

Question 29

COPD

What are interventions for COPD?

Week 3: Non-infectious Respitory Illnesses

Answer 29

• Oxygen Therapy aiming for 88-90%
• Elevate HOB
• Tripod
• Smoking Cesation
• Energy and breathing conservation (pursed lips, diaphragmatic)
• Medications: Bronchodilators, Anti-inflammatory Agents and Mucolytic Agents

Question 30

COPD

What are complications for COPD?

Week 3: Non-infectious Respitory Illnesses

Answer 30

• Hypoxemia
• Acidosis
• Respiratory Infection
• Cardiac Failure
• Dysrrhythmias (A Fib)

Question 31

Chest Tubes

What are expected and not expected actions of the chest tube chamber?

Week 3: Non-infectious Respitory Illnesses

Suction Chamber, Water Seal and Air Leak, Collection Chamber

Answer 31

Suction Chamber
Expected: Gentle, steady, continuous, bubbling
Not Expected: Vigorous bubbling

Water Seal Chamber and Air Leak Monitor
Expected: Tidaling with breathing that slowly diminishes with time
Not Expected: Bubbling of any kind, sudden stop of tidaling

Collection Chamber
Expected: Dark blood drainage of any amount
Not Expected: Bright red drainage > 100/mL per hour

Question 32

Chest Tubes

What are some key things to remember when using the chest tube system

Week 3: Non-infectious Respiratory Illness

Patient assessment, Machine assessment, NEVER

Answer 32

Patient Assessment
* Check lung sounds for shortness of air
* Ask patient to turn, cough and deep breathe
* Check alignment of the trachea
* Always check the patient first, not the machine
* Check inscision site for infection or excessive bleeding

Machine Assessment
* Keep the system below the lungs
* Check the water level in the all the chambers
* Keep the chest tube as straight as possible
* Check and document amount, color and characteristics of fluid

NEVER
* NEVER Milk or strip the tube
* NEVER allow continuous bubbling in the water seal and air leak monitor chamber
* NEVER clamp a chest tube unless changing the system or checking for air leaks