Care of the Surgical Patient ( ch 2 adlt hlth) Flashcards
The patient is 38 years old and is in her second postoperative day after placement of an intramedullary rod in her left femur. She is receiving analgesia via a patient-controlled analgesia (PCA) device. The inappropriate intervention related to caring for a patient with a PCA is:
Administering the analgesia to the patient.
-With the PCA system of medication administration, the patient can self-administer an analgesic by pressing a control button. The nurse should not give medication doses by pushing the control button.
A 73-year-old patient with diabetes was admitted for below-the-knee amputation of his right leg. Removal of his right leg is an example of which type of surgery?
Ablative
The Patient’s Bill of Rights states that a patient must give his or her permission for any specific test or procedure to be performed. What is the legal term for this permission?
Informed consent
An informed consent was to be obtained from the patient for his scheduled open cholecystectomy. Which circumstance could prevent the patient from signing his informed consent?
An injection of Demerol, 75 mg IM, 1 hour ago
The anesthesiologist provides ____ anesthesia by inhalation and IV administration routes.
general
A type of anesthesia that requires a depressed level of consciousness is
conscious sedation.
The older adult patient may not respond to surgical treatment as well as a younger adult because of
his or her body’s response to physiological changes.
A 45-year-old patient has had a repair of a cerebral aneurysm and is presenting signs of increased intracranial pressure (ICP). Which postoperative nursing interventions would be contraindicated?
Coughing every 2 hours
A male patient, age 80, has had a total hip replacement. Anxiety, hypotension, and jarring during transfer from the recovery room to his room can cause a postoperative increase in which of his vital signs?
Pulse rate
A patient, age 65, underwent a right hemicolectomy. On postoperative day 4, her surgical wound dehisced. This means that
there is partial or complete wound separation.
A patient is on postoperative day 2 after a nephrectomy. The nurse is aware that the most effective way to increase her peristalsis is
ambulation.
A patient is transferred from the operating room to the recovery room after undergoing an open reduction and internal fixation (ORIF) of his left ankle. Which is the first assessment to make?
Check airway for patency.
Frequent assessment of a postoperative patient is essential. One of the first signs and symptoms of hemorrhage may be
restlessness.
Frequent monitoring of the postoperative patient’s vital signs assesses which body system?
Cardiovascular
Decreased activity in an obese surgical patient predisposes the patient to which complication?
Hypoventilation
The nurse acknowledges that all preoperative nursing interventions have been performed by signing which document?
Preoperative checklist
Which nursing interventions would be appropriate after a wound evisceration?
Apply a warm, moist normal saline sterile dressing.
When should the nurse offer prescribed analgesics to a patient who is 24 hours postoperative?
Regularly every three to four hours before pain gets severe.
What nursing interventions will minimize the effects of venous stasis?
Early ambulation
Serum potassium levels are usually determined before surgery to
prevent dysrhythmias related to anesthesia.
The nurse is assisting with the sponge and instrument count in the operating room. The operative phase in which the nurse is assisting is called the
intraoperative phase.
Which early postoperative observation is abnormal and should be reported immediately?
Emesis that is red
Sudden chest pain combined with dyspnea, cyanosis, and tachycardia is an indication of
pulmonary embolus.
An appendectomy during a hysterectomy would be classified as
minor, elective, ablative.
Which patients would be at greatest risk during surgery?
27-year-old taking an anticoagulant agent
A patient will have an incision in the lower left abdomen. Which intervention by the nurse will help decrease discomfort in the incisional area when she coughs postoperatively?
Apply a splint directly over the lower abdomen.
Although informed about the proposed surgical procedure, the patient has only vague responses about the postoperative period. A nursing diagnosis at this time would be
Deficient knowledge, postoperative
A patient and a nurse develop a preoperative teaching plan. In teaching the patient to cough effectively after surgery, the nurse should tell her to practice
taking three deep breaths and coughing from the chest.
What is the responsibility of the nurse regarding informed consent?
Obtain the patient’s signature.
On the patient’s return to the medical-surgical unit, the nurse performs an abdominal assessment. To assess bowel sounds, the nurse auscultates the lower abdomen for
1 minute.
Which preoperative fear is linked to postoperative behavior?
Fear of anesthesia and death
Ideally, preop teaching should be done
1 to 2 days before the surgery when anxiety is not as high.
In preparation for the return of the surgical patient, the patient’s bed and equipment should be in what position?
Highest position with the side rails down on receiving side and up on opposite side
Southeast Asian and Native American patients often do not make eye contact when preoperative teaching is being performed because
they believe eye contact is disrespectful.
What are the high-risk conditions that may affect perioperative procedures? (Select all that apply):
Age, mental state, nutritional status, health
A postoperative patient who had a left inguinal hernia repair is ready for his discharge instructions. Which information should the nurse provide? (Select all that apply.)
Care of the wound site and any dressing
When he may operate a motor vehicle
Signs and symptoms to report to the physician
Actions and side effects of any medications
Two considerations for the older adult surgical patient include (Select the two that apply.)
pre- and postoperative teaching.
surgery causes much physiological stress.
In preparing the patient for abdominal surgery, the Assistive Personnel (AP) can perform which interventions? (Select all that apply.)
Vital signs
Enema
Height and weight
_____ therapy is performed to alleviate or decrease uncomfortable symptoms without curing the problem.
Palliative
Discharge planning for a surgical procedure begins in the ______________ period and continues through the _____________ period.
preoperative, recuperative
A patient is transferred from the operating room to the recovery room after undergoing an amputation of his left foot. Place the interventions in the correct order for immediate assessment once the patient enters the PACU. Place a comma between each answer choice (a, b, c, d, etc.).
Airway Breathing Level of consciousness Circulation System review
Anastamosis
Surgical joining of two ducts or blood vessels to allow flow from one to another
Ectomy
Surgical Removal of
Plasty
Plastic surgery
Pexy
Surgical fixation
Otomy
Opening into
Ostomy
Opening made to allow the passage of drainage
Oscopy
Direct visualization with a scope
Orrhaphy
Surgical Repair of
Lysis
Destruction or dissolution of
Surgery
The branch of medicine concerned with diseases and trauma requiring operative procedures
Surgery Seriousness (Minor)
Involves Minimal alteration in body parts
Often designed to correct deformities
Involves minimal risks
Surgery Purpose
Diagnostic, ablation, palliative, reconstruction, transplant, constructive
Antibiotics
Increase action of anesthetic agents
Anticholinergics
Increase potential for confusion
Anticoagulants
Increase the risk for bleeding
abalative
excision or removal of diseased body part
palliative
relieves or reduces disease symptoms, not a cure
Diagnostic Surgery
Surgical exploration that allows physician to confirm diagnosis
Elective Surgery
Planned for correction of a nonacute problem
Cosmetic Surgery
Alteration of personal appearance
Palliative Surgery
Performed to relieve symptoms of a disease process, but does not cure
(ex colostomy, debridement of necrotic tissue)
Reconstructive
Restoration of function or appearance to traumatized or malfunctioning tissue
Curative Surgery
Surgery that cures the problem or condition
When assessing the patient, ask the following
- Chemical, substance or alcohol use
- Herbal use
- Smoker
- Allergies, latex allergy
- Past surgeries
- Prescription meds taken
- OTC drugs
Diuretics
Increased risk for electrolyte imbalance
Coticosteroids
Atrophy of adrenal glands, lowered ability to handle stress
Antihypertensives
Can cause bradycardia, hypotension, and impaired circulation
Antidysthythmics
Decrease cardiac contractibility
Antidepressants
Lower blood pressure during anesthesia
Anticonvulsants
Alter metabolism and ion transport
Preventative
Surgical procedure that prevents any problems or damage from occurring
Transplant
Replacement of malfunctioning organs
Urgent
Necessary for patients health required to keep additional Health problems from occurring
Emergent
Performed immediately to save the individuals life or to preserve the function of a body part or system
atelectasis
an abnormal condition characterized by the collapse of lung tissue
cachexia
ill health, malnutrition, and wasting as a result of chronic disease
conscious sedation
the patient is given drugs that depress the CNS or provide analgesia in order to relieve anxiety or provide amnesia during surgical diagnostic procedures
embolus
a traveling or mobilized clot
venous stasis
a disorder in which the normal flow of fluid through a vessel of the body is slowed or halted. perform leg exercises every 2 hours. do not cross legs
urinary function
it routinely takes 6-8 hours for voiding to occur after surgery if pt’s do not void w//in 8 hrs, catheterization may be necessary, but only as a last measure
hypovolemic shock
in the postoperative period can be a life-threatening emergency and is frequently caused by internal hemorrhage or excessive loss of blood or fluids during surgery
exudate
substances (ex perspiration, pus, serum) that slowly seep from cells or blood vessels through small pores or breaks in cell membranes
incentive spirometer
a device used to force the client to concentrate on inspiration and promote full inflation of the lungs, while providing immediate feedback; used particularly after surgery and in lung disorders.
paralytic ileus
Peristalsis stops as a results of surgery that involves direct manipulation of the bowel. Lasts for 24-48 hours.
singultus
hiccups (involuntary contraction of the diaphragm followed by rapid closure of the glottis
thrombus
an accumulation of platelets, fibrin, and cellular elements of the blood attached to the interior wall of a vessel, sometimes occluding the lumen
ABCDEF
mneumonic device for preoperative patient allergies, bleeding, cortisone, diabetes mellitus, emboli, fighting ability
emboli
Blockage of a vessel by a clot or foreign material brought to the site by the blood current.
echinacea
treat cold symptoms
negative on liver, interference with anesthesia
ephedra sinica
decongestant weight loss
risk cardiac dysrhythmias
garlic
improved immunity, high blood pressure and cholesterol
increased bleeding
ginger
motion sickness, cough, menstrual cramps, intestinal gas
prolonged clotting times
ginkgo biloba
brain function and alertness, tension, erectile dysfunction
increased bleeding
ginseng
overall well-being, diabetes
potential hypoglycemia, anesthetic factors
kava
sleep aid, anxiety, tension
potentiate muscle relaxants, serious liver damage
st. john’s wort
antidepressant, antiviral properties, anti-inflammatory action
general anesthesia
produces amnesia, analgesia, muscle paralysis and sedation
state of unconsciousness
regional anesthesia
causes loss of sensation in an area of the body and is used for some surgical procedures and pain management
nerve block, spinal anesthesia, epidural anesthesia
nerve block
local anesthetic is injected into a nerve, blocking the nerve supply to the operative site
spinal anesthesia
anesthesiologist or CRNA performs a lumbar puncture and introduces local anesthetic into the cerebrospinal fluid in the subarachnoid space
epidural anesthesia
anesthetic agent is injected into the epidural space outside the dura mater and the depth of anesthesia is lighter
infiltrative anesthesia
the anesthetic agent may move upward in the spinal cord and affect breathing
Heat & Cold Therapy
Commercial Hot Packs
- Commercially prepared, disposable hot packs apply warm, dry heat to an injured area
- Sticking, kneading, or squeezing the pack mixes the chemicals & releases the heat
Heat & Cold Therapy
Electric Heating Pads
- Pad consists of an electrical coil enclosed within a waterproof pad covered with cotton or flannel cloth
- The pad is connected to an electro cord that has a temp-regulating unit for a high, medium, or low setting
