Care of the Surgical Pt

Question 1

From the time the decision to have surgery until the pt is transported into the OR

Answer 1

Pre-operative phase

Teaching is the major goal, especially to help decrease anxiety of the patient

Question 2

What are examples of pre-op baseline assessments?

Answer 2

Vitals, allergies, labs, nutritional status, support systems, medical/surgical/family history, tobacco/alcohol, meds, LMP (last period for ladies)

Question 3

What can affect surgical response?

Answer 3

Age, meds, tobacco, alcohol, medical history, psychosocial issues

Question 4

Advocates specific guidelines for preop administration of antibiotics. Within 1 hr of surgical incision.

Answer 4

Surgical Care Improvement Project (SCIP)

Question 5

Non-sterile team member. Coordinates, documentation, communication, pt care

Answer 5

Circulating nurse

Question 6

Sterile team member. Equipment, drapes pt, anticipates needs, specimens.

Answer 6

Scrub nurse

Question 7

Non-sterile team member. Anesthesia, vitals, intake and output, monitoring, blood products.

Answer 7

CRNA/anesthesiologist

Question 8

Definition of general anesthesia?

Answer 8

A state of narcosis, analgesia, relaxation, and loss of reflexes produced by pharmacologic agents.

Question 9

Hyper-metabolic condition involving altered Ca functioning in skeletal muscles which leads to increased muscle contraction (rigidity), hyperthermia, CNS damage. SS?

Answer 9

Malignant hyperthermia
Tachycardia (early), cardiac dyer, hypotension, decreased cardiac output, oliguria, temp elevation (late), skeletal muscle rigidity

Question 10

Skeletal muscle relaxant used to treat.

Answer 10

dantrolene sodium (Dantrium).
Working is ss subside/eliminated
Adverse hepatotoxicity

Question 11

An anesthetic agent is injected around the nerves so that the area supplies by these nerves is anesthetized

Answer 11

Regional anesthesia

Question 12

Injection of a solution containing the anesthetic agent into the tissues at the planned incision site, affecting only the local area

Answer 12

Local anesthesia

Question 13

Involves the use of sedation to depress the level of consciousness without altering the pt’s ability to maintain a patent airway and to respond to physical stimuli and verbal commands.

Answer 13

Moderate sedation

Question 14

What interventions to maintain a patent airway? Causes of airway obstruction?

Answer 14

Monitor pulse ox and RR. Positioning. Apply O2. Deep breathing exercises.
Relaxation of the tongue, secretions, stridor.

Question 15

When is oxygen given to postop patients?

Answer 15

Almost always. Until the pt is conscious and can take deep breaths on their own. O2 stats 92-98%

Question 16

What are some complications from spinal anesthesia? Management?

Answer 16

Headaches from spinal fluid leaks, urinary retention.

Positioning on their back, activity, fluids, medication, neurosensory assessment, urinary output.

Question 17

Upon arrival from PACU, what should be assessed?

Answer 17

Airway, breathing, mental status, surgical incision//dressing, vital signs, IV fluids. Assess tubes and suction if need be. Review, implement orders. Documentation.

Question 18

Interventions for hypotension?

Answer 18

Elevate legs, IV fluids, check for bleeding, frequent vitals/labs, assess sedation level, administer oxygen as directed, assess pain meds pt has received

Question 19

SS of bleeding?

Answer 19

Restlessness, change in LOC, weak thready pulse, tachycardia, hypotension, tachypnea, cold clammy skin

Question 20

Interventions for reparatory compromise?

Answer 20

Cough and deep breathe, incentive spirometer, change position Q2h, hydration, ambulation asap

Question 21

SS of the onset of respiratory compromise?

Answer 21

Fever, tachycardia, bradypnea, tachypnea (more often than Brady), decreased O2, adventitious breath sounds, altered LOC

Question 22

What is seen with fluid overload?

Answer 22

Hypertension, tachy cardia and pnea, rales, weight gain, altered LOC

Question 23

SS of wound dehiscence? Interventions?

Answer 23

SS fever, prolonged increased pain, increased drainage, popping sensation
Stay calm, notify HCP, abdominal binder, no coughing, bedrest, possible surgery

Question 24

SS of wound evisceration? Interventions?

Answer 24

SS pain, popping sensation, protruding abdominal contents
Cover abdominal contents with sterile saline and sterile gauze, notify HCP stat, stay with patient, no coughing, bedrest, stay calm, prepare for surgery: NPO