ER/OR Study Guide Flashcards
How do you remove a tick?
TWEEZERS
-grab at its HEAD and pull straight out WITHOUT CRUSHING BODY.
(crushing releases infected juices into wound)
If direct pressure doesn’t stop bleeding, what is your next measure?
ELEVATE if direct pressure doesn’t work.
Then…
- ICE pack
- INDIRECT PRESSURE (press blood vessel against bone)
Once you have assessed that your pts airway is NOT obstructed, and he is breathing, why are you still watching his chest?
You are observing their RESPIRATORY EFFORT.
-is it HARD, EASY… etc.
Chest injury? —> an cause internal bleeding
What are the ABCDE’s? Why are they in this order?
A=AIRWAY/Cervical Spine
B=Breathing
(sounds, effort, rate, depth, chest I jury?)
C=Circulation
(BLOOD, hr, bp, CMST)
D=Disability –> type of injury? assess NEURO
(LOC using AVPU)
E=Exposure –> what was pt exposed to?
(remove clothing, assessment, HYPOTHERMIA)
Head-tilt-chin-lift Vs. Modified jaw-thrust - when to assess –< what do we have to assess?
We need to know if there is a neck or spine injury.
Head-tilt-chin-lift –> WITHOUT trauma
-most efficient for opening airway
Modified Jaw-thrust –> WITH trauma
-inspect mouth for broken teeth, blood and vomit
What does agitation and confusion have to do with low O2 saturation?
S/S of HYPOXIA/LACK OF O2 –> (SOB)
-Have pt take DEEP BREATHS to increase SpO2
In a disaster, why aren’t the most critical pts attended to first?
ASSESS IN 60 SECS
Pts with NON-LIFE THREATENING injuries can be tended to first so that they can help attend to more serious pts.
CRITICAL pts are called EXPECTANT and are expected to die, and therefore are not attended to.
GOAL is to have to greatest survival of ppl.
Why is it important to let pts vent their feelings prior to surgery?
It is common for pts to experience FEAR, ANXIETY, and APPREHENSIVENESS during pre-op.
- Let them voice questions/concerns
- Assess coping mechanisms/support systems
- Provide support
Why would you suspect DVT in a pt with unilateral leg edema, not bilateral?
This is a S/S OF DVT - UNILATERAL, not bilateral leg edema, along with REDNESS, WARMTH, and TENDERNESS.
What are antiembolic stockings preventing?
DVT
Venous Stasis
Thrombophlebitis
What is the three-tier triage system about during a disaster?
EMERGENT - indicates LIFE/LIMB THREATENING situation.
EX - punctured artery
URGENT - indicated pt needs TX SOON, but the risk posed is NON-LIFE THREATENING
EX - Fractures
NON-URGENT - cases can generally wait for an extended period of time without serious deformation.
Who is responsible for the surgical consent making sure pts understand what is taking place and signed and why?
The SURGEON- explains procedure, risks, benefits, options, etc.
What is the triage protocol in a mass casualty?
EMERGENT (I): THREAT TO LIFE/LIMB
URGENT (II): MAJOR injuries that require IMMEDIATE TX
NON-URGENT (III): MINOR injuries that DO NOT REQUIRE IMMEDIATE TX
EXPECTANT (VI): one who is EXPECTED and ALLOWED to die.
Why do you ask about allergies before administering antivenin to a snakebite victim?
Most common S/E of ANTIVENIN is * ALLERGIC REACTION *
-Flushing, hives, itching, swellinCg, anaphylaxis
Always ASSESS FOR ALLERGIES
If your pt is on their way to surgery and asking too many questions while going over signed consent, and acting apprehensive, what would your next action be?
CONTACT THE SURGEON
It is the SURGEON’s responsibility to explain and make sure the pt understands and is comfortable with everything.
What is the drug of choice to treat anthrax?
ANTHRAX: transmitted by BACTERIA through direct contact.
TX: ANTIBIOTICS
** CIPRO IS DRUG OF CHOICE **
What type of drug is Versed?
VERSED: ** BENZODIAZEPINE **
- Used in CONSCIOUS SEDATION
- Enduces SLEEPINESS, relieves ANXIETY
- (short term amnesia)
Used in ENDOSCOPY
What safety issues are you monitoring with versed?
MONITOR -RR (s/e of versed is respiratory depression) -LOC -FALL RISK (versed has sedative effects)
What is a dehiscence?
SPLITTING OPEN/SEPARATING of a surgical incision.
** 5-10 DAYS POST-OP **
RISK FACTORS
- Obesity
- Coughing (especially without splinting)
- Diabetes
- COVER WITH MOIST STERILE DRESSING *
What is the rationale on why nurses check VS on ALL pts regardless on the severity on why their admitted
To get a BASELINE.
Why do we want the post-op pt up and ambulating 24 hours after surgery?
Encourage EARLY AMBULATION to PREVENT:
- DVT
- ATELECTASIS (partially collapsed lung)
- constipation
What kind of pts should be seen in the ER?
LIFE or LIMB THREATENING.
Clear Liquids vs. Full Liquids
CLEAR LIQUIDS: relatively transparent to light, liquid at body temperature.
- WATER/Bouillon/GELATIN
- Carbonated beverages
- Lemonade/COFFEE/Tea
- Ice pops
FULL LIQUIDS: opaque clear liquid (includes clear liquids)
- Ice cream/PUDDING/custard
- MILK/shakes
- refined cereals
- strained SOUPS/JUICES
What are ALT and AST test for?
ALT and AST both IDENTIFY LIVER INJURY/INFLAMMATION and STATUS OF DZ.
ALT –> 10-40 U/L
AST –> 10-30 U/L
What position do you place a persons arm that has just been bitten by a venomous snake?
The extremity should be IMMOBILIZED and kept BELOW THE LEVEL OF THE HEART.
(DEPENDENT)
What is the purpose of the Jackson-Pratt drain after surgery?
CLOSED drain system.
As the bulb expands it creates gentle suction, DRAINING to PREVENT ACCUMULATION OF FLUID!
Don’t forget to SQUEEZE the bulb entirely AFTER dumping out the drainage.
DOCUMENT!
Why to we splint a fx leg of a pt prior to moving from the scene of an accident?
SPLINT is applied to IMMOBILIZE and to PREVENT FURTHER DAMAGE/INJURY.
Monitor CMST.
Do not Splint is EMS is on scene.
Why is hip or knee replacement at risk for DVT?
These pts have the following risk factors associated with DVT: (due to surgery)
- IMMOBILITY
- Foreign object in body
(artificial hip/knee) - SURGERY
- Bone Surgery —> INCR. RISK FAT EMBOLISM
Why is it important for post-op pts to take deep breaths prior to taking spO2 sats?
You are not breathing deeply during sedation, so if you do not take deep breaths first, your lung expansion will be shallow.
DEEP BREATHS = LUNG EXPANSION = BETTER/More ACCURATE SpO2
If pts post-op have “wet” lung sounds, what would your goal be?
Have the pt COUGH and DEEP BREATHE.
unless coughing is contraindicated
Describe the first aid you would administer to a pt that was just stung by a bee/wasp/yellow jacket.
- REMOVE STINGER –> scrape off stinger with NEEDLE/CREDIT CARD
- DO NOT USE TWEEZERS - you could pinch the venom sac.
- Apply ICE!
** If pt is ALLERGIC - EPI-PEN –> EMERGENCY! **
What leg exercises would you have your pt do to prevent DVT?
-Wiggle toes (
Why is it important to elevate extremities that look red and edematous?
DECREASES SWELLING!!!
S/S OF DVT
- EDEMA/Swelling
- REDNESS
- Warmth
- Tenderness
- UNILATERAL extremity
Adult VS and ACCU ranges
TEMPERATURE
Oral: 96.8 - 100.4
Rectal: 97.7 - 101.3
Axilla: 95.9 - 99.5
PULSE: 60-100bpm
RESP: 12-20 rpm
BP: 90/60 - 139/89
PAIN: 0-10 scale (med @ >3)
ACCU: 70-110
What are the classifications of surgery?
ELECTIVE (Optional)
- NON-LIFE THREATENING
- PLANNNED
- Ex –> Cataracts, removal of nonmalignant mark, cosmetis surgery
NON-ELECTIVE (Required)
- Necessary AT SOME TIME, but pt has time to choose
- Ex –> hip replacement, hernia repair
URGENT
- must be performed WITHIN A SHORT PERIOD OF TIME to prevent further damage to pt.
- CAN BECOME LIFE/LIMB THREATENING
- Ex –> removal of something malignant, inflamed appendix
EMERGENCY (Major)
- IMMEDIATE SURGERY TO SAVE LIFE
- Ex –> Hemorrhage, mastectomy, ruptured appendix
Prioritize post-op pts in order of care.
A. Airway (patency!)
B. Breathing (rate, depth, sounds, chest movement)
C. Consciousness
C. Circulation (VS - “times four”)
S. Systems Review - body systems, drains, dressings, allergies, OUTPUT
What is the purpose of a T-Tube?
T-TUBE: placed after OPEN CHOLECYSTECTOMY of common bile duct.
- DRAINAGE OF BILE until edema resolves
- DRAINAGE IS BROWN-GREEN
- Drains to GRAVITY
What is the rationale on why nurses have to document all findings?
COVER YOUR BUTT!
- If it is NOT DOCUMENTED, it DIDNT HAPPEN
- COMMUNICATION
- CONTINUITY OF CARE
What is the purpose of the incentive spirometer?
INCENTIVE SPIROMETER: instrument that forces the pt to concentrate on inspiration while providing immediate feedback.
- * LUNG EXPANSION! *
- (increases circulation)
- PREVENTS ALELECTASIS
(decrease lung expansion when pt is in anesthesia)
What do we need an adequate supply of in case of an smallpox outbreak?
THE VACCINE!
If you get exposed to smallpox, the vaccine can still help prevent disfigurement.
- VACCINE SUPPLY - ENOUGH FOR EVERY US CITIZEN
- HIGHLY CONTAGIOUS
What is venous stasis?
The slowing, stopping, or POOLING of blood in veins.
How does splinting an incision line help with post-op exercises?
SUPPORT incision/wound.
PREVENT dehiscence
RELIEVE DISCOMFORT during coughing
*pain meds 30 mins prior to exercise
What is the purpose of pre-op medication before surgery?
- HELPS FACILITATE ANESTHESIA **
- HELPS WITH ANXIETY **
SEDATIVES 1. Benzo's --> helps w/ anxiety 2. Barbituates GI MEDS 1. Antiemetics 2. Antacids/H2 Blockers ---> decreases acid --> decrease chance of vomiting.
What is serosanginous drainage?
Drainage composed of SERUM and BLOOD.
- Appears PINK-TINGED
- FIRST 5 DAYS post-op
How long is it normal to have serosanginous drainage?
1-5 DAYS POST-OP
What does “healthcare associated infection” mean?
HAI/ “nosocomial” infection.
An infection that is ACQUIRED IN THE HOSPITAL or healthcare setting.
Define oliguira.
A decrease in the expected amount of urine a person secretes and excretes.
<500ML/DAY
What is the normal protocol on VS upon admission to the PACU?
Take VS using the “TIMES FOUR” method:
- every 15 MINS x 4
- every 30 MINS x 4
- every HOUR x 4
- every 4 HOURS
What exactly does informed consent state?
DESCRIPTION of the procedure OUTCOMES COMPLICATIONS ALTERNATIVES/Options WHO will be in the OR (including students!)
Pt must be deemed COMPETENT to understand what was discussed. Everything discussed and understood must be DOCUMENTED!
Signs/Symptoms of possible infection post-op.
REDNESS EXCESSIVE tenderness PURULENT drainage FEVER/Chills ADVENTITIOUS breath sounds Lung Congestion DECREASE LOC OLIGURIA
What is a UAP/CNA able to do to get a pt ready for surgery?
VITALS
(including SpO2)
TRANSPORT to ER
(non-critical pts only)
pts must be stable for vitals
Post-op pts needing to use the bathroom shortly after surgery can be given what?
BEDPAN or a URINAL
Why is it important to give post op pts pain meds prior to getting them out of bed for ambulation/exercise?
So the pt is more comfortable.
More like to participate.
Why Turn, Cough, Deep Breath?
Turn, Cough, Deep Breath (TCBD)
**LUNG EXPANSION**
- Instruct pt to take DEEP BREATH and hold 2-5 secs.
(allows air to reach most deflated part of lungs) - Instruct pt to do a strong DOUBLE COUGH WITH MOUTH OPEN
(helps to mobilize and remove secretions)
