Exam 1 Review Flashcards
Perioperative is
care for the patient before and after surgery
What legal document should be obtained before surgery?
Informed consent
Who is involved in the intraoperative procedure? (5)
Scrub nurse, circulating nurse, scrub tech, first assistant, surgeon
What is the role of the circulating nurse? (3)
- manages the whole operating room
- counts materials (ex: counting sponges)
- comes in and out of the OR (ex: surgeon drops supply and needs extra)
What is the role of the scrub nurse? (3)
- overlooks the sterile field
- manages sterile field
- proctors if someone drops their hand below their waist or breaks sterility
What are postoperative expectations (6)
- low resp rate
- fine crackles in the lungs
- atelectasis
- pulmonary edema
- paralytic ileus
- urinary retention
How to prevent post-op pneumonia? (3)
Use incentive spirometer (taught to patient before surgery), deep breathing exercises, treat the pain after surgery with medications
Patients with pneumonia will have what type of lung sounds?
Rhonchi
When does a patient usually resume eating following a surgical procedure?
When bowel sounds have returned
What are some concerns that can occur 1-2 days after surgery? (2)
DVT, pulmonary embolisms
Should a patient have multiple HIV tests conducted to determine a positive result?
Yes
What is the most common route for transmission of HIV?
Sexual Intercourse
What causes a cell to become cancerous? (2)
- Exposure to carcinogens
- High amounts of radiation (affects the patient’s DNA)
What happens to the group of infected cells?
proliferates (multiplies)
Malignant cancer cells…
Metastasize
Benign cancer cells can….
Still damages surrounding tissue but does not metastasize to other organs of the body
Characteristics of cancer tissue (5)
- increases in cell number
- large variations in cell appearance and size
- loss of normal arrangement of cells
- distorted shape
- increase in mitotic activity (produces 2 cells instead of 1)
Immunity cells that are used to fight infection? (2)
- tumor necrosis factor
- tumor necrosis genes
How do cancer cells bypass the immune system? (2)
- turning off some of the genes
- release chemicals to suppress the immune response
What are common problems that most cancer patients experience? (3)
- high risk for infection/immunosuppressed
- loss of appetite/malnutrition
- nausea/vomiting
What is recommended for any patient that has malnutrition?
Diet that consist of high-calorie meals in small portions to given more frequently throughout the day
What is the first serious complication that occurs with chemotherapy?
Neutropenia
Neutropenia is?
decrease in WBC which leads to sepsis
Interventions for neutropenia (2)
- temperature must be monitored to prevent infection
- patients must be placed in reverse isolation (visitors are more of a threat to the patient than the patient is to others)
When is the best time to administer zofran to a patient receiving chemotherapy?
1 hr before
What are the risk factors for cancer? (3)
- environmental factors
- age (older has greater risk for cancer)
- smoking
Stage 0 of cancer
cancer in SITU (has not spread from location)
Stage 1 of cancer
tumor limited to the tissue of the origin; localized tumor growth
Stage 2 of cancer
limited local spread
Stage 3 of cancer
extensive local and regional spread
Stage 4 of cancer
metastasis
Chemotherapy is used to?
eliminate/reduce the number of cancer cells in the primary tumor and metastatic tumor sites
Chemotherapy for the treatment of cancer would be most effective to?
Malignant changes in hematopoietic cells
Central IV line is the most effective access for infusion. What should the RN do if extravasation or anaphylaxis is suspected?
Stop the infusion
What can occur in the IV administration of vesicant chemotherapeutic agents?
extravasation
What is expected for patients receiving chemotherapy?
Expected that the patient should be able to carry out normal functioning after chemotherapy
Radiation treatment for cancer is not the first choice for treatment because? It is usually done in conjunction with?
Not the first choice for treatment because its deadly effects to surrounding tissue; in conjunction with chemotherapy
Simulation before radiation treatment is done to?
to see the amount of radiation the patient needs to receive and to mark the location
Where will erythema develop after radiation?
around the radiation site
What should the RN teach the patient to avoid after radiation?
direct sunlight
Surgical treatment for cancer is used to?
eliminate/reduce the risk for cancer development
What is an example of preventing cancer with surgery?
Woman is positive for BRCA 1 and BRCA 2, will get prophylactic mastectomy to prevent breast cancer
Glaucoma is caused by?
high intraocular pressure that is applied onto the optic nerve
What indicates that patient teaching is effective for a patient that has recently had eye surgery?
Patient demonstrates how to self-administer eye drops
Clinical manifestations of cataracts? (4)
- painless burning
- slightly blurry vision
- decrease in color perception
- sensitivity to glare
What can pain indicate for a patient with a cataract?
ocular damage which is usually a post op complication
Teaching for patients after cataract surgery?
- should not lift more than 5 lbs
- should not drive after surgery
Respiratory assessment includes? (4)
- spirometry
- resp rate
- auscultating the whole lung field
- use of intercostal muscles
Are lung sounds clearer from the chest or back?
The back
Adventitious lung sounds include? (5)
- rhonchi
- crackles
- rales
- wheezing
- stridor
Stridor sound?
High pitched musical breath sounds
The use of intercostal muscles could indicate?
Resp issue is severe
Testing methods for TB include? (3)
- Mantoux skin test
- chest x-ray
- blood test
Positive Mantoux test?
Induration of 15 or greater
A positive Mantoux test does not tell if a TB infection is?
a latent or active infection
A small induration can indicate?
HIV
What medication is used to treat latent or exposure to TB?
Isoniazid
Why do we give 4 medications for TB treatment? How long does medication treatment last?
to prevent drug resistance; lasts from 6 months to 1 year
If the patient is suspected to have TB, the patient must be placed in?
Isolation
If the patient has an active TB infection, the patient must be placed in? Treatment should be done?
negative pressure room; treatment should be done right away (early treatment)
What are the two types of COPD?
emphysema and chronic bronchitis
Patients with COPD with present? pH levels will indicate
Acidosis (holding onto CO2); pH levels indicate if the patient is compensated
Medication therapy for chronic long-term COPD?
oxygen therapy
Can a COPD patient be on 10 L of oxygen?
No
Why can’t a COPD patient be given more than 6 L of oxygen?
May lead to decrease drive to breathe and O2 toxicity
What is the primary cause of COPD?
Smoking
Can a patient have emphysema and chronic bronchitis?
Yes
Clinical manifestations of COPD (7)
- barrel chest
- overweight or underweight
- anxious
- sat forward in tripod position
- cyanosis (for person of color, color might appear on the mucosa)
- pursed lip breathing
- fatigued
Patient teaching when using oxygen therapy (3)
- should not have open flame around oxygen
- should not give too much oxygen (might be needed for severe COPD)
- keep supplies clean to decrease risk for infection
Patient teaching for COPD
pursed lip breathing techniques: slow expiration which increases pressure in chest
What does coughing, turning, and breathing do for patients?
Opens up alveoli and bronchioles to decrease atelectasis
Pathophysiology of COPD
Air becomes trapped in alveolar which leads to overdistension of alveoli which causes chest to become barrel-shaped
Diagnostic tests for COPD?
Pulmonary function tests such as residual volume (tests to see how much air is left in the lungs after forced exhalation)
Nursing priorities/interventions for patients with COPD (3)
- patients should eat frequently and include high protein, high calorie foods
- breathing retraining such as pursed lip breathing to prevent air trapping
- sitting the patient up at 90 degree angle if in resp distress
What occurs during emphysema?
lung loses elasticity to push CO2 out, alveolus are filled with too much CO2
What is a clinical manifestation of emphysema?
Pink puffer: skin turns pink because they’re holding onto CO2
What medications are used to treat emphysema?
- corticosteroid
- long acting beta adrenergics
What is tripoding?
patient clasps hands together and leans forward because of difficulty breathing
Describe reason for barrel chest
overinflation of air in the alveoli
How should barrel chested patients be assessed?
measuring with tape ruler; chest should not be round, should be more flat
What is the pathophysiology for emphysema?
exposure to smoke/pollutants leads to breakdown of elastin in connective tissue of the lungs causing destruction of the alveoli
What is the determining factor for chronic bronchitis?
productive cough for 3 months in a row for 2 years
What is one clinical manifestation of chronic bronchitis?
blue bloated
What is the pathophysiology of chronic bronchitis?
exposure to smoke/pollution leads to continual irritation and inflammation in the bronchial causing oversecretion of mucus and chronic cough
What are 4 classifications of pneumonia?
- community-acquired
- ventilator-associated
- aspiration
- opportunistic
If a patient experiences s/s of pneumonia 24 hours after hospital admission, what is this classified as?
Community-acquired pneumonia
If a patient has pneumonia, how do we determine if it is hospital-acquired?
if they developed pneumonia 48 hours after hospital admission
If a patient has aspiration pneumonia, the bed should be positioned?
with HOB at 30-45 degree angle to prevent aspiration
Opportunistic pneumonia is caused by?
P. Jiroveci infection, most common form of pneumonia for those with HIV disease
Types of CAUSES of pneumonia (7)
- pneumococcal
- fungal
- bacterial
- viral
- Mycoplasma organisms
- parasites
- chemicals
Who is the most at risk for pneumococcal pneumonia?
elderly patients; should obtain vaccine when older than 60 years old
Fungal pneumonia is hard to treat with antifungal because?
antifungal medication kills fungal infection and human cellss
Which cause of pneumonia is the most common?
viral pneumonia
Which best supports the nursing diagnosis of ineffective airway clearance?
weak, nonproductive cough effort
Patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurse’s most appropriate action to promote airway clearance?
assist the patient to splint the chest when coughing
Asthma is what kind of respiratory problem?
obstructive and restrictive
One clinical manifestation of asthma is stridor. Describe what stridor sounds like and what is is caused by?
high-pitched wheezing is caused by inflammation of the bronchioles and mucus secretion/plug
Processes that place patients at risk for lung infection? (3)
dysphagia (aspiration pneumonia), aging, concurrent with COPD
Treatment for asthma?
albuterol (emergency inhaler): use indicates that asthma is severe
Can a patient take long-acting beta adrenergic on its own?
No, it must be used in combination with glucocorticoid
Which patient is more severe: patient taking inhaled glucocorticoid or patient taking oral glucocorticoid?
Oral glucocorticoid because it takes longer and is stronger
Side effects of oral glucocorticoid? (3)
- hyperglycemia
- develop oral thrush
- suppresses the immune system (at risk for infections)
What type of diet should a patient with oral thrush have?
soft and non-abrasive diet
Patient teaching to decrease risk of developing oral thrush?
patient should rinse their mouth after inhalation use
What is the first non-invasive way to treat respiratory asthma attacks? (2)
set the HOB to high-fowlers and administer oxygen at 2 L/hr
Patient has anxiety and an exacerbation of asthma. Primary reason for the nurse to inspect the chest wall of the patient?
evaluate the use of intercostal muscles
