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MedSurg > Exam 1 Review > Flashcards

Exam 1 Review Flashcards

1
Q

Perioperative is

A

care for the patient before and after surgery

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2
Q

What legal document should be obtained before surgery?

A

Informed consent

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3
Q

Who is involved in the intraoperative procedure? (5)

A

Scrub nurse, circulating nurse, scrub tech, first assistant, surgeon

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4
Q

What is the role of the circulating nurse? (3)

A
  • manages the whole operating room
  • counts materials (ex: counting sponges)
  • comes in and out of the OR (ex: surgeon drops supply and needs extra)
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5
Q

What is the role of the scrub nurse? (3)

A
  • overlooks the sterile field
  • manages sterile field
  • proctors if someone drops their hand below their waist or breaks sterility
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6
Q

What are postoperative expectations (6)

A
  • low resp rate
  • fine crackles in the lungs
  • atelectasis
  • pulmonary edema
  • paralytic ileus
  • urinary retention
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7
Q

How to prevent post-op pneumonia? (3)

A

Use incentive spirometer (taught to patient before surgery), deep breathing exercises, treat the pain after surgery with medications

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8
Q

Patients with pneumonia will have what type of lung sounds?

A

Rhonchi

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9
Q

When does a patient usually resume eating following a surgical procedure?

A

When bowel sounds have returned

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10
Q

What are some concerns that can occur 1-2 days after surgery? (2)

A

DVT, pulmonary embolisms

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11
Q

Should a patient have multiple HIV tests conducted to determine a positive result?

A

Yes

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12
Q

What is the most common route for transmission of HIV?

A

Sexual Intercourse

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13
Q

What causes a cell to become cancerous? (2)

A
  • Exposure to carcinogens

- High amounts of radiation (affects the patient’s DNA)

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14
Q

What happens to the group of infected cells?

A

proliferates (multiplies)

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15
Q

Malignant cancer cells…

A

Metastasize

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16
Q

Benign cancer cells can….

A

Still damages surrounding tissue but does not metastasize to other organs of the body

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17
Q

Characteristics of cancer tissue (5)

A
  • 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)
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18
Q

Immunity cells that are used to fight infection? (2)

A
  • tumor necrosis factor

- tumor necrosis genes

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19
Q

How do cancer cells bypass the immune system? (2)

A
  • turning off some of the genes

- release chemicals to suppress the immune response

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20
Q

What are common problems that most cancer patients experience? (3)

A
  • high risk for infection/immunosuppressed
  • loss of appetite/malnutrition
  • nausea/vomiting
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21
Q

What is recommended for any patient that has malnutrition?

A

Diet that consist of high-calorie meals in small portions to given more frequently throughout the day

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22
Q

What is the first serious complication that occurs with chemotherapy?

A

Neutropenia

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23
Q

Neutropenia is?

A

decrease in WBC which leads to sepsis

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24
Q

Interventions for neutropenia (2)

A
  • 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)
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25
Q

When is the best time to administer zofran to a patient receiving chemotherapy?

A

1 hr before

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26
Q

What are the risk factors for cancer? (3)

A
  • environmental factors
  • age (older has greater risk for cancer)
  • smoking
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27
Q

Stage 0 of cancer

A

cancer in SITU (has not spread from location)

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28
Q

Stage 1 of cancer

A

tumor limited to the tissue of the origin; localized tumor growth

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29
Q

Stage 2 of cancer

A

limited local spread

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30
Q

Stage 3 of cancer

A

extensive local and regional spread

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31
Q

Stage 4 of cancer

A

metastasis

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32
Q

Chemotherapy is used to?

A

eliminate/reduce the number of cancer cells in the primary tumor and metastatic tumor sites

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33
Q

Chemotherapy for the treatment of cancer would be most effective to?

A

Malignant changes in hematopoietic cells

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34
Q

Central IV line is the most effective access for infusion. What should the RN do if extravasation or anaphylaxis is suspected?

A

Stop the infusion

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35
Q

What can occur in the IV administration of vesicant chemotherapeutic agents?

A

extravasation

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36
Q

What is expected for patients receiving chemotherapy?

A

Expected that the patient should be able to carry out normal functioning after chemotherapy

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37
Q

Radiation treatment for cancer is not the first choice for treatment because? It is usually done in conjunction with?

A

Not the first choice for treatment because its deadly effects to surrounding tissue; in conjunction with chemotherapy

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38
Q

Simulation before radiation treatment is done to?

A

to see the amount of radiation the patient needs to receive and to mark the location

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39
Q

Where will erythema develop after radiation?

A

around the radiation site

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40
Q

What should the RN teach the patient to avoid after radiation?

A

direct sunlight

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41
Q

Surgical treatment for cancer is used to?

A

eliminate/reduce the risk for cancer development

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42
Q

What is an example of preventing cancer with surgery?

A

Woman is positive for BRCA 1 and BRCA 2, will get prophylactic mastectomy to prevent breast cancer

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43
Q

Glaucoma is caused by?

A

high intraocular pressure that is applied onto the optic nerve

44
Q

What indicates that patient teaching is effective for a patient that has recently had eye surgery?

A

Patient demonstrates how to self-administer eye drops

45
Q

Clinical manifestations of cataracts? (4)

A
  • painless burning
  • slightly blurry vision
  • decrease in color perception
  • sensitivity to glare
46
Q

What can pain indicate for a patient with a cataract?

A

ocular damage which is usually a post op complication

47
Q

Teaching for patients after cataract surgery?

A
  • should not lift more than 5 lbs

- should not drive after surgery

48
Q

Respiratory assessment includes? (4)

A
  • spirometry
  • resp rate
  • auscultating the whole lung field
  • use of intercostal muscles
49
Q

Are lung sounds clearer from the chest or back?

A

The back

50
Q

Adventitious lung sounds include? (5)

A
  • rhonchi
  • crackles
  • rales
  • wheezing
  • stridor
51
Q

Stridor sound?

A

High pitched musical breath sounds

52
Q

The use of intercostal muscles could indicate?

A

Resp issue is severe

53
Q

Testing methods for TB include? (3)

A
  • Mantoux skin test
  • chest x-ray
  • blood test
54
Q

Positive Mantoux test?

A

Induration of 15 or greater

55
Q

A positive Mantoux test does not tell if a TB infection is?

A

a latent or active infection

56
Q

A small induration can indicate?

A

HIV

57
Q

What medication is used to treat latent or exposure to TB?

A

Isoniazid

58
Q

Why do we give 4 medications for TB treatment? How long does medication treatment last?

A

to prevent drug resistance; lasts from 6 months to 1 year

59
Q

If the patient is suspected to have TB, the patient must be placed in?

A

Isolation

60
Q

If the patient has an active TB infection, the patient must be placed in? Treatment should be done?

A

negative pressure room; treatment should be done right away (early treatment)

61
Q

What are the two types of COPD?

A

emphysema and chronic bronchitis

62
Q

Patients with COPD with present? pH levels will indicate

A

Acidosis (holding onto CO2); pH levels indicate if the patient is compensated

63
Q

Medication therapy for chronic long-term COPD?

A

oxygen therapy

64
Q

Can a COPD patient be on 10 L of oxygen?

A

No

65
Q

Why can’t a COPD patient be given more than 6 L of oxygen?

A

May lead to decrease drive to breathe and O2 toxicity

66
Q

What is the primary cause of COPD?

A

Smoking

67
Q

Can a patient have emphysema and chronic bronchitis?

A

Yes

68
Q

Clinical manifestations of COPD (7)

A
  • 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
69
Q

Patient teaching when using oxygen therapy (3)

A
  • 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
70
Q

Patient teaching for COPD

A

pursed lip breathing techniques: slow expiration which increases pressure in chest

71
Q

What does coughing, turning, and breathing do for patients?

A

Opens up alveoli and bronchioles to decrease atelectasis

72
Q

Pathophysiology of COPD

A

Air becomes trapped in alveolar which leads to overdistension of alveoli which causes chest to become barrel-shaped

73
Q

Diagnostic tests for COPD?

A

Pulmonary function tests such as residual volume (tests to see how much air is left in the lungs after forced exhalation)

74
Q

Nursing priorities/interventions for patients with COPD (3)

A
  • 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
75
Q

What occurs during emphysema?

A

lung loses elasticity to push CO2 out, alveolus are filled with too much CO2

76
Q

What is a clinical manifestation of emphysema?

A

Pink puffer: skin turns pink because they’re holding onto CO2

77
Q

What medications are used to treat emphysema?

A
  • corticosteroid

- long acting beta adrenergics

78
Q

What is tripoding?

A

patient clasps hands together and leans forward because of difficulty breathing

79
Q

Describe reason for barrel chest

A

overinflation of air in the alveoli

80
Q

How should barrel chested patients be assessed?

A

measuring with tape ruler; chest should not be round, should be more flat

81
Q

What is the pathophysiology for emphysema?

A

exposure to smoke/pollutants leads to breakdown of elastin in connective tissue of the lungs causing destruction of the alveoli

82
Q

What is the determining factor for chronic bronchitis?

A

productive cough for 3 months in a row for 2 years

83
Q

What is one clinical manifestation of chronic bronchitis?

A

blue bloated

84
Q

What is the pathophysiology of chronic bronchitis?

A

exposure to smoke/pollution leads to continual irritation and inflammation in the bronchial causing oversecretion of mucus and chronic cough

85
Q

What are 4 classifications of pneumonia?

A
  • community-acquired
  • ventilator-associated
  • aspiration
  • opportunistic
86
Q

If a patient experiences s/s of pneumonia 24 hours after hospital admission, what is this classified as?

A

Community-acquired pneumonia

87
Q

If a patient has pneumonia, how do we determine if it is hospital-acquired?

A

if they developed pneumonia 48 hours after hospital admission

88
Q

If a patient has aspiration pneumonia, the bed should be positioned?

A

with HOB at 30-45 degree angle to prevent aspiration

89
Q

Opportunistic pneumonia is caused by?

A

P. Jiroveci infection, most common form of pneumonia for those with HIV disease

90
Q

Types of CAUSES of pneumonia (7)

A
  • pneumococcal
  • fungal
  • bacterial
  • viral
  • Mycoplasma organisms
  • parasites
  • chemicals
91
Q

Who is the most at risk for pneumococcal pneumonia?

A

elderly patients; should obtain vaccine when older than 60 years old

92
Q

Fungal pneumonia is hard to treat with antifungal because?

A

antifungal medication kills fungal infection and human cellss

93
Q

Which cause of pneumonia is the most common?

A

viral pneumonia

94
Q

Which best supports the nursing diagnosis of ineffective airway clearance?

A

weak, nonproductive cough effort

95
Q

Patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurse’s most appropriate action to promote airway clearance?

A

assist the patient to splint the chest when coughing

96
Q

Asthma is what kind of respiratory problem?

A

obstructive and restrictive

97
Q

One clinical manifestation of asthma is stridor. Describe what stridor sounds like and what is is caused by?

A

high-pitched wheezing is caused by inflammation of the bronchioles and mucus secretion/plug

98
Q

Processes that place patients at risk for lung infection? (3)

A

dysphagia (aspiration pneumonia), aging, concurrent with COPD

99
Q

Treatment for asthma?

A

albuterol (emergency inhaler): use indicates that asthma is severe

100
Q

Can a patient take long-acting beta adrenergic on its own?

A

No, it must be used in combination with glucocorticoid

101
Q

Which patient is more severe: patient taking inhaled glucocorticoid or patient taking oral glucocorticoid?

A

Oral glucocorticoid because it takes longer and is stronger

102
Q

Side effects of oral glucocorticoid? (3)

A
  • hyperglycemia
  • develop oral thrush
  • suppresses the immune system (at risk for infections)
103
Q

What type of diet should a patient with oral thrush have?

A

soft and non-abrasive diet

104
Q

Patient teaching to decrease risk of developing oral thrush?

A

patient should rinse their mouth after inhalation use

105
Q

What is the first non-invasive way to treat respiratory asthma attacks? (2)

A

set the HOB to high-fowlers and administer oxygen at 2 L/hr

106
Q

Patient has anxiety and an exacerbation of asthma. Primary reason for the nurse to inspect the chest wall of the patient?

A

evaluate the use of intercostal muscles

MedSurg (16 decks)

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