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Nur 3010 exams > Infectious ds. + pre/intra/post op mgmt > Flashcards

Infectious ds. + pre/intra/post op mgmt Flashcards

1
Q

what is preoperative phase

A

begins when decision to proceed w/ surgical intervention is made
- ends w/ transfer of patient onto OR bed

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2
Q

what is intraoperative phase

A

begins when patient is transferred onto OR bed
- ends w/ admission to PACU (post anesthesia care unit)

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3
Q

what is postoperative phase

A

begins with admission of patient to PACU
-ends w/ follow up evaluation in clinical setting or home

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4
Q

what are the 3 reasons for surgery

A

1) facilitating a diagnoses, cure, or repair
2) reconstructive, cosmetic, or palliative (stage 4 metastatic bowel ca -> comfort)
3) rehabilitative

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5
Q

what is the degree of urgency for surgery based on? (5)

A

emergent (ER -> OR life or death, ex: fracture skull, gun shot)
urgent (wait until OR room open, stable, ex: closed fractures)
required (ex: hernia repair, cataracts)
elective (ex: repair of scars, huge quality of life improvement)
optional (cosmetic)

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6
Q

describe preadmission testing

A
  • prior to arrival for surgery
  • includes: admission date (demographics, health history, other information pertinent to the surgical procedure), begins discharge planning by assessing patient’s need for post operative care
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7
Q

what is the included in pre-op assessment (day of)

A

health hx
meds/ax
nutritional/fluid status
dentition (what can be removed)
respiratory and cardiovascular status (older: chest X-ray, cardiac: ECG)
hepatic/renal function (metabolic panel)
endocrine function (blood glucose)
immune function (WBC)
previous meds used
psychosocial factors
spiritual/cultural beliefs

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8
Q

meds that can affect surgical experiences

A

anticoagulants (should be stopped before sx depending on surgery/how long)
opioids (pain harder to control if higher tolerance)
diuretics, phenothiazines, tranquilizers (interactions w/ anesthesia)
antibiotics (educate about taking correct antibiotic dose)
anticonvulsants
OTC/herbals
corticosteroids
insulin
thyroid hormone

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9
Q

who should obtain informed consent

A

surgeon w/ nurse as witness

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10
Q

who should obtain anesthesia consent

A

anesthesiologist or CRNA

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11
Q

describe process of informed consent

A
  • should be in writing before non emergent surgery
  • legal mandate
  • surgeon must explain the procedure, benefits, risks, complications, etc.
  • nurse clarifies information and witnesses signature
  • consent accompanies patient to OR
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12
Q

when is a informed consent valid

A

only when signed BEFORE administering psychoactive premedication
- next of kin if emergent situation

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13
Q

what are prep-op nursing interventions

A
  • providing psychosocial interventions (reduce anxiety, decrease fear, respect culture, spiritual, and religious beliefs)
  • maintain patient safety
  • manage nutrition, fluids
  • prepare bowel (endoscopy procedure)
  • prepare skin (occurs in OR, shaving, CHG bath night before)
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14
Q

what is included in pre-op checklist?

A

chest xray: potential issues w/ respiratory
ECG: cardiac issues, no exposure to radiation for pregnant women
Labs: metabolic panel, PT/INR, PTT, blood type, blood transfusion consent, CBC
consent signed: mark surgical site when patient is awake
NPO status

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15
Q

what is the recommended time for NPO

A

8 hours strict NPO prior to surgery

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16
Q

what are the immediate pre-op actions

A
  • patient changes into gown, mouth inspected, jewelry removed, valuables stored in secure place
  • administer pre-anesthetic medication (low dose)
  • maintaining preoperative record
  • transporting patient to presurgical area
  • attending to family needs
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17
Q

what are some pre-op patient education performed by nurse/doc

A
  • deep breathing, coughing, incentive spirometry, splinting
  • mobility, active body movement
  • pain management
  • cognitive coping strategies
  • instructions for patients undergoing ambulatory surgery (ambulatory pain pumps/drains, activity orders, coagulation concerns, follow up instructions - normal vs. abnormal)
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18
Q

team members of intraop phase

A

patient
anesthesiologist (physician) or CRNA
surgeon
nurses
surgical tech
registered nurse first assistants or certified surgical technologists

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19
Q

what are the 3 zones for surgical environment to prevent infection

A

1) unrestricted zone: street clothes allowed (lobby)
2) semi restricted zone: scrub clothes and caps (new, clean)
3) scrub clothes, shoe covers, caps, and masks (OR) goggles

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20
Q

what is part of surgical asepsis rules to prevent infection

A

sterile field, gowns, gloves, equipment
sterile and unsterile team
1 foot distance surrounding sterile field
- if breached, area is contaminated

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21
Q

what are the environmental controls to prevent infection

A

negative pressure

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22
Q

what are some intra-operative complications

A
  • anesthesia awareness
  • nausea, vomiting
  • anaphylaxis (difficult to identify)
  • hypotension (difficult to identify)
  • hypoxia, respiratory complications
  • hypothermia
  • malignant hyperthermia
  • infection: longer surgery = increased chance of infection
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23
Q

types of anesthesia (4)

A

1) general
2) conscious sedation
3) regional
4) local

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24
Q

describe general anesthesia

A

inhalation, intravenous
- paralytic

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25
Q

describe conscious sedation

A

intravenous
- quick procedures, airway intact, joint dislocations

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26
Q

describe regional

A

can be combined with general
3 types: nerve blocks, epidural, spinal

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27
Q

what is nerve blocks regional anesthesia

A

injection into anatomical nerve site 6-24 hours
- can be continous

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28
Q

what is epidural regional anesthesia

A

injected into the epidural space, delayed onset, continuous infusion

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29
Q

what is spinal regional anesthesia

A

injected into dural sac, immediate relief, limited timeline +2 hours

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30
Q

what is considered local anesthsia

A

lidocaine

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31
Q

how do you protect patient from injury

A
  • patient id
  • correct informed consent
  • verification of records of health history, exam
  • results of diagnostic tests
  • allergies (including latex)
  • monitoring, modifying physical environment
  • safety measures (grounding of equipment, restraints, not leaving sedated patient)
  • verification, accessibility of blood
  • verifying surgical site marked
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32
Q

describe nursing management in the PACU

A
  • provide care for patient until patient has recovered from effects of anesthesia (resumption of motor and sensory function, oriented, stable VS, shows no evidence of hemorrhage or other complications of surgery)
  • vital to perform frequent assessment of patient (airway, breathing, circulation, neurological/temp,, incisions/drains/tubes/pumps, GI/diet, pain - always assess)
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33
Q

outpatient post op vs. inpatient post op

A

outpatient
- more detailed discharge planning (written, verbal instructions to a responsible adult who will accompany patient)
- no driving for 24 hours (never discharge alone)
inpatient
- more detailed assessment (Resp., pain, LOC, general discomfort)
- can use stronger pain medications (IV)

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34
Q

what is the primary consideration of airway..BC maintenance

A

necessary to maintain ventilation, oxygenation
- provides supplemental oxygen as indicated
- assess breathing
- keep HOB 15-30 degrees unless contraindicated
- suction set up at bedside
- if vomiting, turn to side
- head and jaw positioning to open airway

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35
Q

what is the primary consideration of AB..circulation

A

monitor all indicators of cardiovascular status
- assess all IV sites
- potential for hTN, shock
- potential for hemorrhage
- potential for HTN, dysrhythmias

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36
Q

s/sx of hypotension/shock state

A
  • pallor
  • cool, moist skin
  • rapid respirations
  • cyanosis
  • rapid, weak, thread pulse
  • decreasing pulse pressure
  • low bp
  • concentrated urine
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37
Q

how to manage pain and anxiety post op

A
  • assess patient comfort
  • control of environment: quiet, low lights, noise level
  • administer analgesics as indicated; usually short acting opioids IV (follow up 1 hour)
  • family visit, dealing with family anxiety
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38
Q

how to manage n/v post op

A
  • intervene at first indication of nausea
  • medications (zofran, compazine, Benadryl)
  • assessment of postoperative nausea, vomiting risk, prophylactic treatment
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39
Q

what are the 5 drain types we learned

A
  • Jackson pratt
  • Penrose (latex tubes)
  • Hemovac
  • PICO (disposable negative pressure vacs)
  • Wound Vacs (little bit different)
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40
Q

what is the purpose of post-op dressings

A

(sterile, healing environment)
- provide healing environment
- absorb drainage
- splint or immobilize
- protect
- promote homeostasis
- promote patient’s physical and mental comfort
- first dressings change is almost always done by the surgical team

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41
Q

what are some post surgical complications

A
  • pulmonary infection/hypoxia
    (inventions: incentive spirometer, deep breathing/walking)
  • deep vein thrombosis/PE
    (manage with WTE prophylaxis)
  • hematoma/hemorrhage
  • infection
    (eliminate lines, post op Abx)
  • wound dehiscence or evisceration (dehiscence- opens back up)
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42
Q

what are some final post op considerations

A
  • activity order
    OOB (out of bed), NWB (non-weight bearing)
  • diet/fluid orders
  • pain/reassessment
  • urinary retention (intermittent catheterization)
  • GI peristalsis
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43
Q

what is inflammation

A

protective, coordinate response of the body to an injurious agent
- proportional to the extent of tissue injury
- walls off the area of injury, prevents spread of the injurious agent, and directs the body defense
- can be acute or chronic
- “itis”

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44
Q

what are the 5 cardinal signs of acute inflammation

A

heat
redness
pain
swelling
loss of function

45
Q

3 main stages of acute inflammation

A

1) vascular permeability
2) cellular chemotaxis
3) systemic responses

46
Q

what are the outcomes of acute inflammation

A
  • resolution
  • healing proliferation of connective tissue (scar)
  • chronic inflammation
47
Q

describe vascular permeability

A
  • inflammatory mediators such as histamine & bradykinins cause dilation and increased permeability of the blood vessel
  • fluids, WBC, or macrophages, and platelets to move out to the site of injury or infection
  • fluid moving out of the blood vessels to the injured tissues causes swelling, dilution of the toxin and a decrease in pH (pus/purulent, transudate serosanguinous)
48
Q

describe chemotaxis

A
  • a chemical signal attracts platelets and other WBCs to the site of injury
  • margination: WBC’s line up along the endothelium in the area of inflammation in a process
  • includes cytokines: TNF, interleukins, C-reactive proteins (good mark of inflammation)
49
Q

5 types of WBCs

A
  • neutrophils: “first responders”, acute inflammation
  • lymphocytes: small WBC carrying out activities of the immune system
  • eosinophils: allergic reactions
  • basophils: chronic infections (cancer)
  • monocytes: long life span, chronic inflammation
50
Q

describe shifts

A

shifts: neutrophils mature vs. immature
- Left shift: more young (band cells) -> severe
- Right shift: resolved, mature neutrophils

51
Q

what is systemic response (acute inflammation)

A

result from the action of inflammatory mediators released from WBCs
- results in fever, pain, malaise, lymphadenopathy

52
Q

describe fever (systemic response)

A
  • microbial organisms, bacterial products, and cytokines all act as pyrogens
  • pyrogens activate prostaglandins to RESET the hypothalamic temperature-regulating center in the brain to a higher level
  • higher body temperature increased the efficiency of WBCs in their defense of the body
  • cure: antipyretic agent = drug that brings down fever (Tylenol, Motrin)
53
Q

describe histamine release (systemic response)

A
  • inflammatory mediator released from basophils, platelets, and mast cells in response to trauma, immune responses, or other inflammatory mediators
  • sneezing, rhinorrhea (runny nose), eye tearing, sinus inflammation, and pharyngeal irritation are consequences of histamine release in the URT
  • medications: benadryl
54
Q

describe lymhadenopathy

A
  • enlargement of lymph nodes caused by inflammatory processes (depends on location)
55
Q

describe lymph nodes

A
  • small bean-sized masses of tissue located in various regions of the body, including the neck, axillary regions, central thoracic region, inguinal areas, and gastrointestinal tract
  • responsible of the production of lymphocytes
56
Q

what is chronic inflammation

A

inflammatory process that “gets stuck” with resolution resulting in tissue damage, more inflammation, more damage

57
Q

what are the causes of chronic inflammation

A
  • microorganisms
  • viruses, parasites, and fungi
  • autoimmune
  • other
58
Q

what are distinctive patterns of chronic inflammation

A
  • development of granulomas (tuberculosis)
  • delays wound healing leading to chronic wounds (more prone to bed sore, pressure injuries)
59
Q

what is normal wound healing

A

not all cells are regenerate
- 3 phases: inflammation, proliferation (granulation tissue forms: beefy, red, healing about to occur), wound contraction and remodeling

60
Q

what are the 3 processes for wound healing

A

1) primary: edges approximated, lacks significant bacterial contamination, minimal loss of tissue and a “small” scar (ex: surgical incisions)
2) secondary: larger tissue detect to fill, can be partial or full thickness, takes longer to heal, more likely to scar (ex: road rash, skin arm, heal from group up)
3) tertiary: wound with a large gap of missing tissue that has been contaminated, closed once contamination has been resolved (ex: group up injury, PI with eschar)

61
Q

what factors affect wound healing

A
  • nutrition (protein, vitamins, fats and carbohydrates)
  • blood flow and oxygen delivery (septic shock)
  • immune system (comorbidities: prone to infection, drugs)
  • infections
62
Q

what are types of dysfunctional wound healing

A

dehiscence (wound reopens)
keloids
fistulas (chronic bladder infection)
contractures (trigger finger, carpal tunnel syndrome)
adhesions (GI tracts, trigger: surgical lysis of adhesion)

63
Q

pathogens

A

specific microorganisms that are capable of causing infectious disease; categorized as viruses, bacteria, fungi, and parasites

64
Q

host

A

describe the human or animal invaded and colonized by a pathogen

65
Q

colonization

A

indicates that a pathogen is living within the host, but does not mean infection exists

66
Q

infection

A

describes the invasion, colonization, and multiplication of pathogens within the host; diagnosed when there is isolation of a pathogen or evidence of its presence and pathogen-related host symptoms

67
Q

virulence

A

disease-producing potential of an organism
- severity of infection os virulence of the pathogen and strength of host defenses

68
Q

reservoir

A

source of a pathogenic organism that may or may not be suffering from the disease caused by the pathogen

69
Q

fomites

A

environmental objects acting as a reservoirs of microorganisms

70
Q

incidence

A

number of new cases of infection within a population

71
Q

prevalence

A

number of active ongoing cases of infection at any given time

72
Q

endemic

A

incidence and prevalence are relatively stable

73
Q

epidemic

A

abrupt increase in the incidence of disease within a geographic region

74
Q

pandemic

A

global spread of a specific disease

75
Q

what is an example of normal flora vs. pathogens

A

hospital acquired infections vs. community acquired infections (100% preventable, PI, CAUTI)

76
Q

types of microorganisms

A

bacteria, viruses, fungi (immunocompromised), parasites, prions

77
Q

what are the different portals of entry

A

skin
respiratory tract/mucosa
GI tract: CDIFF
GU tract: UTI
blood-blood
maternal-fetal transmission

78
Q

5 stages of infection

A

incubation period
prodromal stage
acute stage
convalescent stage
resolution phase

79
Q

describe diagnosis of infection

A

history and symptoms and physical findings
- wbc
- gram stain (bacteria)
- culture (blood, urine, wound, sputum) (2 vials, done before antibiotic to detect bacteria)
- biopsy
- antibody titer (serology)
- polymerase chain reaction (PCR) detects genetic material
rules of contamination: results in 24h, 48h, 72h

80
Q

describe treatments for infection

A
  • prevention
  • antimicrobial
  • issues with resistance
81
Q

what is mainly associated with staphylococcus infections (causes)

A

hospital acquired pneumonia
MRSA
rheumatic fever
glomerulonephritis (kidney failure)
strept throat
cure: amoxicillin

82
Q

Important GI bacteria

A

-salmonella
-escherichia coli (found in normal flora)
-campylobacter (uncooked raw meat, oral transmission)
-cholera (third world countries)

83
Q

describe influenza

A

-viruses possess surface antigens known as hemagglutinin and neuraminidase that facilitate entry into respiratory cells and enhance release of viral particles
- transmitted primarily through droplet and aerosols
- most severe breakouts: influenza A
- less severe breakouts: influenza B
- treatment: tamaflu (expensive, decreases severity by 1 day)

84
Q

what is candidiasis

A

candida fungus: normal flora found on skin, GI tract, and vaginal tract (pathogenic when overgrowth)
- danger to immunocompromised (overwhelming sepsis)

85
Q

describe amebiasis and giardiasis

A

waterborne protozoan infections contracted by consuming contaminated water or food containing cyst stage of parasite
- sx: nausea, vomiting, intense abdominal pain, tenderness, copious diarrhea of watery stool, sometimes with blood

86
Q

describe Creutzfeldt Jakob

A

rare but fatal degenerative neurological disease caused by prion (progressive death of brain’s nerve cells)
- spongiform appearance of the brain tissue

87
Q

describe immunity

A

distinguishes between self and non self

88
Q

antigens

A

non-self substances are the targets of the immune systemi

89
Q

innate immunity

A

first and immediate defense
- body’s natural barriers, normal flora, WBCs, and protective enzymes and chemicals

90
Q

adaptive immunity

A

occurs after innate immunity
- developed after exposure to antigens
- act rapidly, specifically, destructively, and with memory(!) for every individual antigen encountered

91
Q

main types of cells in adaptive immunity

A

b lymphocyte immune (B cell immunity)
- phagocytosis of bacteria
t lymphocyte immunity (T cell immunity)
- quicker than B cell
- CD4 and CD8, killer T cells

92
Q

active acquired adaptive immunity

A

obtained through exposure to an antigen or through immunization (vaccine)
- individual synthesizes specific immunoglobulins against the antigen

93
Q

passive acquired adaptive immunity

A

injection of remanufactured immunoglobulins
- hep B immunoglobin and immunoglobulins in breast milk (from another human) ex: covid

94
Q

anergy panels

A

t skin test

95
Q

antibody titers

A

used to confirm adequate tests used to confirm adequate immune protection against a particular antigen by measuring IgM and IgG immunoglobulins

96
Q

allergy testing

A

skin testing
serology testing: measures presence of IgE

97
Q

types of hypersensitivity reactions (4)

A

type 1: immediate hypersensitivity
type 2: cytotoxic hypersensitivity
type 3: immune complex disorders
type 4: delayed hypersensitivity

98
Q

type 1 immediate hypersensitivity

A
  • allergy/ anaphylaxis
  • airway constriction recognized within 30m-1h
  • cure: epi-pen (delays reaction)
99
Q

type 2 cytotoxic hypersensitivity

A
  • cell destruction and phagocytosis
  • blood transfusion reactions: slow administration
100
Q

type 3 immune complex

A
  • body forms antibodies against itself
  • systemic lupus erythematous
  • rheumatoid arthritis
101
Q

type 4 delayed hypersensitivity

A
  • delayed response to the antigen
  • contact dermatitis
  • rejection of transplanted tissue (touching someone/something)
102
Q

describe systemic lupus erythematosus

A

chronic multi-system, autoimmune disease characterized by exacerbations and remissions
- body recognizes self as antigen
- kidney disease/HTN, pulmonary fibrosis
- treamtments: aimed at reducing inflammation (NSAIDS, steroids, chemotaxis

103
Q

describe rheumatoid arthritis

A

chronic, immune complex, autoimmune inflammatory disease
- attacks its own synovial tissue
- destruction of cartilage, bone, tendons, and ligaments
- sx: fever, malaise, fatigue, permanent damage
- treatment: anti-inflammatory, biologics

104
Q

what are the 2 types of immunodeficiency diorders

A

congenital (primary): genetically linked, most are x-linked and affect males
acquired (secondary): disorders causing immunosuppression (leukemia, lymphomas, HIV)

105
Q

describe human immunodeficiency virus infection (HIV)

A

acute infection followed by asymptomatic period
- acquired immune deficiency syndrome (AIDS)
- no cell mediated response
- something else is taking immune system out (auto = self)
- asymptomatic for 6 months - 10 years (latent period)
- development of opportunistic infections (pneumocystitis carinii pneumonia, toxoplasmosis)
- karposi sarcoma (epidermal metastatic disease)

106
Q

what are the route of transmissions of HIV

A
  • sexual: semen and vaginal secretions
  • blood
  • transplacenta: only if open wound in baby’s mouth
  • breast milk
  • organ transplants
  • saliva (into open wounds)
107
Q

HIV antibody testing (4)

A
  • post seroconversion ( 2 weeks - 6 months)
  • ELISA
  • Western Blot test
  • OTC tests
108
Q

treatment for HIV

A
  • HIV pre-exposure prophylaxis
  • antiretroviral medications (reverse transcriptase inhibitors, protease inhibitors, agents that block the initial entry of HIV into CD4 cells)

Nur 3010 exams (13 decks)

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