Midterm Flashcards

1
Q

Name 7 post-surgical risks/potential complications.

A
pneumonia
shock
cardiac arrest
respiratory arrest
venous thromboembolism (VTE)
bleeding 
pain
(this list is definitely not exhaustive!)
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2
Q

Describe your post-operative respiratory assessments and interventions.

A
patent airway, adequate gas exchange
note artificial airway when applicable
rate, depth, pattern of respirations
breath sounds
accessory muscle use (work of breathing)
respiratory depression (as evidenced by decreased rate and/or depth of respirations; may be r/t opioid overdose)
hypoxemia (as evidence by decreased PAO2)
IS:  prevent or reverse atelectasis
early ambulation
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3
Q

Interventions for hypoxemia in the post-surgical setting.

A
airway maintenance
monitor SPO2
semi-Fowler's position (30-45 degrees) 
O2 therapy
breathing exercises
early ambulation
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4
Q

Describe your post-surgical cardiovascular assessments and interventions.

A

vital: freq?
heart sounds (note any new dysrhythmias, murmurs, etc.)
cardiac monitoring (telemetry, ecg)
peripheral vascular assessment (pulses, CRT, temp, color, sensation)
monitor for VTE/DVT
early ambulation
use of drugs or devices to prevent cardiovascular complications (need more details here)

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5
Q

What would you want to include in your post-surgical neurological assessment?

A

LOC, orientation

motor and sensory assessment after epidural or spinal anesthesia

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6
Q

How will you monitor fluid, electrolyte and acid-base balance in the post-operative pt?

A

I & O, consider all sources (IV fluids, vomitus, urine, wound drainage, NG tube drainage)
hydration status
monitor acid base balance (ABGs, s/sx of acid-base imbalance)
monitor for electrolyte imbalances (labs and s/sx)

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7
Q

What is your priority urinary system assessment in the postop pt?

A

check for urine retention

report urine output <30 mL/hr

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8
Q

What is a common post-operative GI complaint?

A

n/v (30% of pts report n/v following general anesthesia)

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9
Q

What GI assessment is important postoperatively?

A

assess for bowel sounds

peristalsis can be delayed up to 24 hrs

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10
Q

What are the purposes of a postoperative NG tube?

A
decompress and drain stomach
promote GI rest
allow GI tract to heal
provide enteral feeding route
monitor any gastric bleeding
prevent intestinal obstruction
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11
Q

How often should you assess postoperative NG tube drainage?

A

every 8 hours

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12
Q

Describe normal post-op wound drainage.

A

sanguinous to serosanguinous to serous within the first five days

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13
Q

What nursing interventions would you initiate in post-op pt to address risk of wound infx and delayed healing?

A

assessment of surgical site
dressing changes (first dressing usually applied by surgeon)
wound drains (help prevent deep infx and abscess)
drug therapy
irrigation to treat wound infx
debridement
surgical management required for wound opening

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14
Q

What is pericarditis?

A

Inflammation of the pericardial sac

  • Could be acute or chronic
  • May (or may not) be constrictive
  • Pericardial effusion may (or may not) be present
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15
Q

What are some of the possible causes of pericarditis?

A

Infectious (bacterial, viral, fungal)
Trauma
Post-MI
Cardiac surgery (postpericardiotomy syndrome)
Inflammatory disorders (RA, SLE, rheumatic fever)
Radiation
Idiopathic

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16
Q

S/S of pericarditis

A
chest pain--usually pleuritic (severe, sharp pain; worse with deep breath) 
pericardial friction rub (heard over apex)
ST-T wave changes
fever
palpitations
tachycardia
JVD
peripheral edema
cyanosis
decreased peripheral pulses
17
Q

What diagnostic testing would you suspect if the provider expected pericarditis?

A
lab work
echocardiogram
CXR
ECG
pericardial fluid analysis
CT/MRI may be done
18
Q

How would you (and the medical team) respond to a pt with pericarditis?

A
pain control (NSAIDs, anti-inflammatory--colchicine, corticosteroid)
treat the cause
cardiac monitoring
monitor lab work
monitor v/s
CV assessment
treat pericardial effusion, if present
O2 therapy may be needed
pt/family education
may need to discontinue anticoagulation therapy
19
Q

ARDS is acute respiratory failure with these features:

A

(1) Hypoxemia that persists even when 100% oxygen is given (refractory hypoxemia, a cardinal feature)
(2) Decreased pulmonary compliance
(3) Dyspnea
(4) Noncardiac-associated bilateral pulmonary edema
(5) Dense pulmonary infilatrates on x-ray (ground glass appearance

20
Q

What are some common causes of ARDS?

A
sepsis
pneumonia
inhalation of gastric contents
injury
post-operative complication

Iggy says, “Often ARDS occurs after an acute lung injury (ALI) in people who have no [preexisting] pulmonary disease.”

21
Q

Describe the 3 phases of ARDS.

A

(1) Exudative: early changes; dypnea, tachycardia; fluid-filled alveoli; FOCUS IS EARLY DETECTION
(2) Fibroproliferative: increased lung damage lead to fibrosis and pulmonary hypertension; poor gas exchange, pt may develop multiple organ system failure (MODS); FOCUS IS SUPPORTIVE CARE
(3) Resolution: Usually occurs after 14 days, resolution of injury; if the injury doesn’t resolve, the pt may die or develop chronic disease. Fibrosis may or may not occur.

22
Q

S/S of ARDS?

A
dyspnea
pallor
intercostal retractions
inability to clear cough
cyanosis 
sweating
inability to lie flat
tripod positioning
fatigue