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N233 > Module 1: Part 3 > Flashcards

Module 1: Part 3 Flashcards

1
Q

During the first 24 hours after surgery, nursing care of the hospitalized patient consists of:

A
  • Helping the patient recover from the effects of
    anesthesia
  • Frequently assessing the patient’s physiologic status
  • Monitoring for complications
  • Managing pain
  • Successful management of the therapeutic regimen
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2
Q

In the initial hours after admission to the clinical unit, what are the primary concerns for a pt?
(know 4)

A
  • Adequate ventilation
  • Hemodynamic stability
  • Incisional pain
  • Surgical site integrity
  • Nausea and vomiting
  • Neurologic status
  • Spontaneous voiding
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3
Q

For the 1st hour post-surgery, how often are BP, HR and RR taken?

A

Every 15 min

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4
Q

For the 2 hours following the 1st hour post-surgery, how often are BP, HR, and RR taken?

A

Every 30 min

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5
Q

For the 1st 24 hours how often is the temp monitored?

A

Every 4 hours

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6
Q

Why should you monitor for airway patency and any signs of laryngeal edema post-surg

A

Because pulmonary complications are among the most frequent and serious problems encountered by the surgical patient

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7
Q

What are some factors that may cause shallow and rapid respirations in the post-surg pt?
(Know 3)

A
  • Pain
  • Constricting dressings
  • Gastric dilation
  • Abdominal distention
  • Obesity
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8
Q

What factors may cause noisy breathing?

A

May be due to obstruction by secretions or the tongue

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9
Q

What causes flash pulmonary edema?

A

Protein and fluid accumulate in the alveoli, unrelated to elevated pulmonary artery occlusive pressure

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10
Q

What are some signs and symptoms of flash pulmonary edema?

A
  • Tachypnea
  • Tachycardia
  • Decreased pulse oximetry readings
  • Frothy pink sputum
  • Crackles
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11
Q

What might be indicated by a pt with post-operative restlessness or a change in their mental state?

A

May be related to anxiety, pain, or medications. May also be a symptom of oxygen deficit, urinary retention, or hemorrhage

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12
Q

What are the major goals for postop pts?

Know 4

A
  • Optimal respiratory function
  • Relief of pain
  • Optimal cardiovascular function
  • Increased activity tolerance
  • Unimpaired wound healing
  • Maintenance of body temperature
  • Maintenance of nutritional balance
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13
Q

What is atelectasis?

A

Alveolar collapse, incomplete expansion of the lung

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14
Q

Which postop pt are at a higher risk for atelectasis?

A
  • Pts who are not moving well or ambulating
  • Not performing deep-breathing and coughing
    exercises
  • Not using an incentive spirometer
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15
Q

Signs and symptoms of atelectasis?

A
  • Decreased breath sounds over the affected area
  • Crackles
  • Cough
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16
Q

What are some charateristics of PNA?

A
  • Chills and fever
  • Tachycardia
  • Tachypnea
  • Cough may or may not be present and may or may not
    be productive
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17
Q

Hypostatic pulmonary congestion more frequently occurs in which pts?

A

In older pts who are not mobilized effectively

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18
Q

Signs and symptoms of hypostatic pulmonary congestion

A
  • Slight elevation of temperature, HR, and RR
  • Cough
  • Crackles at the base of the lungs
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19
Q

What is subacute hypoxemia?

A

A constant low level of oxygen saturation when breathing appears normal

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20
Q

What is episodic hypoxemia?

A

Develops suddenly, pt may be at risk for cerebral dysfunction, myocardial ischemia, and cardiac arrest

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21
Q

What are 3 factors that increase the risk for hypoxemia?

A
  • Pts who have undergone major surgery (particularly
    abdominal)
  • Obese pts
  • Pts with pre-existing pulmonary problems
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22
Q

To clear secretions and prevent pneumonia, what should the nurse encourage the pt to do?

A
  • Turn frequently
  • Take deep breaths
  • Cough
  • Use the incentive spirometer
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23
Q

How often should pts use the incentive spirometer?

A

At least every hour

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24
Q

Coughing is contraindicated in which pts?

A
  • Those with head injuries or who have undergone
    intracranial surgery (because of the risk for increasing
    intracranial pressure)
  • Pts who have undergone eye surgery (because of the
    risk for increasing intraocular pressure)
  • Pts who had plastic surgery (because of the risk for
    increasing tension on delicate tissues).
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25
Q

What affect does stress have on the body’s ability to form blood clots?

A

The hypothalamic stress response results in an increase in blood viscosity and platelet aggregation, increasing the risk of thrombosis and PE

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26
Q

What is the goal for pt controlled analgesia (PCA)?

A

Pain prevention rather than sporadic pain control

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27
Q

What are teh 2 requirements for PCA?

A
  1. An understanding of the need to self-dose

2. The physical ability to self-dose

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28
Q

Why are epidural infusions used with caution in chest procedures?

A

Because the analgesic may ascend along the spinal cord and affect respiration

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29
Q

How does intrapleural anesthesia affect breathing/coughing/etc?

A

Allows for more effective coughing and deep breathing in conditions such as cholecystectomy, renal surgery, and rib fractures in which pain in the thoracic region would interfere with these exercises

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30
Q

Is wound drainage included in an input/output record?

A

Yes

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31
Q

If your pt has an indwelling urinary catheter, how often should you be checking it?

A

Every hour

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32
Q

What mL should the pt be voiding every hour?

A

Greater than 30mL/hr, anything less is reported

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33
Q

What mL should the pt be voiding every 8 hours?

A

Greater than 240mL/hr, anything less is reported

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34
Q

What might dec hgb and hct levels indicate?

A

Blood loss or dilution of circulating volume by IV fluids

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35
Q

Venous stasis from dehydration, immobility, and pressure on leg veins during surgery put the patient at risk for:

A

DVT

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36
Q

What can the pt do to prevent thrombosis?

A
  • Leg exercises and frequent position changes
  • Avoid positions that compromise venous return (raising
    the bed’s knee gatch, pillow under the knees, sitting
    for long periods, and dangling the legs)
  • Venous return is promoted by antiembolism stockings
    and early ambulation
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37
Q

How does ambulation reduce postoperative abdominal distention?

A

By increasing GI tract and abdominal wall tone and stimulating peristalsis

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38
Q

How does early ambulation affect pain?

A

Pain is often decreased with early ambulation

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39
Q

What is orthostatic hypotension?

A

An abnormal drop in blood pressure that occurs as the patient changes from a supine to a standing position

40
Q

How is orthostatic hypotension detected?

A

BP is taken in the supine position, after the patient sits up, again after the patient stands, and 2 to 3 minutes later

41
Q

For a safe discharge home, what do pts need to be able to do mobility-wise?

A
  • Be able to ambulate a functional distance
  • Get in and out of bed unassisted
  • Be independent with toileting
42
Q

What is a benefit of wound drains?

A

They allow the escape of fluids that could otherwise serve as a culture medium for bacteria

43
Q

In what situation are nurses permitted to touch a wound dressing with ungloved hands?

A

Never, because of the danger of transmitting pathogenic organisms

44
Q

Why does the tape used for dressing a wound need to be flexible?

A

Because some wounds become edematous after having been dressed, causing considerable tension on the tape. If the tape is not flexible, the stretching bandage will also cause a shear injury to the skin

45
Q

In what situations is a nasogastric tube inserted?

A
  • If risk of vomiting is high due to the nature of surgery
  • If postoperative distention is anticipated
  • If a patient who has food in their stomach requires
    emergency surgery
46
Q

Normal peristalsis may be lost for 24-48 hours after surgery, why is that?

A

Because of the manipulation of the abdm organ during surgery

47
Q

After major abdominal surgery, distention may be avoided by:

A
  • Having the patient turn frequently
  • Exercise
  • Ambulate as early as possible
48
Q

How long does an NG tube inserted before surgery remain in place?

A

Until full peristaltic activity has resumed

49
Q

If the abdomen is not distended and bowel sounds are present, but the pt does not have a bowel movement by the second or third postoperative day, what should you do?

A

Notify the physician so that a laxative can be ordered

50
Q

What affect do anesthetics, anticholinergic agents, and opioids have on the bladder?

A

They interfere with the perception of bladder fullness and the urge to void and inhibit the ability to initiate voiding and completely empty the bladder

51
Q

How soon after surgery is the pt expected to void?

A

8 hours

52
Q

Which is preferred and why:

Intermittent or indwelling catheterization

A

Intermittent because the risk of infct is lower

53
Q

Why should a bedpan be warm when given to a pt for voiding?

A

A cold bedpan will cause automatic tightening of muscles, making it much more difficult to void

54
Q

What should the nurse do after a pt has finished voiding?

A

They should make sure that the bladder is completely empty by palpating or using a bladder scanner

55
Q

How often is intermittent catheterization done?

A

Every 4-6 hours until the post-void residual volume is less than 100mL

56
Q

Why do post-surg assessments include having the pt move their hands and feet through a full range of motion?

A

Because this will verify that no nerve, circulatory, or other damage has been done to the extremities

57
Q

What are some post-surg complications that a pt may experience?

A
  • DVT
  • Hematoma
  • Infct
  • Wound dehiscence and evisceration
58
Q

What are some threats to recovery that may be anticipated in older pts?
(Know 4)

A
  • Delirium
  • Pneumonia
  • Decline in functional ability
  • Exacerbation of comorbid conditions
  • Pressure ulcers
  • Decreased oral intake
  • GI disturbance
  • Falls
59
Q

What are some factors that determine whether a patient is at risk for delirium?
(Know 3)

A
  • Age
  • History of alcohol abuse
  • Preoperative cognitive function
  • Physical function
  • Serum chemistry
  • Type of surgery
60
Q

What would be the result of inhibiting the cytochrome P450 enzyme system?

A

This system is largely involved in opioid metabolism, so it’s inhibition would result in a prolonged effect

61
Q

What qualifies a drug to be classified as “pregnancy category 3” ?

A

Medication that has shown adverse effects on fetuses in animal studies

62
Q

Does morphine have a low or high ability to bind to proteins?

A

Low protein binding ability (40%)

63
Q

12% of the unchanged morphine product can be eliminated via _____.

A

Urine

64
Q

What is the half life of morphine?

A

Between 1.5-2 hours

65
Q

For a pt who is opioid naive, what perameters should be placed on their PCA?

A
  • 1-mg to 2-mg bolus
  • Six-minute lock-out interval
  • Self-administration dose of 1.5 mg to 3 mg per hour.
66
Q

For a pr who is opioid tolerant, what parameters should be placed on their PCA?

A
  • 1-mg to 3-mg bolus
  • Six-minute lock-out interval
  • Self-administration dose of 3 mg to 10 mg per hour
67
Q

What is an absolute contraindication for using morphine? Relative contraindications?

A

Absolute: A pre-existing allergy
Relative: Acute asthma or significant upper airway obstruction

68
Q

Why should morphine be avoided in pregnant or breastfeeding women?

A

Because morphine can cross the placental barrier and has been found in breast milk

69
Q

What are the most serious adverse effects of morphine?

A

Respiratory in nature, leading to hypoventilation and hypercapnia

70
Q

What are some other adverse effects of morphine?

A
  • CNS depression
  • Psychosis
  • Constipation
  • Euphoria
  • Oliguria
71
Q

T or F:

Hydromorphone is not a pregnancy category C medication

A

F, it is

72
Q

What is the avg half life of hydromorphone (IV)?

A

2.5 hours, there is extensive tissue uptake

73
Q

For PCA, how is hydromorphone usually ordered?

A
  • 0.1 mg to 0.2 mg
  • Five to 15-minute lock-out interval
  • A four-hour limit may be set at between 4 mg and 6 mg
74
Q

Why must the perioperative nurse exercise care when administering the product to patients who have respiratory depression or status asthmaticus?

A

Because hypoxia may result

75
Q

What is an absolute contraindication to hydromorphone use? A relative contraindication?

A

Absolute: Known hypersensitivity
Relative: GI obstruction (this product decreases peristalsis)

76
Q

What are some adverse effects of hydromorphone?

A
  • Respiratory depression
  • Hypotension
  • Flushing
  • Constipation
  • Urticaria (hives)
77
Q

IS fentanyl a pregnancy category C med?

A

Yes

78
Q

Why does fentanyl have such a rapid onset?

A

Because of it’s ability to quickly cross the blood brain barrier

79
Q

Large doses of fentanyl can produce _____

A

Apnea

80
Q

Adverse affects of fentanyl?

A
  • Hypoventilation
  • Bradycardia
  • Sedation
81
Q

Is meperidine a pregnancy category C med?

A

Yes

82
Q

Which has a longer duration:

Meperidine or morphine?

A

Morphine.

Meperidine has more kappa affinity and peaks faster but also dissipates faster, resulting in a shorter duration

83
Q

What is the half life of meperidine?

A

3-8 hours in healthy individuals

84
Q

What might a typical PCA order for meperidine look like?

A
  • Initial infusion of 10 mg
  • Range of 1 mg to 5 mg per incremental dose
  • Lock-out interval can range from six to 10 minutes
85
Q

The metabolism of meperidine result in the formation of what bioactive metabolite?

A

Normeperidine, which has an extended half-life elimination period of up to 20 hours

86
Q

Meperidine may also aggravate pre-existing ________ disorders

A

Convulsive

87
Q

The use of meperidine with another CNS agents can have significantly serious interactions. What are some of the adverse effects?

A
  • Respiratory depression
  • Hypotension
  • Sedation
  • Coma
  • Death
88
Q

Do obese pts report having more or less pain?

A

More

89
Q

What effect does an increased weight have on joints?

A

Causes degeneration to happen more quickly

90
Q

More body fat = higher risk of developing ________ _______

A

Metabolic syndrome

91
Q

Fibromyalgia is characterized by..?

A

…chronic widespread musculoskeletal

pain on both sides of the body.

92
Q

What is the link between obesity and fibromyalgia?

A

Obesity contributes to the continued presence of FM and increases the severity of the disorder. (research ongoing)

93
Q

How if the protein binding ability of drugs affected by obesity?

A

There is a decreased ability for drugs to bind to proteins

94
Q

Why might morphine and fentanyl not be ideal for obese pts?

A

Morphine may worsen any pre-existing resp conditions and fentanyl is a lipid soluble drug

95
Q

Why do obese pts require less local anesthetic while having epidural catheters placed?

A

Because they have decreased spinal fluid volume

N233 (3 decks)

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