Module 3 Flashcards

Question

Gerontological considerations during patient teaching

Answer 1

Diminished abilities to hear, see, and understand may interfere with preoperative/postoperative teaching. May need to repeat explanations and demonstrations. Include family members Be aware of cognitive changes due to pain, medications, or change in environment Use the teach-back technique to help understand needs that need to be clarified

Answer 2

Several days prior to surgery, client may be required to bathe with a germicide soap Hair removal is not done unless it may interfere with the incision due to potential microabrasions If necessary, hair is removed with electric clippers

Answer 3

The client may require insertion of an indwelling catheter or the client voids immediately prior to surgery or administration of preoperative medications Enemas or laxatives may be required to clean out the bowel for some abdominal surgeries to prevent potential fecal contamination

Answer 4

NPO at least 8-10 hours prior to surgery Some surgical procedures may allow for clear liquids up to 2 hours prior to surgery An adequate intake of protein and ascorbic acid is necessary for appropriate wound healing

Answer 5

The client’s valuables should be left at home, if possible, given to a family member/significant other, or placed in an envelope to be locked in a secure area If a ring is unable to be removed or the client is reluctant to remove, wrap gauze around the ring or cover with adhesive tape Glasses or contact lenses should be removed

Answer 6

The client generally wears a hospital gown, and a cap to cover the hair All makeup and nail polish should be removed If an ambulatory surgery, only portions of the clothing, makeup or polish may need to be removed Antiembolism stockings or elastic wraps may be required preoperatively

Answer 7

Antianxiety medications, histamine-2 receptor antagonists, anticholinergics, opioids, sedatives, and/or antibiotics

Answer 8

Follow the patient rights for medications administration, check for drug allergies, vital signs, ask client to void, surgical consent is signed

Answer 9

The client should remain in bed, side rails should be placed up for safety, call button is within reach

Answer 10

Surgery that requires less than 24H of hospitalization

Answer 11

Surgery which the client will not be harmed if the surgery is not performed but will benefit if it is performed

Answer 12

Preoperative teaching and listening Assess coping methods Preoperative checklist

Answer 13

When patient is transferred to operative table

Answer 14

Completely or partially alter sensation with our without the loss of consciousness so that surgical procedures can be done painless & safely

Answer 15

Loss of sensation, reflexes, and consciousness. Endotracheal tube may be required for respirations during anesthesia; requires close monitoring of client status; anesthesia is withdrawn at the end of the procedure

Answer 16

Induction - administered with IV or inhalation & produces unconsciousness Excitement - uninhibited movements or vocalizations Surgical anesthesia - appropriate level of anesthesia for the procedure Medullary depression - too much anesthesia

Answer 17

Loss of sensation and decreased mobility to specific anesthetized area with use of local anesthetics; risk for injury and burns due to lack of sensation; may require sedative to promote relaxation; includes spinal and epidural anesthesia; complications can include spinal headache

Answer 18

conscious sedation in which client is free of pain, fear, and anxiety and able to tolerate the procedure; nurses must be aware of side effects and that sedatives can cause respiratory depression; antagonists can be administered to reverse the effects – Naloxone for opioids and flumazenil for barbiturates; requires close monitoring of client status Clients should not be allowed to drive to make important decisions for at least 24-48 hours

Answer 19

Anesthesia, narcotics, and barbiturates can cause confusion, disorientation, or other physiological alterations in the older population

Answer 20

Physician specializing in anesthesia

Answer 21

Physician without an anesthesia specialty or a registered nurse who is certified in anesthesia and works under the supervision of a physician

Answer 22

Assess the client prior to surgery, orders preoperative medications; explains anesthesia, risks and potential complications to the client; administers the anesthesia and monitors the client during and after surgery Not a sterile member of the team

Answer 23

Heads the surgical team Determines procedure to be performed, obtains client’s consent, performs the procedure, and follows the client after the procedure

Answer 24

First assistant assists in procedure and may assist with pre- and postoperative care May be physician, resident or certified RN Second assistant and third assistants assist surgeon and first assistant May be RNs or LPNs or surgical technologists All assistants are sterile members of the team

Answer 25

Hands instruments to the surgeon, prepares sutures, receives specimens, counts sponges, instruments, and needles. Sterile team member.

Answer 26

Oversees health and safety of the client by monitoring all the surgical team’s activities Assesses client for injury with interventions as necessary; obtains and opens wrapped sterile equipment and supplies before and during surgery; keeps records; assists in sponge, instrument, and needle counts; adjusts lighting; receives specimens; and coordinates activities of other personnel Not a sterile team member

Answer 27

The operating room is physically isolated from other areas Only authorized OR personnel or surgical clients are allowed The air is filtered and positive pressure is maintained to reduce infection The temperature is below 70° F to decrease bacterial growth and provide comfort to the surgical team Surgical attire decreases microbial growth All symptoms of infection in the surgical team must be reported Furniture is stainless steel for easy cleaning and disinfecting

Answer 28

Unrestricted zone – Street clothes are allowed; where clients, personnel, and supplies arrive Semirestricted zone – Does require surgical attire, but not masks; Includes sterile and clean storage areas; work areas for cleaning instruments; and corridors leading to the restricted areas Restricted zone – Includes OR and procedure room and scrub sink areas; requires full surgical attire

Answer 29

BP and pulse and respiratory rates Level of consciousness General physical condition Presence of catheters and tubes Review of client’s medical record

Answer 30

Infection prevention includes monitoring for breaks in the sterile technique or field and counting of sharps, sponges, and instruments Fluid volume excess or deficit – The anesthesiologist administers IV fluids, but the circulating nurse tracks IV fluids administered and measures urine output during surgery when appropriate Injury due to positioning can occur in as little as 2 hours due to interruption of blood flow to an area resulting in pressure injuries, nerve injury, postoperative hypotension, dependent edema, and joint injury Hypothermia is a possibility due to the low temperature in the OR; cold IV fluids; inhalation of cool gases; exposure of body surfaces for the procedure; open wounds; and prolonged activity or intentional body temperature lowering for some surgical procedures Malignant hyperthermia is an inherited disorder Body temperature, muscle metabolism, and heat production increase rapidly in response to stress and some anesthetic agents Symptoms include jaw muscle rigidity, rapidly elevating temperature, elevated CO2 levels, elevated potassium, metabolic acidosis, hypotension, irregular heart rhythm, and kidney failure and cardiac arrest if left untreated Gerontological considerations include increased risk for injury with prolonged surgical positioning; chronic conditions increase risk of complications

Answer 31

When client is admitted to the postanesthesia care unit (PACU) or recovery room

Answer 32

Anesthesia personnel/circulating nurse

Answer 33

Maintaining an intact surgical site Observing for vascular changes Keeping client warm Positioning of client; protect incision and drains Assessing for orthostatic hypotension

Answer 34

Refer to the Aldrete scale Airway patency, effective respirations, artificial airways, mechanical ventilation, oxygen Circulatory status; wound condition, dressing, and drains Fluid balance: IV fluids, catheter and drain output Level of consciousness and pain Monitors for potential complications

Answer 35

Aldrete scale is a tool used to assess how well a client is recovering from anesthesia, rating the client’s mobility, respirations, blood pressure, level of consciousness, and pulse oximetry

Answer 36

Hemorrhage: Inspects the dressings, continues or initiates blood transfusions, reinforces dressings, monitors wound drains Shock: Fluid and electrolyte loss, trauma, anesthetics, medications all contribute to shock; treat with blood, plasma expanders, IV fluids, oxygen, and medications if present Hypoxia: Residual drug effects, pain, positioning, pooling of secretions, or obstructed airway can cause hypoxia; oxygen and suction equipment should be available; assess for signs of cyanosis and dyspnea Aspiration: Aspiration from saliva, mucus, vomitus, or blood can occur until client is awake and able to swallow without difficulty; have suction equipment at bedside; assess for difficulty swallowing, side-lying position may be helpful Wound dehiscence is separation of wound edges without protrusion of organs Likely to occur within 7-10 days postoperatively; risks include poor nutrition; chronic disease; older adult; increased abdominal tension; obesity; infection Decrease strain on incision and notify surgeon Evisceration is separation of wound edges with protrusion of organs Cover with sterile dressings moistened with normal saline and notify surgeon Paralytic ileus are paralyzed intestines and no parastaltic activity May require nasogastric tube and NPO status until bowel sounds return Pneumonia and atelectasis, or the collapse of alveoli, are possible due to drug effects, failure to take deep breaths, and immobility The older adult is most at risk for these complications, in addition to the obese, clients with COPD, or clients having had chest or abdominal surgery Infection is indicated by increased wound pain or drainage, erythema, increased warmth, edema, and purulent exudate; increased body temperature; may require antibiotics Infection risk is increased with traumatic wounds, wounds that were not treated promptly, or wounds that were infected preoperatively, in addition to clients who are obese, immunosuppressed or with diabetes mellitus Thrombophlebitis is the inflammation of veins with the formation of blood clots usually caused by long periods of immobility These clients are at increased risk for pulmonary emboli Antiembolism stockings or sequential compression devices may be used to reduce the risk of blood clot formation in the legs

Answer 37

Begins when the client arrives to the hospital room or postsurgical care unit

Answer 38

Respiratory status, circulation, pain management, fluids and nutrition, skin integrity, wound healing, activity, bowel elimination, urinary elimination and psychosocial status The nurse should assess respiratory and cardiac function, general condition, vital signs, fluid status, pain level, elimination and flatus, dressings, drains, and IV lines Respiratory status – Encourage deep breathing exercises, use of incentive spirometer and splinting of incision; provide supplement oxygen as needed; encourage frequent position changes and early mobilization Circulatory status requires assessment of blood pressure and potential orthostatic hypotension; assessment for bleeding; and venous circulation impairment in the form of deep vein thrombosis, which could break off and become pulmonary emboli Postoperative pain is at its greatest 12-36 hours post procedure; pain should be treated before it becomes uncontrollable; pain unrelieved by medication can indicate complications Opioids Indications: Relieve moderate to severe pain; May be used in conjunction with anesthetics; Suppress cough center (codeine) Adverse effects: Constipation; strong abuse potential; flushing and orthostatic hypotension; sedation; N/V; urinary depression; respiratory depression; confusion Contraindications: Drug allergy; severe asthma; respiratory insufficiency; elevated ICP; morbid obesity; sleep apnea myasthenia gravis; paralytic ileus; pregnancy Interactions: CNS depressants; alcohol Treatment of overdose: naloxone and naltrexone Opioid agonists Bind to an opioid pain receptor in the brain causing an analgesic effect Examples: Codeine – Antitussive; ceiling effect (higher doses do not improve pain relief) Fentanyl – Injectable – operative; Transdermal for chronic pain – breakthrough pain may include administration of an immediate-release opioid Hydromorphone Meperidine – High risk of toxicity Methadone – Detoxification of opioid addicts Morphine Oxycodone Agonists-antagonists opioids AKA partial agonist or mixed agonist Bind to a pain receptor and causes a weaker pain response than a full agonist Avoids oversedation – useful in obstetrical clients; useful in opioid addiction; decreased risk for addiction or dependency Examples: Butorphanol, nalbuphine, pentazocine Opioid antagonists Bind to a pain receptor but does not reduce pain signals Examples: Naloxone Fluids and nutrition: IV fluids, dietary progression is dependent on type of surgery, client’s progress, and physician order; assess for nausea and vomiting, nasogastric tube may be placed in abdominal surgery clients Nursing guidelines for resuming oral fluids NPO/assess bowel sounds; GI activity may not resume for 24 to 48 hours Assess swallowing/introduce sips of water/ice chips slowly - usually within 4-24 hours postoperatively unless GI surgery Administer antiemetic medications if client nauseous or vomits When able, promote protein, calories, vitamins A, C, and zinc for wound healing and immune system function Skin integrity/wound healing: wound assessment Wound devices: Drains remove fluids from wounds Drains may remove fluid passively or actively with suction A penrose drain is a flat, silicone-type drain that is placed deep into the wound and lies flat on the skin outside the wound There is often a sterile safety placed in the portion of the drain that lies on the skin to prevent it sliding into the wound A Jackson-Pratt or Reliavac drain is a hollow silicone bulb with a cap to drain and measure the exudate, and is attached to a tube that is placed near the wound through a stab site The cap is open and the bulb is compressed – while holding the compression, the cap is replaced The drain is often secured to the client with a suture The bulb is often secured to a dressing or the client’s clothing with a safety pin through the tab on the bulb to prevent dislodgement A circular, drum-shaped, spring-loaded drain, often referred to as a Hemovac is another option, and is often used with orthopedic surgeries While the cap is open, the drain is compressed, and the cap is replaced This drain may also be secured to the client with a suture This is one of the drains that may have the option of reinfusing sanguinous exudate This drain usually has a clip, similar to those on Foley catheter tubing, to secure it to the bed or client’s clothing Clients may have a nasogastric tube inserted through one the nares and is attached to low, intermittent suction These tubes are secured to the client’s nose with adhesive The tube is often secured to the client’s gown to help prevent dislodgement Wound assessment includes assessing approximation of wound edges, intactness of staples/sutures; signs of infection, and reactions to the adhesive or dressing Phases of wound healing include the inflammatory stage, proliferative phase, and maturation/remodeling phase Three modes of wound healing Primary intention is healing of a wound with edges that are well-approximated with sutures/staples Secondary intention is healing of a wound from the bottom up and edges are not approximated Tertiary intention is the leaving of a wound open initially and going back to suture the edges at a later time Factors affecting healing: impaired circulation, malnutrition; hyperglycemia, infection, foreign bodies, age, immobility Signs of wound infection: increased incisional pain, redness, swelling, heat around incision, purulent drainage, fever, headache, anorexia Complications: dehiscence, evisceration Activity: Advance activity as tolerated as soon as possible, administer pain medication Regional anesthesia—initially restricted until feeling returns Spinal headache: remain lying flat for longer period of time Bowel elimination Abdominal distention: May be caused by narcotics, diet, and inactivity; encourage to ambulate, frequent position changes, diet advancement Paralytic ileus is paralyzed intestines, acute gastric dilatation is a stomach dilated with fluids Urinary elimination may be difficult after surgery If unable to void within 8 hours postoperatively, encourage voiding, may require straight catheterization Psychosocial status may be altered due to changes in body image or lifestyle Assess for issues Referrals for counseling, support groups Gerontological considerations The older adult can develop confusion and disorientation with narcotic and barbiturate use Respiratory depression risk is also greater in the older adult with narcotics May have a delay in healing due to thinner skin and loss of subcutaneous tissue Are at an increased risk for infection due to a diminished immune response