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MedSurg P.M > Periop 2 > Flashcards

Periop 2 Flashcards

1
Q

poor oral hygiene, management: mouth wash with diluted hydrogen peroxide

A

Acute parotitis

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2
Q

Nurse assesses the patient’s decision-making capacity, confirms that patient has been given the necessary information to give informed consent and clarifies any misconception

A

patient’s advocate

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3
Q

what to assess in consciousness

A

GCS scoring, checking for reflexes unless contraindicated, monitor LOC or patient’s responsiveness

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4
Q

last sense to be depressed is

A

hearing

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5
Q

o Explaining the risks and benefits of the surgical procedure to thepatient/legal guardian

A

surgeon

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6
Q

begins with the cessation of
respiration and leads to death.

A

Stage IV (stage of danger/ medullar stage)

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7
Q

authorizes the attending physician and staff to render standard day-to day treatment or to perform generalized treatment and care as the physician deemed
advisable

A

general consent

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8
Q

s/s for Hemorrhage and Shock

A

 Decreased BP
 Rapid, thread pulse
 Apprehension
 Restlessness
 Weakness

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9
Q

o Ensures that sponge, instruments and sharp counts are completed
and appropriately documented

A

Circulating Nurse

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10
Q

fever etiologies

A

atelectasis
dehydration
wound infection
UTI
Thrombophlebitis

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11
Q

legal aspects PURPOSE:

A

o Ensure patient understanding to the nature of the treatment
o Indicate patients, decision
o Protect patient from unauthorized procedure
o Protect the surgeon and hospital against legal action

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12
Q

scrub nurse may be performed by

A

RN, licensed Practical Nurse (LPN), or OR scrub technologist

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13
Q

o In the immediate postoperative period, the anesthesiologist assumes medical responsibility for the patient

A

Anesthesiologist

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14
Q

where the patient is minor, unconscious or mentally unsound, the following may give consent (arranged according to legal interstate succession):

A

o Spouse
o Adult child
o Parent
o Sibling
o For minors: legal guardian

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15
Q

GI complications

A

Abdominal distention
constipation
paralytic ileus

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16
Q

types of regional anesthesia

A

Topical Surface
Local
Peripheral Nerve Block (tetracaine)
Spinal anesthesia
Epidural block
Acupuncture
Cryothermaia

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17
Q

pstn for hemorrhoidectomy, repair of vaginal laceration

A

Lithotomy

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18
Q

position: prone position with extremities lowered and hips over center break of table (i.e. oral surgeries)

A

Kroske/Jack Knife

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19
Q

o Anesthetizing the patient, provide appropriate levels of pain relief

A

Anesthesiologist

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20
Q

Urine output should be at least

A

at least 30 mL/h

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21
Q

begins with the onset of regular
breathing and ends with the cessation of respirations.

A

Stage III (stage of surgical anesthesia)

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22
Q

o Documenting intraoperative nursing care and ensuring surgical specimens are identified and placed in the appropriate media

A

Circulating Nurse

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23
Q

examples of inhalation general anesthesia

A

halothane, ether, nitrous oxide, cyclopropane

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24
Q

Secondary to decreased activity, decreased peristalsis

A

constipation

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25
Q

manifestations of thrombophlebitis

A

 Pain in the part of the body affected
 Skin redness of iflamation( not always present)
 Swelling (edema) of the extremities ( ankle and foot)

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26
Q

Post-operative psychosis manifestations

A

Insomnia, restlessness, anorexia, irritability/suicidal tendency

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27
Q

Must have a thorough knowledge and understanding on the specific surgical procedure and the anatomy and physiology of the involved system.

A

scrub nurse

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28
Q

General anesthesia is accomplished in 4 phases:

A

Pre-induction
Induction
Maintenance.
Reversal/extubation

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29
Q

what to give for patients with decreased level of consciousness

A

mouth guard

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30
Q

etiologies that varies in fever types

A

dehydration, wound infection, thrombophlebitis

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31
Q

position: the patient lies flat on bed with the patient facing the bed (i.e. spinal operation, posterior leg)

A

Prone

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32
Q

an RN whose responsibility is to serve as the patient’s advocate while coordinating events before, during and after a surgical procedure

A

circulating nurse

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33
Q

o Monitoring patients’ physiologic status

A

Anesthesiologist

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34
Q

intervention of thrombophlebitis

A

Bed rest with feet elevated

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35
Q

o Monitoring the scrubbed team members for breaks in the sterile technique

A

scrub nurse

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36
Q

pstn for biliary tract surgery

A

Reverse Trendelenburg

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37
Q

 Components of a consent:

A

o Patient’s full legal name
o Surgeon’s name
o Specific procedures to be performed
o Signature of the patient, next of kin, legal guardian
o Witnesses
o Date

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38
Q

has the obligation to provide the patient or legal guardian full disclosure regarding the risk and benefits of anesthetic agents that are to be used to the patient

A

anesthesiologist

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39
Q

phase that Begins as soon as the patient is brought to the procedure room and ends immediately before the induction of the anesthesia

A

pre-induction

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40
Q

o Providing nursing care to the patient

A

Circulating Nurse

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41
Q

late sign of atelectasis

A

cyanosis

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42
Q

Manifestation:
 Productive cough
 High Grade fever accompanied by chills

A

pneumonia

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43
Q

phase that Begins with the induction of anesthetic agents and ends with stabilization of the patient. Involves putting the patient safely to sleep. A patent airway and adequate ventilation must be ensured

A

induction

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44
Q

length of stay in the PACU is generally ***; for a patient to be transferred to the ward, the patient should be stable and free form signs and symptoms of postoperative complications

A

less than 24 hours

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45
Q

o Preparing supplies and equipment in the sterile field

A

scrub nurse

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46
Q

mgt thrombophlebitis

A

 Bed rest with the affected limb elevated
 Warm compress
 Administration of thrombolytics or anticoagulants as ordered

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47
Q

o Providing appropriate sterile instrumentation, sutures, and supplies to the operating surgeon.

A

scrub nurse

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48
Q

Paralysis of the intestinal peristalsis

A

paralytic ileus

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49
Q

abdominal distention mgt

A

 Insertion of NGT
 Lavage
 IVFluid replacement of electrolytes

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50
Q

intervention of atelectasis

A

Cough, deep breathing
exercises

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51
Q

o Determining the pre-operative diagnosis

A

surgeon

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52
Q

may be attributed to grief of lost body part, body image disturbance, standing emotional problem, exhaustion

A

Post-operative psychosis

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53
Q

An inflammatory condition of lung (alveoli) characterized by consolidation of the lungs

A

pneumonia

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54
Q

o Managing post-operative care

A

surgeon

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55
Q

evisceration mgt

A

 Position patient flat or low fowlers position
 Cover the protruding organ with sterile moist dressing
 Instruct patient not to cough
 NPO
 Notify the surgeon STAT
 Prepared the patient for surgery for immediate closure of wound

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56
Q

Types of general anesthesia

A

Inhalation
Intravenous anesthesia
Rectal anesthesia

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57
Q

pstn for spinal operation, posterior leg)

A

prone

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58
Q

anesthesia commonly employed as induction agent prior to inhalation anesthesia

A

intravenous anesthesia

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59
Q

Factors to consider in determining the type of anesthesia:

A
  • Age and physical condition of the patient
  • Type, location and duration of surgery
  • Degree of technical intricacy of surgery
  • Previous anesthetic history
  • Personal preference, expertise and judgment of anesthesiologist
  • Patient’s preference
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60
Q

position: legs are flexed at right angles and placed on stirrups (to expose perineal and rectal areas) [i.e. hemorrhoidectomy, repair of vaginal laceration]

A

Lithotomy

61
Q

patients become what in stage 1 of guedel’s stages

A

drowsy, dizzy

62
Q

Secondary to failure of cardiac muscles to contract, may be due to effects of anesthesia

A

cardiac arrest

63
Q

begins with the loss of consciousness and ends with the onset of regular breathing and loss of eyelid reflexes; often companied by involuntary muscle activity; the patient should no receive auditory or physical stimulation during this period

A

Stage II (stage of delirium/ excitement)-

64
Q

o Refers to partial or complete separation of the wound edges
o Usually occurs on the 6th-7th post-operative day when sutures heal
o Caused by excessive strain, severe coughing, malnutrition

A

dehiscence

65
Q

phase that starts when stabilization is accomplished and ends when reversal of anesthesia is initiated near the procedure’s end.

A

maintenance

66
Q

introducing anesthetic agent into the epidural space (through the intervertebral space into the space surrounding the dura matter in the spinal column)

A

epidural block

67
Q

position for gallbladder

A

modified supine with shoulders elevated

68
Q

intervention of UTI

A

Antibiotics, increase fluid,
ambulate

69
Q

o Identifying and performing the appropriate surgical procedure

A

surgeon

70
Q

onset fever of UTI

A

day 5-8

71
Q

o Communicate relevant information to individuals outside the OR

A

Circulating Nurse

72
Q

s/s for shock

A

decreased BP, increased PR, cold clammy skins, oliguria

73
Q

o Consent in the form of a telephone call is permissible in such situations provided that there should be *** persons to witness the call

A

two

74
Q

suspension of sensation on affected site of the body; temporarily prevents generation and conduction of nerve impulses and may not affect motor functions; used for patients whom general anesthesia is contra indicated

A

Regional anesthesia

75
Q

Post-surgical atelectasis is treated
through

A

physiotherapy (DBCE, incentive spirometer, ambulation)

76
Q

position for thyroid surgery

A

modified supine with neck extended

77
Q

Vital signs are monitored every ** for two hours
until stable, every ** for two ours then every *** until
stable

A

15 minutes
30 minutes
4 hours

78
Q

intervention of dehydration

A

Increase oral fluid intake, I&O
monitoring

79
Q

Role of the NURSE:

A

To become the patient’s advocate

80
Q

The surgical team

A

Surgeon
 Anesthesiologist
 Scrub Nurse
 Circulating Nurse

81
Q

pstn surgery of lower abdomen

A

Trendelenburg

82
Q

Refers to the inflammation of a vein secondary to blood clot

A

thrombophlebitis

83
Q

anesthesia that is rarely used today; indicated for anesthetizing a child when facial surgery makes it difficult to maintain airway

A

Rectal anesthesia

84
Q

Who are qualified to give consent:

A

Those of legal age
o Those of sound mind (during their lucid interval)

85
Q

may be an evidence of post-operative complications

A

fever

86
Q

examples of Intravenous general anesthesia

A

pentothal, ketalar

87
Q

If no family or legal guardian can be contacted,** with the procedure may take the decision for surgical intervention. In this circumstance a relative must sign an operative consent as soon as possible

A

two physicians who are not associated

88
Q

dehiscence mgt

A

Resuturing, application of adhesive to pull edges

89
Q

intervention of wound infection

A

Antibiotics, proper wound care

90
Q

Types of consent

A

general
informed

91
Q

Fever persisting after 3rd day
 General body malaise
 Increased RR
 Swelling, tenderness of the wound
 Purulent discharge

A

infection

92
Q

position: patient lies on back with the body section raised 45o to 90o (i.e. thoracotomy)

A

Sitting/Fowler’s

93
Q

position: the patient is positioned in supine position, with the neck extended (thyroid
surgery) or shoulders elevated (gallbladder), dorsal recumbent (knees flexed), arm extension (arm
board)

A

Modified Supine

94
Q

injection into the surgical area making the receptor unresponsive to stimuli

A

local

95
Q

manifestation of paralytic ileus

A

 Absent bowel sounds
 No flatus

96
Q

what to avoid When transferring the patient to the PACU:

A

 Avoid exposure
 Avoid rough handling
 Avoid hurried movements and rapid changes in position

97
Q

process (not mere documentation) explanations of the procedures,
risks, benefits and alternative therapy made verbally to the patient’s level of
understanding.

A

Informed Consent

98
Q

injection of certain local anesthesia into subarachnoid space between l3 and l4 using a lumbar interspace, usually employed for almost any type of major operation below the level of diaphragm

A

Spinal anesthesia

99
Q

o Obtaining informed consent for the surgical procedure

A

surgeon

100
Q

partial or total loss of sensation with or without loss of consciousness deliberately induced to prevent pain perception and promote relaxation during surgery

A

Anesthesia

101
Q

In case of emergency, the surgeon may operate without the written permission of the patient or family although every effort is made to contact a family member if time permit

A
102
Q

blocks sensory receptor by penetrating thru sensory nerve endings reducing responses to stimuli

A

topical surface

103
Q

onset fever of wound infection

A

day 3-5

104
Q

refers to the depression of the central nervous system by administration of drugs or inhalation agents; patients under this usually require ventilator assistance

A

general anesthesia

105
Q

wound complications

A

infection
dehiscence
evisceration

106
Q

urinary complications

A

urinary retention, UTI, Renal failure

107
Q

fever type of UTI

A

low grade

108
Q

secondary to decreased mobility, decreased circulation

A

decubitus ulcer

109
Q

o Before and during the induction of anesthetic, provides emotional
support to the patient and assists the anesthesia team during the
induction period

A

Circulating Nurse

110
Q

o Managing the activities outside the sterile field

A

Circulating Nurse

111
Q

pstn for oral surgeries

A

Kroske/Jack Knife

112
Q

o Identifying and making the surgical procedure

A

surgeon

113
Q

treatment for Hemorrhage and Shock

A

Ligation of blood vessels

114
Q

urinary retention mgt

A

catheterization

115
Q

occurs when blood loss is too extensive that the body is not capable of maintain adequate blood flow throughout the system

A

shock

116
Q

position: for sigmoidoscopy, induction of spinal anesthesia

A

knee-chest

117
Q

should be the one to provide information about the procedure, its nature and known possible consequences

A

Surgeon

118
Q

injection of an agent
into the large trunk or nerve plexus

A

Peripheral Nerve Block (tetracaine)

119
Q

o Creating a safe environment for the patient

A

Circulating Nurse

120
Q

Post-operative psychosis mgt

A

Verbalization, 24 hour responsible watcher

121
Q

phase that begins with closure of the wound and ends before patient transport to PACU

A

Reversal/extubation

122
Q

UTI mgt

A

Administration of antibiotics as prescribed, increase fluid intake

123
Q

position: head part is lower than the foot part (surgery of lower abdomen)

A

Trendelenburg

124
Q

Types of anesthesia

A

General Anesthesia
Regional Anesthesia

125
Q

position for exploratory laparotomy, abdominal surgeries

A

supine

126
Q

renal failure mgt

A

I&O monitoring, regulate IVFluid

127
Q

position: flat on bed with arms at sides or supported by arm boards (i.e. exploratory laparotomy,
abdominal surgeries)

A

supine

128
Q

anesthesia that administered through (1) open drop [anesthesia is roped directly into layers of gauze that is held on the patients’ mouth (2) mask

A

inhalation

129
Q

pstn for thoracotomy

A

Sitting/Fowler’s

130
Q

o Obtains supplies and equipment for the sterile team members

A

Circulating Nurse

131
Q

mgt for cardiac arrest

A

CPR, cardiac stimulants

132
Q

begins with the administration of anesthetic agent and ends with the loss of consciousness; patients become drowsy, dizzy; the last sense to be depressed is hearing and first to return.

A

Stage I (stage of analgesia)

133
Q

Characterized by frequent vomiting of small amounts without effort which may impose
strain or diaphragm causing dyspnea

A

abdominal distention

134
Q

paralytic ileus mgt

A

 Ambulation
 Gastric decompression
 IVFluid

135
Q

other complications

A

Acute parotitis
Decubitus ulcer
Post-operative psychosis

136
Q

Commonly Used Operative Positions

A

Supine
Modified Supine
Prone
Sitting/Fowler’s
Trendelenburg
Reverse Trendelenburg
Lithotomy
Kroske/Jack Knife
Knee-Chest

137
Q

to assist the patient in returning to optimal functioning as quickly as possible

A

post operative phase

138
Q

onset fever of dehydration

A

day 2-3

139
Q

There is a separation of all the tissue layers in an abdominal wound and prostrusion of
the abdominal content.

A

evisceration

140
Q

proper positioning for spinal anesthesia

A

flat on bed

141
Q

position: head part is elevated and is higher than the foot part (i.e. billiary tract surgery)

A

Reverse Trendelenburg

142
Q

onset fever of atelectasis

A

Within the first 24
hours

143
Q

most common cause of pneumonia

A

microaspiration of bacteria

144
Q

o Evaluates the patient to determine the appropriate anesthetic to administer

A

Anesthesiologist

145
Q

fever type of atelectasis

A

low grade

146
Q

 Refers to a physician who specializes in administering agents and monitoring the patient’s response to the agents

A

Anesthesiologist

147
Q

onset fever of thrombophlebitis

A

day 7-14

148
Q

four stages of Guedel’s Classification of the Stages of Anesthesia

A

stage of analgesia
stage of delirium/ excitement
stage of surgical anesthesia
stage of danger/ medullar stage

149
Q

Major complications of anesthesia:

A

 Respiratory arrest
 Cardiac arrest

MedSurg P.M (7 decks)

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