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NRS 210 exam 1 > perioperative nursing > Flashcards

perioperative nursing Flashcards

1
Q

what are the purposes of surgery

A 
diagnosis
cure
palliation: alleviate symptoms
preventions
exploration
cosmetic
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2
Q

why is it important to know the surgical patients prescribed and OTC meds

A

some vitamins/herbs can increase/decrease effectiveness of anesthetics
-allergies
ask about hay fever, asthma, allergy to bananas, kiwi, guava, avocados

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3
Q

what are the preoperative interview purposes

A 
patient health history
patient expectations
provide and clarify info
assess emotional state
verify that consent is signed
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4
Q

Discuss effective preoperative teaching with an older adult that has difficulty seeing and hearing.

A

Allow additional time for teaching, ensure adequate lighting and quiet environment for teaching, ensure safety if patient experiences balance, thought or cognitive deficits

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5
Q

Why is deep breathing/incentive spirometer and coughing important for surgical patients? What would be appropriate to do for an abdominal surgical patient prior to coughing and deep breathing?

A

Prevention of complications – pneumonia, atelectasis, pulmonary embolism. Pt with abd

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6
Q

What would be an appropriate intervention when the surgical patient refuses to take off their wedding ring?

A

tape it to their finger

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7
Q

Why is the bedpan the only option for patients that have received preoperative IV medications?

A

After preop meds are given pt is at a higher risk for falls. Safety first!

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8
Q

Review principles of basic aseptic technique.

A

All materials entering sterile field must be sterile
• Front from chest to table level and the sleeves to 2 inches above the elbow are sterile
• If sterile item comes in contact with an unsterile item, it is contaminated
• Tables sterile on tabletop only
• Edges of sterile packages are not sterile
• Bacteria harbor on the skin
• Must maintain margin of safety between sterile and non-sterile (1 inch)
• Bacteria travels on airborne particles

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9
Q

What is general anesthesia

A

General anesthesia- the loss of sensation, with loss of consciousness, skeletal muscle relaxation, analgesia, and elimination of the somatic, autonomic and endocrine responses, including coughing, gagging, vomiting, and sympathetic nervous system responsiveness.

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10
Q

Two types of General Anesthetic Agents:

A

Intravenous induction agents- usually start with this IV induces pleasant sleep lasts a few mins. ET tube and inhalant started
2. Inhalation- Foundation of general anesthesia enters body through alveoli in lungs via mask or ET-Tube can irritating and produce laryngospasms
Patient risks- damage to teeth, irritation of vocal cords

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11
Q

what are adjunct to general anestheia

A

are added to the anesthetic regimen to achieve unconsciousness, analgesia, amnesia, muscle relaxation, or autonomic nervous system control.

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12
Q

what is dissociatvie anesthesia

A

interrupts associative brain pathways, pt appears catatonic is amnesic and experiences profound analgesia into post-op period. Ketamine used promotes bronchodilation (used for asthmatic patients), however can produce hallucinations

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13
Q

what is local anesthesia

A

allows op procedure to be performed on a part of body without loss of consciousness or sedation. Topical, ophthalmic, nebulized, or injectable.

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14
Q

what is topical anesthesia

A

Applied directly to skin (EMLA 30-60 minutes before procedure)

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15
Q

what is local infiltration

A

inject into tissues through which incision will pass- lidocaine.

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16
Q

what is regional

A

(peripheral) nerve block

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17
Q

what are the types of regional

A

Spinal- injection of local anesthesia in CSF usually below L2. Mixes with CSF. Has faster onset, increased H/A with leakage @ injection site.
o Epidural- injection into epidural space. Does not enter CSF, binds to nerve roots entering and exiting spinal cord.

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18
Q

Define malignant hyperthermia. What is the treatment?

A

A rare metabolic disease characterized by hyperthermia with rigidity of skeletal muscles that can result in death. Defect is hypermetabolism of skeletal muscle resulting from altered control of intracellular calcium. This causes muscle contractures, hyperthermia, hypoxemia, lactic acidosis, and hemodynamic and cardiac alterations. Can be prevented by obtaining a thorough family history and alert to MH s/s during the perioperative period.

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19
Q

what is the definition of surgery

A

the art and science of treating disease injuries and deformities by operation and instrumentation

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20
Q

what are the preoperative medications

A

antibiotics- precent postoperative infection
benzodiazepines- sedative and amnesic effect, decrease anxiety
anticholinergics- decrease oral and respiratory secretions
opiods- decrease pain
antimetics- increase gastic emptying, prevent nausea and vomiting

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21
Q

what are the routes of Preop meds

A

oral- 60-90 mins before
IM,SC 30-60 mins before
IV admiinist in OR

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22
Q

in the unrestricted surgical suite what is the attire

A

those in street cloths can interact with those in scrubs

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23
Q

int he semi restricted area in the surgical suite whats the attire

A

peripheral support areas and corridors- only authorized and must wear scrubs

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24
Q

in the restricted area in the surgical suite what is the attire

A

must weak masks and scrub sink area

25
Q

what does the circulating nurse do

A

Prepares room, ID pt, check chart, admits pt to OR, monitoring devices in place, monitors asepsis, labels monitors and measures blood and fluid loss, assists ACP,(Anesthesia care provider) records med used, counts sponges, coordinates activities (students), reports to PACU, goes with patient.

26
Q

what does the scrub nurse do

A

Assists with prepping room, scrubs, gowns & gloves self and others, prepares instruments on table, counts sponges, and needles, assists with draping, keeps track of irrigation solution, reports amount of anesthesia used ACP. Keeps hands above operating table level.

27
Q

what does the LPN or surgical tech do

A

scrub function, passes instruments, supervised by RN

28
Q

what does the surgeon and assistant do

A

perform surgical procedure

29
Q

what does the registered nurse first assist do

A

works collaboratively with surgeon, may provide/require formal education

30
Q

what does the nurse anesthetist do

A

administers anesthesia, assess pt preop- P-rating scale, prescribe preop meds, monitors cardio and resp function, VS’s, fluid and blood.

31
Q

what are the 4 levels of sedation

A

Mild- pt responds normal
Moderate (conscious sedation) - airway and C-V function are maintained, maintains his/her own airway with emotional and physical acceptance of painful stimuli, used for diagnostic procedures, monitor closely
Deep- pt not easily aroused
Anesthesia- pt requires assisted ventilation

32
Q

what are the phases of general anesthesia

A

Phases:
o Preinduction-Pre-op meds to start of IV, monitors, etc..
o Induction- Start of med sequence rendering pt unconscious
o Maintenance-During procedure, pt unconscious
o Emergence- Surgery complete, pt prepared for return to consciousness, removal of airway

33
Q

what are the patient risk with general anesthetic

A

damage to teeth

irritation of vocal cords

34
Q

what are the two types of local anesthesia

A

topical

local infiltration

35
Q

what are catastrophic events in the OR

A

anaphylactic reactions

malignant hyperthermia

36
Q

what is an anaphylactic reaction

A

Most severe form of allergic reaction characterized by decreased BP, tachycardia, bronchospasm, pulmonary edema (ABX or latex?) Reaction may be masked by anesthesia

37
Q

what is the treatment for malignant hyperthermia

A

Rapid administration of Dantrolene (slows metabolism) is a skeletal muscle relaxant along with cardiac support and iced saline lavage to body cavities

38
Q

what is the primary trigger of a malignant hyperthermia

A

succinlycholine

39
Q

hypventialtion is caused by

A

opioids

40
Q

when should post op patent do deep breathing

A

10 times every hour while awake

41
Q

when should you change patients position

A

every 1-2 hours

42
Q

when should you notify the surgeon

A 
systolic BP less than 90 or greater than 160
pulse less than 60 or greater than 120
pulse pressure narrows
BP trends up or down
Change in heart rhythm
43
Q

deep breathing is encouraged to

A

aid in gas exchange

44
Q

what are petition cardiovascular risk problems

A

hypotension
hypertension
dysrhymia

45
Q

early ambulation associated with walking

A

increase muscle tone
stimulate ciruclation
increases vital capacity
maintain normal respiratory function

46
Q

what is DVT prevention

A

Administering LMWH (low molecular weight heparin) in combination with antiembolism stocking

47
Q

how to prevent syncope

A

by making changes slowly in the patient’s position. Raise patient’s head of bed first and then assist patient to sit on the side of the bed. If faintness occurs the nurse can help the patient to a nearby chair or ease the patient to the floor

48
Q

emergence delirium can include what behaviors

A 
restlessness
agitation
disorientation
thrashing 
shouting
49
Q

what is delayed emergence

A

-the most common cause is prolonged drug action- particularly opioids, sedatives, and inhalation anesthetics

50
Q

the most common cause of post op aviation is

A

hypoxemia

51
Q

what is the most reliable indicator of pain

A

patients self report

52
Q

during the first 48 hours of post op

A

opioid are used and then after that nonopioid are used

53
Q

what are non pharmacologic approach of helping with acute pain

A

music
imagery
relaxation
aromatherphy

54
Q

when should you take the temperature

A

every 4 hours for the first 24 hours

55
Q

what are hiccups in the GI problems

A

irritation by the phrenic nerve

56
Q

what is low output caused by

A

increase aldosterone and ADH

57
Q

what is wound dehiscence

A

separation and disruption of previously joined wound edges

58
Q

what are gerontologic considers

A

Decreased respiratory function, Decreased ability to cough and
Decreased thoracic compliance - increases work of breathing and decreases ability to eliminate drugs – need to monitor reaction to drugs.
Pneumonia – common complication
Altered vascular function due to atherosclerosis and decreased elasticity in blood vessels.
Compromised cardia function – decreased circulating blood volume, HTN common.
Drug toxicity due to decreased renal perfusion – decreased ability to excrete drugs.
Changes in mental status due to age, history of alcohol abuse, poor baseline cognition, hypoxia, severe metabolic derangement, hypotension, polypharmacy.
Pain control – do not want to ask for medications.

NRS 210 exam 1 (8 decks)

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