retired cards

Question 1

how can nurses help to reduce surgical risks?

Answer 1

1. Knowledge of patient’s current condition
2. Recognize coexisting problems/co-morbidities and the
   effect on the patient’s surgical experience.
3. Identify the patient’s response to stress of surgery
4. Understand the role of the family/support person
5. Identify risks associated with procedures
6. Undertake complete pre-operative assessment, organize
   and review pre-operative diagnostic tests
7. Full preparation for surgery e.g .fasting/pre-med etc. according to anaesthetist/surgeon instructions
8. Ensure consent signed and pre-op preparation completed
9. Collect documentation to accompany patient to surgery

Question 2

pre-op patient preparation to reduce risk?

Answer 2

Pre‐operative preparation – MDT approach:
1. Assessment by nurse/surgeon/anaesthetist/allied heath
e.g. pharmacist, physiotherapist etc.
2. Begin discharge planning – assess
patient needs and wants
3. Verify understanding of pre-operative orders
4. Assess nutrition status
5. Provide patient education to child and family to minimise complications

Question 3

what is important to ascertain in a history to minimise pre-op risk?

Answer 3

1. Current problem(s)
2. Physical examination e.g. vital signs, urinalysis, weight, height, diagnostic tests
3. Current and past medical/surgical history e.g. co‐morbidities
4. Allergies
5. Medications including OTC, herbs, vitamins
6. Parent’s understanding of condition/upcoming surgery
7. Family or other support e.g. for spiritual/cultural beliefs

Question 4

what are the peri-operative risk factors?

Answer 4

1. Age
2. Nutritional status (inc. obesity/anorexia)
3. Fluid and electrolyte balance
4. Co‐morbidities
5. Lifestyle
6. Medications
7. Allergies
8. Anaesthesia - have they ever had one? have they ever had a reaction?
9. Procedure

Question 5

perioperative risks associated with obesity and anaethesia?

Answer 5

Due to stress on multiple systems

1. Anaesthetic risk - sleep apnoea, difficulty with intubation
2. Slower recovery from anaesthetic because adipose tissue stores inhalation gases, some drugs have less mobility
3. May require higher dosage of medications

Question 6

perioperative risks associated with obesity and cardiac complications?

Answer 6

• Hypertension due to increased length of blood vessels due to excess weight
• High cholesterol resulting in atherosclerosis
• Atrial fibrillation

Question 7

other perioperative risks associated with obesity?

Answer 7

• Diabetes type II with abdominal obesity → increased risk of infection and poor wound healing
• Gastro‐oesophageal reflux disease (GORD) common in obesity (aspiration risk)

Question 8

what is the role of the nurse at the intraoperative stage?

Answer 8

patient safety in positioning, 
specimen collection, 
surgical counts, 
maintaining sterile field, 
assist surgeon/anaesthetist or other staff as required; organize and pass equipment
advocate for patient

Question 9

examples of pre-op nursing education

Answer 9

“when you return to the ward, we will ask you to sit up and practice deep breathing and coughing”
“we may ask you to sit out of bed to help with breathing and mobility”
“we may ask you to do leg exercises to reduce risk of DVT”
explain how PCA works before surgery, why pain relief is important
how to care from a stoma
what you’ll eat post op/how often you should mobilise
what MDT members might be involved

Question 10

how does a child’s respiratory system differ from an adult’s?

Answer 10

1. shorter, narrower airway
2. larger tonsils/adenoids
3. smaller mouth cavity/ larger tongue
4. epiglottis long, swells easily
5. increased risk of oedema
6. neck not rigid, more easily flexed (occlusion)
7. larynx and epiglottis are higher = increased risk aspiration

Question 11

differences in a child’s renal system?

Answer 11

1. urea synthesis and excretion slower
2. less able to adapt to sodium imbalances
3. full set of nephrons but not fully operational yet
4. less able to reabsorb water and sodium (urine very dilute)
5. bladder sits in abdomen
6. less padding on kidneys (more risk of damage)
7. hydrogen/acid/bicarbonate excretion all lower

Question 12

differences in child’s circulatory system?

Answer 12

1. increased HR only way to control cardiac output
2. blood volume higher per kg
3. but generally low blood volume makes bleeding more dangerous
4. HR is higher, oxygen requirements are higher
5. vessels are smaller

Question 13

common T+As post-op symptoms

Answer 13

throat pain (up to 2 weeks)
ear pain (up to two weeks)
dehydration
halitosis
weight loss
low grade fever

Question 14

when would you expect to see bleeding post-op T+As?

Answer 14

when the scab sloughs off, about 6-8 days post-op, for about 2 mins (very small amount)

Question 15

what percentage have a serious bleed T+As post op?

Answer 15

2-5% . any post-op bleeding may be a surgical emergency and should be treated as such, even a small self-limiting bleed

Question 16

describe the different kinds of bleeding post-op T+As?

Answer 16

primary bleeding - less than 24 hours after

secondary bleeding - usually 5-10 days later, can be up to 14

Question 17

PEWS chart - what’s assessed/charted under airway and breathing?

Answer 17

RR
REffort
oxygen therapy
oxygen sats

Question 18

PEWS chart - what’s assessed/charted under circulation?

Answer 18

HR
capillary refill time
BP
skin colour (not scored)

Question 19

PEWS chart - what’s assessed/charted under disability?

Answer 19

AVPU - alert, voice, pain, unresponsive

Question 20

PEWS chart - what’s assessed/charted under exposure?

Answer 20

temperature, urine output (no score for either)

Question 21

what’s the level of urine output below which you should notify the team?

Answer 21

less than 1ml/kg/hr in a child over 12

less than 0.5ml/kg/hr in a child younger than 12

Question 22

what’s the temperature range for suspected sepsis?

Answer 22

below 36 or above 38.5

Question 23

how often should obs be recorded for a child with a pews score of 1?

Answer 23

4/24

Question 24

what pews score triggers an urgent pews call?

Answer 24

7 or above

Question 25

how often should obs be recorded for a child with a pews score of 2?

Answer 25

2-4/24

Question 26

how often should obs be recorded for a child with a pews score of 6 or above?

Answer 26

continuous observations

Question 27

what pews score triggers an urgent medical review?

Answer 27

4-5

Question 28

what pews score triggers a review by the nurse in charge?

Answer 28

3, or any individual score in the pink zone

Question 29

treatment for post-op T+As bleed?

Answer 29

1. sit patient upright, encourage to spit into bowl. suction if needed
2. monitor vitals
3. airway management as needed
4. rehydration - insert a wide bore IVC
5. nil by mouth/ IV therapy
6. consider o-neg blood as needed
7. IV analgesia - not nsaids! and beware of apnea risks
8. ENT consultation

Question 30

role of PACU?

Answer 30

receive handover from anaesthetist, monitor patient’s condition
ensure airway is maintained
observe/report/manage immediate post-op comps
normalise temperature
monitor and record input and output - drains, drips etc
assess and manage pain, alertness, vomiting etc
relevant observations - flap, neuro, limb, colostomy etc
answer questions, give reassurance
determine when pt is ready for transfer to ward

Question 31

ISBAR for clinical handover?

Answer 31

Identify patient, you, your role
Situation - diagnosis/reason for admission/ current issues
Background - anything relevant inc med history
Assessment - list most important and recent assessments
Recommendations -
1. Outline any nursing/medical plans (where you are up to with this/what needs to be done)
2. Identify timeframes and transition of care
3. Use patient records to cross-check information
4. Ensure documentation of all findings or changes of condition

Question 32

types of bowel prep?

Answer 32

1. clear liquids 1-2 days prior with cathartic or enema the night before
2. polyethylene glycol 3L night before
3. picoprep

Question 33

nursing considerations for mechanical bowel prep?

Answer 33

1. caution in people with diabetes, impaired kidney function, electrolyte imbalance, CCF or the elderly
2. monitor fluid balance and electrolytes (strict FBC!)
3. advise pt to slow drinking rate if nausea/bloating severe
4. complete when passing clear fluid from bowel