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NUR 155 Theory Test One > Study Guide 1 > Flashcards

Study Guide 1 Flashcards

1
Q

Common causes of pre-operative anxiety & your interventions:

A

Lack of knowledge - provide information about what to expect, inform the surgeon if more information needed or anxiety is excessive

religious/spiritual conflict - communicate with pt

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2
Q

Interventions for common fears:

  1. Death
  2. Pain & Discomfort
  3. Mutation / Body alteration
  4. Disruption of life functioning
  5. Anesthesia
A
  1. Death- Notify HCP for strong fear of death, they may delay the surgery
  2. Pain & Discomfort - notify ACP & surgeon if fear is extreme, teach to ask for analgesics before pain comes severe + pain intensity scale
  3. Mutation / Body alteration - listen and asses with an accepting attitude
  4. Disruption of life functioning - consult with pt, caregiver, social worker, spiritual advisor etc
  5. Anesthesia - infirm ACP immediately to talk the pt
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3
Q

Nurses Assessment of the pre operative Patient

A
  1. Baseline Data
  2. Determine psychological status
  3. Determine physiological factors directly related or indirectly related to surgery
  4. Participate in marking of the surgical site
  5. Review all pre operative diagnostic test SHARE THIS INFO WITH HCP
  6. Determine religious / ethical factors
  7. Determine if pt received enough info from surgeon for informed consent and witnessed
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4
Q

What is the goal of the pre operative assesment

A

Identify risk factors that can cause intraoperative and postoperative complications

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5
Q

Nurse pre operative intervention: MEDICATIONS

A

All pt drugs are identified, implemented, any changes in the medication plan, and monitor pt for potential interactions and complications

Ensure pt discontinued all herbs 2-3 prior to surgery and tell HCP about any pt herbs.

Document all medications and current use. Ask about recreational drug use stressing that it effects the type of anesthesia needed.

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6
Q

What is the nurses job regarding a pre-operative pt’s valuables

A

Return all pt valuables to a caregiver or secure according to agency policy.

Electrocautery surgery = jewelry and piercing removed

Hearing aids= left in place for pt to follow instructions
Glasses= removed and returned ASAP post op

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7
Q

What can’t the unlicensed worker do?

A

Asses, admin, explain or teach. They can monitor and alert the nurse of changes.

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8
Q

Who determines an appropriate schedule and dose of the patients drug routine before and after surgery

A

The ACP this is why it’s important to communicate with the entire surgical team about pt meds

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9
Q

Explain: Scrub Nurse v.s Circulating Nurse

A

SN:

  • follow surgical hand antisepsis procedure
  • gowned and gloved in sterile attire
  • remain in the sterile field

CN:

  • remains in the unsterile field
  • no sterile attire

BOTH: May be licensed practical/vocational nurse or a surgical technologist. If the circulating nurse is not an RN an RN MUST BE ACCESSIBLE AT ALL TIMES

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10
Q

Every time a pt is transferred to another professional what needs to be handed off?

A

Use SBAR format for clear consistent communication

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11
Q

Surgeons responsibilities for the pre operative pt

A
  • pre op medical history and physical assessment (surgical interventions, choice of surgical procedure, pre operative testing and discussing risk and alternatives to surgery)
  • patient safety and management in the OR
  • post op management of the pt
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12
Q

Who is the surgeons assistant and what are they responsible for ?

A

Can be a physician or under direct supervision of the surgeon a RN first assistant or physicians assistant.

  • may preform some aspect of surgery under direct surgeon supervision
  • usually holds retractors and assist with stitching
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13
Q

Duties of the Anesthesia Care Provider (ACP)

A
  • medically manage pt who’s unconscious or insensible to pain and emotional stress during surgical and medical procedure
  • protect functions and vital organs
  • manage pain, cardiopulmonary resuscitation, pulmonary problems and critically ill pt in special care units
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14
Q

Responsibilities of a Nurse Anesthetist?

A
  • pre anesthetic assessment
  • develop and implement a plan for deserving anesthesia
  • selecting and staring a plan for anesthesia delivery
  • selecting and starting planned anesthetic technique
  • select, obtain, and administer anesthesia, adjunct drugs and fluids
  • manage airway and pulmonary status, emergence and recovery from anesthesia
  • select, apply, insert noninvasive and invasive monitoring devices
  • release/discharge from PACU
  • order, start, modify pain relief
  • ## respond to emergency situations
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15
Q

Routes for general anesthesia

A

IV and Inhalation

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16
Q

Nursing Interventions: After a neuromuscular blocking agent is used.

A
  • if intubated: monitor return of muscle strength, level of consciousness and ventilation
  • maintain airway: monitor rate and rhythm of respiration until pt is able to cough and muscle strength returns
  • non depolarizing reversal agent and emergency respiratory support equipment available
  • monitor temp and muscle strength levels in correlation with temp
17
Q

Temperature after surgery:

1) up to 12 hours
2) first 48 hours
3) after first 48 hours (day 3 and later)

A

1) HYPOTHERMIA: 96.8
(b/c anesthesia effects and body heat loss during surgery)

2) Mild Elevation: 100.4
(inflammatory response to surgical stress)

3) Elevation: 100
(Infection)

18
Q

Your patient has just come from surgery. When monitoring cardiovascular what abnormal findings would cause you to call the ACP or surgeon?

A
  • Systolic = under 90 or over 160
  • pulse is less than 60 or greater than 120
  • pulse pressure narrows
  • BP decreAses or increases over several consecutive readings
  • Changes in heart rhythm
19
Q

Post op you pt is hypotension accompanied by normal pulse and warm, dry, pink skin. What should you do?

A

Continue observation. This is a sign or residual vasodilation effects of anesthesia.

20
Q

Your post op patient is hypotension followed by rapid, weak pulse and their skin is cold, clammy and pale. What should you do?

A

This indicates impending hypovolemic shock. Treatment is needed immediately.

21
Q

What herbs can increase bleeding?

A

Garlic
Vitamin E
Ginkgo
Fish oils

22
Q

Name the normal lab values as well as hypo/hyper values:

  1. Potassium
A
  1. Potassium: 3.5-5, hypo -3.5, hyper +5
  2. Calcium: 8.6-10.2, hypo -8.6, hyper 10.2
  3. Phosphate 2.4-4.4
  4. Magnesium: 1.5-2.5
23
Q

Hyperkalemia:

  1. Manifestations
  2. Nursing interventions
A
  1. Tired, irritable, muscle weakness/tone loss, cramps, paresthesia, decreased weakness, ab cramps, diarrhea, vomiting, confusion, irregular pulse and tetany.
  2. Eliminate oral and parental potassium intake
    - increase elimination of potassium KAYEXALATE removes 1 mEq of k / gram
    - insulin & beta adrenergic agonist removes potassium from ECF to ICF
    - stabilize cardiac membranes with IV calcium chloride or CALCIUM GLUCONATE
24
Q

When potassium levels are mild and kidneys are function it may be helpful to: (prevent hyperkalemia)

A
  • withhold all potassium

- Administer fluids and loop or thiazide diuretics

25
Q

Causes for hypokalemia

A

Abnormal losses from either the kidney or GI tract. Rarely a nutritional issue.

26
Q

Hypokalemia:

  1. Manifestations
  2. Nursing Interventions
A
  1. Soft flabby muscles, leg cramps, paralytic ileus, shallow respiration, weak irregular pulse, constipation, hyperglycemia.

+fatigue, muscle weakness, paresthesia, decreased reflexes,

  1. Oral or IV potassium chloride usually only given if the urine output is at least 0.5mL/kg
    - never give push or undiluted b/c bolus
    - invert bag several times to ensure even distribution in the bag
    - do not add to pre-existing IV bags to prevent bolus
27
Q

Nursing diagnosis for Hypo/Hyperkalemia and Hypercalcemia

What complication do they also share.

A

Risk for:
1) electrolyte imbalance
Hypokalemia: r/t else’s potassium loss
Hyperkalemia: r/t excessive retention or cellular release of potassium
Hypercalcemia: r/t excessive bone destruction

2) activity intolerance
Kalemia: related to muscle weakness
Hypercalcemia: r/t generalized muscle weakness

3) injury
Hyperkalemia: muscle weakness
Hypokalemia: “ and hyporflexia
Hypercalcemia: neuromuscular and sensorium changes

Potential complications: dysrhythmias

28
Q

Hypercalcemia:

  1. Manifestations
  2. Nursing interventions
A
  1. Lethargy, weakness, fatigue, decreased memory and reflexes, increased b/p, confusion, psychosis, anorexia, nausea, vomiting, bone pain, fractures, polyuria, dehydration, nephrolithiasis, seizure and coma
  2. Have pt drink 3000 to 4000 mL of liquid to promote renal excretion of Ca. Administer saline, a biphosphonate (when caused by malignancy) and calcitonin.
29
Q

Hypocalcemia:

  1. Manifestations
  2. Nursing interventions
  3. Nursing diagnosis
A
  1. Weak, fatigue, depression, irritability, confusion, hyperflexia, muscle cramps, decreased BP, numb and tingling extremities and around mouth, chvotsek sign, trousseau sign, laryngeal and bronchial spasms, tetany and seizures
  2. Main goal = rx underlying cause
    - IV calcium gluconate
  3. Risk of: electrolyte imbalance (decreased PTH level), injury (tetany and seizures)
    - Ineffective breathing pattern (r/t laryngospasms)
    - Acute pain (sustained muscle contractions)
    - potential complications: fracture, r arrest
30
Q

Hyperphosphatemia & Hypophosphotemia:

Lab values and clinical manifestations d

A

Values: hyper +4.4, hypo -2.4

Hyper manifestations:
- *a symptomatic unless calcium binds with phosphate
Hypocalcemia
Numb & tingling around mouth and extremities
Hyperflexia and *muscle cramps
*Tetany, *parsenthesias, *seizures calcium-phosphate percipatates in skin, soft tissue, cornea viscera, blood vessels

Hypo manifestations:
CNS depression
Muscle weakness: respiratory muscle weakness
Polyneuropathy, seizures
Cardiac problems (Dysrithmias, heart failure)
Osteomalacia, rickets
- Rhabnomylysis

31
Q

Nursing interventions:

1) hyperphosphatemia
2) Hypophosphotemia

A

1) tread underlying cause, restrict intake of high phosphorus foods and fluids (dairy products), phosphate-binding agents, hemodialysis for severe

2) mild = increase food rich food in phosphorus or phosphate supplements
symptomatic = IV sodium phosphate or potassium phosphate

32
Q

Hypermagnesemia:

  1. Manifestations
  2. Nursing interventions
A
  1. Manifestations: deep tendon reflexes are lost followed by muscle paralysis and coma. Respiratory and cardiac arrest can occur.

2) symptomatic - IV ca gluconate
- avoid magnesium containing drugs and limit diet intake (green vegetables, nuts, bananas,oranges, BP,chocolate)
- with normal renal function: increase fluids and diuretics
- impaired renal function = dialysis

33
Q

HYPOMAGNESEMIA

1) manifestations
2) nursing intervention

A

1) cardiac dysrhythmias

34
Q 
Normal ABG:
PH
PaCo2
Hco3 / bicarbonate:
PaO2
SaO2
Base excess
A 
7.35-.45
35-45
22-26
80-100
95+
\+/- 2
35
Q

Acid-base imbalances

Respiratory and Metabolic

A

R:
Alkalosis - high ph low paco2
Acidosis - opposite

M:
Alkalosis - high ph high paco2
Acidosis - opposite

Hco3 low or matches ph = m. Acidosis is primarily problem

36
Q

Hyper hypo magnesium manifestations and interventionis

A

Hyper: lethargy, drowsy, weak muscle,
Urinary retention,n/v, deminished deep tendon reflexes, flush warm skin (especially face), decreased pulse & b/p

Hypo: confusion
Muscle cramps, tremors seizure, vertigo, hyperactive tendon reflexes, chovstek abd trouusseaus sign, increased p and no

NUR 155 Theory Test One (1 decks)

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