Surgery

Question 1

when should abx be given and when stopped

Answer 1

1 hr before and after procedure unless IV abx which is 48hrs before and after

Question 2

abx given for prophylaxis

Answer 2

vancomycin, levoquin IV 2 hrs prior

Question 3

blood glucose rate should be under what value?

Answer 3

200 mg/dL

Question 4

how does high bg put the pt at risk

Answer 4

increased infection
less likely to get renal failure and receive ventilation support

Question 5

when should urinary catheters be removed by

Answer 5

within 48hours

Question 6

how does hypothermia put pt at risk

Answer 6

below 36 (97F)
risk for infection, impairs healing, affects drug metabolism, adverse cardiac events

Question 7

why is beta blockers given during pre-op

Answer 7

to regulate heart rate and decrease mortality

Question 8

VTE prophylaxis and post sx
how long before and after
what is done

Answer 8

24 hrs before and after
compression hose or SCD
lovenox, coumadin given

Question 9

what lab tests are done for pre-op

Answer 9

pregnancy test
glucose
electrolytes
CBC
BUN/creatinine/eGFR/urinalysis
Coags PT/PTT/INR
CXR/ECG

Question 10

why is atropine sulfate given pre-op

Answer 10

to decrease resp secretions

Question 11

what is the purpose of anticholinergics

Answer 11

blocks acetylcholine which prevents muscle spasms
relieve cramps or spasms of the stomach, intestines, and bladder

Question 12

S/S of malignant hypothermia

Answer 12

tachycardia
muscle stiffness
unstable or increased BP
increased temp
hypercalcemia
met/resp acidosis
increased CK

Question 13

treatment for malignant hyperthermia

Answer 13

dantrolene (dantrium)
sodium bicarbonate for met. acidosis
iced saline inj
d/c triggering agent
transfer to ICU 24hrs

Question 14

when is orientation given when a pt arrives in PACU

Answer 14

first arrival as their hearing is returned first

Question 15

D/C criteria for O2 saturation

Answer 15

90-92%

Question 16

what is UOP

Answer 16

intraoperative urine output given to PACU

Question 17

what is assessed first when arriving to PACU

Answer 17

ABCs
response to reversal of anesthesia
spinal block

Question 18

RR range for PACU and what to do

Answer 18

12-30 max
give O2 cannula regardless of O2 saturation help to get rid of anesthesia gases

Question 19

how often are VS done in PACU

Answer 19

q15mins for an hour

Question 20

when are narcotics given in PACU and range

Answer 20

48hrs of narcotics and then NSAIDS

Question 21

what meds are given for antiemetics

Answer 21

zofran, reglan

Question 22

what is the most common cause of hypoxia during anesthesia recovery

Answer 22

atelectasis

Question 23

Criteria for systemic inflammatory response syndrome

Answer 23

temp: <36 or >38 (97-100 good)
HR: >90
RR: >20 with PaCO2 <32mmHg
WBC: <4,000 or >12,000

Question 24

D/C criterias

Answer 24

No IV narcotics last 30mins
can ambulate
minimum N&V

Question 25

who gives report to PACU nurse

Answer 25

anaesthesiologist verbal report

Question 26

what is emergence delirium

Answer 26

pt can wake up agitated
typically due to hypoxemia

Question 27

what is considered hypoxemia

Answer 27

PaO2 <60mmHg

Question 28

position of unconscious vs conscious pts

Answer 28

on the lateral side - unconscious
supine with head elevated - conscious

Question 29

how often should DB&T and IS be used

Answer 29

DB 10 times/hour while awake. turn q1-2hrs
IS used 10-15 times and cough, q2-3hrs while awake

Question 30

cause of cardiovascular issues post-surg

Answer 30

sympathetic nerve stimulation from pain, anxiety, bladder distension, or resp compromise

Question 31

when is anaesthesiologist or surgeon notified for BP & HR

Answer 31

systolic below 90 or above 160
HR less than 60 or above 120

Question 32

residual vasodilating effects of anesthesia vs/ impending hypovolemic shock

Answer 32

OK - hypotension, normal pulse, warm and dry pink skin
hypov shock - hypotension, tachycardia, cold & clammy skin

Question 33

how often should pts flex and extend all joints

Answer 33

10-12 times every 1-2 hrs while awake

Question 34

nursing assessment for neuro in PACU

Answer 34

PERRLA pupils
sensory & motor status

Question 35

what is used to check motor block as the effects of spinal anesthesia is resolving

Answer 35

ice packs

Question 36

fever in PACU

Answer 36

mild elevation up to 38 first 48 hrs - stress response
higher than 38 - respiratory congestion or atelectasis
after 48hrs - infection

Question 37

response to fever in PACU

Answer 37

CXR, wound culture, urine, blood

Question 38

large intestine vs small intestine response post-op

Answer 38

large intestines slow for 3-5 days
small intestine should return within 24hrs

Question 39

hiccups cause

Answer 39

irritation of phrenic nerve which innervates diaphragm

Question 40

why is NG tube used post-op

Answer 40

decompress stomach to prevent N&V, abdominal distension

Question 41

how to prevent abdominal distension

Answer 41

frequent ambulation

Question 42

what drug is used to encourage flatus, feces, and colonic peristalsis

Answer 42

bisacodyl (Dulcolax)

Question 43

when should catherization be considered in PACU

Answer 43

after 8-12 hours of not voiding

Question 44

expected drainage from wound

Answer 44

go from sanguineous to serosanguineous to serous (clear yellow)

Question 45

sign of wound dehiscence

Answer 45

separation of wound edges with sudden discharge of brown, pink, or clear drainage