Surgery and test nursing care

Question 1

Post op care for breast surgery

Answer 1

Check dressing/bleeding–>hemovac, Jackson-Pratt drain
Elevate affected arm
No work on that arm; no BP, watches, etc.

Question 2

Bronchoscopy precautions?

Answer 2

NPO before surgery and until gag reflex returns

Watch for resp depression, hoarseness, dysphagia, SQEmphysema

Question 3

When is best to collect sputum?

What should client do

Answer 3

In morning and it is sterile

Client should rinse mouth first with water

Question 4

What precautions should you take for a lobectomy

Answer 4

Affected side up/ surgical side up

Question 5

What precautions should you take for a pneumonectomy

Answer 5

Good lung up, non-affected side up
Avoid severe lateral positioning-> mediastinal shift
Never have chest tubes cause theres no pleural space

Question 6

What position do you have a client post total Laryngectomy

Answer 6

Semi-fowlers

Question 7

When do you change appliance from an ileal conduit

Answer 7

In the morning

Question 8

What position do you put someone after a gastrectomy

Answer 8

Fowler’s position

Question 9

What would the thyroxine level do in a patient with hyperthyroidism

Answer 9

it will be increased

Question 10

What tests determine hyperthyroid

Answer 10

T4- increase

Thyroid scan

Question 11

What should clients discontinue when going for a thyroid scan

Answer 11

They should discontinue any iodine containing medication

Amiodarone (Cordarone) - antiarrhythmic drug containing iodine

Question 12

What precautions do you take with thyroidectomy

Answer 12

Teach to support neck
Put personal items close
Elevate HOB
check for bleeding behind the neck
Nutrition needs more calories
Assess for laryngeal nerve damage listen for hoarseness
Trach if there is vocal cord paralysis
Teach to report any c/o pressure
Trach set at bedside

Question 13

What is important with a client who has hyperthyroidism

Answer 13

Eye care

Question 14

What is important for pre- cardiac catherization procedure

Answer 14

1. Ask for allergies to shelfish/iodine
2. Check kidney function because dye will excrete through there
3. tell the pt. they will feel hot shot
4. Palpitations are normal

Question 15

What is important for post-op cardiac catherization

Answer 15

1. Monitor Vs
2. Watch puncture site for bleeding and hematoma formation
3. Assess extremity for 5 P’s: pain, pallor, pulse, parasenthesis, paralysis.
4. Bed rest, FLAT, leg straight for 4-6 hours
   5 Report pain
5. Hold Glucophage (Metformin) for 48 hours post procedure due to kidney fxn

Question 16

What is the major complication with a cardiac catherization

Answer 16

Bleeding

Question 17

What are the dx labs that confirm an MI

Answer 17

CPK-MB- increases
Troponin- increases
Myoglobin- increases

Question 18

Name some bleeding precautions we can take

Answer 18

Watch for bleeding gums
Hematuria and black stool
Use of an electric razor
Soft toothbrush
No IMs

Question 19

When a person goes for a PCI which includes angioplasty what’s a major complication involved

Answer 19

An MI- they could either bleed from that site or it could re-occlude.

Question 20

For Cardiac Rehab what are some lifestyle changes to adhere to

Answer 20

• Smoking cessation
• stepped-care plan (increase activity gradually)
• Low Fat, Low Salt, Low cholesterol diet
• No Isometric exercise
• No Valsalva
• No Straining, no supps; docusate
• Sex only if they can walk comfortably
• Best time for sex in am
• walking and swimming is the best exercise
• Teach s/s of heart failure: Weight gain, ankle edema, SOB, Confusion

Question 21

What do you use to diagnose Heart Failure

Answer 21

• BNP: B-type Natriuretic peptide (Nesiritide can give a false high, turn it off 2 hours prior to drawing BNP)
• CXR
• Echocardiogram
• New York Association Functional Classification of persons with HF (1-4, 4 being the worst)

Question 22

What is important Post-op pacemaker

Answer 22

Immobilize arm
monitor incision
watch out for electrole dysplacement
Assistive passive ROM to preven frozen shoulder
keep client from raising arm higher than shoulder

Question 23

What do we teach patients who have a pacemaker

Answer 23

Check pulse daily in am 
ID card or bracelet
Avoid electromagnetic fields
Avoid MRI
Avoid contact sports
Airport alarm

Question 24

What is an Implantable cardiac device ICD used for

Answer 24

Used to pace heart or to defibrillate people with V Fib

Question 25

Prior to and ECT what should we make sure for our clients

Answer 25

Know that it could indcue a grand mal seizure
it is used to treat depression and manic disorders
Be NPO Pre-op
Signed permit is necessary
Series of treatment depends on client response
use Succinylcholine chloride (Anectine) to relax muscles

Question 26

What do you do Post- ECT

Answer 26

Position patient on side
stay with the client
the client may have a temporary memory loss
reorient the client
and involve the client in day to day activities asap