Surgery and test nursing care Flashcards
Post op care for breast surgery
Check dressing/bleeding–>hemovac, Jackson-Pratt drain
Elevate affected arm
No work on that arm; no BP, watches, etc.
Bronchoscopy precautions?
NPO before surgery and until gag reflex returns
Watch for resp depression, hoarseness, dysphagia, SQEmphysema
When is best to collect sputum?
What should client do
In morning and it is sterile
Client should rinse mouth first with water
What precautions should you take for a lobectomy
Affected side up/ surgical side up
What precautions should you take for a pneumonectomy
Good lung up, non-affected side up
Avoid severe lateral positioning-> mediastinal shift
Never have chest tubes cause theres no pleural space
What position do you have a client post total Laryngectomy
Semi-fowlers
When do you change appliance from an ileal conduit
In the morning
What position do you put someone after a gastrectomy
Fowler’s position
What would the thyroxine level do in a patient with hyperthyroidism
it will be increased
What tests determine hyperthyroid
T4- increase
Thyroid scan
What should clients discontinue when going for a thyroid scan
They should discontinue any iodine containing medication
Amiodarone (Cordarone) - antiarrhythmic drug containing iodine
What precautions do you take with thyroidectomy
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
What is important with a client who has hyperthyroidism
Eye care
What is important for pre- cardiac catherization procedure
- Ask for allergies to shelfish/iodine
- Check kidney function because dye will excrete through there
- tell the pt. they will feel hot shot
- Palpitations are normal
What is important for post-op cardiac catherization
- Monitor Vs
- Watch puncture site for bleeding and hematoma formation
- Assess extremity for 5 P’s: pain, pallor, pulse, parasenthesis, paralysis.
- Bed rest, FLAT, leg straight for 4-6 hours
5 Report pain - Hold Glucophage (Metformin) for 48 hours post procedure due to kidney fxn
What is the major complication with a cardiac catherization
Bleeding
What are the dx labs that confirm an MI
CPK-MB- increases
Troponin- increases
Myoglobin- increases
Name some bleeding precautions we can take
Watch for bleeding gums Hematuria and black stool Use of an electric razor Soft toothbrush No IMs
When a person goes for a PCI which includes angioplasty what’s a major complication involved
An MI- they could either bleed from that site or it could re-occlude.
For Cardiac Rehab what are some lifestyle changes to adhere to
- 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
What do you use to diagnose Heart Failure
- 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)
What is important Post-op pacemaker
Immobilize arm
monitor incision
watch out for electrole dysplacement
Assistive passive ROM to preven frozen shoulder
keep client from raising arm higher than shoulder
What do we teach patients who have a pacemaker
Check pulse daily in am ID card or bracelet Avoid electromagnetic fields Avoid MRI Avoid contact sports Airport alarm
What is an Implantable cardiac device ICD used for
Used to pace heart or to defibrillate people with V Fib
Prior to and ECT what should we make sure for our clients
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
What do you do Post- ECT
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
