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NURS 309 > T4: Caring of the surgical patient > Flashcards

T4: Caring of the surgical patient Flashcards

1
Q

Except in emergencies, surgery cannot be performed legally or ethically until a patient:

A

fully understands a surgical procedure and all implications

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2
Q

Surgeons responsibility for __(6)____ before obtaining oral and written consent

A
  • explain the procedure
  • associated risks
  • benefits
  • alternatives
  • possible complications before obtaining oral and written consent
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3
Q

RN who does not scrub in and uses the nursing process in the management of patient care activates in the OR suite

A

circulating nurse

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4
Q

circulating nurse duties

A

Monitors the surgery closely and also manages patient positioning, antimicrobial skin preparation, medications, implants, placement and function of IPC devices, specimens, warming devices, and surgical counts of instruments and dressings

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5
Q

RN or surgical technologist who is often certified (CST)

A

scrub nurse

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6
Q

works in surgical field with surgeon

A

scrub nurse

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7
Q

collaborates with the surgeon by handling and cutting tissue, using instruments, and medical devices, providing exposure of the surgical area and hemostasis, and suturing

A

RN first assistant (RNFA)

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8
Q

respiratory surgical complications (4)

A
  • atelectasis
  • pneumonia
  • hypoxemia
  • pulmonary embolism
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9
Q

embolus blocking pulmonary arterial blood flow to one or more lobes of lung

A

pulmonary embolism

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10
Q

inadequate concentration of oxygen in arterial blood

A

hypoxemia

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11
Q

inflammation of alveoli involving one or several lobes of lungs

A

pneumonia

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12
Q

Pneumonia developing in ___________ is common in patient who is immobilized after surgery

A

lower dependent lobes of lungs

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13
Q

collapse of alveoli with retained mucous secretions

A

atelectasis

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14
Q

cardiac surgical complications (5)

A
  • hemorrhage
  • hypovolemic shock
  • thrombophlebitis
  • thrombus
  • embolus
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15
Q

loss of large amount of blood externally or internally in short period of time

A

hemorrhage

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16
Q

inadequate prefusion of tissue and cells from loss of circulatory fluid volume

A

hypovolemic shock

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17
Q

inflammation of vein often accompanied by clot formation

A

thrombophlebitis

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18
Q

formation of clot attached to interior wall of a vein or artery, which can occlude the vessel lumen

A

thrombus

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19
Q

piece of thrombus that has dislodged and circulates in bloodstream until it lodges in another vessel

A

embolus

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20
Q

common lodges of embolus (4)

A
  • lungs
  • heart
  • brain
  • mesentery
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21
Q

musculoskeletal surgical complication

A

hospital associated reconditioning

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22
Q

deficit in physical function secondary to immobilization during an acute hospitalization

A

hospital associated reconditioning

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23
Q

gastrointestinal surgical complication (3)

A
  • paralytic ileus
  • abdominal distention
  • nausea & vomiting
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24
Q

nonmechanical obstruction of the bowel caused by physiological, neurogenic, or chemical imbalance associated with decreased peristalsis

A

paralytic ileus

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25
Q

paralytic ileum is most common when:

A

initial hours after abdominal surgery

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26
Q

retention of air within intestines and abdominal cavity during gastrointestinal surgery

A

abdominal distention

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27
Q

symptoms of improper gastric emptying or chemical stimulation of vomiting center

A

nausea & vomiting

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28
Q

genitourinary surgical complications (2)

A

urinary retention

urinary tract infection

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29
Q

integumentary system surgical complications (4)

A
  • wound infection
  • wound dehiscence
  • wound evisceration
  • skin breakdown
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30
Q

partial or total separation of previously approximated wound edges, due to a failure of proper wound healing

A

wound dehiscence

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31
Q

rare but severe surgical complication where the surgical incision opens (dehiscence) and the abdominal organs then protrude or come out of the incision

A

wound evisceration

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32
Q

nervous system surgical complications (2)

A
  • intractable pain

- malignant hyperthermia

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33
Q

pain that is not amendable to analgesics and pain-alleviating interventions

A

intractable pain

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34
Q

severe hypermetabolic state and rigidity of the skeletal muscles caused by an increase in intracellular calcium ion concentration

A

malignant hyperthermia

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35
Q

patient loses all sensation, consciousness, and reflexes, including gag and blink reflex

A

general anesthesia

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36
Q

general anesthesia is given by (2)

A

IV infusion of inhalation

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37
Q

three phases of general anesthesia

A
  • induction
  • maintenance
  • emergence
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38
Q

phase of general anesthesia when patient is first put to sleep

A

induction

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39
Q

phase of general anesthesia when anesthesiologist makes sure patient stays asleep

A

maintenance

40
Q

phase of general anesthesia when anesthetics are decreased and patient begins to awaken

A

emergence

41
Q

loss of sensation in an area of the body by anesthetizing sensory pathways

A

regional anesthesia

42
Q

regional anesthesia is administered:

A

injected along the pathway of a nerve from the spinal cord

43
Q

serious complications of regional anesthesia

A

respiratory paralysis if the level of anesthesia rises, moving upward in the spinal cord

44
Q

what helps prevents respiratory paralysis

A

elevation of upper body

45
Q

loss of sensation at the desired site by inhibiting peripheral nerve conduction

A

local anesthesia

46
Q

local anesthesia is administered by:

A

topical or injection

47
Q

local anesthesia is commonly used in

A

ambulatory surgery

48
Q

local anesthesia can be used in addition to:

A

general or regional anesthesia

49
Q

Administered by IV routinely for short-term surgical, diagnostic, and therapeutic procedures that do not require complete anesthesia but rather a depressed level of consciousness

A

Moderate (conscious) sedation

50
Q

Moderate (conscious) sedation maintains: (2)

A

spontaneous ventilation

patent airway

51
Q

stress of surgery causes activation of the endocrine system, resulting in the release of hormones and catecholamines, which increase blood pressure, heart rate, and respiration

A

surgical stress response

52
Q

surgical stress response affects:

A

all patients

53
Q

Risk factors for surgery (8)

A
  • surgical stress response
  • smoking
  • age
  • nutrition
  • obesity
  • obstructive sleep apnea
  • fluid imbalance
  • immunosuppression
54
Q

smoking increases risk of developing (3)

A

pneumonia, atelectasis, and delayed wound healing

55
Q

both older and younger patients have problems with:

A

temperature control

56
Q

infants have difficulty:

A

-maintaining normal circulatory blood volume which causes risk for dehydration and overhydration

57
Q

how many calories a day are required after surgery for adequate healing

A

1500kcal/ day

58
Q

those who are malnourished are more likely to: (5)

A
  • poor tolerance for anesthesia
  • negative nitrogen balance
  • delayed postoperative recovery
  • infection
  • delayed wound healing
59
Q

chronic sleep disorder characterized by periodic episodes of narrowing or collapse of the upper airway

A

obstructive sleep apnea

60
Q

T/F: Patients have experienced severe apnea and hypoxemia, leading to death after surgical and diagnostic procedures under conscious sedation

A

true

61
Q

T/F: Risk decreases if receiving radiation or chemotherapy, taking immunosuppressive medications, require steroids to treat

A

false

62
Q

Severe _____ breakdown causes negative nitrogen balance and hyperglycemia

A

protein

63
Q

As a response to _______, body retains sodium and water and loses potassium in the first 2-5 days after surgery

A

adrenocortical stress

64
Q

classification of surgical procedure by seriousness (2)

A

major vs minor

65
Q

surgery involves extensive reconstruction or alternation in body parts

A

major surgery

66
Q

surgery involves minimal alterations in body parts

A

minor surgery

67
Q

classification of surgery by urgency (3)

A
  • elective
  • urgent
  • emergency
68
Q

surgery performed on basis of patient’s choice; not essential and is not always necessary for health

A

elective surgery

69
Q

surgery is necessary for patient’s health; often prevents development of additional problems (tissue destruction or impaired organ function)

A

urgent surgery

70
Q

surgery must be done immediately to save life or preserve function of body part

A

emergency surgery

71
Q

classification of surgery based on purpose: (7)

A
  • diagnostic
  • ablative
  • palliative
  • reconstructive/restorative
  • procurement for transplant
  • constructive
  • cosmetic
72
Q

surgical exploration performed to confirm diagnosis; often involves removal of tissue for further diagnostic testing

A

diagnostic surgery

73
Q

surgical excision or removal of diseased body part

A

ablative surgery

74
Q

surgery relieves or reduces intensity of disease symptoms; does not produce cure

A

palliative surgery

75
Q

surgery restores function or appearance to traumatized or malfunctioning tissue

A

reconstructive/restorative surgery

76
Q

surgical removal of organs and/or tissues from a person pronounced brain dead or from living donors for transplantation into another person

A

procurement for transplant

77
Q

surgery restores function lost or reduced as result of congenital anomalies

A

constructive surgery

78
Q

surgery performed to improve personal appearance

A

cosmetic surgery

79
Q

Normal healthy patient

Healthy, nonsmoking, no more than minimal alcohol use

A

ASA I

80
Q

A patient with mild systemic disease

Mild disease only without substantive functional changes

A

ASA II

81
Q

a patient with sever systemic disease

Substantive functional changes with one or more moderate-to-severe-disease

A

ASA III

82
Q

a patient with severe systemic disease that is a constant threat to life

A

ASA IV

83
Q

a moribund patient who is not expected to survive without the operation

A

ASA V

84
Q

a patient who has been declared brain dead whose organs are being removed for donor purpose

A

ASA VI

85
Q

Postoperative nausea and vomiting can lead to __(3)____ because of electrolyte imbalance

A
  • pulmonary aspiration
  • dehydration
  • arrhythmias
86
Q

postoperative nauseas affects ____ % of patients

A

70%

87
Q

Procedure specific risk factors for postoperative nausea and vomiting (4)

A
  • anorectal surgery
  • joint arthroplasty
  • hernia repair
  • incontinence surgery
88
Q

single time catheterization is recommended when ______ of urine is measured on bladder scanner

A

> 600mL

89
Q

bladder scanner is used for patients who have not voided in ____ postop

A

4 hours

90
Q

considered a never event (meaning that CMS expects this to never happen at hospitals and will not pay for it)

A

deep vein thrombosis after total knee and hip surgery

91
Q

most at risk for DVTs

A
  • undergo general anesthesia

- surgical time more than 90 minutes (60 minutes if surgery involves pelvis or lower limbs)

92
Q

complications of general anesthesia (5)

A
  • hypotension
  • changes in heart rate or rhythm
  • lowered body temperature
  • respiratory depression
  • emergence delirium in form of shivering, trembling, confusion, or hallucinations
93
Q

complications of spinal anesthesia (5)

A
  • headache
  • hypotension
  • decreased cardiac output
  • cyanosis
  • difficulty breathing
94
Q

complication of neuromuscular blocking drugs (NMDs) (2)

A
  • intraocular pressure

- intracranial pressure

95
Q

complications of local anesthesia (6)

A
  • skin rash
  • allergic reaction with edema of the face, lips, mouth, or throat
  • restlessness
  • bradycardia
  • hypotension
  • ischemic necrosis at injection site
96
Q

complications of moderate conscious sedation (4)

A
  • respiratory depression
  • bradycardia
  • hypotension
  • nausea & vomiting
97
Q

complications of epidural (6)

A
  • cyanosis
  • breathing difficulties
  • decreased heart rate
  • irregular heart rate
  • pale skin color
  • nausea and vomiting

NURS 309 (10 decks)

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