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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
paralytic ileum is most common when:
initial hours after abdominal surgery
26
retention of air within intestines and abdominal cavity during gastrointestinal surgery
abdominal distention
27
symptoms of improper gastric emptying or chemical stimulation of vomiting center
nausea & vomiting
28
genitourinary surgical complications (2)
urinary retention | urinary tract infection
29
integumentary system surgical complications (4)
- wound infection - wound dehiscence - wound evisceration - skin breakdown
30
partial or total separation of previously approximated wound edges, due to a failure of proper wound healing
wound dehiscence
31
rare but severe surgical complication where the surgical incision opens (dehiscence) and the abdominal organs then protrude or come out of the incision
wound evisceration
32
nervous system surgical complications (2)
- intractable pain | - malignant hyperthermia
33
pain that is not amendable to analgesics and pain-alleviating interventions
intractable pain
34
severe hypermetabolic state and rigidity of the skeletal muscles caused by an increase in intracellular calcium ion concentration
malignant hyperthermia
35
patient loses all sensation, consciousness, and reflexes, including gag and blink reflex
general anesthesia
36
general anesthesia is given by (2)
IV infusion of inhalation
37
three phases of general anesthesia
- induction - maintenance - emergence
38
phase of general anesthesia when patient is first put to sleep
induction
39
phase of general anesthesia when anesthesiologist makes sure patient stays asleep
maintenance
40
phase of general anesthesia when anesthetics are decreased and patient begins to awaken
emergence
41
loss of sensation in an area of the body by anesthetizing sensory pathways
regional anesthesia
42
regional anesthesia is administered:
injected along the pathway of a nerve from the spinal cord
43
serious complications of regional anesthesia
respiratory paralysis if the level of anesthesia rises, moving upward in the spinal cord
44
what helps prevents respiratory paralysis
elevation of upper body
45
loss of sensation at the desired site by inhibiting peripheral nerve conduction
local anesthesia
46
local anesthesia is administered by:
topical or injection
47
local anesthesia is commonly used in
ambulatory surgery
48
local anesthesia can be used in addition to:
general or regional anesthesia
49
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
Moderate (conscious) sedation
50
Moderate (conscious) sedation maintains: (2)
spontaneous ventilation | patent airway
51
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
surgical stress response
52
surgical stress response affects:
all patients
53
Risk factors for surgery (8)
- surgical stress response - smoking - age - nutrition - obesity - obstructive sleep apnea - fluid imbalance - immunosuppression
54
smoking increases risk of developing (3)
pneumonia, atelectasis, and delayed wound healing
55
both older and younger patients have problems with:
temperature control
56
infants have difficulty:
-maintaining normal circulatory blood volume which causes risk for dehydration and overhydration
57
how many calories a day are required after surgery for adequate healing
1500kcal/ day
58
those who are malnourished are more likely to: (5)
- poor tolerance for anesthesia - negative nitrogen balance - delayed postoperative recovery - infection - delayed wound healing
59
chronic sleep disorder characterized by periodic episodes of narrowing or collapse of the upper airway
obstructive sleep apnea
60
T/F: Patients have experienced severe apnea and hypoxemia, leading to death after surgical and diagnostic procedures under conscious sedation
true
61
T/F: Risk decreases if receiving radiation or chemotherapy, taking immunosuppressive medications, require steroids to treat
false
62
Severe _____ breakdown causes negative nitrogen balance and hyperglycemia
protein
63
As a response to _______, body retains sodium and water and loses potassium in the first 2-5 days after surgery
adrenocortical stress
64
classification of surgical procedure by seriousness (2)
major vs minor
65
surgery involves extensive reconstruction or alternation in body parts
major surgery
66
surgery involves minimal alterations in body parts
minor surgery
67
classification of surgery by urgency (3)
- elective - urgent - emergency
68
surgery performed on basis of patient's choice; not essential and is not always necessary for health
elective surgery
69
surgery is necessary for patient's health; often prevents development of additional problems (tissue destruction or impaired organ function)
urgent surgery
70
surgery must be done immediately to save life or preserve function of body part
emergency surgery
71
classification of surgery based on purpose: (7)
- diagnostic - ablative - palliative - reconstructive/restorative - procurement for transplant - constructive - cosmetic
72
surgical exploration performed to confirm diagnosis; often involves removal of tissue for further diagnostic testing
diagnostic surgery
73
surgical excision or removal of diseased body part
ablative surgery
74
surgery relieves or reduces intensity of disease symptoms; does not produce cure
palliative surgery
75
surgery restores function or appearance to traumatized or malfunctioning tissue
reconstructive/restorative surgery
76
surgical removal of organs and/or tissues from a person pronounced brain dead or from living donors for transplantation into another person
procurement for transplant
77
surgery restores function lost or reduced as result of congenital anomalies
constructive surgery
78
surgery performed to improve personal appearance
cosmetic surgery
79
Normal healthy patient | Healthy, nonsmoking, no more than minimal alcohol use
ASA I
80
A patient with mild systemic disease | Mild disease only without substantive functional changes
ASA II
81
a patient with sever systemic disease | Substantive functional changes with one or more moderate-to-severe-disease
ASA III
82
a patient with severe systemic disease that is a constant threat to life
ASA IV
83
a moribund patient who is not expected to survive without the operation
ASA V
84
a patient who has been declared brain dead whose organs are being removed for donor purpose
ASA VI
85
Postoperative nausea and vomiting can lead to __(3)____ because of electrolyte imbalance
- pulmonary aspiration - dehydration - arrhythmias
86
postoperative nauseas affects ____ % of patients
70%
87
Procedure specific risk factors for postoperative nausea and vomiting (4)
- anorectal surgery - joint arthroplasty - hernia repair - incontinence surgery
88
single time catheterization is recommended when ______ of urine is measured on bladder scanner
>600mL
89
bladder scanner is used for patients who have not voided in ____ postop
4 hours
90
considered a never event (meaning that CMS expects this to never happen at hospitals and will not pay for it)
deep vein thrombosis after total knee and hip surgery
91
most at risk for DVTs
- undergo general anesthesia | - surgical time more than 90 minutes (60 minutes if surgery involves pelvis or lower limbs)
92
complications of general anesthesia (5)
- hypotension - changes in heart rate or rhythm - lowered body temperature - respiratory depression - emergence delirium in form of shivering, trembling, confusion, or hallucinations
93
complications of spinal anesthesia (5)
- headache - hypotension - decreased cardiac output - cyanosis - difficulty breathing
94
complication of neuromuscular blocking drugs (NMDs) (2)
- intraocular pressure | - intracranial pressure
95
complications of local anesthesia (6)
- skin rash - allergic reaction with edema of the face, lips, mouth, or throat - restlessness - bradycardia - hypotension - ischemic necrosis at injection site
96
complications of moderate conscious sedation (4)
- respiratory depression - bradycardia - hypotension - nausea & vomiting
97
complications of epidural (6)
- cyanosis - breathing difficulties - decreased heart rate - irregular heart rate - pale skin color - nausea and vomiting

NURS 309 (10 decks)

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