TERM 3- MY NOTES ADULT NURSING CH.2 "SURGICAL CARE OF PATIENT" Flashcards
Surgery is defined as that branch of medicine concerned with diseases and trauma requiring operative procedures
A)true
B)false
A
________is defined as that branch of medicine concerned with diseases and trauma requiring operative procedures
Surgery
early surgeons had little knowledge of the principles of asepsis, and anesthetic techniques and that it were primitive and unsafe. Indeed, a surgeon’s success was based on speed during that time
A)true
B)false
A
Surgery is classified as elective, urgent, or emergency.
A)true
B)false
A
Elective surgery is not necessary to preserve life and may be performed at a time the patient chooses.
A)true
B)false
A
Elective surgery can be performed at anytime during a patient life
A)true
B)false
A
Urgent surgery is required to keep additional health problems from occurring.
A)true
B)false
A
Emergency surgery is performed immediately to save the individual’s life or preserve the function of a body part.
A)true
B)false
A
Surgery is performed for various purposes, including diagnostic, ablation, palliative, reconstructive, transplant, constructive, and cosmetic.
A)true
B)false
A
amputation or excision of any body part or removal of a growth or harmful substance is called
A)ablation
B) palliative
A
therapy to relieve or reduce uncomfortable symptoms without cure
A)palliative
B)ablation
A
CLASSIFICATION OF SURGICAL PROCEDURES
,
Involves extensive reconstruction or alteration in body parts; poses great risks to well-being (e.g., coronary artery bypass, colon resection, gastric resection)
A)major
B)minor
C)elective
A
Involves minimal alteration in body parts; often designed to correct deformities; involves minimal risks compared with those of major procedures (e.g. , cataract extraction, skin graft, tooth extraction)
A)major
B)minor
C)elective
B
Performed on basis of patient’s choice (e.g., bunionectomy, plastic surgery)
A)minor
B)major
C)elective
C
Necessary for patient’s health (e.g., excision of cancerous tumor, removal of gallbladder for stones, vascular repair for obstructed artery [e.g ., coronary artery bypass])
A)urgent
B)emergency
C)major
A
Must be done immediately to save life or preserve function of body part (e.g., removal of perforated appendix, repair of traumatic amputation, control of internal hemorrhaging)
A)emergency
B)urgent
C)elective
A
removal of perforated appendix, repair of traumatic amputation, control of internal hemorrhaging are all
A)emergency
B)false
A
coronary artery bypass, colon resection, gastric resection are all
A)major
B)minor
C)both a and b
A
cataract extraction, skin graft, tooth extraction are all
A)urgent
B)elective
C)minor
C
excision of cancerous tumor, removal of gallbladder for stones, vascular repair for obstructed artery [e.g ., coronary artery bypass]) are all
A)urgent
B)emergency
C)major
A
bunionectomy, plastic surgery are all
A)elective
B)minor
A
Excision or removal of diseased body part (e.g., amputation, removal of appendix, cholecystectomy)
A)Ablation
B)Palliative
A
Surgery for relief or reduction of intensity of disease symptoms; will not produce cure (e.g., colostomy, debridement of necrotic tissue)
A)Ablation
B)Palliative
B
PERIOPERATIVE NURSING
,
Perioperative nursing refers to the nurse’s role during the preoperative, intraoperative, and postoperative phases of a surgical experience
A)true
B)false
A
preoperative (before surgery) intraoperative (during surgery) postoperative (after surgery) A)true B) false
A
Perioperative nursing stresses the importance of providing continuity of care for the surgical patient using the nursing process.
A)true
B)false
A
In many hospitals, perioperative nurses assess a patient’s health status preoperatively, identify specific patient needs, teach and counsel, attend to the patient’s needs in the OR, and then follow the patient’s recovery.
A)true
B)false
A
The nurse’s major responsibility is safe, consistent, and effective nursing interventions during each phase of surgery.
A) true
B)false
A
SURGICAL TERMINOLOGY
,
Surgical joining of two ducts or blood vessels to allow flow from one to another; to bypass an area (e.g., Billroth I, joins stomach and duodenum)
A)Anastomosis
B)lysis
A
Destruction or dissolution of (e.g., lysis of adhesions, removal of adhesions)
A)orrhagy
B)lysis
B
Surgical repair of (e.g., herniorrhaphy, repair of a hernia)
A)orrhaphy
B)ostomy
A
Opening made to allow the passage of drainage (e.g., ileostomy, formation of an opening of the ileum onto the surface of the abdomen for passage of feces)
A)ostomy
B)otomy
A
Opening into (e.g., thoracotomy, surgical opening into the thoracic cavity)
A)otomy
B)ostomy
A
Fixation of (e.g., cecopexy, fixation or suspension of the cecum to correct its excessive mobility)
A)pexy
B)pasty
A
Plastic surgery (e.g., mammoplasty, reshaping of the breasts to reduce, lift, reconstruct)
A)pexy
B)pasty
B
Common Surgical Settings
,
Inpatient: Patient hospitalized for surgery
A)true
B)false
A
• One-day (same-day surgery): Patient admitted the day surgery is scheduled and dismissed the same day
A)true
B)false
A
• Outpatient: Patient, not hospitalized, admitted either to a short-stay unit or directly to the surgical suite (some-times referred to ambulatory surgery)
A)true
B)false
A
• Short-stay surgical center (“surgicenter’’): Independently owned agency; surgery performed when overnight hospitalization is not required {also called ambulatory surgical center or one-day surgery center)
A)true
B)false
A
• Short-stay unit: Department or floor where a patient’s stay does not exceed 24 hours (sometimes referred to as outpatient/observation unit)
A)true
B)false
A
• Mobile surgery units: Units that move from place to place; go to the patient instead of the patient traveling to the unit
A)true
B)false
A
DELEGATION CONSIDERATION IN PERIOPERATIVE NURSING
,
The skills of assessment that are part of preparing the patient for surgery require the critical thinking and knowledge application unique to a nurse. For these skills, delegation is inappropriate.
A)true
B)false
A
Assistive personnel (AP) may obtain vital signs and weight and height measurements. A)true B)false
A
AP can reinforce and assist patients in performing postoperative exercises.
A)true
B)false
A
AP may administer an enema or douche; obtain vital signs; apply antiembolic stockings; and assist patient in removing clothing, jewelry, and prostheses.
A)true
B)false
A
- Instruct AP in proper observations and precautions if the patient has an IV catheter in place
A)true
B)false
A
The skills of sterile gowning and gloving can be delegated to a surgical technologist or the nurse who has acquired the proper skills.
A)true
B)false
A
AP may obtain vital signs, apply nasal cannula or oxygen mask, and provide basic comfort and hygiene measures.
A)true
B)false
A
INFLUENCING FACTORS
,
By helping patients express their concerns, the nurse can offer support, reassurance, and information the best way to address fear of the unknown.
A)true
B)false
A
AGE
,
The young and the old do not tolerate major surgical treatment as well as those in other age-groups. Their altered metabolic needs may not respond to physiologic changes quickly. Specific concerns center on the body’s response to temperature changes, cardiovascular shifts, respiratory needs, and renal function.
A)true
B)false
A
To assist patients in returning to their optimal level of health, nursing assessments and appropriate interventions should be ongoing
A)true
B)false
A
PHYSICAL CONDITION
,
Healthy patients have smoother and faster recovery periods than patients who have coexisting health problems. Assess each body system to identify actual and potential problems, then select measures to prevent postsurgical complications
A)true
B)false
A
NUTRITIONAL FACTORS
,
The body uses carbohydrates, proteins, and fats to supply energy-producing glucose to its cells.
A)true
B)false
A
Carbohydrates and fats are the primary energy producers
A)true
B)false
A
protein is essential to build and repair body tissue.
A)true
B)false
A
Nutritional needs are affected by a patient’s age and physical requirements; patients who maintain a sound, nutritional diet tend to recover more quickly.
A)true
B)false
A
A complete diet history identifies the patient’s usual eating habits, nutritional patterns, and food preferences.
A)true
B)false
A
Dietary practices are influenced by a patient’s ethnic, cultural, religious, and socioeconomic background.
A)true
B)false
A
Surgery may decrease a patient’s appetite and alter metabolic functions, so observe the patient for signs of malnutrition.
A)true
B)false
A
Surgery can alter the patient regular nutritional diet so assess for malnutrition
A)true
B)false
A
If malnutrition is promptly identified, tube feedings, intravenous (IV) therapy, or parenteral hyperalimentation can be initiated
A)true
B)false
A
Life Span Considerations Older Adults Undergoing Surgery
,
Older adults undergoing surgery have higher morbidity and mortality rates than younger people.
A)true
B)false
A
Older patients tend to recover more slowly from surgery compared with younger patients.
A)true
B)false
A
Recovery is affected by the level of mental functioning, individual coping ability, and the availability of support systems.
A)true
B)false
A
Risks of aspiration, atelectasis, pneumonia, thrombus formation, infection, and altered tissue perfusion are increased in the older adult
A)true
B)false
A
Disorientation or toxic reactions can occur in the older adult after the administration of anesthetics, sedatives, or analgesics. These reactions are often present for days after administration of the medication.
A)true
B)false
A
When communicating with older adult patients, be aware of any auditory, visual, or cognitive impairment that may be present.
A)true
B)false
A
ABCDE Mnemonic Device to Ascertain Serious Illness or Trauma in the preoperative Patient
,
A
Allergy to medications, chemicals, and other environmental products such as latex. All allergies are reported to anesthesia and surgical personnel before the beginning of surgery. Place an allergy band on the patient’s arm immediately.
B
Bleeding tendencies or the use of medications that deter clotting, such as aspirin or products containing aspirin, heparin, or warfarin sodium. Herbal medications may also increase bleeding times or mask potential blood-related problems.
C
Cortisone or steroid use.
D
Diabetes mellitus, a condition that not only requires strict control of blood glucose levels but is also known to delay wound healing.
E
Emboli. Previous embolic events (such as lower leg blood clots) may recur because of prolonged immobility.
True
DM can delay wound healing
A)true
B)false
A
Patients whose immune systems are suppressed are at a much higher risk for development of postoperative infection and are less capable of fighting that infection.
A)true
B)false
A
PSYCHOSOCIAL NEEDS
,
Preoperative fear has been linked to postoperative behavior.
A)true
B)false
A
The preoperative anxiety level influences the amount of anesthesia required, the amount of postoperative pain medication needed, and the speed of recovery from surgery.
A)true
B)false
A
Determine each patient’s perceptions, emotions, behavior, and support systems that may help or hinder their progress through the surgical period.
A)true
B)false
A
Patiently and actively listening to the patient, the family, and significant others it invites confidence and helps reduce anxiety levels
A)true
B)false
A
ln addition to nursing and medical personnel, ministerial staff, social workers, or patient advocates can provide support for patients and families during this stressful time
A)true
B)false
A
SOCIOECONOMIC AND CULTURAL NEEDS
,
Even geographic location affects the way a patient responds to surgery.
A)true
B)false
A
A multicultural perspective helps nurses approach patients with respect and individually tailor care that promotes recovery
A)true
B)false
A
Common Fears Associated with Surgery
,
Fear of loss of control is associated primarily with anesthesia. The patient becomes almost totally dependent on the health care team during the surgical experience, even for basic needs such as breathing and life support-while under the influence of anesthesia.
A)true
B)false
A
• Fear of the unknown may result from uncertainty about the surgical outcome or a lack of knowledge regarding the surgical experience
A)true
B)false
A
Fear of the unknown can be fixed by the nurse giving postive attitude and knowledge of the whats going to happen
A)true
B)false
A
Fear of anesthesia may include fears of unpleasant induction of or emergence from anesthesia. The patient may fear waking up during the operation and feeling pain while under anesthesia.
A)true
B)false
A
This fear is often related to loss of control and fear of the unknown.
A)fear of anesthesia
B)fear of the unknown
A
• Fear of pain or inadequate postoperative analgesia is common. Reassure the patient and significant others that the pain will be controlled.
A)true
B)false
A
Fear of death is a legitimate fear. Even with the great strides in surgery and anesthesia, no anesthetic or operation is perfectly safe for all patients.
A)true
B)false
A
• Fear of separation from the usual support group may arise because the patient is separated from spouse, family, or significant others, as well as other support groups, and is cared for by strangers during this highly stressful period.
A)true
B)false
A
Fear of disruption of life patterns relates to surgery and recovery interfering in varying degrees with activities of daily living, social activities, work, and professional activities.
A)true
B) false
A
• Fear of change in body image and mutilation is not unusual. Surgery disrupts body integrity and threatens body image.
A) true
B)false
A
• Fear of detection of cancer produces a high anxiety level.
A)true
B)false
A
Patient Teaching Preoperative Care
,
Recovery room or postanesthesia care unit
- Place where the patient will awaken
-Frequent monitoring of vital signs
- Return to room when vital signs are stable
A)true
B)false
A
• Probable postoperative therapies
-Need for increased mobility as soon as possible
-Need to keep respiratory passages clear
A)true
B)false
A
MEDICATIONS
,
Polypharmacy (concurrent use of multiple medications) occurs in all age-groups but is more common with older adults
A)true
B)false
A
Large numbers of medications increase the chance of interactions.
A)true
B)false
A
The anesthesiologist, in collaboration with the patient’s physician and surgeon, determines whether these medications should be taken the day of surgery and postoperatively.
A)true
B)false
A
Remember to assess for allergies to drugs that may be given during any phase of the surgery
A)true
B)false
A
Also ask about non-drug allergies, including allergies to foods, chemicals, pollen, antiseptics used to prepare the skin for surgery, and latex rubber products.
A)true
B)false
A
Patients with a history of allergic responsiveness are more likely to have hypersensitivity reactions to anesthesia agents.
A)true
B)false
A
Cultural Considerations
The Surgical Patient
,
Use of the patient’s language helps put an anxious patient at ease. Use an interpreter when possible; learn some key phrases in foreign languages; and use references such as medical dictionaries, which usually have key phrases listed in an appendix.
A)true
B)false
A
• Because some Southeast Asians and Native Americans may avoid eye contact and consider it disrespectful, consider limiting eye contact when dealing with such patients.
A)true
B)false
A
Chinese-Americans may not ask for pain medication and may need teaching to help explain how comfort and relief from pain promote healing and a quicker recovery.
A)true
B)false
A
• Native Americans are often stoic when ill. Complaints of pain to the nurse may be in general terms such as, “I am uncomfortable.” Undertreatment of pain is common. The patient may lack basic trust.
A)true
B)false
A
stoic is a person who can endure pain and hardship without showing it
A)true
B)false
A
Among Arab-Americans, verbal consent often has more meaning than written consent because it is based on trust. Fully explain the need for written consent. The patient is expressive regarding pain; pain may cause intense fear. Prepare the patient for painful procedures, and develop a care plan to prevent pain
A)true
B)false
A
Among Arab-Americans, verbal conformation has more value then the written conformation
A)true
B)false
A
Blacks may be open to expression of pain but may avoid medication because of fear of addiction. For a terminal diagnosis, news is best expressed in a family care conference or by speaking with the patient’s religious representative.
A)true
B)false
A
Blacks may avoid medication because of fear of addiction.
A)true
B)false
A
For Vietnamese-American patients, having an interpreter (often a hired one) is important, depending on the sensitivity of the subject under discussion, because of modesty. A female family member is expected to be at the bedside to provide care and comfort. Men are the decision makers and support the family; therefore speaking with the male head of the family may be necessary
A)true
B)false
A
For Vietnamese-American patients,Men are the decision makers and support the family; therefore speaking with the male head of the family may be necessary
A)true
B)false
A
Russian-American patients often prefer an amiable nurse who has a friendly smile. Use open, inviting, nonverbal postures. A Russian-American patient is more willing to follow instruction if the nurse providing it is sincere, competent, and trustworthy. Russian-American families usually have a principal patriarch.
A)true
B)false
A
amiable means having a friendly and pleasant manner
A)true
B)false.
A
patriarch means the male is the head of the family
A)true
B)false
A
Preoperative Considerations for Commonly Ingested Herbs
,
Echinacea is used Treat cold symptoms
A)true
B)false
A
Garlic is used to Improved immunity, High blood pressure and cholesterol
A)true
B)false
A
Ginger is used for motion sickness, Cough, Menstrual cramps, Intestinal gas
A)true
B)false
A
St. John’s wort is used for Antidepressant, Antiviral properties and Antiinflammatory action
A)true
B)false
A
SURGICAL EFFECTS ON THE BODY SYSTEMS
,
CARDIOVASCULAR
Hypotension and cardiac dysrhythmias are the most common cardiovascular complications of the surgical patient. Early recognition and management before these complications become serious enough to diminish cardiac output depend on frequent assessment of the patient’s vital signs.
,
ENDOCRINE
-Liver disease alters metabolism and elimination of drugs administered during surgery and impairs wound healing because of alterations in protein metabolism.
-Diabetes increases susceptibility to infection and may impair wound healing from altered glucose metabolism and associated circulatory impairment. Fluctuating blood levels may cause central nervous system malfunction during anesthesia.
,
GASTROINTESTINAL
Preoperative and postoperative medication may be necessary to control gastric acidity. Risk of hemorrhage may increase due to intubation.
,
intubation means insertion of a tube into a body
A)true
B)false
A
IMMUNE
Disease slows the body’s ability to fight infection. Immunologic disorders increase risk of infection and delay wound healing after surgery. Hypothermia during surgery decreases immune function.
AIDS
MUSCULOSKELETAL
Osteoporosis and increased risk for fractures in the older adult places patient at increased risk for injury.
,
NEUROLOGIC
(Seizures) Check the therapeutic levels of patient’s medications. (Myasthenia gravis) Muscle relaxants may need to be excluded due to decreased ability to reverse their effects. (CVA) Impaired verbal communication, defective perception of the body, paralysis, and visual disturbances place patient at high risk for injury. (PVD) Patient has a decreased threshold for peripheral pain
,
RESPIRATORY
Lung motility is decreased and gas exchange slowed. Anesthetic agents reduce respiratory function, increasing risk for severe hypoventilation.
,
URINARY
Impaired kidney function decreases excretion of anesthesia and alters acid-base balance. Prostate enlargement may increase risk of urinary tract infection.
,
PREOPERATIVE PHASE
,
Before surgery, patients require a thorough health assessment. Acute or chronic diseases hinder the body’s ability to repair itself or adjust to surgical treatment.
A)true
B)false
,
Postoperative care is also adjusted, when possible, to prevent potential complications.
For example, a patient who smokes cigarettes may have impaired alveoli and reduced lung capacity. Mucus and anesthesia by-products may be trapped in the lung, causing atelectasis and pneumonia. After surgery, . breathing exercises and treatments for the smoker aid in lung expansion and decrease the risk of respiratory complications
A)true
B)false
A
PREOPERATIVE TEACHING
,
Patient teaching before surgery helps decrease the patient's stress associated with fear of the unknown. Preoperative information helps reduce (1) anxiety (2) the amount of anesthesia needed (3) postsurgical pain (4) corticosteroid production. A)true B)false
A
Decreasing postsurgical complications through preoperative teaching speeds wound healing.
A)true
B)false
A
For surgical procedures that have potential long-term effects, support groups can offer support preoperatively.
A)true
B)false
A
Ideally, preoperative teaching is provided 1 or 2 days before surgery, when anxiety is not as high.
A)true
B)false
A
Generally, instruct the patient about the surgical procedure, informed consent, the method of skin preparation, and the gastrointestinal (GI) cleanser to be used.
A)true
B)false
A
Clarify what the physician has explained. Review the time of the surgery and information about the recovery area (e.g., previously assigned units, intensive care, specialty units, or outpatient area).
A)true
B)false
A
Reinforce that vital signs, dressings, and tubes are assessed every 15 to 30 minutes until the patient is awake and stable.
A)true
B)false
A
PREOPERATIVE PREPARATION
,
For surgery in a short-stay or ambulatory setting, the workup normally occurs a few days in advance. If the patient is admitted to the hospital, testing may be conducted to assess for potential problems. Preparation frequently includes both in-hospital testing and evaluation of test results that were completed in the physician’s office.
A)true
B)false
A
Serum electrolytes are evaluated if extensive surgery is planned or the patient has associated problems. One essential electrolyte examined is potassium; if not enough potassium is available, dysrhythmias can occur during anesthesia and the patient’s recovery may be delayed by general muscle weakness
A)true
B)false
A
if not enough potassium is available, dysrhythmias can occur during anesthesia and the patient’s recovery may be delayed by general muscle weakness
A)true
B)false
A
Blood chemistry profile (lactate dehydrogenase, -y-glutamyltransferase, alkaline phosphatase, total bilirubin) and urine bilirubin levels are used to assess hepatic function.
A)true
B)false
A
informed consent (permission to perform a specific test or procedure) before the beginning of any procedure. A)true B)false
A
A witness only verifies that this is the person who signed the consent and that it was a voluntary consent.
A)true
B)false
A
Informed consent should not be obtained if the patient is disoriented, unconscious, mentally incompetent, or, in some agencies, under the influence of sedatives
A)true
B)false
A
If necessary, contact the physician and indicate that the patient does not understand the procedure.
A)true
B)false
A
In an emergency, the patient may not be able to give consent for surgery. Every effort is made to locate family members to assume this responsibility. Occasionally telephone permission may be obtained.
A)true
B)false
A
Hospitals have standard guidelines for obtaining verbal consent. If the patient’s life is in danger and family members cannot be located, the surgeon may legally perform surgery. If family members object to surgery that the physician believes is essential, a court order may be obtained for the procedure
A)true
B)false
A
Gastrointestinal Preparation
,
At midnight before surgery, the patient is usually placed on nothing by mouth (NPO) status; this ensures the GI tract is empty when the patient is anesthetized, thereby decreasing the chance of vomiting or aspirating emesis after surgery
A)true
B)false
A
Reinforce with both the patient and the family the importance of not ingesting foods or fluids. If the patient fails to comply with the NPO order, notify the physician
A)true
B)false
A
An order for NPO after midnight should apply to solid foods for patients scheduled for surgery in the morning. An early light breakfast is allowed for afternoon procedures. Clear liquid may be taken up to 3 hours before surgery.
A)GI preparation
B)false
A
Patients can have oral care while NPO, but caution them not to swallow fluids used. A wet cloth on the lips helps relieve dryness. If patients need to be hydrated or require special IV medications, the physician may order parenteral fluids or medication
A)true
B)false
A
Because anesthesia relaxes the bowel, a bowel cleanser may be ordered to evacuate fecal material and lessen postoperative GI problems (nausea and vomiting)
A)true
B)false
A
Go-LYTELY is contraindicated in patients with GI obstruction, gastric retention, bowel perforation, toxic colitis, or megacolon
A)true
B)false
A
Before bowel surgery, medication (neomycin, sulfonarnides, erythromycin) may be given over a period of days to detoxify and sterilize the GI tract.
A)true
B)false
A
Skin Preparation
,
The operative site must be shaved carefully to remove the hair without injuring the skin
A)true
B)false
A
surgeons generally order hair removal only if it might interfere with exposure, closure, or dressing of the surgical site.
A)true
B)false
A
Shaving the hair before surgery creates microscopic cuts that increase the risk of surgical site infection.
A)true
B)false
A
A lower rate of infection occurs with either no shave or use of electric clippers than with any other method
A)true
B)false
A
If shaving is used, it should be performed close to the actual time of the surgical procedure to decrease the time for growth of bacteria and lower the potential for infection
A)true
B)false
A
Once the patient is in the OR, scrub the skin thoroughly with a detergent solution and then apply an antiseptic solution to kill more adherent and deeper residing bacteria. The surgeon may place a transparent sterile drape directly over the skin before making an incision.
A)true
B)false
A
Special concerns for patients undergoing a surgical skin preparation are as follows:
• Small children may be easily frightened by this procedure, and it may need to be done in the OR.
• Older adults need a detailed explanation to relieve their anxiety.
• Older adults have less subcutaneous tissue, less skin elasticity, and more delicate skin tissue. Take extreme care when shaving the older adult.
• Older adults are usually more susceptible to infections.
True
Performing a Surgical Skin Preparation Nursing Action (Rationale)
,
Lather skin with antiseptic soap and warm water (Cleanses skin, softens hair, and reduces friction from razor.)
A)true
B)false
A
Hold razor at a 30- to 45-degree angle to skin. (Minimizes chances of cutting or nicking skin.)
a. Shave small areas while holding skin taut.
b. Use short, smooth strokes. (Prevents pulling skin.)
c. Shave hair in same direction it grows (see illustration). (Removes hair close to skin surface.)
True
Rinse razor frequently. (Removes accumulation of hair from razor and prevents contamination from dirty water.)
A)true
B)false
A
Latex Allergy Considerations
,
Focused assessment of risk factors helps identify patients with the nursing diagnosis of risk for latex allergy response
A)true
B)false
A
The type IV allergic reaction to latex is a cell-mediated response to the chemical irritants found in latex products
A)true
B)false
A
The true latex allergy is the type I allergic reaction, and it occurs shortly after exposure to the proteins in latex rubber. The type I reaction is an immunoglobulin E-mediated systemic reaction that occurs when latex proteins are touched, inhaled, or ingested.
A)true
B)false
A
Risk factors for latex allergy include the following:
• History of anaphylactic reaction of unknown etiology during a medical or surgical procedure
• Multiple surgical procedures (especially from infancy)
• Food allergies (specifically kiwi, bananas, avocados, chestnuts)
• A job with daily exposure to latex (health care, food handlers, tire manufacturers)
• History of reactions to latex (balloons, condoms, gloves)
• Allergy to poinsettia plants
• History of allergies and asthma
True
Identification of patients at risk is the first step in preventing a reaction.
A)true
B)false
A
Responding to a Patient’s Risk for Latex Allergy
,
LATEX-ALERT PATIENT (HIGH RISK FOR ALLERGIC RESPONSE)
• No premedications are required.
• No special pharmaceutical protocols are required.
• Use nonlatex gloves.
• Use latex-safe supplies.
• Keep a latex-safe supply cart available in patient’s area
True
LATEX-ALLERGY PATIENT (SUSPECTED OR KNOWN ALLERGIC RESPONSE)
- Administer prophylactic treatment with steroids and anti-histamines preoperatively.
- Prepare a latex-safe environment, include latex-safe supply cart and crash cart.
- Apply cloth barrier to patient’s arm under a blood pressure cuff.
- Use medications from glass ampules.
- Do not puncture rubber stoppers with needles.
- Wear synthetic gloves.
- Use latex-free syringes.
- Use latex-safe (polyvinyl chloride) intravenous (IV) tubing.
- Do not use latex preparation on IV bags.
True
Respiratory Preparation
,
If a general anesthetic is administered, it is essential to ventilate the lungs postoperatively to prevent or treat atelectasis, improve lung expansion, improve oxygenation, and prevent postoperative pneumonia
A)true for respiratory preparation
B)false
A
Because the lungs do not expand fully during surgery, mucus and gases remain in the lungs until expelled. Pulmonary exercises can assist in expanding the lungs and removing these by-products.
A)true
B)false
A
In spirometry, referred to as incentive spirometry, the patient uses a device (spirometer) at the bedside at regular intervals to promote deep breathing.
A)true
B)false
A
To encourage patient use, place the spirometer in the bed or close by on the bedside stand. The usual rate of use is 8 to 10 breaths hourly during waking hours.
A)true
B)false
A
This type of incentive spirometer is inexpensive and measures inspiration. Encourage the patient to keep the colored balls floating as long as possible.
A)Flow-oriented inspiratory spirometer
B)Volume-oriented spirometer:
A
This form of incentive spirometer maintains a known volume of inspiration.Encourage the patient to breathe with normal inspired capacity
A)Flow-oriented inspiratory spirometer
B)Volume-oriented spirometer:
B
coughing increases intracranial pressure, it is usually contraindicated in cranial and spinal-related surgeries.
A)true
B)false
A
Coughing is also contraindicated for patients having cataract surgery
A)true
B)false
A
Patients frequently ambulate within a few hours of surgery to return cardiovascular and respiratory functions to normal more quickly.
A)true
B)false
A
Incentive Spirometry or Positive Expiratory Pressure Therapy and “Huff” Coughing
,
Nursing Action (Rationale}
,
Assess patient’s respiratory status and lungs sounds. Indications for spirometry are
(a) asymmetric chest wall movement,
(b) increased respiratory rate,
(c) increased production of sputum, and
(d) diminished lung expansion postoperatively.
(Alerts health care personnel to those patients at risk for respiration; complications during illness or after surgery.)
True
- Place prescribed incentive spirometer at the bedside. (Prepares equipment for procedure.)
A)true
B)false
A
- Place patient in semi-Fowler’s or full Fowler’s position. (Promotes optimal lung expansion for use of the incentive spirometer.
A)true
B)false
A
- Place tissues, emesis basin, and bedside trash bag within easy reach. (Enables sanitary disposal of respiratory secretions expectorated during procedure.)
A)true
B)false
A
Incentive spirometry
a. Instruct patient to completely cover mouth-piece with lips (use a noseclip if patient is unable to breathe through the mouthpiece) and to
(a) inhale slowly until maximum inspiration is reached,
(b) hold breath 2 or 3 seconds, and
(c) slowly exhale. (Promotes maximum inspiration.)
True
Store spirometer in an appropriate place, such as the bedside table, until next scheduled time. (Provides a convenient place for repeated use.)
A)true
B)false
A
PEP therapy and “huff” coughing
Instruct patient to assume semi-Fowler’s or high Fowler’s position, and place noseclip on patient’s nose. (Promotes optimum lung expansion and expectoration of
mucus.)
Instruct patient to place lips around mouth-piece and (1) take a full breath and exhale two or three times longer than inhalation and (b) repeat this pattern for 10 to 20 breaths. (Ensures that all breathing is done through the mouth and that the device is used properly.)
Remove device from mouth, and have patient take a slow, deep breath and hold for 3 seconds. (Promotes lung expansion before coughing.)
Instruct patient to exhale in quick, short, forced “huffs.” (“Huff” coughing, or forced expiratory technique, promotes bronchial hygiene by increasing expectoration of secretions.)
True
Patient Teaching Controlled Coughing Technique
,
The home health nurse may need to reinforce the importance of coughing one or two times an hour during waking hours for the patient at home
A)true
B)false
A
After brain, spinal, head, neck, or eye surgery, coughing is often contraindicated because of a potential increase in intracranial pressure.
A)true
B)false
A
Teaching Controlled Coughing
,
NURSING ACTION (rationale)
,
Assist patient to upright position. Place pillow between bed or chair and patient. (Facilitates deep breathing and optimum chest expansion.)
A)true
B)false
A
Cough two or three consecutive times without inhaling between coughs. (Consecutive coughs . remove mucus more effectively and completely than one forceful cough.)
A)true
B)false
A
Abdominal or thoracic incision can be splinted before coughing with hands, pillow, towel, or rolled bath blanket. (Surgical incision cuts through muscles, tissues, and nerve endings. Deep breathing and coughing place additional stress on suture Line and cause discomfort. Splinting incision provides firm support and reduces incisional pulling.)
A)true
B)false
A
Teaching Postoperative Breathing Techniques, Leg Exercises, and Turning NURSING ACTION (rationale)
,
Postoperative Breathing Techniques
,
Place pillow between patient and bed or chair. (Allows for fuller chest expansion. [Bed or chair itself . is too firm to provide expansion.])
A)true
B)false
A
Demonstrate taking slow, deep breaths. Avoid moving shoulders and chest while inhaling. Inhale through nose. (Prevents panting and hyperventilation. Moistens, filters, and warms inhaled air.)
A)true
B)false
A
Hold breath for a count of three, and slowly exhale through pursed lips. (Allows for gradual expulsion of air.)
A)true
B)false
A
Instruct patient to take 10 slow, deep breaths every 2 hours until ambulatory. (Helps prevent postoperative complications.)
A)true
B)false
A
Leg Exercises
,
Lifting one leg at a time and supporting joints, gently flex and extend leg 5 to 10 times. (Stimulates circulation and helps prevent . thrombi formation.)
A)true
B)false
A
Assess pulse, respiration, and blood pressure. (Aids in determining complications from exercise.)
A)true
B)false
A
Turning Exercises
,
Instruct patient to turn every 2 hours while awake. (Reduces risk of vascular and pulmonary complications.)
A)true
B)false
A
Surgeries for Which Coughing Is Contraindicated or Modified
,
- Intracranial: Coughing increases intracranial pressure (ICP), leading to cerebrospinal fluid leak.
- Eye: Coughing increases ICP, which then increases intra-ocular pressure, causing pressure on suture line.
- Ear: Mouth must be kept open if coughing occurs to prevent pressure backup through eustachian tube to middle ear, causing pressure on suture line.
- Nose: Mouth must be kept open if coughing occurs to prevent dislodgment of a clot with subsequent bleeding.
- Throat: Vigorous coughing may dislodge a clot with sub-sequent bleeding.
- Spinal: Coughing increases spinal canal pressure.
True
SURGICAL CARE OF THE PATIENT
,
Cardiovascular Considerations
,
Because blood stasis occurs when the patient lies flat, encourage him or her to do leg exercises to assist venous blood flow.
A)true
B)false
A
blood stasis occurs when the patient lies flat, so to prevent it, encourage the patient to do leg exercises to assist venous blood flow.
A)true
B)false
A
lf a thrombus is dislodged, it can travel as an embolus to the lungs, the heart, or the brain, where the vessel can be occluded.
A)true
B)false
A
Patient Teaching Use of Thromboembolic Deterrent Stockings and Sequential Compression Devices
,
- Teach patient appropriate care of the stockings. (Wash in warm water and mild soap, do not wring dry, and lay over flat surface to dry.)
- Instruct patient not to massage legs because of the risk of dislodging a thrombus.
- Teach patient the signs of possible complications. (If stockings or devices are too restrictive, edema and pain could result.)
True
Applying Thromboembolic Deterrent Stockings and Sequential Compression Devices
,
Nursing Action (Rationale)
,
Examine legs and assess risk for conditions. (Helps nurse determine presence of pigmentation around ankles, pitting edema, or peripheral cyanosis, which may indicate inadequate circulation.)
A)true
B)false
A
Assess patient for calf pain or positive Homans’ sign. (May indicate presence of thrombophlebitis or DVT.)
A)true
B)false
A
Thromboembolic Deterrent Stockings
,
Assist patient to supine position to apply stockings before patient rises. Patient should be recumbent for at least 30 mlnutes before application of the stocking. (Prevents veins from becoming distended or edema from occurring.)
A)true
B)false
A
Sequential Compression Devices
,
When the SCD is in place, make sure there are no wrinkles or creases in stockings
A)for SCD stocking
B)false
A
Vital Signs
,
Vital signs mirror the body’s response to anesthesia and surgery.
A)true
B)false
A
Genitourinary Considerations
,
After general anesthesia, the urinary bladder’s tone is decreased. Therefore you should know the patient’s normal bladder habits and identify when the bladder is full and distended.
A)true
B)false
A
Occasionally a urinary catheter is inserted to monitor urinary output. This procedure is normally reserved for patients undergoing urinary surgery or those who may have difficulty voiding.
A)true
B)false
A
The catheter is usually removed 1 or 2 days postoperatively to reduce the chance of bladder infection. Once it is removed, encourage the patient to drink 8 ounces of fluids per hour while awake unless contrainclicated.
A)true
B)false
A
Urinary retention and urinary tract infections are common postoperative complications.
A)true
B)false
A
Pain
,
Patients fear pain more than any other postsurgical complication. Emphasize to the patient that pain relief is an important part of care
A)true
B)false
A
non-pharmacologic analgesia which are imagery, biofeedback, .relaxation techniques
A)true
B)false
A
Postoperative pain is what the patient says it is, so it is important to reassure patients that addiction to analgesics rarely occurs in the time frame needed for comfort.
A)true
B)false
A
For the patient who is apprehensive tell the patient about intermittent injections, patient-controlled analgesia (PCA) and opioids injected into the epidural space (patient-controlled epidural) that they are safe and effective for postoperative pain management.
A)true
B)false
A
Preoperative Medication
,
Preoperative medication reduces the patient’s anxiety, decreases the amount of anesthetic needed, and reduces respiratory tract secretions
A)true
B)false
A
Barbiturates and tranquilizers (pheno-barbital and diazepam [Valium]) are sometimes given for sedation to reduce the amount of the anesthetic required.
A)true
B)false
A
Opioid analgesics (meperidine and morphine) may be administered by intermittent injection or PCA if the patient has pain before surgery; this also reduces the amount of anesthetic required. A)true B)false
A
Anticholinergics such as atropine reduce spasms of smooth muscles and decrease gastric, bronchial, and salivary secretions
A)true
B)false
A
The patient frequently becomes drowsy, notices a dry mouth, and experiences vertigo after receiving the preoperative medication
A)true
B)false
A
Institute safety measures, such as putting the bed in low position and raising side rails, and monitor the patient every 15 to 30 minutes until the patient leaves for surgery.
A)true
B)false
A
Surgery cancels all medications ordered before surgery, except for medications for long-term conditions, -such as phenytoin (Dilantin) for seizure control.
A)true
B)false
A
Anesthesia
,
___________means the absence of feelings (pain) (an, meaning “without,” plus esthesia, meaning “awareness of feeling”).
Anesthesia
Anesthesia is divided into three categories: general, regional, and local.
A)true
B)false
A
What category of anesthesia results in an immobile, quiet patient who does not recall the surgical procedure. The patient’s amnesia acts as protection from the unpleasant events.
General
General anesthesia is used for major surgery requiring extensive tissue manipulation.
A)true
B)false
A
An anesthesiologist gives general anesthetics by IV and inhalation routes through the four stages of anesthesia.
A)true
B)false
A
Stage I the patient is awake and the adrninistration of anesthetic agents begins. The stage is completed when the patient loses consciousness.
A)true
B)false
A
Stage II begins with the loss of consciousness and ends with the onset of regular breathing and loss of eyelid reflexes. This is referred to as the excitement or delirium phase because it is often accompanied by involuntary motor activity. The patient must not receive any auditory or physical stimulation during this period because it can stimulate a release of catecholarnines, which can raise heart rate and blood pressure
A)true
B)false
A
Stage III begins with the onset of regular breathing and ends if respirations cease.This stage is known as the operative or surgical phase.
A)true
B)false
A
Stage IV begins with the cessation of respirations and must be avoided, or it will necessitate the initiation of cardiopulmonary resuscitation and may lead to death. These stages were defined in the past when ether was used and may be less clear with newer anesthetic agents.
A)true
B)false
A
A more useful designation of stages includes the three phases of induction, maintenance, and emergence.
The induction phase includes the administration of agents and endotracheal intubation.
The maintenance phase includes positioning the patient, preparing the skin for incision, and performing the surgery. Appropriate levels of anesthesia are maintained during this phase.
During the emergence phase, anesthetics are decreased and the patient begins to awaken. Because of the short half-life of today’s medications, emergence often occurs in the OR.
True
intubation means insertion of a tube
A)true
B)false
A
To prevent aspiration and other respiratory complications, the anesthesiologist puts an endotracheal tube into the patient’s airway.
A)true
B)false
A
Endotracheal intubation is usually performed after administration of short-acting or, occasionally, long-acting muscle relaxants.
A)true
B)false
A
An anesthesia provider or OR nurse may assist with cricoid pressure during induction of general anesthesia and endotracheal cuff inflation during intubation.
A)true
B)false
A
Cricoid pressure reduces the risk of aspirating stomach contents by compressing the esophagus to prevent passive regurgitation. (This technique cannot, however, stop active vomiting.) Once initiated, pressure must be held constant until the cuff has been inflated or aspiration can happen rapidly.
A)true
B)false
A
