Test 1 Chapters 4, 5, 7 Flashcards
Why would a patient take Epogen prior to surgery?
Epogen may be given before surg to stimulate red blood cell production; Pt will prob not need a blood transfusion
What do you want to ensure happens prior to giving preoperative medications?
ensure the correct surgical procedure is identified on the consent form, the pt is mentally competent, the pt understands the procedure and risks and that it is signed before any pre-op meds are administered
What are meridians when talking about acupressure or acupuncture
meridians are similar to that of nerve pathways; acupuncture originates from China and involves the use of tiny needles inserted into the skin at specific points called meridians
Nursing interventions that help prevent atelectasis after surgery
Incentive spirometer, ‘huff’ cough, deep breathing, early ambulation, teach to cough properly
Cultural considerations when patient have pain
-Stoic/denies pain: may not admit to having pain and may continue with regular activities
-May have many reasons for not admitting to pain: lack of understanding of pain control methods, fear of addiction, family expectations
Adverse reaction that can occur when an Asian person is given Atropine
Asian + Atropine = tachycardia
Frequency of nursing assessments while in the PACU
Assessments are performed at least every 15 mins or according to the pts status
temp initially then every 8 hours
Check every 15min x 1hr, every 30 mins x 4 hrs, every 1 hr x 4 hrs, every 4 hrs x 24-48hrs; or per agency protocol
continually assess pain
Nursing interventions to do if a transdermal patch falls off too early
Thoroughly search pt and pts bed for patch (if found discard) and put another patch on and document the previous patch fell off
Know what the Aldrete score is and what it tells us about the patient’s condition
is used to determine readiness for transfer; activity, respiration, circulation, consciousness, skin color, and oxygen saturation; the score needs to be 9 or 10 to transfer to nursing unit
How do we advance a patient’s diet after surgery?
at least once per shift listen for bowel sounds in all four quadrants; once they are heard and pt is tolerating ice chips and clear liquids, a regular diet may be tolerated
What do we teach family members about the use of massage in pain relief?
When a painful area has inflammation or consists of a wound or an incision, massaging another area of the body w/ gentle but firm pressure helps the pt direct attention away from the pain.
How to know if your patient is emotionally prepared for surgery – what statement by the patient causes concern
Psychological assessment
Risk factors excessive fear
If a patient tells you the surgery is not wanted, delay preoperative preparations and explore the issue with the patient.
Why is it important to obtain height and weight prior to surgery?
Height and weight measured and charted so anesthesiologist can accurately calculate anesthetic dosages
Know the nociceptive pain sequence in order and what happens in each stage
Transduction
Transmission
Perception
Modulation
Post-operative complications that can happen with a 90-year-old patient
The Risk of hypoventilation is greater in older adults because lung expansion may be hampered by cartilage and weakened respiratory muscles.
Know the responsibilities of the circulating nurse prior to surgery and during surgery
-Prior to surgery: collects consent form, ensuring the surgical site has been marked
-During surgery: Opens sterile supplies for the scrub nurse, inserts foley catheter, updates families during long procedures
How does the nurse use distraction in a patient with poor pain control?
Includes watching television, talking with friends, using an electronic device, or playing a game.
Nursing actions when patient wake up from surgery confused
You need to reorient and reassure the patient that the surgery is over, that they are in the recovery room, and that their family member or contact person has been notified.
Abnormal findings to report to the surgeon if they occur prior to surgery
Any deviations from normal range should be brought to the attention of the surgeon.
Nursing interventions to offer a patient using the gate theory of pain management
Massage and vibration produce activity in the large-diameter nerve fibers
Distraction in the form of activity or social interaction produces these brainstem impulses.
Discharge criteria for a patient being discharged home after same-day surgery
Normally takes 1 to 3 hours
Stable vitals
Able to sit up and ambulate unassisted
Take fluids without nausea
Empty the bladder
If your patient refuses to take off her jewelry prior to surgery, what do you do to protect it
Tape it. If it is a stone, use a cotton ball with tape.
What to teach your patient to do if they are having too much pain to cough after surgery
If the patient cannot cough effectively, instruct the patient to “huff” cough. If the patient is too weak to remove secretions, tracheal suctioning is indicated.
What are the purposes of preoperative medications
Reduce anxiety and promote a restful state
Decrease secretion of mucus and other body fluids
Counteract nausea and reduce emesis
Enhance the effects of the anesthetic
What do we teach patients about robotic surgery?
-Robot’s tiny camera has multiple lenses allowing magnification up to 12x that of normal vision
-Surgeon performs w/ assistance from second surgeon and assistants
-Remote-controlled instruments inserted through small incisions
-Advantage is ‘rock-steady’ than, with precision beyond human dexterity
-Pt has less postop pain and healing time with the smaller incisions
How are pain threshold and pain tolerance different?
Pain threshold is the paint at which pain is perceived.
Pain tolerance is the length of time or the intensity of pain a person will endure before outwardly responding to it.
Post-operative complications to report to the MD
-Atelectasis: Decreased breath sounds over area not aerating; dyspnea
-Wound dehiscence: Discharge of serosanguineous drainage from wound and sensation that “something gave”; Separation of wound edges
Nursing interventions to perform if a patient is having increased pain after surgery and it is too early to give them additional pain meds
-Sleep, Heat, Cold, Distraction, Relaxation, Guided Imagery, Meditation, Hypnosis, Biofeedback, Music, Binders, Massage, Acupuncture and acupressure, Electrostimulation Devices, Spinal cord stimulator
Know the postsurgical complications that can occur after a three-hour surgery and who is most likely to have complications
Pressure ulcer and joint pain
What is the gate theory of pain control?
-The gate control theory recognizes that stimuli other than pain pass through the same gate. When a large volume of non-painful stimuli are competing for the gate, pain impulses may be blocked. A high volume of pain, however, may override other stimuli and pass through the gate, causing the individual to perceive the pain.
Who is at risk for developing post-operative thrombophlebitis?
Pt who has had a past blood clot or CVA
What is the temperature range in the operating room?
66 - 70 degrees to discourage microbial growth and keep the surgical team comfy under the bright lights and layers of surgical clothing
What do we teach our patients after surgery regarding fear of addiction?
-False Perception: addiction to pain-relieving drugs is always a hazard, and for the sake of the pt, the nurse must withhold a drug even if pt is requesting it
-Fact: Approx 1% (no more than 3%) pt’s become addicted to drugs administered for the purpose of relieving acute pain. Addiction is an increasing problem in America, but acute pain managed properly is not the reason for the national opioid addiction increase. Pt’s need adequate pain relief
Nursing interventions for patient who are experiencing increased gas after surgery
Taking only small amounts of liquid or food at a time, drinking only tepid liquids, refrain from drinking with a straw, and ambulating
What position do we usually place patients in if possible in the PACU?
On their side
What do you do when a patient taking pain medications breaks out in hives
-Report immediately
-Discontinue med’s and obtain alternative order
-May need an antihistamine
Know the differences between the types of anesthesia that were discussed in Chapter 4
-4 types: General, Regional, Procedural/Conscious sedation (or Procedural Sedation and Analgesia PSA), and other
-Gen: Inhalation, IV
-Reg: Spinal, Epidural, Nerve block, Local
-Proc: USE- Surgery of short duration for which unconsciousness is undesirable; May be used in combination with local, spinal, or nerve blocks to enhance pt comfort. ADVANTAGE- Reversal is rapid; pt is unaware but can breathe without assistance; Little if any n/v; Amnesia of surgery
Dangers of smoking postoperatively
Smoking decreases the amount of hemoglobin available to carry oxygen to the healing tissues and prolongs healing time
Physiologic changes in the older adult that make them higher risk for surgery
-Pt’s older than 75 have 3x the surgical complication rate than those of younger adults
-Older adults are less able to adjust and compensate for the stress of surgery due to declining physiologic factors (cardiac, respiratory, renal)
-More likely to have impaired renal, hepatic, respiratory, and cardiac function that alter metabolism and excretion of drugs and anesthesia
-Presence of chronic diseases causes vulnerability to fluid and electrolyte imbalances during and after surgery
What do you do if a patient tells you they don’t understand about their surgery after their consent is signed?
Notify the surgeon
Teaching is completed on a patient having a needle biopsy – what should be included in this teaching?
-Diagnostic test
-Breast pain is still possible after surgery
-Usually not urgent
-Usually done with a local anest.
-May need further treatment
Performed to determine the origin and cause of a disorder or the cell type for cancer; Breast biopsy, exploratory laparotomy, arthroscopy
diagnostic
Why is it important to know if a pt is taking a corticosteroid
Can delay wound healing, alter fluid and electrolyte balance, and affect several metabolic functions (which would increase surgical risk)
Which pain process begins when tissue damage causes the release of substances that stimulate the nociceptors and initiate the sensation of pain
transduction
Which pain process involves the movement of the pain sensation to the spinal cord
transmission
Which pain process occurs when impulses reach the brain and the pain is recognized
perception
Which pain process occurs when neurons in the brain send signals back down the spinal cord by the release of neurotransmitter
modulation
