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NUR 103 > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Define the perioperative period

A

preop, intra op and post op

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2
Q

Diagnostic surgery

A

diagnose and confirm
used to determine the seriousness of a condition.
biopsy

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3
Q

ablative surgery

A

remove diseased organ tissue extremity
cures a health problem
appy, amputation, AV node ablation

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4
Q

palliative surggery

A

to alleviate symptoms, but doesn’t cure
the underlying cause is still there but symptoms are relieved.
(bowel resection with bowel cancer)

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5
Q

reconstructive surgery

A

rebuild tissue and/or organs
usually done to improve physical appearance.
total joint, or skin graft, boob job.

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6
Q

constructive surgery

A

building tissue or organ that is absent
also done to improve physical appearance
cleft palate

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7
Q

transplant surgery

A

replace to restore function

heart, lung, tissue, kidney

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8
Q

incidental surgery

A

to do along with another surgery
remove at the same time as planned surgery, tends to be controversial
tying tubes during a Csection
appendectomy with bowel resection

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9
Q

Elective surgery

A

suggested surgery but can wait
done at a time when it is convenient for client and surgeon
knee surgery, bunions, cataract.

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10
Q

emergency surgery

A

surgery that must be done immediately

must be done ASAP to save pts life or ability to function; ruptured spleen, torn urethra, ruptured aneurysm, ect.

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11
Q

urgent surgery

A

necessary 1-2 days
may need to be admitted while waiting for surgery time.
(fx hip and CABG)

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12
Q

inpatient stay length

A

anything greater than 23 hours

patient begins recovery in the hospital and is sometimes admitted 24 hours prior to surgery

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13
Q

outpatient stay

A

anything less than 23 hours
pt will have surgery at hospital then go home once awake from anesthesia and VSS, how long pt stays depends upon the type of anesthesia what type of surgery and how fast they wake up (alertness), pain/nausea or other complications can lead to admission.

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14
Q

minor risk surgeries

A

minimal risk (skin lesion removals)

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15
Q

major risk

A

serious risk

heart bypass TJR

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16
Q

describe the perioperative assessment

A

looking at as much info as possible
age-elderly at increased risk because of comorbidities
tobacco- increases risk of pulmonary complications
ETOH- alters the effects of anesthesia
Medications-current meds anesthesia needs to know about, herbal products, avoiding potential drug interactions meds need to bed re-ordered post op.
Previous surgeries and Hospitalizations- familiarity and complications
Allergies- anesthesia, prep solution, pain meds
Vital signs-assess for abnormalities, know baseline
Resp- lung sounds, determine ability to exhale anesthetic agent
Elimination- baseline, anticolenergic effects of anesthesia increase risk of constipation and urinary rtn.
Nutrition- malnutrition interferes with wound healing
Coping and Stress- reduce anxiety, support system and discharge planning
Obesity- increases risk wound healing- dehiscence, evisceration, pneumonia, VTE, arrythmiss, heart failure, clotting risks.

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17
Q

Nursing diagnosis and Client goals with pre op

A

knowledge deficit
anxiety
sleep pattern disturbance
ineffective coping

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18
Q

client goals for pre op

A

for preop to decrease post op complications and to increase pts understanding of surgery

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19
Q

Informed consent r/t surgery

A

the surgery’s risks and complications have been explained so when patient signs they are signing informed consent.
surgeons responsibility to inform patient
the op permit is a legal document.

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20
Q

role of nurse with informed consent

A

advocate- want the patient to sign, but want the patient to be of sound mind and body before signing, nurse can request that the surgeon talk to patient before signing if patient doesn’t completely understand something

witness- that the correct pt signed the form and that said person is aware of what they are signing.
Student’s CANNOT be witnesses.

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21
Q

common preop diagnostic tests

A

lab work: CBC, lytes, BUN, Creat, PT, PTT
X-rays: CXR, MRI
EKGs

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22
Q

CBC

A

complete blood count
wbc, rbc, hemoglobin, platelets, hematocrit
looks for anemia, infection and platelet issues

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23
Q

electrolytes

A

up to 20 tests

i.e. potassium (abnormal potassium causes arrhythmias)

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24
Q

blood sugar

A

should be 60-100

looks for undiagnosed diabetes

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25
Q

BUN and creat

A

blood urea nitrogen and creatinine look at kidney function, some anesthetics are eliminated thru the kidneys so pt needs to have good kidney fx

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26
Q

PT and PTT

A

prothrombin time
partial thromboplastin time
looks at weather blood will clot or not and how long it takes

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27
Q

EKGs for preop

A

routinely done on anyone over age 40 anesthesiologist orders the test, hx of hypertension is one reason it is ordered r/t increased cardiac risk

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28
Q

preoperative interventions

A

client has medical clearance***
ordered labs, and other diagnostic tests, results are done and accessible
NPO status
pre-op meds are given- document
maybe a shower or scub ordered (hibbiclens)
usually no shaving- clip vs shave
enemas or golytely may be ordered preop
if needed tubes (catheters extra IVS, NG) inserted in OR
void before leaving for surgery

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29
Q

NPO status evidence

A

current evidence= clear liquids 2 hours before then NPO

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30
Q

Client teaching preop

A

alert and inform patient of the probability of having drains, tubes, and IVs and what precautions to take.
Breathing and Coughing with return Demo preop- keeps lungs clear after surgery and patients are more likely to do what they are taught preop
antiembolism devices- SCDs TEDs
early ambulation- MUST WALK WITH ASSISTANCE POSTOP
nurse teaches about prn pain meds that patient needs to ask for and rate pain.

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31
Q

Surgeon

A

responsible for all judgment in pt care, may be assisted by another surgeon they are equal partners,

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32
Q

First assist

A

usually a resident, can be an RN, assists with surgery.
can not function alone
med student, PA/NP, OR tech, scrub tech

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33
Q

Anesthesiologist or CRNA

A

monitors labs, vitals, monitors patient, administers anesthesia, records meds and vitals signs.

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34
Q

holding area nurse

A

starts IV, marks surgical site, has consents signed, assesses anxiety and allergies, looks at preop check list, does not go into OR, escorts patients family to holding area

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35
Q

circulating nurse

A

RN for patient in the operating room.
concerned with client safety, advocates for patient.
sets up non sterile OR room while patient is being seen by anesthesia.
positions patient and placeses catheter. gives the go ahead for surgery.
watches for breaks in sterile technique.

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36
Q

Scrub Nurse

A

sets up sterile field. OR tech or scrub tech. sets up sterile field, handles all sterile supplies. hands instruments to the surgeon or first assist.

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37
Q

Methods to ensure client safety during OR

A

traffic flow controlled
surgical scrubs worn (not worn in public)
surgical gown- sterile gown, covers arms and caps
no jewelry by scrubbed persons
sterile drapes and clothing
pt identification- name birthdate 2 identifiers
positioning with documentation
universal protocol “time out” what surgery, who the patient is and marks on body.
sponge and instrument counts

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38
Q

List OR protocols and why they are done

A 
10 minute scrub in the morning
maintaining sterile field
pt identification
pt positioning 
ALL done for patient safety
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39
Q

Anesthesia definition

A

is an artificially inducted state of partial or total loss of sensation, occurring with or without Loss Of Consciousness

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40
Q

General anesthesia

A

reversible, unconscious state characterized by amnesia (pt doesn’t remember anything), analgesia (pt doesn’t experience pain) and depression of reflexes (diaphragm) muscle relaxation and homeostasis (maintaining profusion, B/P etc., can be done with IV drugs and inhalation drugs.
when a combination is used its called balanced anesthesia

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41
Q

Regional anesthesia

A

reversible loss of sensation in a specific region or area of the body when a local anesthetic is injected, anesthesia blocks the nerve. these include spinals, epidurals, caudal, peripheral nerve blocks.
pt is awake and responds to verbal stimulation

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42
Q

Monitored Anesthesia Care (MAC)

A

area is infiltrated with an anesthetic block or local at a particular site AND the patient is getting IV drugs (by anesthesiologist) to make them unaware.

Deeper than conscious sedation- patient doesn’t respond to verbal commands

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43
Q

Conscious sedations

A

drug induced depression of consciousness during which patient responds purposely to verbal stimuli. level up from MAC, pt keeps own airway open. CV function is maintained. commonly used for endo, colonoscopy procedures

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44
Q

Local anesthesia

A

least amount of anesthesia, smaller than regional.
infiltrate the area with anesthetic but no sedation will occur.
used for dental, and derm procedures

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45
Q

pre anesthetic meds

A

given to a pt before anesthesia, mostly for anxiety.

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46
Q

benzodiazepine

A

in the family of anti anxiety drugs- all these drugs end in lam or pam
Ativan
valium
versed

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47
Q

opioids and narcotics

A

may give to pt so there is less pain post-op because drugs are already in system
decreases B/P
helps with muscle relaxation

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48
Q

anticholinergic antagonist

A

dry up secretions to decrease aspiration
given in or
increase HR urinary retention and constipation
Atropine and Robinul-

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49
Q

post anesthesia meds

A

analgesics- opioids if severe
antiemetics- Zofran and Phenergan
cardiac- atropine for bradycardia and hypotension

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50
Q

Nursing dx for intra-op

A 
airway clearance
skin integrity
risk for injury
risk for aspiration
altered elimination
fluid volume deficit
powerlessness
51
Q

info given to PACU from OR (report)

A 
what type of anesthesia
what surgery
any drains
any significant pre-op/intra op events
rxn to anesthesia
resp status
hearing or other impairments
estimated blood loss
52
Q

Balanced anesthesia

A

several different drugs used at once:
versed- alters LOC
IV anesthesia- used to start anesthesia short-acting barbiturates (induction
Neuromuscular blocking agents- for muscle relaxation during surgery- paralyze muscles
Opioids and Narcotics- help with muscle relaxation decrease BP, pain management post op
inhalation anesthetics- nitrous oxide most common
anti emetics- Zofran/Phenergan use after surgery so pt is less nauseated in PACU

53
Q

Nursing assessments/interventions in PACU

A 
VS
Dressings, Drains, Bleeding
Return of gag reflex
airway patency- suctioning (intervention
adequate respirations- O2 (interventions)
peripheral circulation
fluid volume- IV fluids rate 
LOC- pt must breath on his or her own to leave PACU
Pain
N&V
54
Q

Common Nursing Dx post op

A 
Impaired gas exchange
impaired physical mobility
risk for injury
impaired skin integrity
pain
high risk for urinary retention
ineffective airway clearance 
fluid volume deficit
constipation 
knowledge deficit
55
Q

What is ranked higher for post op nursing diagnosis, high risk for urinary retention or ineffective airway clearance?

A

High risk for Urinary retention- UO must be at least ml/hr by- 4-6 hrs post op. VERY important.

Airway clearance is cough and deep breathing. different that airway patency

56
Q

Nursing assessments and interventions post op

A

Resp exercises cough and deep breath use incision splinting for coughing to ease pain.
maintain suction and other drainage tubing
dressings (drainage and changes) and other incisional care
describe drainage- sanguineous, serosanguineous, purulent
analgesia- pain relief
client family teaching
progressive activity and restrictions
D/C planning* starts at admission

57
Q

Post op meds

A

stool softeners and laxatives- narcotics cause constipation, anticholinergic effects of anesthesia
vitamins- to aid in healing
anticoagulants- decrease risk of DVT r/t bed rest and decreased mobility
Abx- decrease risk of infection especially ortho and neuro
pain meds

58
Q

Colace

A

stool softener (usually given BID)

59
Q

Peri-Colace

A

stool softener with gentle laxative added usually given BID

60
Q

Milk of Magnesia

A

laxative- not given to people with real failure because their kidneys cant handle the Mag

61
Q

Miralax

A

laxative that pulls fluid from intestine- can be used as a colon prep

62
Q

Metamucil

A

a bulk laxative- not usually given post op because bulk doesn’t help the decreased peristalsis caused by narcotics and anesthesia

63
Q

Heparin or Lovenox

A

subQ low dose

used for risk of DVTS

64
Q

Muscle relaxants

A

used for ortho (back and Knee) and neuro surgery

65
Q

Anti-spasmodic

A

urinary pt to keep bladder from being irritable

66
Q

hormones

A

after hysterectomy

67
Q

Post op Pain management

A

3 types of pain control
PRN
PCA
Epidural

68
Q

PRN meds
advantage
disadvantage

A

most common- pt has to ask for these- injectable or oral

Advantages- pt doesn’t get over medicated. pt doesn’t get them if they don’t need or want them.

Disadvantages- pt has to wait for them while nurse prepares to give them. pain levels can build up to intolerable level while patient waits

69
Q

PCA (patient controlled analgesia)
Advantage
Disadvantage

A

Pump with large syringe (30ml) full of narcotic- Hydromorphone or morphine MD determines amount
pt pushes button for dose

advantage- dosing is immediate- pt is in control

disadvantage- not necessarily easier for nurse. doesn’t save time, pt has to be physically and mentally able to push button. dosing is small and controlled. hooked to running IV
families will push button.

70
Q

Epidural

advantage and disadvantage

A

catheter is put in patients back by anesthesiologist during surgery. drug is analgesic not anesthetic- doesn’t remove all of the pain.

advantage- excellent pain control

disadvantages- numbs the lower abdominal area- causes difficulty with urination- pt will need a foley
invasive procedure- risk for infection

71
Q

Lab tests pre op and post op

A 
WBC
Hgb
Hct
platelets
CBC 
sodium
potassium
BG
72
Q

WBC

A

4-10 thousand

73
Q

Platelets

A

150-400 thousand

74
Q

Hemoglobin (Hgb)

female/ male

A

Female 12-14

Male 14-16

75
Q

sodium (Na+)

A

135-150

76
Q

Potassium (K+)

A

3.5-5

muscle and heart contraction

77
Q

Hematocrit (Hct)

male/female

A

35-47 percent females

42-52 percent males

78
Q

Blood sugar

A

60-100

79
Q

SCD/TEDs

A

compress to increase venous return because patients are not mobile so DVTs are not formed

80
Q

Incentive spirometer

A

Expand lungs/ alveoli
cough and deep breath to prevent pneumonia
use pillow splinting

81
Q

Atelectasis

A

lungs not fully expanded

82
Q

Ileus

A

cause- usually from handling the bowel during surgery, anesthesia (anticholinergic effects), electrolyte imbalance, intraperitoneal infection

prevention- early ambulation, increase activity, pain meds- pain doesn’t interfere with mobility but they do cause constipation by slowing peristalsis

treatment- NG tube for nausea
colenergic meds- stool softeners, and stimulators
IV fluids and electrolytes

Assess bowel sounds and measure distension

83
Q

Acute Blood Loss Anemia Defining characteristics

A

Could be r/t surgery/trauma
peripheral blood vessels constrict (trying to bring what O2 carrying blood is left back to organs)
normocytic ( RBCs are normal size and shape)
normochromic (RBCs are normal color)
Tachycardia- trying to pump more blood because O2 demand is high
H&H (hematocrit and Hemoglobin are normal in early stages- then drop drastically.

84
Q

Sickle Cell Disease/Anemia defining characteristics

A

High risk for Infection- sickle cells damage the spleen.
thrombotic crisis can occur- deformed RBCs are caught in capillaries and form clots leading to ischemia
avoid stress- triggers a crisis.
Hydroxyurea drug used during crisis- makes RBCs more flexible.
Ischemia can lead to acute chest pain and all over pain in the body- especially in joints
increased WBCs seen

85
Q

Vitamin B12 deficiency anemia defining characteristics

A

can be r/t lack of intrinsic factor (helps absorb vit. B12) after a stomach or ilium resection
Seeking early treatment is important because neurological symptoms happen with this anemia (paresthesia and loss of balance) if treated before 6mo of onset these are reversible.
IM or intranasal vit B12 for treatment on monthly basis because pills won’t work for people who lack intrinsic factor
Painful Tongue, smooth red and inflamed

86
Q

Folic Acid Deficiency anemia defining characteristics

A

r/t chronic malnourishment
r/t ETOH abuse
Causes birth defects in baby if inadequate intake during pregnancy (neurological problems)
symptoms develop gradually
Diet high in green leafy veggies, fortified cereals and meats

87
Q

Aplastic anemia

A 
increased infection rates
pancytopenia- All blood parts affected- RBCs, WBCs, Platelets
Bone marrow failure
result of chemo
HIV
Bleeding tendencies
88
Q

Iron (Fe) deficiency anemia

A

Common in elderly
Cheilosis- brittle nails
PICA appetite- paper, chalk, Ice, things that are not food.
Most prevalent form of nutritional anemia in the world, effects the poorest
Results from inadequate intake of Iron so body cant make good Hgb

89
Q

Hematologic disorders anemias GFHP

A

Activity and Exercise

90
Q

Anemia is not

A

A condition itself- it is a SYMPTOM of something else going on

91
Q

Anemia Definition

A

abnormally low number of circulating RBCs, hemoglobin concentration, or both.
this results in a lack of O2 to cells and tissues

92
Q

Causes of Anemia

A 
inadequate production of RBCs
Increased destruction (nutrition, meds, depression of bone marrow) (aplastic)
Blood loss (acute and chronic)
insufficient or defective Hgb (sickle cell)

Affects all major organs if severe because of decreased O2 carrying capacity of RBCs

93
Q

Anemia Categorized by cause (4)

A

Blood loss
Nutritional
Hemolytic
bone marrow failure/Suppression

94
Q

Blood loss anemia

A

Acute: surgery/ trauma. Symptomatic- fatigue
normochromic and normocytic RBCs
Chronic: blood loss (colon Cancer). depletes iron stores.
less symptomatic because the body compensates. Hypochromic and microcytic RBCs

95
Q

Nutritional anemia’s

and what their cells look like

A

Iron Deficiency Anemia- inhibition of Hgb synthesis. microcytic and hypochromic RBCs
Vitamin B12 Anemia-inhibition of DNA synthesis (cell multiplications) Macrocytic, misshaped RBCs with short life span
Folic Acid deficiency anemia- Fragile megaloblastic cells, large and immature RBCs, r/t not enough intake higher demands with pregnancy and chemo therapy

96
Q

Hemolytic anemia

A

Sickle cell anemia- hereditary, chronic, stress and increased demands of O2 cause crisis. most common in African Americans

97
Q

Aplastic anemia

A 
more rare than other types of anemia 
bone marrow failure usually r/t chemo
radiation, exposure to chemicals, virus and meds 
problems with anemia- RBC
problems with infection- WBC
problems with clotting- Platelets.
Everything in the blood is low
98
Q

Pancytopenia

A

every part of the blood is affected. RBC, WBC and Platelets. r/t aplastic anemia

99
Q

General signs and symptoms of anemia

A

pale skin,mucus membranes, conjunctiva, nail beds because blood needs to go to organs
increased HR and RR- compensatory need more O2 and circulation.
Angina and Fatigue- night cramps- lack of O2, Bone pain- marrow working harder, ischemia
DOE and SOB- r/t lack of O2
Cerebral hypoxia
Heart Failure
Signs of circulatory shock with rapid blood loss- low BP tachy, decreased LOC and Urine Output

100
Q

Cerebral Hypoxia

A

general symptom of anemia, HA dizziness, dim vision, possible stroke r/t anemia

101
Q

Explain fluid movement during acute blood loss anemia

A

shifts from tissue and interstitial space to vascular space to try and increase BP

102
Q

Hct and Hgb ratio

A

1:3
1 being Hgb,3 Hct
i.e.
12:36

103
Q

Nutritional Anemia in general

A

Megaloblastic anemia
affect RBC formation (vitamin B12 and folate play a big role in RBC development and Iron plays a big role in Heme Group development)
Caused by inadequate diet, increased need (pregnancy and chemo), malabsorption (r/t alcoholism or gastric bypass), and GI disorders

104
Q

Symptoms of Iron Deficiency anemia

A

Nails- brittle
Mouth- Cheilosis cracks in the corner of mouth
Tongue- smooth and sore
Eating habits- PICA, hungry for things that aren’t food

105
Q

Treatment for Fe deficiency Anemia

A

Iron supplement- oral tabs
increased absorption if taken with Vit C

don’t take with milk or tums/milk of mag because calcium decreases absorption as well as Bran

106
Q

Vitamin B12 deficiency anemia symptoms

A

gradual onset of neuro problems- numbness, tingling, paresthesia, lose sense of balance
tongue- beefy sore smooth red
mouth- chielosis- cracked

107
Q

Treatment for Vit B12 Anemia

A

EARLY INTERVENTION- treated early

108
Q

Folic Acid deficiency anemia symptoms

A

develop gradually.
NO NEURO SYPMOTOMS- that’s only B12
Palor, general weakness

109
Q

treatments of folic acid deficiency anemia

A

eating greens, whole grains, meat

taking supplements- especially prenatal vitamins during pregnancy.

110
Q

Hemolytic Anemia causes

what do the cells look like

A

premature breakdown of RBCs
normocytic and normochromic RBCs but immature BCs won’t last a long time. bone marrow tries to keep up by pumping out more

Intrinsic- inside RBC- Sickle cell
Extrinsic- Outside RBC- chemo, bacteria, infection, trauma, radiation

111
Q

Treatment of Hemolytic anemia

A

treat what is CAUSING the problem

112
Q

Sickle Cell anemia signs and symptoms

A 
Pain. 
fatigue 
increased WBC couth
Sustained erection
Angina/MI
Stroke/ TIA
pallor
jaundice- r/t spleen breaking down so many RBC
irritable
decreased circulation
ischemia
113
Q

treatment of sickle cell anemia

A

meds- hydroxyurea- increase production of Hgb, makes RBC more flexible
Transplant- Bone marrow- brings in more healthy RBC making stem cells.
pain management- during crisis- r/t thrombo crisis.

114
Q

aplastic anemia signs and symptoms

A 
vary with severity
pallor 
fatigue
HA
DOE
Tachy
bleeding***
HF
115
Q

Treatment of aplastic anemia

A

remove causative agent, blood transfusions, BMT

116
Q

Diagnostic tests for anemias

A

CBC
Iron levels and TIBC (total iron binding capacity- transferrin levels)
Serum ferritin- another iron test
sickle cell test- screening for sickle cell
BM examination- biopsy

117
Q

CBC includes what

A

WBC
RBC
Platelets
RBC distribution, width, size, shape

CBC with Diff means all different kinds of WBC are identified

118
Q

Iron overdose is toxic to

A

young children

119
Q

Iron teaching

A

don’t take with calcium or bran
it may need to be taken for a long time
vitamin C increases absorption

120
Q

Nursing diagnosis for anemias

A

pain
fatigue
decreased tissue perfusion
activity intolerance

121
Q

Intradermal injections

A 
Used for TB and other skin tests
25-29 g
1/4-5/8" needle
5-15 degree angle with bevel up- no aspiration or massage
inner forearm or upper back
122
Q

Subcutaneous injections

A 
Used for Heparin, Lovenox, and Insulin
25-31g needles
1/2-5/8" needle
45-90 degree angle- no aspiration 
abdomen, upper outer arms, upper outer thighs, and outer back
123
Q

Intramuscular injections

A 
Used for Immunizations and B-12
20-25 g needles depending on site
Deltoid- 5/8-1"
Vastus lateralus- 5/8-1.5"
Dorsal gluteal- 1-3"
Ventrogluteal- SAFEST SITE- 1.5-2.5"
Can airlock to prevent leaking into SubQ- aspirate except for immunizations
124
Q

Z track

A

Used for Iron and injections that can be damaging to the skin
dorsogluteal and ventrogluteal can use 1.5” needle- may need larger if patient is obese
90 degree angle with skin pulled to the side.

NUR 103 (3 decks)

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