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NUR123 Exam 1 > Unit 1: The Surgical Patient > Flashcards

Unit 1: The Surgical Patient Flashcards

1
Q

Masks are worn at all times in the restricted zone of the OR

A

True

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2
Q

An advantage of IV anesthesia is that the onset of the anesthesia is pleasant, therefore, it is often used.

A

True

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3
Q

Tachycardia is often the first sign of malignant hyperthermia

A

True

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4
Q

Shock results from hypervolemia

A

False- hypovolemia can cause shock

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5
Q

_______is the most common endocrinopathy.

A

Diabetes

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6
Q

The major purpose of withholding fluids before surgery is to prevent _______.

A

Aspiration

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7
Q

The ___________ phase begins when the patient is transferred onto the OR table and ends with admission to the PACU.

A

Intraoperative

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8
Q

________ is a state of narcosis, analgesia, relaxation, and reflex loss.

A

Anesthesia

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9
Q

Spinal anesthesia produces anesthesia of the lower extremities, _______, and lower abdomen.

A

Perineum

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10
Q

What phases does perioperative nursing include?

A

Preoperative, Intraoperative, Postoperative

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11
Q

What is the preoperative phase?

A

The period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table

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12
Q

What is the intraoperative phase?

A

The period of time from when the patient is transferred to the operating room table to when he or she is admitted to the postanesthesia care unit (PACU)

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13
Q

What is the postoperative phase?

A

The period of time that begins with the admission of the patient to the PACU and ends after a follow-up evaluation in the clinical setting or home

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14
Q

What is first-intention healing?

A

a method of healing in which wound edges are surgically approximated and integumentary continuity is restored without granulation

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15
Q

What is second-intention healing?

A

a method of healing in which wound edges are not surgically approximated and integumentary continuity is restored by the process of granulation

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16
Q

What is third-intention healing?

A

A method of healing in which surgical approximation of wound edges is delayed and integumentary continuity is restored by apposing areas of granulation

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17
Q

What factors would you include in the assessment of a surgical patient?

A 
Fluid & nutritional status
Drug & alcohol use
Respiratory status
Cardiovascular status
Hepatic & Renal function
Endocrine function
Immune function
Medication use
Psychological factors
Spiritual & Cultural beliefs
Presence of genetic disorders
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18
Q

What is the preoperative checklist?

A

A list of elements that must be checked preoperatively, including: patient identification, correct documents, and patient understanding of the procedure

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19
Q

What is the role of the nurse in the informed consent process?

A

To ensure the patient/patient representative is provided the information necessary to enable them to evaluate the surgery before agreeing to it
as well as verifying that the patient signing the document is the patient receiving the operation

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20
Q

What are the routine screening tests for surgical patients?

A 
Bloodwork
Urinalysis
Chest X-Ray
Pulmonary function test
ECG
Pregnancy test
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21
Q

What are some age-related changes that put older adults at risk for surgery?

A

Decreased subcutaneous fat
Poor skin tugor
Tissue fragility
Decreased physiologic reserve

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22
Q

What are factors that place older adults at risk for surgery?

A

Age related changes
medications
medical history

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23
Q

What are the effects of medications taken preoperatively?

A

Medications will cause relaxation, lightheadedness, and drowziness

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24
Q

What are some key points to make during preoperative teaching?

A

the possible need for a ventilator, drainage tubes, etc
instruction for breathing and leg exercises
promote mobility
proper breathing techniques
pain intensity scale

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25
Q

What are characteristics of patients under general anesthesia?

A

not arousable, even with painful stimuli
lose ability to maintain ventilatory function
require assistance maintaining a patent airway

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26
Q

What is Stage I of general anesthesia?

A

Beginning Anesthesia: warmth, dizziness, detachment; may hear buzzing or ringing, may sense inability to move extremities

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27
Q

What is Stage II of general anesthesia?

A

Excitement: struggling, shouting, talking, singing, laughing, crying; often avoided if anesthesia is given quickly and smoothly

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28
Q

What are the different types of anesthesia?

A

General anesthesia
Local anesthesia
Moderate sedation/analgesia
Monitored anesthesia care

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29
Q

What is Stage III of general anesthesia?

A

Surgical Anesthesia: reached by continuous administration; pt is unconscious

30
Q

What is Stage IV of general anesthesia?

A

Medullary Depression: too much anesthesia has been administered; cyanosis; can be fatal

31
Q

What is Local Anesthesia?

A

Blocks the nerves in the CNS & PNS, can be used alone or in conjunction with other types; topical or local infiltration

32
Q

What is Regional Anesthesia?

A

A form of local anesthesia where an anesthetic agent is injected around nerve so the area the nerve supplies is anesthetized

33
Q

What are examples of regional anesthesia?

A

Spinal, epidural, peripheral nerve blocks

34
Q

What is Moderate sedation/analgesia?

A

Sedation without anesthesiologist; conscious sedation

35
Q

What is monitored anesthesia care?

A

Potential for a deeper level of sedation where the sedation/analgesia is always monitored by and anesthesiologist

36
Q

What do moderate sedation & monitored anesthesia have in common?

A

Depress a pt’s LOC to a moderate level to enable surgical, diagnostic, or therapeutic procedures to be preformed while ensuring the pt’s comfort and cooperation
Allows pt to maintain a patent airway, retain protective airway reflexes, respond to verbal and physical stimuli, and recover more rapidly

37
Q

What is emergent surgery?

A

Life-threatening, needs to be done ASAP

38
Q

What is urgent surgery?

A

Necessary, but can wait 24 hours

39
Q

What is required surgery?

A

necessary, but can wait

40
Q

What is elective surgery?

A

Unnecessary, but will make quality of life better

41
Q

What is optional surgery?

A

No medical need; cosmetic

42
Q

What are the types of surgical techniques?

A

Conventional
Laparoscopic
Robotic
Natural orifice

43
Q

What types of bloodwork is completed pre-operatively?

A

CBC
Electrolytes
Chem 7
PT, PTT, & Clotting

44
Q

What percentage of surgery is outpatient?

A

70-90%

45
Q

What is the anesthesiologist’s assessment focused on?

A

Cardiac history
respiratory history
previous anesthesia experiences
current medications

46
Q

Pre-operative checklist criteria

A 
Vitals
Height & weight
consent signed?
H&P charted/dated?
Diagnostics
NPO
ID Band
Allergies
hospital gown
jewelry off
disposition of valuables
meds given
pt voided
47
Q

What are common pre-op orders?

A

NPO (usually @ 12a)
IVF
Medications OK to give

48
Q

What are common pre-op preps?

A

Skin- cleanse/clip hair

Bowel

49
Q

Prior to the surgery, the patient is nervous and does not understand hte procedure or how it will be preformed; the nurse should…

A

Have the HCP come and explain & review the procedure with the patient

50
Q

Who’s in the OR?

A 
Primary surgeon
Assistant surgeon
Scrub nurse
Circulating nurse
Anesthesia provider
51
Q

SURGICAL TIME OUT prevents

A

Wrong person
wrong procedure
wrong site

52
Q

What is malignant hyperthermia?

A

An inherited complication of general inhalation anesthesia; causes contractillity of muscles leading to extreme hyperthermia

53
Q

What are the sympotms, in order, of MH?

A 
Tachycardia*
Tachypnea
Hypercarbia/hypoxemia
Muscle rigidity
venticular dysrhythmias
Lactic acidosis
Extreme hyperthermia
54
Q

What is the treatment of MH?

A

Stop anesthetic
Hyperventilate 100% O2
Cool
IV dantrolene

55
Q

How do you prevent a patient from MH?

A

Obtain a family history

56
Q

What criteria is used to evaluate if a PACU pt is ready for discharge?

A 
Stable BP
Adequate respiratory function
Adequate O2 sat
Spontaneous movement/movement on command
AAOx3
Urine output of > 30 ml/hr
absent n/v
57
Q

What is the role of the RN during pt admission to PACU?

A 
assess pt
maintain patent airway
maintain cardiovascular stability
relieve pain & anxiety
Control n/v
prep for discharge
58
Q

What are possible immediate post-op complications?

A 
Respiratory depression
laryngospasm
aspiration
cardiac arrest
hypo/hypertension
dysrhythmias
syncope
59
Q

What is the intervention to post-operative respiratory depression?

A

Verbal stimulation

administer naloxone

60
Q

What is the intervention to post-operative nausea/vomiting?

A

Administer metaclopromide or promethazone

61
Q

What is the intervention for post-operative hypothermia?

A

Warming blanket

62
Q

What is the intervention to post-operative pain?

A

IV push
PCA
epidural
morphine, fentanyl, hydromorphone

63
Q

Identify tasks that can be delgated to UAP

A 
vital signs
repositioning pt
assistance with ambulation
collecting UA
height & weight
64
Q

Describe the use of patient controlled analgesia (PCA) in the post-op period

A

allows pt to control the administration of their medication w/i predetermined safety limits

65
Q

Describe the use of epidural analgesia in the post-op period

A

the infusion of opiods or local anesthetic agents into the epidural space

66
Q

What are common post-operative complications?

A 
DVT/PE
Infection
Pneumonia
UTI
Sepsis
Wound dehiscence
evisceration
67
Q

What is a cataract?

A

The clouding/opacity of the eye lens

68
Q

What are the assessment findings of cataracts?

A

painless, blurry vision
abnormal color perception
dim surroundings

69
Q

What kind of surgery is cataract surgery?

A

required, outpatient

70
Q

What are complications of cataract surgery?

A 
Minimum eye pain
Hemorrhage
Infection
increased intraoccular pressure
Toxic anterior segment syndrome
71
Q

What are the expected outcomes of cataract surgery?

A

improved vision
better ADL performance
minimal to no pain

NUR123 Exam 1 (5 decks)

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