Week One Modules Flashcards
what is the flow of surgery?
pre-op, surgery, and post-op
true/false: higher priority patients bump those of lower priority
for example:
whose surgery will be performed first?
an unstable crash-craniotomy patient or a patient who has a scheduled surgery for a femur fracture repair?
true
unstable crash-craniotomy patient
NPO = ______
why is it required that patients be NPO the night before a surgical procedure?
nothing by mouth
b/c anesthesia is known to make patients nauseous which increases their risk for choking and aspiration
what tasks are delegated to the nurse the morning of surgery?
full set of vital signs, perform a head to toe assessment, and report any abnormal VS to the surgeon immediately
when does the IV fluid order for the patient begin?
begins at midnight after the patient has become NPO
what is the pre-op checklist and what does it consist of?
entering the last set of VS, entering the time of the last food & drink, checking the patient ID band, flushing the peripheral IV line, and making sure the consent form is signed by patient
During pre-op checklist it is also the nurse’s job to do what?
prepare the patient psychologically by asking questions like “how are you feeling about your surgery tomorrow?”, or “do you have any questions about your surgery?”
what are the three requirements of informed consent?
adequate disclosure by the surgeon, demonstration of clear understanding by the patient (through teachback), and voluntary consent
an informed consent is a ________ between both the _____ and the ____
decision making process; patient; surgeon
what is the RN’s role in obtaining informed consent?
to determine whether the patient has a clear understanding of what will happen during surgery
what is an example question the RN can ask the patient to assess their knowledge and understanding of the surgical procedure?
“tell me what you know about what they’re going to do during your surgery”
what are the FOUR main points the RN should touch on during the pre-op teaching?
sensory information (five senses), procedural information (specific information about what will happen), process information (info about the general flow of surgery), and what to expect post-operatively
pre-op teaching:
limit the use of _______
begin teaching at a ___ literacy level
_____ give too much information at once
remember, ____ will affect the patient’s ability to learn and retain new information
medical terminology, low, don’t, anxiety
intra-operative nursing care:
_____: prepares the OR and interacts with the patient before surgery
_____: assists the surgeon directly and is actively involved in the surgery
circulating nurse; scrub nurse
which OR nurse serves as the “patient protector” during surgery?
circulating nurse
what kinds of information are we looking for when we receive report from the PACU nurse post-surgery?
EBL, fluids/blood pt. received, the types of medications pt. received, and the timing of the last pain medication
when the patient arrives back on the acute floor post surgery what does the RN need to do?
take VS, perform a head to toe, assess the surgical site, review post-op orders, and assess for nausea/vomiting
what are the two neurological post-op complications that can occur?
fever and pain
____ is common within the first ___ hours after surgery
fever; 24
what are some nursing interventions when it comes to treating fever post-op?
administer NSAIDS such as acetaminophen
should ibuprofen be prescribed to patients who are post-op for orthopedic surgeries?
no, because it impedes bone growth and repair
what are some common narcotics that are prescribed for post-op pain related to surgery?
morphine, dilaudid, and fentanyl
is fentanyl a medication that is often prescribed for pain?
no, not often because of its short life meaning it doesn’t last long in the body
what is a pca machine?
patient controlled analgesia
benefits of PCA machines:
allow the patient to _____ earlier
more likely to have ____ hospital stays
_____ pulmonary complications
_____ satisfaction with post-op pain control
ambulate; shorter; fewer; better
PCA machines also help patients to avoid what?
the peaks and valleys of having to wait for their nurse to administer their pain medication
what does a PCA order look like?
the order would indicate the type of narcotic, the dose, the dosing interval, and the lockout interval
interpret this pca prescription
(1: 6: 10)
morphine 1mg/mL
dose: 1 mg
time interval: every 6 minutes
lockout interval: 10 mg
the patient can receive 1 mg every 6 minutes up to 10 mg total in one hour
what is the lockout interval that is recommended by the American Pain Society?
one hour
with the pca, there should be no basal infusion because it increases the risk of what?
increases the risk of oversedation
you must have ___ RNs check the pca pump when setting it up for the first time
the RN must check the pca pump settings every ___ hours
2; 4
documenting sedation level
if the patient is at a level three sedation, this means what?
if the patient is at a level four sedation, this means what?
pt. is frequently drowsy, and drifts off to sleep; pt. is somnolent with minimal response to sensation
if the patient is at level three sedation what kind of nursing intervention is required?
decrease the dosage of the pca
what are some common side effects of the pca?
nausea/vomiting, itchiness (pruritus), constipation, and hallucinations
if the patient is at level four sedation what kind of nursing intervention is required?
stop opioid and consider narcan
PCA PRN Medications
what can be prescribed to treat nausea?
ondansetron 4mg every 8 hours/prn
PCA PRN Medications
what can be prescribed to treat itchiness/pruritus
diphenhydramine 25-50 mg every 6 hours/prn
PCA PRN Medications
what can be prescribed to treat sedation or RR <8?
naloxone 0.04mg diluted in 10 mls of normal saline
PCA PRN Medications
what can be prescribed to treat constipation?
docusate sodium, dulcolax suppository, or walking
what are some respiratory complications that can happen post-surgery?
hypoventilation, hypoxemia, aspiration, atelectasis, and pneumonia
if you notice that your patient is suffering from hypoventilation what are some interventions that could correct this problem?
sit the patient up, raise the HOB to 60 degrees, or take the pca button away if applicable
if you notice that your patient is suffering from hypoxemia what are some interventions that could correct this problem?
sit the patient up so they can breathe easier, ask the patient to take 3 deep breaths and then recheck the O2 sat, if all else fails, place the patient on 2L NC
if the patient’s O2 sat is 88% or below, what does this tell us?
the patient might be suffering from hypoxemia
if you notice that your patient is suffering from aspiration what are some interventions that could help solve this problem?
increase the HOB to 60-90 degrees, hold oral fluid, and suction secretions using a yankauer
_______: condition of collapsed alveoli, usually resulting from obstruction of fluid or mucus
atelectasis
if you notice that your patient is suffering from atelectasis, what are some interventions that could help solve this problem?
practice coughing and deep breathing, use of incentive spirometer, or increase HOB 60-90 degrees
what are some gastrointestinal post-op complications that can occur?
nausea/vomiting, distension, and delayed gastric emptying
if your patient is nauseated what are some interventions you could perform?
give anti-nausea medications such as ondansetron or reglan
if your patient hasn’t had a bowel movement post surgery what could you do?
give docusate sodium, prune juice, or get the patient out of bed if possible
what are some genitourinary post-op complications that can occur?
urine retention or infection
if your patient hasn’t urinated 6 hours post-op, it is your job as the nurse to do what?
call the provider to let them know and possibly order a bladder scan to see how much urine is being retained
if your patient is retaining more than 400mls of urine what is a nursing intervention you could perform?
in/out catheterization to get the urine out
if your patient is retaining less than 400mls of urine what is a nursing intervention you could perform?
hydrate the patient and ask them to try and urinate again in a couple of hours
what is the most common type of healthcare associated infection reported to the National Safety Health Network?
catheter associated urinary tract infection
_______: the concentration of a solution expressed as the total number of solute particles PER LITER
______: the concentration of a solution expressed as the total number of solute particles PER KILOGRAM
osmolarity; osmolality
concentrations of IVFs
______: <270 mOsm/kg
______: 270-300 mOsm/kg
______: >300 mOsm/kg
hypotonic concentration; isotonic concentration; hypertonic concentration
a hypotonic solution is a concentration of dissolved particles that is ______ that of plasma, so fluid shifts from the ______ to the ______
less than; intravascular; intracellular
what are some examples of a hypotonic solution?
0.45% normal saline; 0.5% normal saline
what is the purpose of giving a hypotonic solution
with hypotonic solutions its important to monitor the patient for _____
to hydrate cells and stop dehydration; hypotension
true/false: we can administer hypotonic solutions to patients who have increased ICP/neuro patients
FALSE YOU CANNOT DO THIS
an isotonic solution is a concentration of dissolved particles that is _____ to plasma
isotonic solutions have ___ fluid shifts in cells
similar; no
what are some examples of isotonic solutions?
0.9% saline or normal saline
isotonic solutions are used to treat what types of conditions?
hemorrhage, vomiting, and diarrhea
when infusing isotonic solutions, we want to monitor for what?
fluid overload
when veins/arteries have low fluid, normal saline is used for what?
VOLUME
what is the only fluid that can be transfused with blood?
0.9% saline or normal saline
if a patient goes into fluid overload due to the isotonic solution, what are some signs and symptoms we would expect to see?
edema, bounding pulse, HTN, crackles/dyspnea
what is another example of an isotonic solution?
what is it used for?
lactated ringers; used for volume and soft electrolyte replacement in trauma patients
a hypertonic solution is a concentration of dissolved particles that is _____ than that of plasma
with hypertonic solutions, the fluid shifts from the _____ to the ______
greater; intracellular; extracellular
with hypertonic solutions, the higher concentration of fluid pulls the water/fluid from the cells into the ______(veins/arteries)
vasculature
what are some examples of hypertonic solutions?
3% saline and D5 1/2 NS
what is 3% saline used for?
used to treat symptomatic hyponatremia and patients with head injuries
3% saline is used primarily in _____ situations and requires a ____ to infuse
critical; central line
D5 1/2 NS is used as a _______ IV solution
maintenance
crystalloid solutions are ______, ____, and have molecules that can ____ cross a semipermeable membrane
easily dissolved, clear, easily
what are some examples of a crystalloid mixture?
lactated ringers, D5 1/2 NS, NS, and 1/2 NS
colloid solutions are ___ molecules that ____ cross a semipermeable membrane, are ____ in color, and ____ intravascular volume by drawing fluid in
large; don’t; cloudy; expand
what are some examples of a colloid mixture?
albumin, blood, fresh frozen plasma, and hespan
D5W is considered a _____ outside the body and _____ solution in the body
isotonic; hypotonic
does D5W replace electrolytes?
no, because it doesn’t have any electrolytes
should D5W hypotonic solution (in the body) be used for patients with increased ICP?
no, because it would increase the pressure as more fluid would enter the cells making the intracranial pressure worse
_____ is a IVF colloid that is used for patients with ___ albumin levels
it can also be used for patients who need ______ expansion but cannot tolerate large fluid volumes
5% albumin; low; plasma volume
_____ is a IVF colloid that is given to neuro patients with ____ ICPs to ____ the fluid in the brain which effectively reduces the ICP
mannitol; high; decrease
