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168.362 > Week Two > Flashcards

Week Two Flashcards

1
Q

What are common signs and symptoms of acute abdominal pain?

A
  • Pain
  • Nausea
  • Vomiting
  • Diarrhoea
  • Constipation
  • Flatulence
  • Fever
  • Bloating
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2
Q

What is in the Right Upper Quadrant (RUQ)?

A
  • Liver
  • Gallbladder
  • Duodenum
  • Head of pancreas
  • Right kidney and adrenal
  • Hepatic flexure of colon
  • Part of ascending and transverse colon
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3
Q

What is in the Left Upper Quadrant (LUQ)?

A
  • Stomach
  • Spleen
  • Left lobe of liver
  • Body of pancreas
  • Left kidney and adrenal
  • Splenic flexure of colon
  • Part of transverse and descending colon
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4
Q

What is in the Right Lower Quadrant (RLQ)?

A
  • Cecum
  • Appendix
  • Right ovary and tube
  • Right ureter
  • Right spermatic cord
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5
Q

What is in the Left Lower Quadrant (LLQ)

A
  • Part of descending colon
  • Sigmoid colon
  • Left ovary and tube
  • Left ureter
  • Left spermatic cord
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6
Q

What is in the Midline?

A
  • Aorta
  • Uterus (if enlarged)
  • Bladder (if distended
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7
Q

How do you assess abdominal pain?

A

Old Carts:

  • Onset
  • Location
  • Duration
  • Characteristics
  • Aggravating factors
  • Relieving factors
  • Timing
  • Severity
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8
Q

What is the aetiology of inflammation?

A
  • Gastroenteritis
  • Appendicitis
  • Pancreatitis
  • Diverticulitis
  • Cholecystitis
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9
Q

What are life threatening effects of inflammation?

A
  • Risk of perforation and peritonitis
  • Fluid shifts to area of inflammation
  • Unable to ingest fluid
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10
Q

What can the life threatening effects of inflammation cause?

A
  • Septic shock

- Hypovolaemic shock

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11
Q

What is the aetiology of peritonitis?

A
  • Perforated peptic ulcers
  • Ruptured diverticula
  • Ruptured appendix
  • Intestinal perforation
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12
Q

What are life threatening effects of peritonitis?

A
  • Overwhelming infection
  • Fluid shifts to area of inflammation
  • Unable to ingest fluid
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13
Q

What can the life threatening effects of peritonitis cause?

A
  • Septic shock

- Hypovolaemic shock

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14
Q

What is the aetiology of obstruction?

A
  • Bowel obstruction
  • Biliary obstruction
  • Mesenteric vascular occlusion
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15
Q

What are life threatening effects of obstruction?

A
  • Strangulation risk
  • Fluid trapped in bowel
  • Fluid shifts to interstitial space
  • Unable to ingest fluid
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16
Q

What can the life threatening effects of obstruction cause?

A
  • Septic shock

- Hypovolaemic shock

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17
Q

What is the aetiology of internal bleeding?

A
  • Trauma
  • Ruptured abdominal aneurysm
  • GI bleed
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18
Q

What are life threatening effects of internal bleeding?

A
  • Blood lost from vascular space

- Unable to ingest fluid

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19
Q

What can the life threatening effects of internal bleeding cause?

A

Hypovolaemic shock

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20
Q

Types of pain?

A

Nociceptive:
- Somatic
- Visceral
Neuropathic

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21
Q

What is the nursing assessment you would undertake of a patient who presents to the ED complaining of acute abdominal pain?

A
  • Pain assessment
  • Patient history
  • Family history
  • Diet
  • Medications
  • Constipation
  • ABCD
  • Vital signs
  • Intake and output
  • LOC
  • Skin colour/temp
  • Abdominal assessment
  • Pregnancy test
  • STI
  • Amylase and lipase
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22
Q

What are diagnostic studies and MDT care?

A
  • Complete history and physical examination
  • FBC and Lytes
  • ? X-match
  • Urinalysis
  • ? stool spec
  • ECG
  • AXR
  • USS
  • CT scan (+/- contrast)
  • Pregnancy test
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23
Q

What is appendicitis?

A
  • Inflammation of the appendix

- Most common cause is obstruction of the lumen by faeces, foreign body or tumour

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24
Q

What are signs and symptoms of appendicitis?

A
  • Periumbilical pain
  • Anorexia
  • Nausea and vomiting
  • Persistent pain , eventually shifting right lower quadrant and localising at McBurney’s point
  • Localised tenderness, rebound tenderness and muscle guarding
  • Patient may lie still often with the right leg flexed
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25
Q

What is peritonitis?

A
  • Localised or generalised inflammatory process of peritoneum
  • Results in massive fluid shifts and adhesions as body attempts to wall off infection
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26
Q

What are signs and symptoms of peritonitis?

A
  • Abdominal pain
  • Rebound tenderness
  • Muscular rigidity
  • Spasm
  • Patient has shallow respirations
  • Abdominal distension
  • Fever
  • Tachycardia, tachypnoea
  • Nausea and vomiting
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27
Q

What is intestinal obstruction?

A
  • Intestinal obstruction (partial or complete) occurs when intestinal contents cannot pass through the GI tract
  • Requires urgent treatment
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28
Q

What are types of intestinal obstruction?

A
  • Mechanical (90% of admissions)

- Non- mechanical

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29
Q

What are symptoms of a small intestinal obstruction?

A
  • Onset - Rapid
  • Vomiting - Frequent and copious
  • Pain - Colicky, cramp like, intermittent pain
  • Bowel movement - Faeces for a short time
  • Abdominal distension - Greatly increased
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30
Q

What are symptoms of a large intestinal obstruction?

A
  • Onset - Gradual
  • Vomiting - Rare
  • Pain - Low-grade, cramping abdominal pain
  • Bowel movement - Absolute constipation
  • Abdominal distension - Increased
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31
Q

What is the nursing assessment for intestinal obstruction?

A
  • Early recognition of deterioration
  • Patient history and physical examination
  • Assessment of vomitus
  • Hydration status
  • Pain
  • Nutritional status
  • Need for surgery
  • Anxiety
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32
Q

What is cholelithiasis?

A

Stones in gallbladder

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33
Q

What is cholecystitis

A

Inflammation of the gall bladder

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34
Q

What is choledocholithiasis?

A

One or more gallstones in the CBD

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35
Q

What is assessment and care of cholelithiasis and acute cholecystitis?

A
  • Pain control
  • Antiemetic
  • Antibiotics
  • Maintain fluid and electrolytes
  • Potentially NBM
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36
Q

What are symptoms of total obstruction?

A
  • Jaundice
  • Dark amber urine
  • Clay-colored stools
  • Pruritus
  • Intolerance of fatty foods
  • Bleeding tendencies
  • Steatorrhoea
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37
Q

What are signs and symptoms of cholelithiasis and acute cholecystitis?

A
  • Pain
  • Indigestion
  • Fever
  • Jaundice
  • Nausea and Vomiting
  • Restlessness
  • Diaphoresis
  • Inflammation
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38
Q

What are etiological factors of acute pancreatitis?

A
  • Alcohol
  • Biliary tract disease
  • Trauma
  • Infection
  • Drugs
  • Postoperative GI Surgery
  • Unknown
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39
Q

What can etiological factors in acute pancreatitis lead to?

A
  • Activation of pancreatic enzymes

- Injury to pancreatic cells

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40
Q

What is nursing care for peritonitis?

A
  • Analgesics
  • NBM
  • Respiratory assessment
  • Oxygen therapy
  • Antibiotic therapy
  • Fluids and electrolytes
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41
Q

What are signs and symptoms of acute pancreatitis?

A
  • Abdominal pain – LUQ radiating to the back
  • Aggravated by eating, relieved by vomiting
  • Abdominal tenderness with muscle guarding
  • Paralytic ileus
  • Greys Turners spots
  • Cullen’s sign
  • Signs of shock
  • Watch for respiratory distress – ARF to ARDS
  • D.I.C.
  • Clots
  • Tetany
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42
Q

What is treatment of pancreatitis?

A
  • Relief and control of pain
  • Prevention of or treating shock
  • Fluid and electrolyte imbalances corrected
  • Nasogastric tube to decompress the stomach
  • NBM w/ NG
  • Antacids, PPI’s to neutralise gastric secretions and decrease hydrochloric acid stimulation
  • Antibiotics and antispasmodics
  • Removal of precipitating cause if possible
  • Nutritional therapy
  • When food allowed small frequent high carbohydrates
43
Q

What is management of pancreatitis?

A
  • Pain management
  • Watch electrolytes and blood glucose
  • Manage fluid imbalance
  • Manage nutritional imbalances: maintain caloric needs while NBM
  • Assessment: TPR, weight
  • Surgery: pre and post operative care
44
Q

What surgery can a patient receive if they have gallstones?

A
  • ERCP with or without sphincterotomy/stenting (opens sphincter allowing stones to pass)
  • ESWL (breaks up stones)
45
Q

What does the activation of pancreatic enzymes cause?

A

Pancreatic enzymes (e.g. Trypsin) begin to digest within the pancreas (e.g. forming trypsinogen)

46
Q

What is a non-acute surgical patient?

A
  • Usually made by a General Practitioner (GP) or specialist
  • Patient is evaluated for eligibility of accessing treatments by using Clinical Priority Access Criteria, and in some areas, a Clinical Priority System is used in the outpatient clinic by the specialist
  • The patient is put on the elective waiting list
47
Q

What is an acute surgical patient?

A
  • Patient is usually admitted through the ED
  • The patient maybe referred by the GP
  • The patient is urgently referred due to an urgent or emergency surgical condition
  • The patients may further classified as:
    Either an acute elective case
    Or an emergency case that can be life threatening and needs immediate treatment
48
Q

Why does a person need surgery?

A
  • Diagnostic
  • Curative
  • Restoration
  • Ablative
  • Palliative
  • Cosmetic
49
Q

How is surgery done?

A
  • Laser surgery
  • Cryosurgery
  • High frequency sound waves – ultrasound
  • Endoscope
  • Transplantation surgery
  • Skin/tissue graft
50
Q

What is the risk level presenting in the surgery?

A
  • Minor

- Major

51
Q

What occurs in the pre-admission clinic?

A
  • Admitted one month prior to the preoperative clinic for assessment and preparation for pending surgery
  • Scheduled to have a specific surgery with a specialist due to health problem
  • Discuss the nurses role during this appointment
52
Q

What are routes of admission for elective patients?

A
  • Day surgery patient: day-of-surgery admission (DOSA)
  • Other elective patients: via Operating Room Direct Admission service (ORDA) then transferred to the ward post-operatively
  • Private patients reviewed in the surgeon’s room/clinic
53
Q

What are routes of admission for acute/emergency patients?

A
  • Acute admission to the ward

- Acute admission to the operating theatre

54
Q

What assessment is done with the patient pre-operatively?

A
  • Past medical history and allergies
  • Physical examination
  • Blood tests, blood grouping and antibody screen, biochemical tests indicated, ECG, x-ray, etc
  • Radiology
  • Medications
  • Psychosocial concerns
  • Language and cultural needs
  • Discharge planning
55
Q

What are factors that may affect the patient’s surgical experience?

A
  • Older adult patients
  • General health status
  • Reason for admission
  • Habit/lifestyle
56
Q

Why do pre-operative preparation?

A
  • To ensure the patient participates in the goal setting of treatment plan
    (patient-centred care)
  • To establish trust and rapport (therapeutic communication)
  • To ensure the process of signing the informed consent is valid (legal and ethical aspect)
  • To identify and manage any physiological and psychosocial issues (physical and psychological preparation)
  • To take proactive steps in managing adverse factors that may increase risk of post-op complications
  • To determine if patient is safe and understands the scheduled surgery in order to achieve the best outcome
57
Q

What are physiological effects of surgery?

A 
Surgery is a stressor
All systems are affected:
- Respiratory
- Cardiovascular
- Urinary/hepatic
- Neurological/Musculoskeletal
- Endocrine system
- Immune system
- Gastrointestinal/Nutritional status
- Integumentary
58
Q

What is physical preparation for surgery?

A
  • Bowel preparation
  • Food and fluid restriction (NBM)
  • Preparation of the skin
  • Dress the patient with the theatre gown (no undies)
  • DVT prophylaxis: compression stockings and low-molecular weight heparin administration
  • Prostheses
  • Medications: pre-operative medications
59
Q

What are examples of pre-operative patient education?

A
  • Anti-embolism stockings
  • Anticoagulant agents administration
  • Education of bed exercises and deep breathing and coughing exercises
  • Pain management
  • Information on the procedure and equipment
  • Dietary restrictions
60
Q

What is the psychosocial nursing care help to determine?

A
  • Perception of the surgery
  • Expected outcome
  • Coping mechanisms
  • Knowledge level
61
Q

What are psychosocial questions you could ask the patient?

A
  • Why you are having surgery?
  • How much you know about the surgery?
  • What you expect from the surgery?
  • How will the surgery impact upon your life?
  • What are your cultural and spiritual beliefs that may impact on your surgical experience?
  • What concerns do you have regarding your role at home or elsewhere?
  • Who do you get help from in case of need?
  • Where you will go post discharge?
62
Q

What are examples of psychosocial nursing diagnoses?

A 
Fear specifically related to:
- Anaesthesia
- Pain and discomfort
Anxiety generally related to:
- Unknown
- Loss of control
63
Q

What should surgical informed consent include?

A 
Always:
- Consent for procedure
- Consent for anaesthesia
Most likely:
- Consent for blood and blood products
64
Q

What is a nurse’s role in the informed consent process?

A
  • A legal and ethical document
  • A voluntary and written consent signed by the
    individual patient (or other legal person)
  • Surgeon and anaesthetist’s responsibility
  • Special considerations
65
Q

What do you document for surgery?

A
  • Pre-operative checklist
  • Observation charts
  • Medication charts: FBC, drug chart
  • Nursing notes: initiating the care plan and progress notes
66
Q

For surgery what is the nurse responsible for?

A
  • Performs physical, psychological and social assessment and preparation
  • Communicates pre-operative concerns with the multidisciplinary teams
  • Ensure the patient’s consent is “informed”
  • Acts as an advocate for the patient
  • Completes relevant documentations
67
Q

What occurs in the preoperative phase?

A
  • Starts with the patients decision to have surgery and ends with her transferred to OR
  • Care focuses on preparing and teaching the patient
68
Q

What occurs in the intra-operative phase?

A
  • Starts when the patient is placed on the OR table and ends when transferred to the PACU
  • Care focuses on providing safe environment during surgery
69
Q

What occurs in the postoperative phase?

A
  • Starts when the patient is admitted to the PACU and ends when no longer needs surgery-related nursing care
  • The focus is on preventing complications and relieving pain
70
Q

What forms of teaching can occur pre-op?

A
  • Medications
  • Diagnostic tests
  • Dietary and fasting guidelines
  • Surgical preparation
  • Anaesthesia concerns
  • Surgical procedures
  • PACU experience
  • Pain control
  • Deep breathing and coughing exercises
  • Incentive spirometer use
  • Postoperative exercises
  • Use of assistive devices, such as crutches or a walker
  • Postoperative tubes and drains
  • Postoperative expectations
71
Q

What are the different key areas of operating suites?

A
  • Unrestricted (waiting room)
  • Semi-restricted (pre op area)
  • Restricted (operating suites)
72
Q

What are the staff during surgery?

A
  • Surgeon
  • Surgeon assistant
  • Scrub nurse
  • RN First Surgical Assistant
  • Anaesthetist
  • Anaesthetic assistant
  • Circulating nurse
  • Observers
73
Q

What is the OT/OR experience?

A
  • Scrubbing (5 min scrub)
  • Gowning
  • Gloving
  • Aseptic technique in theatre and the sterile field
  • Observing potential for syncopal episodes, breach of sterility
74
Q

What are the classifications of anaesthesia?

A
  • Conscious sedation
  • Procedural sedation
  • General anaesthesia and adjuncts
  • Regional anaesthesia
  • Local anaesthesia
75
Q

What are catastrophic events in the OT?

A
  • Sudden death
  • Anaphylactic reactions
  • Malignant Hyperthermia
76
Q

After transferring to PACU what is the responsibility of PACU nurses?

A 
Initial assessment includes:
- ABC (airway, breathing and circulation)
- Oxygen therapy
- Electrocardiographic (ECG) monitoring
- Neurological assessment
- Urinary system
- Surgical site
Ongoing assessment
77
Q

What are potential alterations in respiratory function?

A

Airway compromise causes:

  • Airway obstruction
  • Hypoxaemia
  • Atelectasis, pulmonary oedema, aspiration of gastric contents, bronchospasm
  • Hypoventilation
78
Q

What are potential alterations in cardiovascular function?

A
  • Hypotension
  • Hypertension
  • Cardiac arrhythmias
79
Q

What are potential alterations in neurological function?

A
  • Emergence delirium
  • Delayed awakening
  • Normally is transient and reversible
80
Q

What are negative effects of pain due to surgery?

A
  • Common reason for a prolonged stay

- May contribute to complications

81
Q

Who has an increased risk of hypothermia in surgery?

A
  • Older adult patients
  • Debilitated patients
  • Intoxicated patients
82
Q

What is the ward nurse responsible for before go picking up post-op patient?

A
  • Clear the bed space, make your surgical bed
  • Get the equipment or devices: e.g. IV pole; BP cuff, stethoscope, pulse oximeter
  • Check O2 and suction patency
  • Anticipate if your patient needs heel pads (extra pillows), vomit cartons, tissues, extra blankets; due to the type of surgery
83
Q

What is the ward nurse responsible for when arriving at PACU?

A
  • Take the handover and then
  • Determine if your patient is ready to be discharged from the PACU
  • Remember do not take patient back to the ward if you do not think they are stable
84
Q

What occurs in a PACU handover?

A 
General information:
- Demographic data, anaesthetist, surgeon and surgical procedure
Patient history:
- Medical history, meds and allergies
Intra-operative management:
- Anaesthetic types and medications
- Other meds given pre/intra-op
- Blood loss
- Fluid replacement
- Urine output
- Unexpected intra-operative events
PACU management:
- Potential and expected problems in PACU
- Interventions
- Medications given or charted; PCA/Epidural 
Documentation:
- Vital signs, FBC, and monitoring trends
- Medication charts for pain and nausea
- Results of intra-op lab tests
- Postoperative orders from surgeon and anaesthetist
Family notification
85
Q

How to determine your patient’s readiness for discharge to the ward?

A
  • Stable vital signs
  • Orientated to person, place, time (and events)
  • Uncompromised pulmonary function (no airway support)
  • Adequate pulse oximetry readings
  • Urine output at least 30-35 mL/h (≥0.5mL/kg/hr)
  • Nausea and vomiting absent or under control
  • Minimal pain (aim for <2-3/10)
86
Q

What do you assess postoperatively?

A
  • Record time of arrival back on ward
  • Assessment of ABC’s
  • Assessment of neurological status
  • Baseline vital signs
  • Assess wound (do not take dressing off), dressing intactness and drainage tubes (attached to? – measure and mark on FBC)
  • Assess colour and appearance of skin, check PP, peripheries
  • Assess urine output (IDC – note on FBC) (2L bag or urometer?)
  • Assess pain and nausea (sore throat) – PCA? Epidural? (know policies)
  • Positioning for airway maintenance, safety, SR, bed low, call bell in place
  • Check intravenous therapy (check from OT records and current Rx) –FBC
  • Check drainage tubes/drains/bottles – mark levels
  • Emesis basin and tissues
  • Emotional status
  • Orient patient to environment / family; orientate family to processes
  • Check and carry out postoperative orders
87
Q

What are cues for post-operative assessment?

A

A, B, C, 4Ds (drips drains, drugs, and disabilities), and E (extras)

88
Q

What are levels of consciousness (LOC)?

A
  • Drowsiness
  • Alertness
  • Disorientation
  • Confusion
89
Q

What to check for airway?

A
  • Check patency of airway
  • Head and neck position
  • Evidence of obstruction
90
Q

What to check for breathing?

A
  • Rate > 12
  • Rhythm
  • Depth and quality
  • O2 requirements, O2 Sats >95%,
  • Presence of stridor, wheeze, use of accessory
    muscles
91
Q

What are common concerns for airway?

A

Ineffective airway clearance

92
Q

What are common concerns for breathing?

A
  • Ineffective breathing
    pattern
  • Ineffective gas exchange
  • Presence of atelectasis
93
Q

What to check for circulation?

A
  • BP compare to baseline
  • Pulse, rhythm, rate
  • Temperature
  • Skin colour and moistness
  • Capillary refill
94
Q

What are common concerns for circulation?

A
  • Decreased cardiac output
  • Fluid deficit
  • Fluid overloading
  • Ineffective tissue perfusion
  • Potential of thrombosis
95
Q

What are clinical manifestations of inadequate oxygenation?

A
  • Restless
  • Tachycardia, bradycardia and arrhythmias
  • Cyanosis
  • Prolonged capillary refill
  • Flushed and moist skin
  • Increased or absent respiratory effort
  • Abnormal breath sounds
  • Abnormal arterial gases
96
Q

What are types of drips post surgery?

A
  • IV therapy: IV fluids; blood transfusion
  • Infusions - GIK infusion in patients with diabetes
  • PCA and Epidural infusion
  • Order for post-operative diet (POD)
97
Q

What are types of drains post surgery?

A
  • Surgical drains
  • Wound discharge
  • Nasogastric (NG) tube
  • Any vomiting
  • Urinary catheter: indwelling catheter (IDC), suprapubic catheter (SPC)
  • Any packing: vaginal packing, nasal packing
98
Q

What are types of drugs post surgery?

A 
PRN and regular medications prescribed:
- Analgesics
- Antiemetics
- Anti-inflammatory
- Anti-coagulant
- Antibiotics
- Adjuvant drugs: antidepressant
Patient’s self-medications clarified and prescribed
99
Q

What are types of disabilities to be aware of for surgery?

A
  • LOC-GCS
  • Diabetes
  • Heart disease
  • Arthritis
  • Any long term health conditions and treatment
100
Q

What are extras to be aware of for surgery?

A
  • Family notification
  • Patient comfort care: post-op wash, mouth care
  • Pressure area care
  • Procedure specific care: neurovascular assessment, bowel sounds
  • Special requirement: sedative request, post-op exercise, nutrition
101
Q

What kind of complications affect post-op patients?

A
  • Pneumonia
  • Hypovolemia
  • Paralytic ileus
  • Pressure ulcers
  • Pulmonary embolism
  • Infection/ septicaemia
  • Urine retention
  • Wound infection
  • PONV (post-op nausea and vomiting)
    Also:
  • Atelectasis
  • Compartment syndrome
  • Fat embolism
  • Thrombophlebitis
  • Wound dehiscence and evisceration
102
Q

What are post-op exercises for every post-op patient?

A
  • DB and C q1-2h
  • Incentive spirometry q2h while awake
  • Leg exercises
  • Splinting incision with pillow
  • Changing position q1-2h
  • Chest physio if patient has atelectasis
103
Q

What are drugs for nausea and vomiting?

A
  • Cyclozine
  • Phenergan
  • Stemetil
  • Ondansetron
  • Dexamethasone

168.362 (6 decks)

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