NR 226 Final Exam Practice | Latest Update 2023/2024 (VERIFIED)

Medical Conditions and Risk for Surgery (Table 50-4), 11. Bleeding disorders: Risk hemmorage during and after 12. DM: Hyperglycemia, infection, impaired wound healing 13. Heart dz: Anaesthesia depress cardiac function and Stress of surg inc myocardial oxygen demand 14. HTN: Inc stroke and inad tissue oxygenation during anesthesia 15. OSA: Opiods inc risk airways obstruction after surgery and pts Desat: dec in pulse ox 16. URI: Inc risk pneumonia and laryngeospasm during anasthesia 17. Renal dz: Alters excretion of anesthesia drug and their metabolites = inc risk acid-base imbalance 18. Liver dz: alters metab and elimination of drugs. Impaired wound healing and clotting b/c altered ptn metab 19. Fever: predispose to fluid/electrolyte imbalance and indicate infection 20. Asthma, emphysema, bronchitis: reduce acid base compensation. Anesthesia reduces respiratory function = hypoventillation 21. Immune disorders: inc risk of infection and delayed wound healing after surgery 22. Alcohol abuse/street drugs: withdrawl during and after surgery 23. Chronic pain: higher tolerance. Inc analgesics needed to control post op pain Anesthesia Types, 1284 General: pt loses all sensation, consciousness, and reflexes including gag and blink. Muscle relaxation and amnesia Regional: Loss of sensation in an area of the body by anesthetizing sensory pathway Elevation of upper body to prevent resp paralysis Local: loss of sensation at desired site by inhibiting peripheral nerve conduction Moderate Conscious Sedation: used routinely for shortterm surgical, diagnostic, and therapeutic procedure. Depress level of consciousness. Pt breathes on own. Pt responds to light touch and verbal stimuli Surgical Classifications, 1. Seriousness a. Major: extensive reconstruction or alteration of body part. Poses greatest risk to well being i. CABG, colon resection, removal of larynx, lung resection b. Minor: minimal alterations to body part. Correct deformities. Minimal risk i. Cataract extraction, facial plastic surg, tooth extraction 2. Urgency i. Elective: pt choice. Not essential not necessary 1. Bunion, face plastic, breast, hernia ii. Urgent: necessary for pt’s health to prevent tissue destruction or impaired organ function 1. Excise cancer, remove gallbladder, CABG iii. Emergent: must b done immediately to save life or preserve function 1. Appy, control internal hemorrage 3. Purpose i. Diagnostic: exploratory ii. Ablative: removal of dz body part: appy iii. Palliative: relieve or reduce intensity of dz but not cure: colostomy iv. reconstructive/restorative: restores function or appearance: fx, scar revision v. procurement for transplant vi. constructive: restores function lost from congeital anomaly: cleft lip or palate vii. cosmetic: approve personal appearance: rhinoplasty How to Turn a Post-Op Patient, 1301 Turn every 2 hrs Lie supine, one leg bent and one straight, grab straight leg side rail with opposite hand Post-Op Wound Care, Inspect Skin, Dressing COCA, Surgeons prefer to change dressings for the first time, Braden scale risk for developing pressure ulcers (sensory, moisture, mobility, activity, nutrition, friction/shear) 15-16 low risk 12 and under high risk Post-Op Medication Care, Control pain with PCA or epidural Pain Control and Surgery, Most pain 24-48 hrs after surg IV PCA or epidural Post-Op Diets, Pt’s who chew gum experience faster GI return Ice chips -> clear fluids- > nml diet Go slow, prevent nausea Ch. 44 (Pain) Ch. 46 (Urinary Elimination) Common urinary elimination problems CH 47 Stool Testing/Samples, (ch 47)