Med/Surg Exam 1

Preoperative Phase - correct answer Decision for surgery is made and ends when the patient is transferred to the operating room Intraoperative Phase - correct answer Begins with the patient's entry into the operating room and ends with admittance to the postanesthesia care unite (PACU) or recovery room Postoperative Phase - correct answer Begins with the patient's admittance to the PACU and ends with the patient's complete recovery from the surgical intervention Elective Surgery - correct answer Suggested and scheduled, no forseen ill effects if postponed Urgent Surgery - correct answer Necessary to be performed within 1 to 2 days (ASAP) Emergency Surgery - correct answer Performed IMMEDIATELY; life or limb threatening Ambulatory Admission - correct answer Surgeries are performed that DONT require hospital admission; Outpatient procedure Same Day Admission - correct answer Admission of surgical patients to the hospital on the day of surgery Early Admission - correct answer Patient that may have multiple and/or significant comorbidities are admitted 1 to 2 days prior to surgery to maintain or prepare Diagnostic Surgery - correct answer Surgical exploration that alows health care providers to confirm diagnoses ex: laparotomy Curative Surgery - correct answer Surgery performed to resolve a health problem by repairing or removing the cause • Ex. Lap chole, Mastectomy, Hysterectomy Palliative Surgery - correct answer Surgery that improves comfort or reduces intensity of disease symptoms; will not produce cure (ex. colostomy, debridement of necrotic tissue) Cosmetic Surgery - correct answer Surgeries specific in the surgical restoration and reconstruction of body structures (ex. rhinoplasty) Reconstructive Surgery - correct answer Surgery performed to improve/restore a client's functional ability • Ex. Total knee replacement, Finger reimplantation Neuroendocrine Response - correct answer SNS stimulation (stress response) = compensatory vasoconstriction Increased HR and BP (risk for stroke, bleeding) Decreased Peristalsis (No Bowel Sounds, pain meds not effective) Hormonal Response - correct answer Norepinephrine = increased HR Aldosterone = increased fluid/Na (decreased UO) Glucocorticoids = increased blood sugar Metabolic Response - correct answer Relative rate of starvation ~Gluconeogenesis ~Fat metabolism ~Protein breakdown ~Negative Nitrogen balance Healing - correct answer Adequate protein and Vitamin C Psychological Response - correct answer Anxiety and Fear r/t to cause for surgery and poor coping skills Preoperative Management - correct answer ~Patient Safety is PRIMARY CONCERN ~NPO ~Bowel Prep and Skin Prep ~Pre-Op Labs ~Hospital gown, voiding, removal of dentures, jewelry, contacts, etc. ~Attend to family's needs Hold Meds: Preop Care - correct answer Insulin Aspirin Coumadin Heparin Signed Operative Consent Form - correct answer ~Disclosure of the risks associated with the intended operation or procedure to the patient ~The patient, nurse and surgeon sign ~Nurse serves as witness PreOp Teaching - correct answer ~PreOp experience ~PreOp meds (IV or IM, feels like...) ~Breathing exercises, coughing, incentive spirometer, leg exercises ~Position changes and movement ~Pain management ~Reducing anxiety and fear, support of coping Surgical Risk Factors - correct answer ~Age ~Obesity ~Nutrition alterations ~Co-morbidities ~Smoking ~Anticoagulants Operating Room - correct answer ~Surgeon, surgical assistant, CRNA or Anesthesiologist, circulating nurse, scrub nurse Circulating Nurse - correct answer ~identifies and assesses the patient on admission to the operating room ~oversees the equipment ~assists with transferring and positioning the patient's skin ~ensures no break in aseptic technique occurs ~Counts all sponges and instruments ~Responsible for documenting intraop nursing activities, meds, blood administration, placement of drains and catheters and length of procedures Unrestricted Zones - correct answer Permit access by those in hospital uniforms or street clothes waiting room Semi-restricted Zones - correct answer Require scrub attire, including a scrub suit, shoe covers and a cap or hood hallways, work areas, and storage areas Restricted Zones - correct answer Personnel wear MASKS, STERILE gowns and gloves in addition to appropriate scrub attire if they are participating at the operating table; Temp and pressure control in room Surgical Hand Scrub - correct answer Performed to render hands and arms as clean as possible in preparation for a procedure; 5-10 minutes periphery to center (fingertips to elbows) Equipment Principles - correct answer ~Sponge and needle counts at opening and closing ~Far tray corners opened first ~Dropped trays are contaminated ~NEVER turn back on sterile field ~Keep trays at waist level or above Goals of Proper Positioning - correct answer ~Avoid SKIN BREAKDOWN ~Avoid NEUROMUSCULAR damage Methods for Positioning - correct answer ~Correct body alignment AT ALL TIMES ~Padding of any bony prominences ~ Re-positioning/re-padding Q2 Hours in OR Conscious Sedation - correct answer Combination of intravenous medications with opioids; Depresses level of consciousness minimally yet patient is able to independently maintain airways (Allows patient to respond to verbal and physical stimuli) General Sedation - correct answer Administered by inhalation or IV; Produces CNS depression and as a result patient loses consciousness and does not perceive pain eg. Propofol and Fentanyl (Total IV Anesthesia) eg. Isoflurane, Nitrous Oxide (High risk pt) Phases of General Sedation - correct answer ~Pre-Induction ~Induction ~Maintenance ~Reversal/Emergence Pre-Induction Phase - correct answer Application of monitoring equipment (ECG) Induction Phase - correct answer ~Patient receives the anesthetic agent intravenously or by inhalation ~Airway patency is achieved and maintained by Endotracheal (ETT) or Laryngeal Mask Airway (LMA) Maintenance Phase - correct answer ~Patient is positioned, skin is prep'd, surgery is performed ~Anesthesiologist maintains proper depth of anesthesia while constantly monitoring HR, BP, RR, O2 and CO2 levels Reversal/Emergence Phase - correct answer ~Wound closure and awakening ~EET or LMA is removed to establish voluntary breathing ~Uncontrolled movements may occur ~High risk for laryngospasms Narcotic/Analgesic Agents - correct answer Morphine, Dilaudid, Demerol Muscle Relaxing Agents - correct answer Pavulon Inhalant Agents - correct answer Mixed with O2; buzzing sensation Nitrous Oxide, Fluothane IV Anesth