NUR 303 Detailed Complete Exam 2025

NUR 303 Detailed Complete Exam 2025 1. Describe the surgical experience, including perioperative phases, classifications of surgery, types of anesthesia, informed consent, and advance directives, and outpatient/same-day surgery. - -3 phases of the perioperative period: - Perioperative: begins w/decision to have surgery; ends when pt is transferred to OR - Intraoperative: begins when pt is transferred to OR; ends when pt is transferred to PACU - Postoperative: begins when pt is admitted to PACU; ends at complete recovery/last follow-up Purpose of surgeries: - Diagnostic: make/confirm a diagnosis - Ablative: remove a diseased body part - Palliative: relieve/reduce intensity of an illness - Reconstructive: restore function to traumatized/malfunctioning tissue - Transplant: replace a diseased/malfunctioning organ - Constructive: restore function in congenital anomalies Types of anesthesia: - General: inhalation/IV; CNS depression; vent needed; NPO prior - Moderate sedation/Analgesia: conscious sedation; short-term minimally invasive procedures; pain controlled - Regional: injected near nerve/nerve pathway or around operative site; pt is awake - Topical/local: pt is awake; only affects area of procedure Informed Consent: description of procedure & alternative therapies, disease process, surgeon/physician info, risks, right of refusal/withdraw, expected outcome, recovery/rehab, treatment, etc. (must be done before pain meds administration) Advanced Directives: allow pts to specify instructions for treatment should they be unable to communicate postop (living wills, durable POA) Outpt/Same-Day Surgery: reduces length of stay; cuts costs; reduces stress; may require additional teaching/home care services 1. Consider preoperative nursing assessment to identify factors that increase risks for surgical and postoperative complications. - -- developmental level (older adult) - medical history (CVD, respiratory disorders, kidney/liver diseases, endocrine diseases) - surgical history (previous complications, latex sensitivity, pneumonia, thrombophlebitis, DVT, thrombus, infection) - medication history - nutritional status (malnutrition/obesity) NURS 303 NURS 303 - use of alcohol, nicotine, drugs (alcohol/drugs require higher doses of anesthesia, nicotine use warrants higher risk of respiratory complications) - ADLs & occupation (active vs sedentary) - coping patterns/support system (fears, resources) - sociocultural needs (beliefs about surgery, individualized nursing care needs) Medication risks: - Anticoagulants (hemorrhage) - Diuretics (electrolyte imbalance, respiratory depression) - Tranquilizers (hypotension) - Adrenal steroids (CV collapse due to abrupt withdrawal - Antibiotics in mycin group (respiratory paralysis when combined with certain muscle relaxants) 1. Discuss preparation of a patient physically and psychologically for surgery. - Presurgical screening: Common tests: - chest x-ray - ECG - complete WBC count - electrolyte levels - UA Nursing care: - explain tests to pt - record results before surgery - report abnormals Nursing interventions: - establish therapeutic relationship - allow pt to verbalize concerns - use active listening - use open-ended questions - use touch to demonstrate genuine empathy - be prepared to respond to common questions Prepping for surgery: - physician visit for informed consent - anesthesiologist/anesthetist visit - physical prep (NPO, meds, preop checklist) - show visitors to waiting room & tell them what to expect Prep: - teach pain management (timing to request, ambulation, stay on top, splinting incision, alternatives) - teach physical activities (deep breathing, coughing, IS, leg exercises, turning, early ambulation) NURS 303 NURS 303 - skin prep - elimination (foley) - nutrition/fluids (NPO prior, IV fluids after) - rest & sleep verify consent is signed TJC Protocol: - preoperative pt ID - marking operative site - final verification ("time out") - OR nurse transfers pt & does safety checks 1. Identify assessments and interventions specific to the prevention of complications in the immediate and early postoperative phases. - -Every 10-15 mins: - respiratory status (airway, SpO2) - CV status (BP) - temp - CNS status (LOC, movement) - fluid status - wound status - GI status (N/V) - general condition (comfort, position, tubes) Prevention of CV complications: - Hemorrhage (internal/external; BP drops; HR increases) - Shock (inadequate perfusion; possible organ failure; place pt flat, elevate legs, increase fluids, CPR if needed) - Thrombophlebitis (may cause occlusion or embolization) - DVT (leg exercises, SCDs, ambulation) Prevention of pulmonary complications (most common): - Pulmonary embolus (elevate HOB, administer O2, meds as ordered) - Pneumonia (cough & deep breathe every 2 hours; IS) - Atelectasis (cough & deep breathe; can lead to pneumonia; IS) - Airway obstruction (monitor SpO2 & respirations; open airway; may need to place airway; monitor analgesia response; position; listen for crowing sounds) Splinting to facilitate coughing: - semi-Fowler's position, leaning forward - inhale & exhale deeply through the nose 3 times - take a deep breath & hold for 3 seconds - hack out for 3 short breaths - take quick breath through mouth - cough deeply take another deep breath NURS 303 NURS 303 Prevention of GI complications: - paralytic ileus (assess for return of bowel sounds (within 4 hours); assess N/V & passing gas; encourage fluids when ordered & tolerated) Prevention of tissue/healing complications: - dehiscence & evisceration (assess incision; if evisceration occurs, apply saline soaked sterile dressing) - impaired healing (common in diabetes; maintain blood sugar) 1. Apply knowledge of pathophysiology when caring for the client with fluid and electrolyte imbalances. - -Fluid Intake: - Ingested water: 1300ml - Ingested food: 1000ml - Metabolic oxidation: 300ml - Total: 2600ml Fluid Output: - Kidneys: 1500ml - Skin: 600ml - Lungs: 300ml - GI: 200ml - Total: 2600 Blood urea nitrogen (BUN): 8-20 mg/dl - increased in impaired renal function Creatinine: men (0.9-1.3 mg/dl) women (0.6-1.1 mg/dl) - increased in impaired renal function - more sensitive than BUN - low urine pH can occur in metabolic acidosis, diabetic ketosis, & diarrhea - high urine pH can occur in respiratory alkalosis, K+ depletion, & renal failure Urine Specific Gravity: 1.010-1.025 1. Relate the functions of electrolytes potassium, calcium, magnesium, phosphate, chloride, and sodium in the body. - -Sodium: - controls & regulates volume of body fluids - Na & H2O follow each other - 135-145 mEq/L Potassium: - chief regulator of cellular enzyme activity & water content - 3.5-5.0 mEq/L NURS 303 NURS 303 Calcium: - nerve impulses - blood clotting - muscle contraction - B12 absorption - 8.6-10.2 mEq/L Magnesium: - metabolism of carbs & proteins - vital actions involving enzymes - 1.3-2.3 mEq/L Chloride: - maintains osmotic pressure in blood - produces HCl - 97-107 mEq/L Phosphate: - important chemical reactions in the body - cell division - hereditary traits - 2.5-4.5 mg/dL 1. Describe the function of the primary organs and body systems involved in homeostasis. - -Kidneys: - filter 180L plasma daily - excrete 1.5L urine daily - regulate ECF volume & osmolarity by selective retention & excretion - regulate electrolyte levels in ECF by selective retention of needed substances & excretion of unneeded substances - regulate pH of ECF by excretion/retention of H+ ions CV System: - pumps & carries nutrients & water in body - circulates blood through kidneys with sufficient pressure for urine to form - reacts to hypovolemia by stimulating fluid retention (stretch receptors in the atria & blood vessels) Lungs: - regulate O2 & CO2 levels in blood - remove 300ml water daily - eliminate H+ - quickly correct acid-base imbalance Adrenal Glands: - regulate blood volume & Na/K balance by secreting aldosterone NURS 303 NURS 303 - help body conserve Na, save Cl & H2O, & excrete K Pituitary Gland: - stores & releases ADH - regulates Na & H2O intake & excretion Thyroid Gland: - increases blood flow in body - increases renal circulation Nervous System: - inhibits & stimulates mechanisms influencing fluid balance - regulates oral intake by sensing intracellular dehydration which triggers thirst (located in the hypothalamus) Parathyroid Glands: - regulate level of Ca & PO through secretion from parathyroid hormone GI tract: - absorbs water & nutrients that enter the body through this route 1. Differentiate between normal and critical laboratory values for arterial blood gasses (pH, PO2, PCO2, SaO2, HCO3), potassium, calcium, magnesium, phosphate, chloride, and sodium and relate when to notify the provider. Know basic blood gas interpretations. - -pH: 7.35-7.45 Bicarbonate: body's primary buffer system Acidosis: - Acid: substance containing H+ ions that can be released - excess of H+ ions - either acid excess or base deficit - pH 7.35 - pH 6.80 = death Alkalosis: - Base: substance that can trap H+ ions - deficit of H+ ions - either base excess or acid deficit - pH 7.45 - pH 7.80 = death Buffers: - chemical buffer systems - respiratory mechanisms - renal mechanisms NURS 303 PaO2: - 80-100 mmHg - partial pressure of O2 in blood PaCO2: - 35-45 mmHg - partial pressure of CO2 in blood HCO3: - 22-25 mEq/L - amount of bicarb in system Respiratory Acidosis: - low pH - high pCO2 - normal HCO3 Respiratory Alkalosis: - high pH - low pCO2 - normal HCO3 Metabolic Acidosis: - low pH (7.35) - normal pCO2 - low HCO3 (22) - abdominal pain - CNS depression - coma - hypotension - arrhythmias - Kussmaul respirations - flushed red dry skin - muscle weakness Metabolic alkalosis: - high pH - normal pCO2 - high HCO3 1. Identify assessments of client fluid and electrolyte and/or acid-base imbalance. - Edema: - pitting vs non-pitting - pitting: pressure forces fluid into underlying tissues, causing an indentation that fills slowly NURS 303 NURS 303 NURS 303 - severity = depth in cm (1+ is 1cm, 2+ is 2cm) - nonpitting: pressure leaves no indentation because fluid has coagulated into the tissues; skin tight & firm Hyponatremia: - N/V - confusion - decreased LOC - lethargy - seizures - decreased muscle strength - (all due to the decreased CNS due to decreased Na levels) - restrict water - administer meds (diuretics) - ensure open airway - seizure precautions - monitor cardiac status - administer hypertonic IV solution Hypernatremia: - provide water - IV fluids (isotonic or hypotonic) - assess neuro status - daily weights Hypokalemia: - caused by use of diuretics - arrhythmias (U waves) - muscle weakness - decreased reflexes - fatigue - confusion - N/V - administer meds (IV potassium chloride slowly/potassium supplements with food) - monitor respiratory & CV status - assess bowel sounds - monitor I&Os - high potassium foods Hyperkalemia: - administer meds (diuretics) - continuous cardiac monitoring - monitor K levels until stabilized - monitor I&Os - low K diet NURS 303 NURS 303 Hypocalcemia: - caused by deficient intake, impaired absorption, & excessive loss - muscle spasms - increased reflexes - tetany - Chvostek's sign - Trousseau's sign - EKG changes - decreased bone density - seizure precautions - administer meds (calcium replacement; magnesium) - monitor cardiac & respiratory status 1. Describe nursing interventions that address potential and actual fluid and electrolyte imbalance. Be familiar with nursing interventions for each of the highlighted areas on the Electrolyte Imbalances document that is located in the week 10 folder. - Hyponatremia: - restrict water - administer meds (diuretics) - ensure open airway - seizure precautions - monitor cardiac status - administer hypertonic IV solution Hypernatremia: - provide water - IV fluids (isotonic or hypotonic) - assess neuro status - daily weights - low Na diets Hypokalemia: - administer meds (IV potassium chloride slowly/potassium supplements with food) - monitor respiratory & CV status - assess bowel sounds - monitor I&Os - high potassium foods Hyperkalemia: - administer meds (diuretics) - continuous cardiac monitoring - monitor K levels until stabilized - monitor I&Os - low K diet Hypocalcemia