NR 226 Exams 3 Questions and Answers

NR 226 Exams 3 Questions and Answers Types of surgery Categories: Seriousness, Urgency, Purpose Seriousness of surgery major: involves extensive reconstruction of body parts (ex. colon resection) minor: involves minimal alteration of body parts; correct deformities (ex. cataract extraction) purposes of surgery diagnostic, ablative, palliative, reconstructive, transplantation, constructive urgency of surgery 1. Elective: not necessary for health (ex. BA) 2. Urgent: necessary for health (ex. removal of mal. tumor) 3. Emergent: must be done asap to save life (ex. appendix repair after rupture) purposes of surgery: Diagnostic confirms a diagnosis for further testing (ex. biopsies) purposes of surgery: ablative excision or removal of diseased body part (ex. amputation or appendix removal) purposes of surgery: palliative relieves or reduces intensity of disease symptoms (ex. colostomy) purposes of surgery: reconstructive /restorative restores fxn or appearance to trauma tissues (ex. scar revision) purposes of surgery: transplantation removal of organ or tissues from one person to another (ex. heart transplant) purposes of surgery: constructive restores fxn lost or reduced as a result of congenital anomalies (ex. clef palate) purposes of surgery: cosmetic improves personal appearance (ex. nose job) Pre-operative phase The period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table. pre-operative assessment Hx & Physical Current level of function Expectations Advanced directives (DNR, DNI) Medical hx, medications Nursing hx Surgical hx Risk factors Surgery & anesthesia is very hard on the heart due to large amounts of fluid given IV. IF pt, has CHF there's risks of edema, PE, O2 issues, etc. Medications Allergies Smoking & alcohol use Pregnancy Knowledge of the surgical procedure Support systems Occupation Pain assessment Emotional health pre-operative nursing diagnoses Deficient knowledge related to surgery as evidenced by Anxiety/Fear related to surgical procedure as evidenced by Risk for infection Pain (set realistic expectations) RNs role in surgical consent 1) Assess pt's understanding of the procedure 2) Call surgeon if pt has more questions 3) Sign as the witness Keys points about consent - Surgeon must get surgical constant not the RN - Minors (18 years old) need a parent or legal guardian to sign the consent form - Older clients may need a legal guardian to sign the consent form - No sedation should be administered before the consent is signed Intraoperative Phase period of time that begins with transfer of the patient to the operating room area and continues until the patient is admitted to the postanesthesia care unit Types of Anesthesia general, regional, local, conscious sedation general anesthesia the blockage of all body sensations, causing un-consciousness and loss of reflexes = major procedures Regional Anesthesia Temporary interruption of nerve conduction, is produced by injecting an anesthetic solution near the nerves to be blocked = Childbirth local anesthesia Loss of sensation at the desired site of action Minor Procedures (Novocain, topical gels, sprays) Conscious Sedation a decreased level of consciousness in which the patient is not completely asleep Oral Surgery, colonoscopy, cardiac cath surgery time out checklist Correct _Patient (name, DOB, wristband, med record #)_ Correct _prodcedure_ Correct _site/location_ (the surgeon will write ‘yes’ and sign over site, no ‘X’s’ or ‘checks’) Circulating Nurse a nurse who assists the scrub nurse and the surgeons during surgery, positioning the patient and equipment, obtaining additional supplies, and adjusting lighting as needed Scrub Nurse a nurse who assists surgeons during surgery, wearing sterile attire and handling sterile equipment and supplies Postoperative Phase period of time that begins with the admission of the patient to the postanesthesia care unit and ends after follow-up evaluation in the clinical setting or home Post Anesthesia Care Unit (PACU) Area where immediate postoperative care of the patient takes place before transfer to the hospital room or ICU What information must you get for pt's in PACU? type of anesthesia, nature of surgery, require close monitoring Aldrete Score or post anesthesia recovery score (PARS) Goal: 8-10pts Aldrete Score a score of 8-10 based on a set of objective criteria must be reached before discharge from PACU PARSAP Postanesthesia Recovery Score for Ambulatory Patients Score that includes five more areas of assessment than the PARS; includes the condition of the dressing, the intensity and location of pain, the ability to stand and ambulate, tolerance of oral fluids and/or food, and the ability to urinate spontaneously. How often do you take vitals after surgery? every 15 minutes twice, then every 30 minutes twice, then hourly for 2 hrs. Then, every 4hrs or per orders. Post op complications: Respiratory Atelectasis ← Inadequate lung expansion Pneumonia ← Poor lung expansion with retained secretions Hypoxemia ← Respiratory depression from drugs Pulmonary embolism ← causes of thrombus/embolus formation How to prevent respiratory post op complications Monitor: SpO2, ABGs, respirations Give incentive spirometer, practice deep breathing & ambulate Put on supplemental O2, ensure to try to wean off Weaning: keep pt on continuous pulse ox, take down by 1L at a time, ensure stats remain btw 95-100. Post op complications: Circulatory Hemorrhage ← suture failure, dislodge clots Hypovolemic shock ← hemorrhage Thrombophlebitis ← prolonged sitting, trauma to veins Thrombus ← venous stasis Embolus ← increased coagulability of blood How to prevent circulatory post op complications Monitor: pulses, clotting times, measure circumference of calves Give SCDs, ambulate, elevate Watch for DVT formation Post op complications: GI Paralytic ulcer ← major handling of the intestines during surgery Abdominal distention ← slowed peristalsis Nausea & vomiting ← fear, pain, medications, slowed peristalsis How to prevent GI post op complications Listen to bowel sounds, look for distention, pain, drainage, infection Help pt ambulate & hydrate, provide stool softener Post op complications: neurological Intractable pain ← related to the incision Malignant hyperthermia ← genetics How to prevent Neuro post op complications Assess LOC, signs of stroke (FAST) Post op complications: Integumentary Wound infection ← poor aseptic technique Wound dehiscence ← separation of wound at sutures Wound evisceration ← protrusion of intestines Skin breakdown ← prolonged OR times How to prevent Integumentary post op complications Assess for pressure injuries, pain, tears, wounds, incisions, drainage COCA Reinforce dressings, check orders, ambulate Post op complications: Genitourinary Urinary retention ← effects of anesthesia UTI ← poor sterile / aseptic techniques How to prevent Genitourinary post op complications Assess urine COCA, perineal area for redness/infection. Incontinence, foley care, Is & Os Let pt know they will not regain urinary fxn for 6 to 8hrs after surgery Pt should void 30ml - 50ml per hour Blood Transfusion consent separate from surgery consent (RN's can get this consent) What must the RN do for blood transfusions - Get labs for blood type & cross references - Tubing – unique Y tubing to hang blood unit and NS together, also has a filter built into the tubing - 2 RN’s must verify blood unit & patient wristband - Take vitals before transfusion, 15 minutes after starting, and after unit is complete - Place saline and blood transfusion at the same height, only one clamp is opened at a time - You have 4hrs to complete the transfusion from when you leave the blood bank - Take VS, start blood transfusion, stay with patient, wait 15 take VS again, then another set after transfusion is complete RN must stay with the patient during the first 15 minutes of the transfusion! What to do if blood transfusion reaction? 1) STOP the transfusion 2) Finish assessment (rash, VS, ect.) 3) Disconnect bing at the hub & flush with NS 4) Notify MD, rapid response, code team, RN supervision, CNA 5) Hang new NS and new tubing 6) Anticipate med administration 7) Return blood, NS, & tubing back to blood bank Febrile reaction to blood transfusion S/S Caused by antibodies. S/S include fever, chills, nausea, HA, flushing, tachycardia Allergic reaction to blood transfusion S/S Mild: hives, itching, flushing Severe: SOB, bronchospasm, anxiety Hemolytic transfusion reaction Back pain Hypotension Tachycardia Chest pain Tachypnea The nurse has just reassessed the condition of a postoperative client who was admitted 1 hour ago to the surgical unit. The nurse plans to monitor which parameter most carefully during the next hour? a. Urinary output of 20 ml/hr b. Temperature of 37.6 C (99.6 F) c. Blood pressure of 100/70 - systolic 100 you're good d. Serous drainage on the surgical dressing a A postoperative client asks the nurse why it is so important too deep breathe and cough after surgery. When formulating a response the nurse incorporates the understanding that retained pulmonary secretions in a postoperative client can lead to which condition? Pneumonia Hypoxemia Fluid imbalance Pulmonary embolism Pneumonia