MATC Health Alterations Exam 1Questions With 100% Verified Correct Answers.

diagnostic - correct answers determine or confirm diagnosis curative - correct answers resolve health issue or remove cause restorative - correct answers improve patient's functional ability palliative - correct answers alleviate symptoms - not curative Urgency of surgery - correct answers 1. Elective- planned 2. Urgent- within 1-2 days 3. Emergent- immediate, emergency, life-threatening extent of surgery - correct answers simple- only most overtly affected areas involved in surgery radical- extensive surgery beyond the area obviously involved; directed at finding root cause minimally invasive surgery (MIS)- surgery performed in cavity through one or more endoscopes outpatient surgery - correct answers Surgery performed in the hospital or doctor's office, after which a patient is allowed to return home Advantages- Cost-effective, High degree of patient satisfaction Disadvantages- Increased responsibility on patient/family to care for patient postop, May need a case manager to coordinate follow up (i.e. treatments, procedures) in-patient surgery - correct answers surgery done in hospital, usually requires an overnight stay, often more complex/major Advantages- More time/patient care (assessments, teaching, monitoring for any complications; Develop rapport between the nurse and the patient Disadvantages- Increased expense, Greater risk for infection (nosocomial infections), Increased lost time from work, More interruptions between patient/family preoperative stage - correct answers Primary goal: complete a physical assessment that is used to determine baselines and look for any underlying conditions or concerns that might be problematic during or after the surgery. •Medical & surgical health hx •Medications •Allergies •Vital signs •Physical assessment •Psychosocial concerns •Learning needs •Discharge planning -EBP - more effective before hospital & surgery •Cultural influences & variations Nursing History and Assessment - correct answers 3 main goals: 1. Obtaining a baseline assessment -Head to toe, vs, neuro status 2.Identifying risk factors.. What type of chronic conditions does the patient have? Cardiac disease and diabetes increase our risks post-operatively 3. Identifying learning needs - what is the patient unclear on, where do we need to focus our education? Increased risk factors - correct answers increases risk of complications Older patients- Decreased immune system, Higher incidence of chronic disease, Age-related kidney & liver, & lung function Smoker- Decreased lung function, May have poor response to anesthesia/pain medicine Medications/herbal supplements- Anti-coagulants (Warfarin), Certain herbal supplements may increase risk for bleeding, Collect thorough medication history! Cardiac history- Increased stress/workload on heart, Hypertension Pediatric operative concerns - correct answers •Immature physiological status •Body temperature •Circulatory blood volume •Renal •Dehydration and over-hydration Geriatric operative concerns - correct answers •Physiologic changes with aging •Chronic illnesses •Polypharmacy •Immobility informed consent - correct answers Legal document that must meet the 3 major areas -the patient must be given adequate disclosure, the patient must be able to comprehend, and the patient must consent voluntarily SURGEON is RESPONSIBLE for explaining and ensuring consent is signed prior to sedation; RN clarifies facts, verifies form is signed, witnesses signature. anesthesia - correct answers Blocks nerve impulses so patient doesn't feel pain, 3 kinds- general, local, regional general anesthesia - correct answers produces CNS depression: -Loss of consciousness, no pain perception, skeletal muscles relax, reflexes diminish, amnesia. Given by IV or inhalation. Post op risks include resp depression, hypotension, dysrhythmias, hepatic dysfunction, malignant hyperthermia and N&V Malignant hyperthermia - correct answers A rare inherited genetic metabolic disease characterized by hyperthermia with rigidity of skeletal muscles that can result to death as a reaction to inhaled general anesthesia. •S&S: temp, tachypnea, tachycardia, muscle contractions Only treatment: dantrolene sodium, a muscle relaxant regional anesthesia - correct answers -A form of local anesthesia in which an anesthetic agent is injected around nerves so that the area supplied by these nerves is anesthetized -Produces analgesia, relaxation, and reduces reflexes. The patient is awake and alert unless they have been given other medications that produce sedation or relieve anxiety -Ex: topical, local, nerve block -Side effects: Headache, hypotension, urine retention •Nursing implications: Lay flat (decrease headache), Increase fluids, Pressure to site, Monitor output, Caution narcotics balanced anesthesia - correct answers a variety of medications given pre-op and during surgery to achieve the desired outcomes but minimize the potential side effects by resulting in needing less general anesthesia IV and inhalation given together Less risk of cardiac complication and post op N&V postoperative - correct answers Patient care aimed at preventing complications; begins once procedure ends in PACU; d/c home; surgical unit Postoperative hand-off report - correct answers Look at chart p 171 Includes Pt name, age, anesthesia care provider and type of anesthesia, surgeon, surgical procedure & why they had the surgery, Meds used pre- and intra-OR, blood loss, I&O, Unexpected events, VS ranges, Lab results, PMH, and med allergies Post-op patient assessment - correct answers ABC's Vitals are assessed q 15 minutes x 1 hr, q ½ hour x 2 hours, q 1 hr x 4 hrs, q 4 hr Patient must be recovered from effects of anesthesia (shows resumed motor and sensory functions), is orientated, has stable vitals, and shows no sign of hemorrhage or other major complications. Usually a patient is in PACU ~1 hour post-op airway assessment - correct answers 1st assessment patent and airway equipment in place Most common PACU emergency Interventions: Suction, O2, Positioning (head of bed up if tolerated), Antiemetics, Cough & DB&C, Pain control, Hydrate to loosen secretions, Remove artificial airways At risk for inadequate ventilation - correct answers •Older/younger pts, smokers, lung disease, obese, undergone airway/ thoracic or abdominal surgery. Complications •Laryngospasm/ bronchospasm (stridor)- swelling, edema, airway not wide enough •Pulmonary edema •Aspiration - usually due to vomiting/secretion in mouth post-op assessment- cardiovascular - correct answers Vitals, heart sounds, pulse, CMTS, cap refill Most common cardiovascular complications in the PACU are hypotension and shock, hemorrhage, hypertension and dysrhythmias hypovolemic shock - correct answers Can result from blood loss, hypoventilation, position changes, pooling of blood in extremities or side effects of medications and anesthesia. Most common cause is blood loss Signs & Symptoms •↑HR ↑R ↓ BP narrow pulse pressure ↓ O2 sats (pulse oximetry), cool, clammy, pale skin, concentrated urine Causes Dehydration, Decrease intravascular volume Treatment •volume replacement-IV (blood, IV fluids), O2, check for bleeding, call MD Post-op hypertension - correct answers common in the immediate post op period and it can be related to sympathetic nervous system stimulation from pain, bladder distention or hypoxia or an effect for pre-op meds Post-op arrhythmias - correct answers Can result from hypokalemia, hypoxia, hypercapnia (breathing too fast), or pre-existing HTN. A pulse deficit can indicate a dysrhythmia Post-op: Neurological assessment - correct answers Know: anesthetic type, Baseline neuro, LOC, Orientation, Sensory/motor status, Spinal H/A (headache), PERRLA Hearing is 1st sense to return emergence delirium- hyper-agitated, temporary Post-op GI - correct answers N/V is one of the most common post op concerns and is usually related to pain medications, anesthesia and type of surgery Nausea & Vomiting-Give antiemetics, Increase fluids, Assess for distention Assess NG- Output, Suction, COCA, Not expected in PACU for patient with NG, Bowel sounds, Flatus Post-op discharge criteria - correct answers Must have: stable vitals, orientated x 4, uncompromised pulmonary function, normal pulse ox, urine output 30 ml/hr, controlled N&V, and minimal pain Aldrete System (may also be referred to as: "Post-Anesthesia Recovery Score") 1.Activity 2.Respirations 3.Circulation (BP) 4.Consciousness 5.O2 Saturation (Pulse Oximetry) paralytic ileus - correct answers Usually temporary paralysis of intestinal wall that may occur after abdominal surgery or peritoneal injury and that causes cessation of peristalsis; very uncomfortable- bloated, possibly nauseous/constipated Post-op alteration in fluid and electryolye balance - correct answers Fluid Volume Overload, Fluid Volume Deficit, Potassium imbalances, Acid base imbalances, Abnormal liver function tests Nursing assessments: I&O, and lab results-abnormalities in sodium, potassium, hemoglobin and hematocrit, BUN and Creatinine Drainage colors - correct answers •Serous: clear yellow •Serosanguinous: pink •Sanguineous: red •Purulent Leadership - correct answers the ability to guide and influence the behavior of an individual or a group, may have no formal authority Must develop 3 importance competencies: 1) the ability to diagnose or understand a situation that the leader wants to influence, 2) the ability to close the gap between the current situation and what they want to achieve, 3) communication Management - correct answers assigned, responsible for work getting done, monitors and adjusts to ensure current goals are met, coordinates resources Managing Patient Care - correct answers **All nurses must have management skills** Patient assignments, Planning care, Decision making, Delegation, Prioritization Leadership Style - correct answers authoritarian- strong control, communication from top down, no staff input; EX: disaster, code, cardiac arrest democratic- staff involvement encouraged, communication two way street, directed through suggestions and guidance; EX: brainstorm new equipment laissez-faire-more permissive, hand-off, group makes decisions Conflict Management - correct answers Avoiding, Cooperating (accommodating), Smoothing, Competing, Compromising, Collaborating: (win-win) Organizational Care Models - correct answers Model used depends on staff skills, resource availability, patient acuity, & nature of work 1.Case Management: (Total patient care), oldest mode, RN assumes total repsonsibility for care 2.Functional nursing- assigned specific task, RN manages care 3.Team nursing (modular nursing is a variation)- RN team leader responsible for knowing condition and needs of all patients, coordinates the care 4.Primary nursing-RN assumes 24 hr responsibility for planning care and provides total direct care Delegation - correct answers The transfer of authority to perform a specific task but retains the accountability for the delegated task Delegator has ultimate responsibility 5 Rights of Delegation - correct answers Right task, circumstances, person, direction/communication, level of supervision TEAACUP: Teaching Evaluation Assessments Advanced interventions (blood administration, IV push medications) Collaboration (physicians, advanced providers) Unstable patients Planning: RNs develop client goals and care plans. Cannot delegate - correct answers Initial nursing assessment & subsequent assessment if nursing judgment is needed Decisions/judgments about the nursing diagnoses Decisions/judgments about outcomes Determining & approving plan of care (POC) Interventions that require professional nursing knowledge, decisions, or skill Decisions/judgments of the evaluation of care. State Board of Nursing - correct answers Designed to "Protect the Public", Defines "scope of nursing practice", Oversees the licensing process & fees, Responds to ?s RT practice issues, Conducts disciplinary proceedings, Certifies APRN, Reviews nursing education & clinical enrichment programs, Declares new rules and regulations. WI Nurse Practice Act - correct answers Lists distinct RN functions and responsibilities Assessment process, Dx of nursing or collaborative problems, Creating a plan of care, Defining outcomes, Selection of nursing interventions, Choosing who will complete nursing interventions (delegation), Evaluation of POC Nurse Licensure Compact - correct answers allows licensed nurses who reside in a compact state to practice in other compact states under a multi-state license; must provide care in accordance to statutes and rules in state care is being provided