BEST UPDATE ATI MED SURG TERMS FINAL REVIEW QUESTIONS & ANSWERS (SCORED A+)

BEST UPDATE ATI MED SURG TERMS FINAL REVIEW QUESTIONS & ANSWERS (SCORED A+) Medical Surgical ATI final review Terms in this set (197) The term used for before surgery? What is the nurses responsibility for this term? Peroperative Educator, advocate and health promotion. What is the term used during surgery? What is the nurses responsibility for this term Intraoperative Safety and advocacy. What is the term used after surgery? What is the nurses responsibility for this term? Postoperative On going evaluation and stabilization of clients, prevention of post-op complications. Purpose of surgery: give examples 1. Diagnostic: 2. Curative: 3. Restorative: 4. Palliative : 5. Cosmetic surgery: Purpose of surgery: 1. Diagnostic: exploratory laparotomy. 2. Curative: fibroid tumors-hysterectomy. 3. Restorative: hip replacement. 4. Palliative surgery makes the client more comfortable. Does not cure, ex. suprapubic catheter. 5. Cosmetic surgery reconstructs the skin and underlying structures, ex. scar revision. Who is responsible for obtaining a signed consent before sedation is given and surgery is performed? The surgeon What is the nurses role when a consent is being signed? witness client signature. (pg. 642) The nurse is responsible for making sure pt is NPO b/f surgery, what happens if pt eats? Surgery get CX and by eating increases the risk for pt to have aspiration. How many hours does a pt have to be NPO b/f surgery? Usually after midnight for 6-8 hours. Why are bowel or intestinal preparation performed b/f surgery? to prevent injury to the colon and to reduce the number of intestinal bacteria. An enema or laxative may be ordered by the physician. Do we shave the patient b/f surgery? It is viewed as controversial and an increase risk to infection Name things that you would teach the pt for postoperative. -Breathing exercises, incentive spirometry, coughing and splinting, leg procedures and exercises, antiembolism stockings, and elastic wraps, early ambulation, and range of motion exercises. Upgrade to remove ads Only $3.99/month Name 5 things the nur se woul d do for anxiety pr e v ention b / f sur ger y ? . Pr1 eoper a tive tea ching. . Encour2 a ging communica tion. 3 . Pr omoting r es t. 4 . U sing dis tra ction. 5 . Tea ching famil y and significant other s. If some one has come bk from surgery and had anesthesia what are the two high risk patients the nurse should really look out for? -Those with liver and kidney disease. Induced state of partial or total loss of sensation, occurring with or without loss of consciousness. Used to block nerve impulse transmission, suppress reflexes, promote muscle relaxation, and in some instances achieve a controlled level of unconsciousness. Anesthesia -Reversible loss of consciousness. -State can be achieved by a single agent or a combination of agents. -CNS is depressed resulting in analgesia, amnesia and unconsciousness with loss of muscle tone and reflexes. -With this the nurse needs to consider emotional/psychological effects which include the fear of being put to sleep. General Anesthesia Name the two types of General anesthesia and info about them. 1. Inhalation-Intake and excretion of anesthetic gas or vapor to the lungs through a mask. 2. Intravenous Injection- injected through an IV line disposed in the blood. How long does recovery take when given general anesthesia? Recovery depends on type of agent, length of time client is anesthetized and if a reversal agent is used. What are possible responses to general anesthesia? Retching, vomiting, restlessness and changes in the ability to control body temperature. What are some interventions we might use when some one went through general anesthesia? Suction equipment, warmth and O2. ***************test question******************* What is the biggest complication from general anesthesia? Malignant hyperthermia *************test question******************** This is the biggest complication from general anesthesia. Malignant hyperthermia Name 5 complications of General anesthesia. 1. Malignant hyperthermia 2. Overdose 3. Complications of specific anesthetic agents. 4. Unrecognized hypoventilation. 5. Complications of intubation. Upgrade to remove ads Only $3.99/month This is caused by a l ocal or regional anes thesia: Secondar y to the int erruption o f the sensor y ner v e impul se transmission from a specific bo dy ar ea or r egion. Insensibil ity Name 4 things that local or regional anesthesia does to the body. 1. Insensibility 2. Motor function may be affected. 3. Client remains conscious and able to follow instructions. 4. Gag and cough reflexes remain intact. Condition that is marked by a rapid rise in body temperature, increase in serum calcium and potassium, signs of increased muscle metabolism (muscle proteins detected in the urine) and rigidity. Can be lifethreatening. Malignant Hyperthermia What type of agents are used on the pt before the have a local or regional anesthesia? Sedatives, opioid analgesics, or hypnotics. When the is an over dose of local or regional anesthesia what are the signs to look for? respiratory depression and sedation Name 4 complications of local or regional anesthesia. 1. Anaphylaxis 2. Incorrect delivery technique 3. Systemic absorption 4. Overdosage What S&S should the nurse look for with complications of local or regional anesthesia. Assess for CNS stimulation, CNSand cardiac depression, metallic taste, nausea and vomiting, tremors, seizures, increased pulse, respirations, and bp. Medical Surgical ATI final review What are the treatments for complications of local or regional anesthesia? 1. **Establish an open airway.************ 2. Give O2. 3. Notify the surgeon. 4. Fast-Acting barbiturate is usual treatment. If toxic rx is untreated, unconsciousness, hypotension, apnea, cardiac arrest, and death may result. IV delivery of sedative, hypnotic, and opioid drugs reduces the level of consciousness but allows the client to maintain a patent airway and to respond to verbal commands. Conscious Sedation When pt is in a conscious sedation what is the nurses role? Assessment of airway, level of consciousness, oxygen saturation, electrocardiographic status, and vital signs are monitored every 15-30 minutes. Upgrade to remove ads Only $3.99/month Name 3 interventions for risk for perioperative positioning injuries. 1. Proper body position 2. Risk for pressure ulcer formation 3. Prevention of obstruction of circulation, respieation, and nerve conduction. During what operative state are Postoperative our assessment skills crucial? Medical Surgical ATI final review What is the recovery room AKA? PACU Ongoing evaluation and stabilization of clients to anticipate, prevent and treat complications after surgery. Usually located close to the surgical suite. Recovery room AKA PACU. What kind of nurse is skilled in the care of clients with multiple medical and surgical problems that can occur following a surgical procedure. A PACU nurse AKA recovery room nurse. After a patient has had what done should you assess for: -motor and sensory assessment. After an epidural or spinal anesthesia. What is an example of a command you would ask a patient to assess for motor fx? Simple commands, ask pt to move extremities. While pt is going through the return of the sympathetic nervous system tone what position should they be in and what should you assess for? Gradually elevate head and monitor for hypotension. Medical Surgical ATI final review The effects of drugs, anesthetic agents, or manipulation during surgery can cause urine what? Retention How should a nurse assess for urine retention? Look for bladder distention. What are other sources of output other than urine? sweat, vomiting, or diarrhea Post surgery at what level should we report urine out put? <30 mL/hr What is a common GI problem post surgery? Nausea and vomiting 1. Why is peristalsis delayed post surgery? 2. Pt's who have abdominal surgery often have decreased peristalsis for at least how long? 24 hours How often should the nurse assess drained material from a Every 8 hours nasogastric tube? Medical Surgical ATI final re view Can you irrigate a nasogastric tube after gastric surgery with out an order? No, you need an order from the surgeon Ineffective wound healing can be seen how soon after surgery? Between the 5th-10th day. A partial or complete separation of the outer wound layers, sometimes described as a splitting open of the wound. Wound heals from the bottom up. Dehiscence When a wound heals from the bottom up it is know as what intention? Secondary A total separation of all wound layers and protrusion of internal organs through the open wound requires surgical intervention. Evisceration Upgrade to remove ads Only $3.99/month What type of pt's are at a Mehigherdic riskal Sur for egicvisceral Aation?TI final re Obese people view Dressings and drains, including casts and plastic bandages, must be assessed for bleeding or other drainage when? On admission to the PACU (recovery room) and hourly thereafter. When does pain usually reach it's peak level post surgery? The second day. In what situation should a nurse have a patient in a side-lying position or turning his or her head to the side to prevent aspiration? When there is an impaired gas exchange. When a patient has an impaired gas exchange what are a couple interventions a nurse should do? 1. Encourage deep breathing exercises. 2. Encourage mobilization as soon as possible to help remove secretions and promote lung expansion. Provide and exit route for air, blood, and bile as well as help prevent deep infections and abscess formation during healing. Drains The first dressing on a patient post surgery is always changed by who? The surgeon 1. Acute pain can activate what? 2. When that happens what are 1. SNS 2. Restlessness, increased HR, BP, RR, dilated pupils and sweating. symptoms of the patient? Medical Surgical ATI final review 1 1 Name three interventions for hypoxemia. 1. Maintain airway patency and breathing pattern. 2. Prevention of hypothermia. 3. Maintenance of oxygen therapy as prescribed. Is under treatment of pain a serious health care problem? Yes Name the 3 types of pain. 1. Acute pain 2. Chronic CA pain 3. Chronic non-cancer pain Name the 3 sources of pain. 1. Somatic-tissue 2. Visceral-organ pain like an MI 3. Neuropathic-pain from the CNS Which pain is the hardest to treat? Nerve pain Is a state of adaptation in which exposure to a drug induces changes in its effect over time. Tolerance Is the adaptation manifested by a drug class specific with drawl syndrome. Physical dependence Results when dependent use of opioids ceases abruptly. Withdrawal symptoms Medical Surgical ATI final review This is a chronic neurobiologic disease characterized by: impaired control over drug use compulsive drug use continued use despite harm craving occurs over time, not a result of one hospital stay Addiction Measures the quality of pain the scale 1-10 During an assessment you ask what questions about the location of the pain. Is it localized, projected, radiating, or referred Name the three types of analgesics that are for relieving pain. 1. Non-opioids 2. Opioids 3. Adjuvants Acetylsalicylic acid, acetaminophen, and nonsteroidal anti- imflammatory drug (NSAIDS) like motrin, aleve, tramadol. These are examples of what type of drug? Non-opioid analgesics Codeine, hydrocodone, oxycodone, morphine, hydromorpnone, fentanyl, methadone, tramadol, and meperidine are examples of Opioid analgesics what type of drug? Medical Surgical ATI final review Name a few side effects of opioid analgesics Nausea, vomiting, constipation, sedation and respiratory depression. Antiepileptic drugs, tricyclic antidepressants and topical meds are examples of what type of drug? Adjuvant analgesics Instead of pain drugs what can we do for the pt? apply heat, cold pressure massage PT Vibration therapeutic touch What are some things they do that are invasive to help with pain? nerve blocks spinal cord stimulation What are surgical techniques used for chronic pain? Rhizotomy Cordotomy What is the purpose of inflammation and immunity? Is to neutralize, eliminate or destroy invading organism or the antigen. Inflammation occurs how long after infection sets in? 24 hours Provides immediate, short term protection against the effects of tissue injury and foreign proteins. Inflammation The key function of inflammation is what? Phagocytosis Initiates both antibody and cell mediated immunity. Inflammation What type of damage can happen to the body from excessive inflammatory response? Tissue Causes visible symptoms and can rid the body of harmful organisms. Inflammation Infection is usually accompanied by what? Inflammation Can inflammation occur without invasion by organisms? Yes, inflammation does not always mean there is an infection. How many stages of inflammation are there? 3 What stage of inflammation is this? (Vascular) change in blood vessels (seconds to minutes) Phase I constriction Phase II hyperemia and edema (increased blood flow, plasma). Stage I What stage of inflammation is this? (cellular exudate hours after invasion) neutrophilia, pus. Stage II What stage of inflammation is this? (tissue repair and replacement) Stage III Name S&S of inflammation warmth redness swelling pain decreased function What gives you edema? plasma Do T-Cells secrete antibodies? NO First line of defense, phagocytosis, they mature in 12-14 days. It is involved in inflammation. Neutrophils Important in the immediate in inflammation response and phagocytosis. Predominantly in the liver and spleen, long life spans months to years. Macrophages Responsible for vascular leak syndrome, and has a role in Basophils clotting. What are the two types if immunity? Antibody-mediated (b-cells) Cell-mediated (t-cells) Where does b and t cells originate from? Bone marrow These things are stimulated by what? bacteria viruses fungi parasites drugs pollen and food Antigen stimulated T-Cells mature where? in the thymus B-Cells mature where? in the bursa These type of cells are protective against fungi, virus and some CA. T-Cells -stem cells in the bone marrow - Migrate into secondary lymphoid tissue (spleen, lymph nodes, tonsil and Peyer's patches of the intestinal tract) where the mature completely. -Provides long lasting immunity (memory cells) -Antibodies are called immunoglobulins and gamma globulins. -Neutralize, eliminate or destroy the antigen. -Transferable from person to person. Acquiring Antibody Mediated Immunity this antibody has to do with anaphalatic IgE Helps protect the body by differentiating self from nonself cells, non-self cells most easily recognized by cellmediated immunity are CA cells and those self cells infected by organisms that live within host cells (RBC's). *************Its function is to protect against CA cells and viruses, responsible for delayed hypersensitivity and transplant rejection. Cell-Mediated Immunity (t-cells) What are these types of? memory helper suppressor cytotoxic (killer) Natural killer cells Types of T-Cells At what age do we have all of our T-Cells? After puberty B-Cells protect against what? Bacteria Because the elderly has fewer B- lymphocytes what does this increase the chances of? Bacterial infections Because elderly have few TLymphocytes what does this increase their chances of having? Fungal infections a congenital disorder that causes the absence of serum Igs they can give them antibodies. X linked Agammaglobinemia of Burton A congenital disorder that causes the absence of cellmediated immunity. They can have a thymus transplant. Di George's Syndrome What is the last stage of a continuum of symptoms that result from HIV? Profoundly immunosuppressed HIV is classified according to clinical conditions and CD4+ counts what is the norm count? 800-1000 CD4+ cells/mm3 of blood What category of HIV is this: asymptomatic, persistent lymphadenopathy Category A What category of HIV is this: deficiency of cell mediated immunity Category B What category of HIV is this: The person had AIDS Category C Name the 3 top ways HIV is transmitted. 1. Sexual 2. Parenteral 3. Perinatal What is the top 2 ways a healthcare worker gets HIV? 1. needle stick. 2. infected through exposure of non-intact skin and mucous membranes to blood and body fluids. What is the name of the CA HIV patients can get? Kaposi's sarcoma, and malignant lymphomas they can also have endocrine complications Labs on some one with HIV: what would there WBC be? WBC=low CD4=low what would there CD4+ be? Medical Surgical ATI final re view What is the name of the antibody test done to see if pt has HIV? (ELISA). What is the test confirmed by? Enzyme-Linked Immunosorbent Assay Western blot 1. This test monitors disease progression in HIV? 2. This test determines presence of HIV? 1. Viral load 2. Viral culture Drug therapy does what to the virus? Inhibits, does not kill the virus. These are nrs dx related to what disease? -chronic low self esteem -social isolation -disturbed thought processes -diarrhea -impaired skin integrity HIV Is an altered immunologic reaction to an antigen and it results in a pathologic immune response upon re-exposure to the antigen. Hypersensitivity One of the 5 types of hypersensitivity Rapid hypersensitivity, IgEmediated reactions Type I One of the 5 types of hypersensitivity Tissue-specific reactions Type II One of the 5 types of hypersensitivity Immune-complex-mediated reactions Type III One of the 5 types of hypersensitivity Cell-mediated tissue reactions Type IV One of the 5 types of hypersensitivity Stimulatory Type V -This type of hypersensitivity is characterized by the production of IgE after exposure to an antigen. - caused by release of histamine. -Re-exposure produce severe allergic reaction. -Symptoms last about 10 minutes. -Peak 1-2 minutes. Type I Clinical Manifestations of what type of hypersensitivity? GI tract, the skin and the respiratory tract - Local anaphylaxis -Urticaria -Angioedema (cutaneous swelling) -Allergic rhinitis -Nasal and conjunctival discharge. Target tissues are those that contain a large amount. Type I Anaphylaxis of what type of hypersensitivity? -severe rx -rapid, systemic affecting multiple organs simultanously. Type I What should you do to prevent anaphylaxis? Avoid the allergen, do not choose epipen on the test A severe fall in systemic blood pressure during an anaphylactic reaction. Anaphylactic Shock Interventions for systemic anaphylaxis Name 9 things 1. Establish airway 2. Epinephrine 0.3-0.5ml 3. Antihistamine to treat angioedema/uticaria 4. Oxygen at 2-6 L/min 5. Aminophylline for bronchospasms it is a steroid pt needs to stay 24 hours. 6. ABG's 7. Pulse ox 8. Suction available 9. CPR may be necessary What type of hypersensitivity is this? -Antibody reacts with antigen on surface cells -Most common IgG and IgM -Involves activation of complement types: Hemolytic anemia (rapid break down of RBC) involves antibodies produced against RBC. -Transfusion reactions involves antibodies produced against donor blood cells. - erythroblastosis Fetalis involves maternal antibodies produced against fetal blood cells. ( Mom RH+ and Infant RH- Moms body thinks baby is foriegn and when she has a second baby it will die. They give the mom rogan. Type II AKA cytotoxic What would you consider to do with a Type II (cytotoxic) response? Plasmapheriesis to remove autoantibodies What type of hypersensitivity is this? -Antigens cause immune complexes to form in the blood. -Not organ specific, activates complement and mast cell degranulation-tissue and capillary damage. ex. serum sickness, glomerulnephritis, systemic lupus erythematous, rheumatoid arthritis. This is people who have antigen-antibody rx. Type III (immune complex rx) treatment is chemo, steroid, ASA This type of hypersensitivity does not involve antibodies, mediated by sensitized T lymphocytes. -delayed response (hoursdays) -ex. PPD for TB -contact dermatitis -poison ivy insect stings transplant rejections Type IV (cell mediated) This type of hypersensitivity is continous "turned on" state of cell -Inappropriate stimulation of normal cell surface receptor by autoantibody. -ex. graves disease (hyperthyroidism) -Interventions are surgical removal or radiate the thyroid. and immunosuppression of autoantibodies. Type V (stimulatory) This is an example of autoimmunity this is when all connective tissue becomes hard, there is no cure. Scleroderma Inappropriate immune response it is the breakdown of tolerance- antibodies are directed against healthy, normal cells. List 2 examples Autoimmunity 1. Rheumatiod arithritis 2. Rheumatic fever What are the interventions for autoimmunity? 1. Anti-inflammatory drugs 2. Immunosuppressive drugs 3. Symptomatic treatment Is Osteoarthritis inflammatory or non-inflammatory? What type of people do you see this in mostly? What joints does it typically effect? non-inflammatory obese people weight bering joints Clinical manifestations of what disease? -pain and stiffness in one or more joints (usually wgt bearing joints) -Joint enlargement (heberden's and Bouchard's nodes -Crepitus Osteoarthritis What is the treatment for Osteoarthritis? -minimize inflammation but preserve ROM (rest and exercise the joint) -Analgesics and anti-inflammatory drugs. ex. celebrex -surgery (joint replacement)