Medical-Surgical Nursing Exam #1 with verified solutions already graded a+.

- Identify patients correctly - Improve staff communication - Use medicines safely - Use alarms safely - Identify patient safety risks - Prevent Infection - Prevent mistakes in surgery What Are the 2017 Hospital National Patient Safety Goals? - Diagnosis (Yes or No) - Exploration (Find Problem) - Cure (Remove/Fix) - Prevention (Early Stages) - Palliation (Dying, Hospice, Comfort, No Cure) - Cosmetic Improvement (Burns, Mastectomy, Reconstruction) What Are the Purposes of Surgery? 1.) Preoperative (Until the OR) 2.) Intraoperative (Inside OR) 3.) Postoperative (PACU) What Are the Three Surgical Phases? A planned surgery Ex: Knee replacement What is Elective Surgery? Unplanned Ex: Burst appendix What is An Emergency Surgery? Inpatient - Same day admission Outpatient (Ambulatory) - Leave hospital when recovered and awake Inpatient vs. Outpatient - Knowledge of the nature of the disorder - Determine the client's response to the stress of surgery - Assess the results of preoperative diagnostic tests (Look at lab tests) What does the patient know, why are they here Nursing Management of the Surgical Client 1.) Purpose: Where is the patient at mentally, most anxious, take vitals after a little while, reassurance 2.) Check documented information prior to the interview (Avoids repetition; see how nervous) 3.) Occurs in advance or on day of surgery Preoperative: Client Interview 1.) Health Hx 2.) Medication Hx (Prescription and OTC) 3.) Diagnostic Testing 4.) Psychosocial Factors (Spiritual/Cultural) Stop taking Ibuprofen before, stop smoking, when they last ate, etc Preoperative: Client Assessment - Psychosocial Assessment (Age, Current health) - Influencing Factors Fears: Past experiences, death, complications, disfigurement, disruption of life, disability, viruses, needles, etc. Pain: Pain medication and management Hope: To be cured, do not take away hope Stress raises glucose levels; always ask about pain Identify caregivers, also the patient must know what is happening What Subjective Information is Important from the Preoperative Client Interview? Anxiety can arise from: - Lack of knowledge (More they know the better, use layman's terms) - Unrealistic expectations (I will have this surgery and be fine) - Information lessens anxiety Anxiety & Nursing Assessment - Health Hx - Family Diseases (Anesthesia problems/malignant hypothermia) - Previous and Current Diagnoses medical conditions - Previous surgeries or problems - Menstrual/Obstetric History (Pregnant?) - Current Medications - Drug Intolerance (Allergies/Adverse Rxn) Preoperative Nursing Assessment - Physical Exam - Lab Diagnostic Testing - Document Relevant findings and report to the perioperative team Always have a CBC; electrolytes, blood sugars, EKG, Chest X-Ray, etc. Know the normal labs, LOW PLATELETS IS A BIG DEAL What Objective Information is Important from the Preoperative Client Interview? - Heart rate, blood pressure, skin color, sounds, capillary refill, edema, history of heart attack or cardiac problems, blood clots in legs? REPORT: Any cardiac problems so they can be monitored during the intraoperative period. The use of cardiac drugs, and the presence of a pacemaker/ICD (Implantable Cardioverter Defibrillator) Cardiovascular System Objective Data - Respiratory rate, lung sounds, O2 Saturation REPORT: History of dyspnea, coughing, or hemoptysis (Blood) - COPD or Asthma (High risk for atelectasis and hypoxemia) - Smokers (Encourage to quit) Respiratory System Objective Data: - Level of Consciousness, can they follow commands, sight, hearing - Evaluation of neurological functioning (Vision or hearing loss can influence results) - Cognitive function (Determine if any deficits are present) Nervous System Objective Data: - Kidney problems, frequency of urination, urgency, blood, period - History of renal diseases - Assess BUN, Creatinine, Specific Gravity Renal Dysfunction contributes to: - Fluid and electrolyte problems - Altered response to drugs - Increased risk of infection Genitourinary System Objective Data: - Jaundice, Ascites - Liver involved in drug metabolism and clotting - Hepatic dysfunction may increase risk of postoperative complications Hepatic System Objective Data: - Ulcers - History of skin and musculoskeletal problems (Arthritis, stroke deficit problems, ask the patient if they are comfortable) - History of pressure ulcers (Vulnerable) Integumentary System Objective Data: - Arthritis (Changes in knuckles, if their head needs to be put back, bring mobility aid) - Cannot flex lumbar spine Musculoskeletal System Objective Data: - Clients with Diabetes Mellitus are especially at risk for delayed healing time, changes in blood sugar, higher risk for infections - Clients with thyroid dysfunction have an altered metabolic rate - Clients with adrenal insufficiency (Addison's Disease) also do not heal as well; sterioids Endocrine System Objective Data: - Auto-Immune Disorders - Will not heal as well - Clients with a history of compromised immune system or use of immunosuppressant drugs can have infections and delayed healing Immune System Objective Data: - Assess Electrolytes - Use of diuretics (Evaluate serum electrolyte levels; can alter K+) - NPO Status (Dehydrated) - Critical assessment for older adults because they have a reduced adaptive capacity Fluid and Electrolyte Balance Objective Data: - Obesity can change incisions; changes medications, dehiscence is more likely - Underweight clients may have healing issues, as well as bony prominences - Dietary habits that may affect recovery (Caffeine) Nutritional Status Objective Assessment: The Joint Commission (TJC) requires a history and a physical - Preoperative teaching - Client has the right to know what to expect and how to participate - Limited time available, address needs of highest priority Preoperative Nursing Management 1 Sensory: Hear/See/Smell/Feel Process: What is being done, more info Procedure: How they are doing all the work Three Types of Information - Time and place - Fluids and food restrictions (Do not want to throw up) - Need for shower - Anesthesiologist makes decision about insulin MOST CAREFUL DOCUMENTATION TAKES PLACE IN THE OR Basic Information Before Arrival - Teach deep breathing, coughing (expand and clear out their lungs), incentive spirometry (IS) and early ambulation to prevent blood clots - Pain management plan (Practice pain assessment scale, and discuss coping strategies for anxiety relief - Post op tubes, drains, etc - Surgery specific information Preoperative teaching All required forms are signed and in the chart: - Informed consent - Blood transfusions - Advanced Directives; DNR, etc - Power of attorney or Health Care Proxy Legal Preparation for Surgery Informed Consent Includes: - Adequate disclosure, understanding and comprehension, voluntarily given consent - Surgeon is responsible for obtaining consent - Nurse may obtain and witness the signature - Consent for surgery and anesthesia Emergency surgery may override need for consent - Legally appointed representatives of family may consent if the client is: A minor, unconscious, or mentally incompetent Consent for Surgery - Final preoperative teaching - Assessment and report of pertinent findings - Verify signed consent - Labs - History and physical examinations - Baseline vitals - Consultation results - Nurse's notes (Documentation) - Client should not wear cosmetics - Dentures, contacts, prostheses are removed - Identification and allergy bands on wrist - Void before surgery to: Prevent involuntary elimination under anesthesia or during early postoperative recovery; before medication administration Day-of-Surgery Preparation Oral and respiratory secretions dry up!!!! Atropine - ectomy: excision or removal of - lysis: destruction of - orrhaphy: repair or suture of - oscopy: looking into - ostomy: creation of opening into - otomy: cutting into or incision of - plasty: repair or reconstruction of Suffix meanings - Anesthesia - Pharmacology - Surgery - Surgical Interventions Intraoperative Nursing Care Requires the Understanding of? - Opthalmology - Gynecology - Plastic Surgery - Otorhinolaryngology - Orthopedic Surgery - General Surgery (Ex: Hernia Repair) What Specialties Have the Highest Number of Surgical Clients?