NURS 5010 Exam 1 Study Guide | Comprehensive Spring Prep Notes & Key Concepts

NURS 5010 Exam 1 Study Guide |
Comprehensive Spring Prep Notes & Key
Concepts

,Remember to think about prioritization when answering test question. When answering questions that
ask you to prioritize or choose what is most important or the priority care, select the option which has
the greatest potential to result in a negative outcome or is an indicator of a medical emergency as
describe in class and reading. Remember to focus teaching interventions on modifiable risk factors.

Surgery

1. Describethe nursingassessment andprioritiesofthepreoperativepatient.
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GOALS:

➢ Determinebaseline physiologic and psychological
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➢ Determinemedications taken by patient statusof patient: includingprescription Hx& OTC, Herbal:
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Vitamin E, which can increase bleeding, and St. John’s Wart which can affect anesthesia, and can block
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the effects of a lot of other medications pts may be taking like birth control and other SSRIs, Garlic,
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gingko and genzing can prolong bleeding
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➢ Determineamount&significanceof preoperative preparation
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➢ Identifycultural&ethnicfactorsthatmayaffect surgicalexperience
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➢ Reviewresultsofpreoperativediagnosticstudies
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ASSESSMENT:

PastHistory
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➢ ChronicConditions– HTN, diabetes?
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➢ PreviousSurgicalHistory j j




➢ Familyhistory-malignanthyperthermia: Hypermetabolismofskeletalmuscle hyperthermia,
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hypoxemia, cardiac alterations j j




➢ Allergies:
o Medications
o Food (Shellfish) j




o Chemicals (Iodine) j




o Latex
▪ Risk Factors: j




• ConcurrentFoodallergies:Thingsthatincreasethelikelihoodof j j j j j j j j j




latex allergies or additional allergies: avocados, guava, kiwi, j j j j j j j j




banana, water chestnuts, hazelnuts, tomatoes, potatoes, j j j j j j




peaches, grapes, and apricots (All of these can go hand and hand j j j j j j j j j j j j




with latex allergies) j j




• Frequentor prolonged exposure to latex j j j j j




o Symptoms:

, ▪ Skinredness,hives,rhinitis,conjunctivitis,
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asthma, anaphylaxis j




• Treatment:
o Removeoffendingmaterial j j j




ASAP

CurrentHistory
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➢ Health Perception-Health Management
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o Smoking history j




o Alcohol, drug use j j




o Medications
o Herbal products j




o Health care expectations j j




o Durable power of attorney j j j




➢ Nutritional/Metabolic
o Height & weight j j




o Woundhealing(poor?) j j




o Dentures,removalbridge/plate j j




o Dentures Found Post-Op j j




• Are they taking warfarin or insulin? Can make pt bleed more j j j j j j j j j j j




duringsurgery.Ifinsulin,maywanttoholdthatmedicationtil j j j j j j j j j j j




after surgery j




Functional Health Patterns
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➢ Activity-Exercise
o BaselineBP,Pulse,RR,EKG,pulseox(O2) j j j j j j j




o Lung sounds j




o EKG
o Limited mobility? j




➢ Cognitive-Perceptual
o A&O X3 j




o Glasses,contacts, hearingaids, dentures
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o Painrelief j




➢ Sexuality-Reproductive
o Possibilityof pregnancy (anyone with a uterus, nomattergender)j j j j j j j j j




➢ Value-Belief
o Value conflict j




o Request for visit with religious advisor j j j j j




NursingAssessmentofpreoperativepatient:Physical(HeadtoToe)***
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, • CV – 12 lead ECG, venous thromboembolism prophylaxis, coagulation studies to know how
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quickly they will bleed j j j




• Respiratory: auscultate lungs, encourage smokers to stop smoking 6 weeks before surgery =
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decrease the risk for complications, sleep apnea, obesity, airway deformities that can affect
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respiratory function and intubation, see if they have an acute infection
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• Nervous:visionor hearing loss,aretherecognitive deficitsthatcanaffectinformed consent (esp.
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in older adults), cognitive status before surgery b/c added stresses in surgery can contributed
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to an alerted delirium post-op = need to know baseline before surgery
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• GI/GU: F&E imbalances, N/V?, are they at risk for that during surgery?, NPO before surgery to
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decrease risk of N/V, baseline elimination? Toilet, bedpan?
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• Integumentary(SKIN): pressureinjuriesalready?,lookfortattoos&piercing(nometal), old j j j j j j j j j j j j j




tattoos have metal in them (can cause fire in OR)
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• MSK: identifyjointsaffectedwitharthritis&mobilityrestrictionsthatmayaffectpositioningand
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ambulation pre and post-op j j j




Immediate Preoperative phase:
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• SameDay Surgery Nurse j j j




• Admits the patient on the day of surgery. j j j j j j j




• Reviews&Updates Assessment j j j




• Verifiesanyabnormalresultsfrom assessment j j j j j




• Allergies
• Jewelryandtattoocheck j j j




• Transfusionreactions–previousreactions,transfusionreactions j j j j j j




• Helpthem use the restroom prior to administering any sedation
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• Pre-oppreparation j




• - Last food/ drink? When’s the last time?
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• Clear liquids to sips (2 hrs), breast milk (4 hrs), nonhuman milk
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containingformula(6hrs),light meal(6 hrs),regularmeal(8 hrs) j j j j j j j j j j j




• - Meds taken
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• Timingof pre-op medications is really important j j j j j j




• - Enemas/ laxatives
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• Completespre-opchecklist j j




• Reviews&Updates Assessment j j j