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when your teaching your pt. about an upcoming outpt. surgery, as a nurse, what kinds of things do you concentrate on?
- preoperative teaching:
- instruct the client not to smoke for at least 24 hrs before surgery.
- instruct the client to refrain from aspirin, selected vitamins, & complementary therapies unless approved by the surgeon.
- teach client deep breathing & coughing techniques, & use of the incentive spirometer to prevent pneumonia & atelectasis (partial collapse of a lung).
- teach the client leg & foot exercises to prevent venous stasis & to facilitate venous return.
- teach client how to turn & reposition.
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who's job is it to discuss the risks w/ surgery?
the surgeon (physician) is responsible for obtaining informed consent.
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who's job is it to discuss the type of anesthesia that will be used in surgery?
- anesthesiologist (physician)/certified registered nurse anesthetist (CRNA)
- *circulating nurse assists anesthesia provider w/ induction of anesthesia
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what is the most important thing that a nurse should teach the pt. in a pre-operative plan?
psychosocial: ask the client about questions or concerns he/she may have about surgery.
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pt. is about to undergo general anesthesia, what is the greatest risk factor for this pt. from the following:
the pt. smoked a cigarrette in the last 12 hrs
the pt. has a hx of HTN controlled by meds
the pt. has anxiety about the procedure
the pt. ate < 3 hrs ago
the pt. ate < 3 hrs ago (should've been 6-8 hrs ago).
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who has the capacity to give consent?
- client (age 18 or >)/legal guardian.
- *pregnant minor/in the military?
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what does informed consent mean?
consent implies that the client has been given sufficient info to understand the following: nature & reason for surgery, who will be performing the surgery & whether others will be present (students), all available options & risks associated w/ the options, risks associated w/ surgery & anesthesia.
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while a pt. is recieving a pre-operative enema, the pt. starts to cry & say, "i'm so sorry, you have to do this messy thing". which of the following would be the best response:
"i don't mind a bit"
"this is part of my job"
"nurses get use to this"
"you seem to be upset"
"you seem to be upset"
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a pt. is having an exploratory laporatomy done in the abd, which order would be of highest priority?
walk the pt. down the hallway 2 times a day
document the hgb & hct lab results on the OR checklist
prepare injections
client has pre-operative physohex
client has pre-operative physohex--instruct the client to shower w/ an antiseptic solution such as hexachlorophene (pHisoHex)/providone-iodine (Betadine)
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if a pt. asks, "what exactly am i going to have done in surgery". what would be the best response?
ask the pt. what the surgeon explained/told them.
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what kind of preoperative care is done to prevent infection?
skin preparation: client may be asked to shower w/ an antiseptic solution such as providone-iodine (Betadine)/hexachlorophene (pHisoHex); shaving may be ordered using sterile supplies & aseptic principles only in the preoperative holding area/the OR; shaving is thought to decrease bacterial count & reduce the chance for infection.
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what would be your priority pre-operatively for a pt. having total knee replacement?
- pre-operative data collection: sensitivity/allergy to certain substances such as providone iodine for skin cleansing/latex allergy may alert to possible reaction to agents/substances used before/during surgery.
- pre-operative teaching: surgery will be painful but pain medication will be prescribed & given as the client requests.
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which of the 2 would be a higher priority?
identifying the pt.
finding out about allergies
- identifying the pt.
- *then find out about what kind of surgery the pt. is having.
- *then check that the consent reflects exactly what kind of surgery the pt. is having (ex: which part/side of the body).
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what are some risk factors for aspiration during & after surgery?
- if the pt. had something to eat < 6 hrs ago prior to surgery
- loss of gag-reflex (during/after surgery)
- how the pt. is positioned (ex: trendelenburg)
- obesity (enlarged abd, puts pressure on diaphragm)
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what is malignant hyperthermia?
- rare genetic disorder that is most common in young adult males--it is an inherited muscle disorder that can cause skeletal muscle contractions, hyperthermia, & CNS damage when exposed & triggered by the use of certain anesthetics.
- *those w/ a genetic predisposition are at a high risk for this complication from halothane, enflurane, isoflurane, desflurane, sevoflurane, & succinylcholine.
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how can you tell if someone is at risk for malignant hyperthermia?
- (obvious) if it occurs during surgery.
- if pt. had past complications w/ anesthesia from prior surgeries.
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a pt. is undergoing a conscious sedation, what is the most important parameter that should be monitored?
pt's level of consciousness.
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who can administer general anesthesia?
- anesthesiologist.
- CRNA (certified registered nurse anesthetist).
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when is the most dangerous stage of inducing anesthesia to a pt.?
- stage 2--excitement, delirium
- -begins w/ loss of consciousness & ends w/ relaxation, regular breathing, & loss of eye reflex.
- -client may have irregular breathing, increased muscle tone, & involuntary movements of the extremities due to systemic stimulation.
- -laryngospasm/vomiting may occur.
- -client is susceptible to external stimuli.
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when does the pre-operative phase start & end?
the time from the decision for surgery to transfer to the pre-operative area.
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when does the intra-operative phase start & end?
the time in the OR.
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when does the post-operative phase start & end?
the time of transfer of the client to the postanesthesia care unit (PACU).
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what is the purpose of sending a pt. to a PACU unit/specialized post-operative unit?
the purpose of a PACU/recovery room is the ongoing evaluation & stabilization of clients, to anticipate, prevent, & tx complications after surgery.
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what is the highest priority during post-anesthesia?
- during the immediate post-operative stage, maintaining airway patency & ventilation are main priorities of care.
- *clients who have recieved general anesthesia need frequent assessment of their respiratory status.
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what would be sign of a compromised airway post-operatively?
- continually monitor for airway patency & adequate ventilation--check for snoring & stridor.
- *anxiety.
- *restlessness.
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a pt. has a compromised airway & is still unconscious (recovering). how do you open airway/what mechanism do you use?
head-tilt jaw-lift (unless they had neck surgey).
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which of the following measures could the nurse include in the plan of care to help reduce the clinical manifestations of laryngospasm (when the larynx goes into spasm)?
- skeletal muscle relaxant like succinylcholine (Anectine) may be used to relaxe the larynx in post-operative laryngospasm.
- *other muscle relaxants:
- -atracurium (Tracrium)
- -cistatracurium (Nimbex)
- -doxacurium (Nuromax)
- -mivacurium (Mivacron)
- -pancuronium (Pavulon)
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what position would you put a pt. in post-operatively to drain secretions?
laterla/side-lying position.
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if you are monitoring a pt. post-operatively who has an ineffective thermoregulation. what are you going to monitor?
temp.
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a pt. becomes hypothermic post-operatively, what do you do?
- warm fluids/baths.
- take off wet/cold clothing they may have.
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a pt. was induced general anesthesia, which of the following observations would be reported immediately?
pt. c/o nausea
mild HTN
decreased urine output
an increase in body temp.
an increase in body temp. (could lead to malignant hyperthermia).
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what characteristics should you chart concerning drainage? "SLACC"
smell,location of where drainage is coming from (dressing, wound vac, jackson-pratt, penrose drain), amount, color, consistency.
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how much blood can be lost before a pt. can become hypotensive?
1/5 or (20%) or 500 mL.
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a pt. is c/o pain after having abd surgery. what should your response be?
describe the pain--COLDSPA (characteristic, onset, location, duration, severity, pattern, association)
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after asking the pt. who is c/o pain after an abd surgery to describe the pain. what should be your next priority?
check VS (if it's not good, may have to alter the meds that will be given).
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pt. had surgery for a hip fx, you gave him morphine 1 hr ago & the pt. is still c/o pain. describes pain is 3-4. what should you do?
re-position the pt.
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what is important to teach about CVA pump?
- don't let anyone else push the button.
- when you feel pain, just push the button.
- *do not mistake the CVA pump for the call light.
- pt. cannot OD/get addicted to the med.
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what is the most common complication following a spinal anesthesia?
headache.
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what electrolyte is depleted during a prolonged surgery?
potassium.
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a pt. is told they need to stay in bed post-operatively, what do you teach them to do?
leg exercises.
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to minimize orthostatic hypotension, how should you have the pt. move?
- rise slowly from a lying position.
- sit on the edge of the bed & dangle before standing.
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pt. came in post-operatively after an abd surgery c/o a pop & gush of warm fluid that looks like serous sanginous fluid. what do you suspect?
- wound dehisence (partial/complete separation of the outer wound layers).
- *client feels a pull/give/pop; sudden gush of serosanguineous drainage (pink).
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what do you do to a pt. w/ a wound dehiscence?
- place the pt. in a supine position w/ hips/knees bent.
- cover w/ sterile moist saline dressing; notify MD & contact surgical team.
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you are emptying a jackson-pratt, how full should it get before emptying it?
1/3 to 1/2 full.
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when putting the jackson-pratt back together, what should you do?
deflate it before accessing the port again.
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a pt. has been on a prophylactic antibiotic, how do you know its not effective?
WBC's is elevated.
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