Exam #2

• Major
• Minor

• Elective
• Urgent
• Emergency

• Ablative
• Pallitative
• Diagnostic
• Constructive
• Reconstructive
• Cosmetic
• Restorative
• Procurement of Organs

• Bleeding disorders
• Diabetes mellitus
• Heart disease
• Liver disease
• Fever
• Heavy smoker
• Chronic respiratory disease
• Immunological conditions
• Abuse of street drugs
• Chronic pain

• Low BP
• Rapid HR
• Restlessness
• Moist skin (cold and pale)

• Hypovolemic
• Cardiogenic
• Septic
• Neurogenic

• Regional (spinal, epidural, peripheral block)
• General
• Local
• Conscious sedation

• Flat or to side (unless contraindicated)
• Administer antiemetic w/ persistent N/V
• Keep pt. warm
• Maintain airway. (SPIRO-CARE HOURLY )

• Alteration in comfort
• Impaired skin integrity
• Risk of ineffective airway clearance
• Risk for volume deficit
• Anxiety
• SCD: bathing and groomin

• abd. distention
• depression
• anxiety
• thrombophlebitis
• generalized muscle weakness

• Abd. distention
• Atelectasis
• Hyperstatic pneumonia
• Hypoxia
• Nausea
• Shock
• Urinary retention
• Wound hemorrhage

• Thrombophlebitis
• Wound infection
• Wound dehiscence
• Wound evisceration
• Pulmonary embolus
• Malignant hyperthermia

• Airway clearance, ineffective
• Breathing patterns, ineffective
• Constipation, risk for
• Coping, family, ineffective
• Fear or Anxiety
• Fluid volume deficit or excess, risk for
• Infection, risk for
• Mobility impaired, risk for
• Skin integrity impaired
• Knowledge deficit

• Planning starts early-starts at admission
• Plan on continuity of care
• Discharge instruction sheet
• Document how pt. went home
• Follow up

Surgical manipulation of bowel, swallowed air

Shallow breathing

Shallow resp. and fluid accumulation

• respiratory depressants
• mucus
• pain
• poor positioning

• medications
• eating or drinking before peristalsis returns

• loss of fluids and electrolytes
• VS instability
• trauma
• medications
• sepsis

• medications
• local edema
• positioning

• slipping of suture
• dislodged clot
• wound evisceration

• venous stasis
• irritation from IV needles
• blood clot

• poor technique
• "dirty" wound
• decreased immune system

• (seperation of wound edges)
• old age
• malnutrtion
• unusual strain

protrusion of abd. viscera through incision

• dyspnea
• tachycardia
• cough
• hemoptysis
• pleuetic pain

• Improve recognition and response to changes in pt's condition
• Hold a "Time out" before any procedure in the hospital
• A pre-op verification checklist is requires

• A specific item that can easily be measured in many hospitals.
• JCAHO uses this method in order to make valid comparisons between hospitals.
• Uses standardized sets of valid, reliable, evidence-based "core" measures that can be used to track progress in making hospitals safer for everyone.

• Surgical Care Improvement Project
• This project is a national quality partnership of organizations focused on improving surgical care.

• AKA- Propofol
• General anesthesia
• short-acting

• antiarrhythmics
• anticholinergic
• antimuscanarics
• Given pre-op to decrease oral/respiratory secretions
• Might increase HR

• antianxiety agent
• sedative/hypnotic
• benzodiazepines
• pre-op sedation, conscious-sedation, post-op amnesia
• short-term

• AKA- diazepam
• relief of anxiety
• sedation
• amnesia
• skeletal muscle relaxation
• decreased seizure activity

to manage nausea and vomiting

Management of moderate to severe pain

Used to control mild to moderate pain and/or fever

treatment and prophylaxis of various bacterial infections

• chemical modifications of the penicillin stucture.
• bactericidal

1st gen - used for skin/soft tissue infections. primarily active against gram-positive bacteria.

2nd gen - have increased activity against gram-negative micro-organisms and few cover anaerobes

More active against gram-negative bacteria. However, the 3rd gen is less effective against gram-positive cocci.

Has antimicrobial effects comparable to the 3rd gen. It has the advantage of coverage against many Pseudomonas species and activity against gram-positive pathogens.

• Are synthetic, broad-spectrum agents with bactericidal activity.
• The antimicrobial spectrum for fluoroquinolones includes gram-negative and positive aerobes.

They bind to opiod receptors and competively displace the opiod analgesics from their receptor sites.

• AKA - dolasetron
• Antiemetic

• AKA - prochlorperazine
• Antiemetic

• AKA - metoclopramide
• Antiemetic

• AKA - hydroxyzine
• Antiemetic

• AKA - trimethobenzamide
• Antiemetic

• AKA - ondansetrom
• Antiemetic

• AKA - naloxone
• Opioid antagonist

Analgesic

Analgesics

• AKA - Meperidine
• Analgesic

• AKA - hydromorphone
• Analgesic

• AKA - hydrocodone and acetaminophen
• Analgesic

• AKA - oxycodone and aspirin
• analgesic

• AKA - Oxycodone and acetaminophen
• Analgesic

• AKA - promethazine
• Analgesic

• AKA - nalbuphine
• Analgesic

• AKA - ketorolac
• Analgesic

• AKA - cefazolin
• 1st generation cephlosporins - antibiotic

• AKA - cephalexin
• 1st generation cephlosporins - antibiotic

• AKA - ceftriaxone
• 3rd generation cephlosporins - antibiotic

• AKA - levofloxacin
• fluoroquinolones

• AKA - ciprofloxacin
• fluoroquinolones

• 0-18 months
• Gender is assigned, genitals sensitive
• males may have erections
• females vaginal lubrication

• 1-5 years
• Identifies gender
• labels body parts correctly
• parent of opposite sex is focus of love

• 6-12 years
• Becomes curious about sex roles and reproduction
• friends are usually same sex

• 12-18 years
• sex characteristics develop
• friendships may include the opposite sex
• may engage in masturbation and sexual activity

• 18-65 years
• Establishes family to include sexual activity, values and family roles
• Between 40-65 hormone production decreased leading to climacteric in both sexes

• 65-death
• frequency of sexual activity decreases
• men and women experience altered sexual functioning

• acceptance of one's body image
• sexual identity
• self-concept

• "a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity"
• sexual intercourse
• refers to the physical part of a relationship, genital sexual activity
• gender/all developmental stages in life

FSH and LH stimulate the testes to release the male sex hormone, testosterone.

FSH and LH result in the production and release of mature egg cell and in the production of female sex hormones, estrogen and progesterone.

• environment
• illness
• medications
• surgery

the problem has existed most of the individuals adult life

• sexual problem is recent in origin
• HTN
• Painful intercourse due to vaginal lubrication

• sexual abuse
• inhibited sexual drive
• impotence
• ejaculatory dysfunction
• orgasmic dysfunction
• dyspareunia
• vaginismus

• Decrease in self esteem and in self confidence
• interpersonal relationships may be affected
• less emotional energy to concentrate on important aspects of daily living

The absence of germs or microorganisms

• Those actions designed to reduce the number of pathogens in an area and decrease the likelihood of their transfer.
• Use of technique of clean to dirty (hand washing, changing pt's bed, cleaning thermometer, ect)

• Actions to make or keep an object or person free of all microorganisms.
• Sterilization destroys all microorganisms and their spores.

• Hospital acquired
• Higher in critical care areas (sicker pts and more invasive procedures)

• Storage and handling of food
• Hand washing
• individual tooth brush, ect.
• immunizations
• covering cough or sneeze
• Precautions regarding sexuality
• keeping newborns out of crowds
• cleaning, dishwasher, laundry
• liquid soap, paper cups in bath room
• keeping contagious disesae people at home

• skin
• mouth
• eye
• respiratory tract
• urinary tract gastrointestinal tract
• vagina

• Infectious agent
• Reservoirs
• Portal of exit
• Means of transmission
• Portal of entry
• susceptible host

• disinfection
• sterilization
• disinfectant

• Good dressing techniques
• non contaminated water pitchers

• good hand washing
• good asepsis with dressings
• isolation techniques
• proper disposal of urine

• good care of skin and mucous membranes
• no contaminated food or food serving utensils

• identification of high risk pts
• assessment and maintenance of nutrition and fluid balance
• promoting therapeutic health habits
• admin meds and assessment of effects of medicaiton on pt's defense mechanisms
• supporting body's defenses

• Incubation - entering to 1st symptoms
• Prodromal - nonspecific to more specific
• Illness - specific to type of infection
• Convalescence - acute symptoms to good health

• vancomycin resistant enterococcus
• enterococcus bacterium that is resistant to the antibiotic vancomycin
• infected pts show clinical s/s
• colonized pts do not show s/s
• category - contact (and mask for respiratory tract symptoms

• causes pseudomembronous colitis
• may be due to antibiotic use
• primary symptom - diarrhea (stool sent to lab)

Antibiotics diminish normal colon flora and may result in overgrowth and release of toxins which injure mucosa

• Contact precautions
• May treat with oral flagyl or vancomycin
• Must wash hands with soap and water

• Methicillin Resistant Staphylococcus Aureus
• Staph bacteria have become resistant to various antibiotics including penicillin-related antibiotics

Precautions may be droplet, contact. ect. depending on where infection is

• indicates presence of bacteria but absence of signs and symptoms of infection
• once initial infection for MRSA and VRE is treated, patient can remain colonized for indefinite period of time

• The door must be closed at all times
• N95 particulate respirator mask (orange duckbill) MUST BE WORN BY ALL WHO ENTER

mask must be worn when working within 3 feet of the patient

• gloves upon entry to the room
• gown when you will be working directly with the patient

• cleansing
• disinfection
• sterilization

procedures used to reduce the number of microorganisms and prevent their spread

procedures used to eliminate all microorganisms including pathogens and spores

elimination of pathogenic organisms, with the exception of spores, on inanimate objects.

process of destroying all microorganisms, including spores

• 1. sterile object to sterile object
• 2. sterile object on sterile field
• 3. sterile object or field out of range of vision or an object held below person's waist is considered contaminated
• 4. contamination by prolonged exposure
• 5. wet = contaminated
• 6. fluid flows in the direction of gravity
• 7. edges of sterile field or container = contaminated

• autoclave (moist heat under pressure)
• used for surgical instruments

used in sterilizing drugs, plastics and food

• requires object to be in boiling water for at least 15 minutes
• bacterial spores and some viruses resist

used to sterilize rubber, paper, plastic items

used for instruments and equipment

• sterile dressing changes
• urinary catheter insertions
• preparing and administering injectable medications

• orderly and timely reparative process
• sustained restoration of anatomical and functional integrity
• caused by trauma from sharp object
• wound edges clean and intact

• not orderly and timely reparative process
• unsustained restoration of anatomical and functional integrity
• caused by friction, secretions, pressures
• wound edges may be necrotic, drainage maybe present

• skin edges approximated
• little loss of tissue
• low risk of infection
• healing is rapid and primarily by collagen synthesis

• Wound edges not approximated
• large and irregular
• involves loss of tissue
• takes longer to heal and has greater risk of infection
• (burns, pressure ulcers, severe lacerations)

Wound is initially left open and later closed

usually occurs within 24 to 48 hours

commonly occurs on 4th or 5th day with post-operative wound

before starting antibiotics

commonly 3 to 11 days

• medical emergency
• IMMEDIATE ACTION

• increases risk of infection
• fluid/electrolyte imbalance

protective response of body tissues to irritation or injury

infectious agent is living and growing in the tissues and overcomes the body's normal defenses

• fever
• tenderness
• pain
• elevated WBC
• purulent and odorous drainage

• age
• nutrition
• general health
• weight
• smoking
• oxygen availability
• drugs
• wound stress

• 1. size
• 2. appearance of tissue
• 3. edges appoximated
• 4.signs of inflammation or infection
• 5. amount of discharge with color and odor
• 6. discomfort
• 7. drains (hemovac, jackson-Pratt (JP), penrose)

• to protect wound from microorganism contamination
• promote healing
• support or splint the wound site
• promote thermal insulation of the wound surface
• provide maintenance of high humidity between wound and dressing

• Contact or primary layer
• Absorbent layer
• Outer protective layer

• Woven guaze sponges
• non-woven sponges
• non-adherent guaze
• self-adhesive
• transparent
• hydrocolloid
• hydrogel
• alginate

• dry
• wet to dry

• keep the ulcer bed continuously moist
• debridement
• type, size and depth of wound
• controlling exudate
• caregiver time
• area where wound is located
• hospital protocol

• Take meds exactly as prescribed
• evenly spaced intervals of dosing
• take medication for the full length of time prescribed or until all the drug is gone
• infection may return if the full course of therapy is not completed
• any leftover medication should be appropriately discarded
• provide list of adverse reactions, drug & food interactions