Nur103 test 2

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Nur103 test 2
2012-03-28 15:54:55
perioperative nursing care

knowledge nurses need for perioperative care
Show Answers:

  1. How are surgeries classified?
    • purpose
    • urgency
    • risk
  2. What is diagnostic surgery?
    Give some examples
    • Determine or confirm a diagnosis
    • Breast biopsy
    • bronchoscopy
  3. What is ablative surgery?
    Give some examples.
    • Remove diseased tissue, organ, or extremity Appendectomy
    • amputation
  4. What is constructive surgery?
    Give some examples.
    Build tissue/ organs that are absent (congenital anomalies) Repair of cleft palate
  5. What is reconstructive surgery?
    Give some examples.
    • Rebuild tissue/ organ that has been damaged
    • Skin graft after a burn,
    • total joint replacement
  6. What is palliative surgery?
    Give some examples.
    • Alleviate symptoms of a disease (not curative)
    • Bowel resection in patient with terminal cancer
  7. What is transplant surgery?
    Give some examples.
    • Replace organs/ tissue to restore function
    • Heart, lung, liver, kidney transplant
  8. Name the 6 purposes of surgery.
    • Diagnostic
    • Ablative
    • Pallitive
    • Constructive
    • Reconstructive
    • Transplant
  9. Name 2 classes of surgical risk.
    • minor
    • major
  10. Decribe minor surgery.
    Give some examples.
    • Minimal physical assault with minimal risk
    • Removal of skin lesions,
    • dilation and curettage ( D& C),
    • cataract extraction
  11. Describe major surgery.
    Give some examples.
    • Extensive physical assault and/ or serious risk
    • Transplant,
    • total joint replacement,
    • thoracotomy,
    • colostomy,
    • nephrectomy
  12. Describe elective surgery.
    Give some examples.
    • Suggested, though no foreseen ill effects if postponed Cosmetic surgery,
    • cataract surgery,
    • bunionectomy
  13. Describe urgent surgery.
    Give some examples.
    • Necessary to be performed within 1 to 2 days
    • Heart bypass surgery,
    • amputation resulting from gangrene,
    • fractured hip
  14. Describe emergency surgery.
    Give some examples.
    • Performed immediately
    • Obstetric emergencies,
    • bowel obstruction,
    • ruptured aneurysm,
    • life- threatening trauma
  15. What is informed consent?
    Informed consent is disclosure of risks associated with the intended procedure or operation to the patient.
  16. Who is responsible for optaining informed consent?
    The surgeon.
  17. What is the nurse's responsibility r/t informed consent?
    • Witness the signing,
    • answer the pt's questions
    • assess whether the pt is understanding the procedure
    • inform the surgeon if there are questions or doubts
  18. What things should the pt understand when siging informed consent forms?
    • Need for the procedure in relation to the diagnoses
    • Description and purpose of the proposed procedure
    • Possible benefits and potential risks
    • Likelihood of a successful outcome
    • Alternative treatments or procedures available
    • Anticipated risks should the procedure not be performed
    • Physician’s advice as to what is needed
    • Right to refuse treatment or withdraw consent
  19. For an adolescent, what are some surgical risks?
    • Diversity in age and physical, cognitive, and psy-chologic maturation makes preparation for surgery vary in content and inclusion of significant others.
    • Increased need for control, privacy, and peer inter-action poses special challenges in the acute care setting.
  20. For an older adult, what are some surgical risks?
    • related changes that affect physiologic, cognitive, and psychosocial responses to the stress of surgery;
    • decreased tolerance of general anesthesia and postoperative medications;
    • delayed wound healing.
  21. What are some surgical risks associated with malnutrion?
    • Reserves may not be sufficient to allow the body to respond to surgery;
    • organ failure and shock
    • Increased metabolic demands may result in poor wound healing and infection.
  22. What are some surgical risks associated with obesity?
    • delayed wound healing,
    • wound dehiscence,
    • infection,
    • pneumonia,
    • atelectasis,
    • thrombophlebitis,
    • dysrhythmias,
    • heart failure.
  23. What are some surgical risks associated with poverty?
    • limited access to health care, pathology may be more advanced at diagnosis
    • Greater risk of exposure to hazardous waste
    • emotional stress
    • poor nutrition
    • lack of exercise
    • poor social support systems
  24. What are some surgical risks associated with alcoholism?
    • malnourished
    • experience delirium tremens
    • more general anesthesia may be required
    • hemorrhage and delayed wound healing can result from liver damage and poor nutritional status
  25. What are some surgical complications r/t arthritis?
    Inflammation or degenerative changes in joints limits mobility and comfort
  26. What are some surgical risks r/t cardiac disease?
    • increased risk of heart failure,
    • hemorrhage and shock,
    • hypotension,
    • venous thrombosis,
    • pulmonary embolism,
    • stroke (especially in the older patient),
    • fluid volume overload.
  27. What are some surgical risks r/t diabetes?
    • increased risk for fluctuating blood glucose levels, hypoglycemia
    • ketoacidosis
    • increased risk for cardiovascular disease,
    • delayed wound healing,
    • wound infection.
  28. What are some surgical risks r/t a suppressed immune system?
    impaired ability to resist infection and promote tissue repair.
  29. What are some examples of things that cause an impaired immune system?
    • Advanced age
    • HIV
    • autoimmune diseases
    • chronic pain
    • immune deficiency diseases
    • malnutrition
    • splenectomy
    • alcohol abuse
  30. What are some surgical risks r/t smoking?
    • increased risk for respiratory complications:
    • pneumonia
    • atelectasis
    • bronchitis
    • because of increased mucous secretions and a decreased ability to expel them.
  31. What are some surgical complications r/t renal and liver disorders?
    • poorly tolerate general anesthesia
    • have fluid/ electrolyte imbalances
    • acid– base imbalances
    • decreased metabolism and excretion of drugs
    • increased risk for hemorrhage
    • delayed wound healing.
  32. What are some risk complications r/t respiratory disorders?
    • bronchitis,
    • atelectasis,
    • pneumonia
    • Respiratory depression from general anesthesia and acid– base imbalance
  33. What is a common nursing diagnosis r/t informed consent?
    understands the procedure
  34. What is medical asepsis (clean)? When is it used?
    • reduces number of pathogens
    • referred to as clean techniques
    • used in administration of medications
    • enemas
    • tube feeding
    • daily hygiene
    • handwashing is number 1
  35. What is surgical asepsis (sterile)?
    When is it used?
    • eliminates all pathogens
    • referred to as sterile technique
    • used in dressing changes
    • catheterizations
    • surgical procedures
  36. What are some pre-op interventions?
    • medical clearance
    • labs
    • sometimes need blood,
    • cross matched and typed
    • how long has the patient been NPO
    • scrubbing or showering, or shaving
    • prophylactic antibiotic
  37. When should a nurse do client teaching? Why?
    Before the medications are started. After the surgery, the anesthesia will make the pt too drowsy to learn.
  38. What are some things a nurse should be teaching a pre op pt?
    • will there be a drain
    • how much pain to expect
    • how much what kind tubes, iv, o2
    • not allowed to get out of bed alone
    • coughing deep breathing
    • anti embolism thingies,
    • stockings,
    • pulses, etc,
    • leg exercises,
    • early ambulation,
  39. Name some possible members of a surgical team.
    • surgeon
    • first assist
    • anesthesiologist
    • holding area nurse
    • circulation nurse
    • scrub nurse or tech
  40. Name some methods that assure client safety during surgery.
    • control traffic flow
    • zones
    • surgical scrub
    • time out
    • sponge and instrument count
  41. Describe the zones around the surgery room.
    • 1. unrestricted zone
    • street clothes
    • 2. semi restricted
    • scrub clothes
    • 3. restricted
    • sterile, mask, gowns, etc.
  42. Describe surgical scrub.
    • 1. 5-10 min. hand washing
    • 2. no jewerly
    • 3. sterile drapestime
  43. What is surgical time out?
    • Everything stops as the patient is identified,
    • what is going to be done and where, and
    • positioning w/ documentation
  44. What are some reasons for OR protocols?
    • maintain standards
    • safety of pt
    • prevent infection
    • maintaining sterile field
  45. What is anesthesia?
    artificially induced state of partial or total loss of sensation, occurring with or without LOC
  46. What is general anesthesia?
    • central nervous system depression
    • unconscious
    • no pain
    • no memory
    • skeletal muscles relax
    • reflexes diminish
  47. What are some advantages of general anesthesia?
    • rapid excretion of anesthesia
    • quick reversal of effects when wanted
    • used with all age groups
    • used with all types of surgery
  48. What are some disadvantages of general anesthesia?
    • Risks associated with impaired systems:
    • circulatiory
    • respiratory
    • renal
    • hepatic
  49. What are the 3 phases of general anesthesia?
    • 1. induction
    • 2. maintenance
    • 3. emergence
  50. What is regional anesthesia?
    Medicine is instilled around the nerves of a particular region of the body. The nerves can't send impluses to the brain. The pt is conscious but can't feel pain.
  51. What are 3 types of regional anesthesia?
    • 1. local nerve inflitration
    • 2. nerve blocks
    • 3. epidural blocks
  52. Explain local nerve inflitration.
    limits feeling in a small part of the body for stitches, biopsy, etc.
  53. Explain a nerve block.
    anesthesia is injected into the nerve trunk to numb a larger part of the body such as an extremity
  54. Explain an epidural block.
    Anesthesia is injected directly into the spinal cord. Safer than general anesthesia.
  55. What is conscious sedation?
    Moderate sedation to block sensations but the pt is still conscious. Pt can respond to directions.
  56. What are nine steps in anesthesia/surgery?
    • 1. give pt a sedative
    • 2. patient receives the anesthetic agent intravenously or by inhalation
    • 3. maintain airway
    • 4. surgery is done, anesthesia is maintained, vitals monitored
    • 5. anesthesia withdrawn or drugs reversed
    • 6. pt begins to awaken
    • 7. pt breathes on own
    • 8. extubation
    • 9. pt goes to PACU
  57. What are some possible nursing dx during surgery?
    • high risk of injury r/t postioning
    • fluid volume defict
    • high risk for infection
    • fear and powerlessness
  58. What are some important things to report to PACU
    • loc/alertness
    • allergies to meds
    • type of surgery done
    • how long it lasts
    • how it was tolerarted
    • limb immobility
    • language
    • location of incision drains, how many where complications
  59. What does the PACU nurse need to monitor/assess?
    • stable VS
    • pulse ox,
    • temp
    • standing order for o2
    • overt bleeding
    • bleeding on the dressing,
    • amount of drainage in the drain,
    • return of gag reflex
    • airway patency
    • suction equip,
    • adequate repirs
    • nasal canual, face mask,
    • intubation
    • peripheral circulation
    • cap. refill
    • fluid volume
    • loc
    • pain (usually not in the PACU)
    • N/V
  60. What are some post op nursing dx?
    • urinary retention
    • ineffecite airway clearance
    • constipation
  61. What is dehiscence?
    separation or splitting open of layers of a surgical wound, nothing comes out
  62. What is evisceration?
    extrusion of viscera or intestine through a surgical wound
  63. What are some nursing interventions that prevent complications?
    • monitor vital signs
    • inspect the incision
    • locate drain cath
    • ask about pain
    • make sure of coughing, deep breathing,
    • maintain suction
    • assess dressings,
    • assess/measure drainage
    • administer analgesia
    • client and family teaching
    • progressive activity
    • continue discharge planning