Card Set Information
Surg pt elimination med asepsis surg asepsis sexuality
Surg pt.,elimination, med.asepsis, surg. asepsis, and sexuality
Sx Classifications: Seriousness
Sx Classifications: Urgency
Sx Classifications: Purpose
Procurement of Organs
Chronic respiratory disease
Abuse of street drugs
Symptoms of Shock
Moist skin (cold and pale)
Types of shock
Types of anesthesia
Regional (spinal, epidural, peripheral block)
Flat or to side (unless contraindicated)
Administer antiemetic w/ persistent N/V
Keep pt. warm
Maintain airway. (SPIRO-CARE
Possible Post-op Nursing Diagnosis
Alteration in comfort
Impaired skin integrity
Risk of ineffective airway clearance
Risk for volume deficit
: bathing and groomin
What is early ambulation helpful for?
generalized muscle weakness
Some early post-op complications
Some later post-op complications
Overall possible Surg pt. Nursing diagnosis
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
Planning starts early-starts at admission
Plan on continuity of care
Discharge instruction sheet
Document how pt. went home
Causes of abdominal distention?
Surgical manipulation of bowel, swallowed air
Symptom of atelectasis?
Symptoms of hypostatic pneumonia?
Shallow resp. and fluid accumulation
Reasons for hypoxia?
Reasons for nausea?
eating or drinking before peristalsis returns
Reasons for shock?
loss of fluids and electrolytes
Reasons for urinary retention?
Reasons for wound hemorrhage?
slipping of suture
Reasons for thrombophlebitis?
irritation from IV needles
Causes of wound infection?
decreased immune system
Causes of wound dehiscence?
(seperation of wound edges)
What is wound evisceration?
protrusion of abd. viscera through incision
Symptoms of pulmonary embolus?
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
What is a core measure?
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.
What is SCIP?
Surgical Care Improvement Project
This project is a national quality partnership of organizations focused on improving surgical care.
Given pre-op to decrease oral/respiratory secretions
Might increase HR
pre-op sedation, conscious-sedation, post-op amnesia
relief of anxiety
skeletal muscle relaxation
decreased seizure activity
What do antiemetics generally do?
to manage nausea and vomiting
What do opiod analgesics generally do?
Management of moderate to severe pain
What do non-opiod analgesics generally do?
Used to control mild to moderate pain and/or fever
General use of anti-infectives?
treatment and prophylaxis of various bacterial infections
What are cephalosporins?
chemical modifications of the penicillin stucture.
1st generation cephalosporin?
1st gen - used for skin/soft tissue infections. primarily active against gram-positive bacteria.
2nd generation cephalosporin?
2nd gen - have increased activity against gram-negative micro-organisms and few cover anaerobes
3rd generation cephalosporin?
More active against gram-negative bacteria. However, the 3rd gen is less effective against gram-positive cocci.
4th generation cephalosporin?
Has antimicrobial effects comparable to the 3rd gen. It has the advantage of coverage against many
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.
What do opioid antagonists do?
They bind to opiod receptors and competively displace the opiod analgesics from their receptor sites.
AKA - dolasetron
AKA - prochlorperazine
AKA - metoclopramide
AKA - hydroxyzine
AKA - trimethobenzamide
AKA - ondansetrom
AKA - naloxone
Tylenol & codeine (#3 & #4)
AKA - Meperidine
AKA - hydromorphone
AKA - hydrocodone and acetaminophen
AKA - oxycodone and aspirin
AKA - Oxycodone and acetaminophen
AKA - promethazine
AKA - nalbuphine
AKA - ketorolac
AKA - cefazolin
1st generation cephlosporins - antibiotic
AKA - cephalexin
1st generation cephlosporins - antibiotic
AKA - ceftriaxone
3rd generation cephlosporins - antibiotic
AKA - levofloxacin
AKA - ciprofloxacin
Gender is assigned, genitals sensitive
males may have erections
females vaginal lubrication
labels body parts correctly
parent of opposite sex is focus of love
Becomes curious about sex roles and reproduction
friends are usually same sex
sex characteristics develop
friendships may include the opposite sex
may engage in masturbation and sexual activity
Establishes family to include sexual activity, values and family roles
Between 40-65 hormone production decreased leading to climacteric in both sexes
frequency of sexual activity decreases
men and women experience altered sexual functioning
Sexuality key concepts
acceptance of one's body image
WHO definition: Sexual Health
"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"
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.
Factors affecting sexual behavior
the problem has existed most of the individuals adult life
sexual problem is recent in origin
Painful intercourse due to vaginal lubrication
Manifestations of altered sexuality
inhibited sexual drive
How does sexual dysfunction impact activities of daily living?
Decrease in self esteem and in self confidence
interpersonal relationships may be affected
less emotional energy to concentrate on important aspects of daily living
What is asepsis?
The absence of germs or microorganisms
What is medical asepsis?
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)
What is surgical asepsis?
Actions to make or keep an object or person free of all microorganisms.
Sterilization destroys all microorganisms and their spores.
What are nosocomial infections?
Higher in critical care areas (sicker pts and more invasive procedures)
Some normal self-care prevention of biological hazards.
Storage and handling of food
individual tooth brush, ect.
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
The normal defense mechanisms against infection
urinary tract gastrointestinal tract
What are the steps to the infection chain?
Portal of exit
Means of transmission
Portal of entry
Breaking the chain: Use of infectious agents
Breaking the chain: Reservoir
Good dressing techniques
non contaminated water pitchers
Breaking the chain: Means of transmission
good hand washing
good asepsis with dressings
proper disposal of urine
Breaking the chain: Portal of entry
good care of skin and mucous membranes
no contaminated food or food serving utensils
Breaking the chain: Susceptible host
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
The course of infection by stage
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)
Why can antibiotic use lead to c.diff?
Antibiotics diminish normal colon flora and may result in overgrowth and release of toxins which injure mucosa
Treatment of c.diff?
May treat with oral flagyl or vancomycin
Must wash hands with soap and water
What is MRSA?
Methicillin Resistant Staphylococcus Aureus
Staph bacteria have become resistant to various antibiotics including penicillin-related antibiotics
What precautions are to be taken with MRSA?
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
What to do with airborne precautions?
The door must be closed at all times
N95 particulate respirator mask (orange duckbill) MUST BE WORN BY ALL WHO ENTER
What to do with droplet precautions?
mask must be worn when working within 3 feet of the patient
What to do with contact precautions?
gloves upon entry to the room
gown when you will be working directly with the patient
3 things to breaking cycle of infection
Definition of medical asepsis?
procedures used to reduce the number of microorganisms and prevent their spread
Definition of surgical asepsis?
procedures used to eliminate all microorganisms including pathogens and spores
Definition of disinfection?
elimination of pathogenic organisms, with the exception of spores, on inanimate objects.
Definition of sterilization?
process of destroying all microorganisms, including spores
The 7 principles of surgical asepsis?
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
by prolonged exposure
5. wet =
6. fluid flows in the direction of gravity
7. edges of sterile field or container =
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
Ethylene Oxide gas
used to sterilize rubber, paper, plastic items
used for instruments and equipment
Which procedures at bedside require sterile aseptic technique?
sterile dressing changes
urinary catheter insertions
preparing and administering injectable medications
Describe an acute wound?
orderly and timely reparative process
sustained restoration of anatomical and functional integrity
caused by trauma from sharp object
wound edges clean and intact
Describe a chronic wound?
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
When does does hemorrhage occur?
usually occurs within 24 to 48 hours
When does does infection occur?
commonly occurs on 4th or 5th day with post-operative wound
When do you get a culture and sensitvity specimen of a wound?
before starting antibiotics
When does does dehiscence occur?
commonly 3 to 11 days
When does does evisceration occur?
What are the complications of a fistula?
increases risk of infection
Definition of inflammation?
protective response of body tissues to irritation or injury
Definition of infection?
infectious agent is living and growing in the tissues and overcomes the body's normal defenses
S&S of an infection?
purulent and odorous drainage
Factors influencing healing
When assessing the appearance of a wound what 7 things should you note?
2. appearance of tissue
3. edges appoximated
4.signs of inflammation or infection
5. amount of discharge with color and odor
7. drains (hemovac, jackson-Pratt (JP), penrose)
What are the 5 purposes of wound dressing?
to protect wound from microorganism contamination
support or splint the wound site
promote thermal insulation of the wound surface
provide maintenance of high humidity between wound and dressing
What are the main surgical dressing layers?
Contact or primary layer
Outer protective layer
Types of dressings?
Woven guaze sponges
Mode of application?
wet to dry
Goals for wound treatment
keep the ulcer bed continuously moist
type, size and depth of wound
area where wound is located
What is important to teach with meds going home
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