Nurs 112

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Nurs 112
2011-04-11 21:01:50
Med Surg

Med Surg
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  1. Priority care in Postanesthesia care unit (PACU)?
    • Monitoring/Management of respiratory & circulatory function
    • pain
    • temp
    • surgical site
  2. Assessment begins with
    • eval of airway, breathing, and circulation (ABC)
    • *evidence of respiratory compromise requires intervention
  3. Pulse oximetry is?
    a noninvasive means of assessing the oxygenation of the patient
  4. Electrocariographic (ECG) monitoring is?
    used to determine cardiac rate and rythm.
  5. Initial neurologic assessment focuses on?
    • Level of consciousness
    • orientation
    • sensory
    • motor status
    • size, equality, and reactivity of pupils
  6. Which is the 1st sense to return after surgery?
    Hearing which is why the RN explains all activities to the patient from the moment of admission to the PACU
  7. The most common causes of airway compromise in the immediate PACU period include?
    • Airway obstruction
    • Hypoxemia
    • Hypoventilation
  8. Pts at risk for respiratory complications are?
    • pts who
    • had general anesthesia
    • are holder
    • smoke heavily
    • have lung disease
    • are obese
    • have had airway, thoracic or abd. surgery
  9. Hypoxemia is?
    • an arterial oxygen tension (PaO2) of less than 60 mm Hg
    • characterized by various signs ranging from agitation to somnolence, hypertension-hypotension, tachycardia-bradycardia
  10. causes of hypoxemia?
    • atelectasis
    • pulmonary edema
    • aspiration
    • broncospasm
  11. Hypoventilation is characterized by?
    • decreased resp rate or effort
    • hypoxemia
    • ^ arterial carbon dioxide tension (PaCO2) also known as hypercapnia
  12. The RN evaluates
    • airway patency
    • chest symmetry
    • depth, rate & character of respers
    • symmetry of movement
    • auscultate breath sounds anteriorly, laterally & Posteriorly
  13. Hypoxemia maybe be noticed by?
    • rapid breathing
    • gasping
    • apprehension
    • restlessness
    • rapid or thready pulse
  14. Position of client postop
    • lateral "recovery" position
    • unless contraindicated
  15. Common cardiovascular problems postop?
    • hypotension
    • hypertension
    • dsyrhythmias
  16. Pts at greatest risk for cardio problems include
    • alterations in resp function
    • Hx of cardiovascular disease
    • elderly
    • debilitated
    • critically ill
  17. Hypotension commonly caused by?
    • unreplaced fluids & blood loss
    • which may lead to hypovolemic shock
  18. Treatment of hypotension begins with?
    oxygenation, aka oxygen therapy
  19. Hypertension is caused by?
    • pain
    • anxiety
    • bladder distention
    • resp compromise
  20. Treatment of hypertension?
    centers on elimination of precipitating cause
  21. Dysrhythmias result from?
    • hypokalemia
    • hypoxemia
    • hypercarbia
    • alterations in acid-base status
    • circulatory instability
    • hypothermia
    • pain
    • surgical stress
    • preexisting heart disease
  22. Treatment of dysrhythmias?
    focus on elminating the cause
  23. VS
    • are monitored Q15 mins
    • more often if unstable and then less often when stable
  24. Systolic BP is less than 90 mm Hg or greater than 160 mm Hg
    RN should notify the anesthesia provider (ACP) or surgeon
  25. Pulse rate less than 60 bpm or greater than 120 bpm
    RN should notify the ACP or surgeon
  26. Pulse pressure difference between systolic and diastolic pressures narrows
    RN should notify ACP or surgeon
  27. BP gradually decreases during several consecutive readings
    RN should notify ACP or surgeon
  28. Change in cardiac rhythm
    RN should notify ACP or surgeon
  29. Significant variation from preoperative readings
    RN should notify ACP or surgeon
  30. Emergence delirium "waking up wild" is?
    • restlessness
    • agitation
    • disorientation
    • thrashing
    • shouting
  31. Emergence delirium maybe caused by?
    • anesthestic agents
    • hypoxia
    • bladder distention
    • pain
    • electrolyte abnormalities
    • pt's state of anxiety pre op
  32. Delayed emergence caused by
    • prolonged drug action particularly of opiods, sedatives &
    • inhalational anesthetics
  33. Hypothermia core temp of less than 96.8 f (36 c)
    Frequent assessment of pt's temp is important to detect patterns of hypothermia &/or fever
  34. Potential resp problems in clinical unit
    atelectasis & pneumonia especially after abd and thoracic surgery
  35. Deep breathing is encouraged to be done how often
    10 times every hr while awake
  36. Pt's position should be changed how often and why?
    every 1-2 hrs to allow for full chest expansion and ^ perfusion of both lungs
  37. syncope (fainting) may occur b/c of
    • decreased COP, fluid deficits
    • defects in cerebral perfusion
  38. RN should monitor
    • I&Os
    • electrolytes
    • hematocrit
    • rate of fluid replacemet
  39. Hypokalemia causing dysrhythmias can be a result of?
    • urinary or GI losses
    • inadequate potassium replacement
  40. Deep Vein Thrombosis (DVT) may form in leg veins as a result of?
    • inactivity
    • body position
    • pressure
  41. Leg exercises should be encouraged how ofter?
    10-12 times every 1-2 hrs while awake
  42. Two types of postoperative cognitive impairment seen in surgical patients?
    delirium & postoperative cognitive dysfunction
  43. Sources of Confusion & delirium are?
    • fluid & electrolyte imbalance
    • hypoxemia
    • drug effects
    • sleep deprivation
    • sensory deprivation/ or overload
  44. Alcohol withdrawl delirium is characterized by?
    • restlessness
    • insomnia/nightmares
    • irritability
    • auditory/ or visual hallucinations
  45. The RN should do what to prevent/manage post op delirium?
    address factors known to contribute to condition
  46. Pain can contribute to dysfunction of?
    • immune sys
    • blood clotting
    • delayed return of GI function
    • ^ risk of atelectasis
    • impaired resp function
  47. what is the most reliable indicator of pain?
    The PT.
  48. what pain can be expected?
    • incisional pain
    • (however other pain may be present such as the pain of a full bladder)
  49. If the analgesic fails to relieve the pain or makes the PT. excessively lethargic or somnolent(sleepy/drwosy) the RN should?
    Notify the DR. and request a change in the med order
  50. Two alternative approaches to pain control are?
    Patient - controlled analgesia (PCA) & epidural analgesia
  51. The surgical stress response can be seen as?
    a fever of 100.4 during the 1st 48 hrs after surgery
  52. A fever that spikes in the afternoon or evening and is near normal in the morning could mean?
    wound infection
  53. Septicemia is characterized by
    an intermittent high fever accompanied by shaking chills & diaphoresis
  54. If vomiting occurs it is important to determine?
    the quantity, characteristics, & color
  55. Antiemetic or prokinetic drugs are used to treat?
    Nausea & vomiting
  56. Abdominal distention can be caused by?
    • Handling of the intestine during surgery
    • decreased peristalsis,and dietary intake before & after surgery
  57. Early and frequent ambulation can?
    prevent or minimize abd distention
  58. A nasogatric tube may be used to?
    decompress the stomach to prevent nausea, vomiting, and abd. distention
  59. Low urine output after surgery is?
    • normal regardless of fluid intake
    • (800-1500ml) in the 1st 24 hrs