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Medical Surgical Test 1

The period of time surrounding a surgical procedure?


Name three things that perioperative includes?

1. Peroperative
2. Intraoperative
3. Postoperative

The term used for before surgery?
What is the nurses responsibility for this term?

Educator, advocate and health promotion.

What is the term used during surgery?
What is the nurses responsibility for this term

Safety and advocacy.

What is the term used after surgery?
What is the nurses responsibility for this term?

On going evaluation and stabilization of clients, prevention of post-op complications.

What are these things:
1. Diagnostic: exploratory laparotomy.
2. Curative: fibroid tumors-hysterectomy.
3. Restorative: hip replacement.
4. Palliative surgery makes the client more comfortable. Does not cure, ex. suprapubic catheter.
5. Cosmetic surgery reconstructs the skin and underlying structures, ex. scar revision.

Purpose of surgery

When would you collect these things:
-Hx and data collection.
-Drugs and substance use (look for withdrawls)
-Medical hx, including cardiac and pulmonary hx (specifically comorbities ex. DM and CAD).
-Previous surgeries and anasthesia.
-Blood donations (this will tell you if they may have a disease like HIV)
-Discharge planning.

Collaborative management assessment

What are these things?
-Chronic illness-inc. risk
-Prior surgical experiences-ex. anesthesia rx.
-Type of surgical procedure-ex. exploratory laparotomy inc. risk for paralytic ileus.

Risk factors based on assessment

What are these things:
-Baseline vital signs.
-Focus on problem areas identified by the clients hx on all body systems affected by the surgical procedures.
-Report any abnormal assessment findings to the surgeon.

Physical Assessment/Clinical Manifestations

What is the common NRS Dx for pt's who are preoperative?

Lack of knowledge secondary to lack of surgical experience.

Who is responsible for obtaining a signed consent before sedation is given and surgery is performed?

The surgeon

What is the nurses role when a consent is being signed?

Clarify facts and witness client signature.

The nurse is responsible for making sure pt is NPO b/f surgery, what happens if pt eats?

Surgery get CX and by eating increases the risk for pt to have aspiration.

How many hours does a pt have to be NPO b/f surgery?

Usually after midnight for 6-8 hours.

Can pt still take his meds even if he is NPO b/f his surgery?

Consult the physician and anesthesia for instructions, especially for meds for DM, CAD, glaucoma, anticonvulsants, antihypertensives, anticoagulants, antidepressants, or corticosteroids.

Why are bowel or intestinal preperation performed b/f surgery?

to prevent injury to the colon and to reduce the number of intestinal bacteria. An enema or laxative may be ordered by the physician.

Do we shave the patient b/f surgery?

It is viewed as controversial.

Name things that you would teach the pt for postoperative.

-Breathing excerises, incentive spirometry, coughing and splinting, leg procedures and exercises, antiembolism stockings, and elastic wraps, early ambulation, and rang of motion exercises.

Name 5 things the nurse would do for anxiety prevention b/f surgery?

1. Preoperative teaching.
2. Encouraging communication.
3. Promoting rest.
4. Using distraction.
5. Teaching family and significant others.

If some one has come bk from surgery and had anesthesia what are the two high risk patients the nurse should really look out for?

-Those with liver and kidney disease.

Induced state of partial or total loss of sensation, occurring with or without loss of consciousness. Used to block nerve impulse transmission, suppress reflexes, promote muscle relaxation, and in some instances achieve a controlled level of unconsciousness.


-Reversible loss of consciousness.
-State can be achieved by a single agent or a combination of agents.
-Central nervous system is depressed resulting in analgesia, amnesia and unconsciousness with loss of muscle tone and reflexes.
-With this the nurse needs to consider emotional/psychological effects which include the fear of being put to sleep.

General Anesthesia

Name the two types of General anesthesia and info about them.

1. Inhalation-Intake and excretion of anesthetic gas or vapor to the lungs through a mask.
2. Intravenous Injection- injected through an IV line disposed in the blood.

How long does recovery take when given general anesthesia?

Recovery depends on type of agent, length of time client is anesthetized and if a reversal agent is used.

What are possible responses to general anesthesia?

Retching, vomiting, restlessness and changes in the ability to control body temperature.

What are some interventions we might use when some one went through general aneshthesia?

Suction equipment, warmth and O2.

***************test question*******************
What is the biggest complication from general anesthesia?

Malignant hyperthermia

*************test question********************
This is the biggest complication from general anesthesia.
Marked by a rapid rise in body temperature, increase in serum calcium and potassium, signs of increased muscle metabolism (muscle proteins detected in the urine) and rigidity. Can be life-threatening.

Malignant hyperthermia

Name 5 complications of General anesthesia.

1. Malignant hyperthermia
2. Overdose
3. Complications of specific anesthetic agents.
4. Unrecognized hypoventilation.
5. Complications of intubation.

This is caused by a local or regional anesthesia:
Secondary to the interruption of the sensory nerve impulse transmission from a specific body area or region.


Name 4 things that local or regional anesthesia does to the body.

1. Insensibility
2. Motor function may be affected.
3. Client remains conscious and able to follow instructions.
4. Gag and cough reflexes remain intact.

What type of agents are used on the pt before the have a local or regional anesthesia?

Sedatives, opioid analgesics, or hypnotics.

When the is an over dose of local or regional anesthesia what are the signs to look for?

respiratory depression and sedation

Name 4 complications of local or regional anesthesia.

1. Anaphylaxis
2. Incorrect delivery technique
3. Systemic absorption
4. Overdosage

What S&S should the nurse look for with complications of local or regional anesthesia.

Assess for CNS stimulation, CNSand cardiac depression, metallic taste, nausea and vomiting, tremors, seizures, increased pulse, respirations, and bp.

What are the treatments for complications of local or regional anesthesia?

1. **Establish an open airway.************
2. Give O2.
3. Notify the surgeon.
4. Fast-Acting barbiturate is usual treatment.
If toxic rx is untreated, unconsciousness, hypotension, apnea, cardiac arrest, and death may result.

IV delivery of sedative, hypnotic, and opioid drugs reduces the level of consciousness but allows the client to maintain a patent airway and to respond to verbal commands.

Conscious Sedation

When pt is in a conscious sedation what is the nurses role?

Assessment of airway, level of consciousness, oxygen saturation, electrocardiographic status, and vital signs are monitored every 15-30 minutes.

Name 3 interventions for risk for perioperative positioning injuries.

1. Proper body position
2. Risk for pressure ulcer formation
3. Prevention of obstruction of circulation, respieation, and nerve conduction.

During what operative state are our assessment skills crucial?


What is the recovery room AKA?


Ongoing evaluation and stabilization of clients to anticipate, prevent and treat complications after surgery.
Usually located close to the surgical suite.

Recovery room AKA PACU.

What kind of nurse is skilled in the care of clients with multiple medical and surgical problems that can occur following a surgical procedure.

A PACU nurse AKA recovery room nurse.

After a patient has had what done should you assess for:
-motor and sensory assessment.

After an epidural or spinal anesthesia.

What is an example of a command you would ask a patient to assess for motor fx?

Simple commands, ask pt to move extremities.

While pt is going through the return of the sympathetic nervous system tone what position should they be in and what should you assess for?

Gradually elevate head and monitor for hypotension.

The effects of drugs, anesthetic agents, or manipulation during surgery can cause urine what?


How should a nurse assess for urine retention?

Look for bladder distention.

What are other sources of output other than urine?

sweat, vomiting, or diarrhea

Post surgery at what level should we report urine out put?

<30 mL/hr

What is a common GI problem post surgery?

Nausea and vomiting

1. Why is peristalsis delayed post surgery?
2. Pt's who have abdominal surgery often have decreased peristalsis for at least how long?

24 hours

How often should the nurse assess drained material from a nasogastric tube?

Every 8 hours

Can you irrigate a nasogastric tube after gastric surgery with out an order?

No, you need an order from the surgeon

Ineffective wound healing can be seen how soon after surgery?

Between the 5th-10th day.

A partial or complete separation of the outer wound layers, sometimes described as a splitting open of the wound. Wound heals from the bottom up.


When a wound heals from the bottom up it is know as what intention?


A total separation of all wound layers and protrusion of internal organs through the open wound requires surgical intervention.


What type of pt's are at a higher risk for evisceration?

Obese people

Dressings and drains, including casts and plastic bandages, must be assessed for bleeding or other drainage when?

On admission to the PACU (recovery room)
and hourly thereafter.

When does pain usually reach it's peak level post surgery?

The second day.

In what situation should a nurse have a patient in a side-lying position or turning his or her head to the side to prevent aspiration?

When there is an impaired gas exchange.

When a patient has an impaired gas exchange what are a couple interventions a nurse should do?

1. Encourage deep breathing exercises.
2. Encourage mobilization as soon as possible to help remove secretions and promote lung expansion.

Provide and exit route for air, blood, and bile as well as help prevent deep infections and abscess formation during healing.


The first dressing on a patient post surgery is always changed by who?

The surgeon

1. Acute pain can activate what?
2. When that happens what are symptoms of the patient?

1. SNS
2. Restlessness, increased HR, BP, RR, dilated pupils and sweating.

Name three interventions for hypoxemia.

1. Maintain airway patency and breathing pattern.
2. Prevention of hypothermia.
3. Maintenance of oxygen therapy as prescribed.

Is under treatment of pain a serious health care problem?


Name the 3 types of pain.

1. Acute pain
2. Chronic CA pain
3. Chronic non-cancer pain

Name the 3 sources of pain.

1. Somatic-tissue
2. Visceral-organ pain like an MI
3. Neuropathic-pain from the CNS

Which pain is the hardest to treat?

Nerve pain

Is a state of adaptation in which exposure to a drug induces changes in its effect over time.


Is the adaptation manifested by a drug class specific with drawl syndrome.

Physical dependence

Results when dependent use of opioids ceases abruptly.

Withdrawal symptoms

This is a chronic neurobiologic disease characterized by:
impaired control over drug use
compulsive drug use
continued use despite harm
occurs over time, not a result of one hospital stay


Measures the quality of pain

the scale 1-10

During an assessment you ask what questions about the location of the pain.

Is it
localized, projected, radiating, or referred

Name the three types of analgesics that are for relieving pain.

1. Non-opioids
2. Opioids
3. Adjuvants

Acetylsalicylic acid, acetaminophen, and non-steroidal anti-imflammatory drug (NSAIDS) like motrin, aleve, tramadol.
These are examples of what type of drug?

Non-opioid analgesics

Codeine, hydrocodone, oxycodone, morphine, hydromorpnone, fentanyl, methadone, tramadol, and meperidine are examples of what type of drug?

Opioid analgesics

Name a few side effects of opioid analgesics

Nausea, vomiting, constipation, sedation and respiratory depression.

Antiepileptic drugs, tricyclic antidepressants and topical meds are examples of what type of drug?

Adjuvant analgesics

Instead of pain drugs what can we do for the pt?

apply heat, cold pressure
therapeutic touch

What are some things they do that are invasive to help with pain?

nerve blocks
spinal cord stimulation

What are surgical techniques used for chronic pain?


What is the purpose of inflammation and immunity?

Is to neutralize, eliminate or destroy invading organism or the antigen.

Inflammation occurs how long after infection sets in?

24 hours

Provides immediate, short term protection against the effects of tissue injury and foreign proteins.


The key function of inflammation is what?


Initiates both antibody and cell mediated immunity.


What type of damage can happen to the body from excessive inflammatory response?


Causes visible symptoms and can rid the body of harmful organisms.


Infection is usually accompanied by what?


Can inflammation occur without invasion by organisms?

Yes, inflammation does not always mean there is an infection.

How many stages of inflammation are there?


What stage of inflammation is this?
(Vascular) change in blood vessels (seconds to minutes)
Phase I constriction
Phase II hyperemia and edema (increased blood flow, plasma).

Stage I

What stage of inflammation is this?
(cellular exudate hours after invasion) neutrophilia, pus.

Stage II

What stage of inflammation is this?
(tissue repair and replacement)

Stage III

Name S&S of inflammation

decreased function

What gives you edema?


Do T-Cells secrete antibodies?


First line of defense, phagocytosis, they mature in 12-14 days. It is involved in inflammation.


Important in the immediate in inflammation response and phagocytosis. Predominantly in the liver and spleen, long life spans months to years.


Responsible for vascular leak syndrome, and has a role in clotting.


What are the two types if immunity?

Antibody-mediated (b-cells)
Cell-mediated (t-cells)

Where does b and t cells originate from?

Bone marrow

These things are stimulated by what?
pollen and food

Antigen stimulated

T-Cells mature where?

in the thymus

B-Cells mature where?

in the bursa

These type of cells are protective against fungi, virus and some CA.


-stem cells in the bone marrow
-Migrate into secondary lymphoid tissue (spleen, lymph nodes, tonsil and Peyer's patches of the intestinal tract) where the mature completely.
-Provides long lasting immunity (memory cells)
-Antibodies are called immunoglobulins and gamma globulins.
-Neutralize, eliminate or destroy the antigen.
-Transferable from person to person.

Acquiring Antibody Mediated Immunity

this antibody has to do with anaphalatic


Helps protect the body by differentiating self from non-self cells, non-self cells most easily recognized by cell-mediated immunity are CA cells and those self cells infected by organisms that live within host cells (RBC's).
*************Its function is to protect against CA cells and viruses, responsible for delayed hypersensitivity and transplant rejection.

Cell-Mediated Immunity (t-cells)

What are these types of?
cytotoxic (killer)
Natural killer cells

Types of T-Cells

At what age do we have all of our T-Cells?

After puberty

B-Cells protect against what?


Because the elderly has fewer B-lymphocytes what does this increase the chances of?

Bacterial infections

Because elderly have few T-Lymphocytes what does this increase their chances of having?

Fungal infections

a congenital disorder that causes the absence of serum Igs they can give them antibodies.

X linked Agammaglobinemia of Burton

A congenital disorder that causes the absence of cell-mediated immunity. They can have a thymus transplant.

Di George's Syndrome

What is the last stage of a continuum of symptoms that result from HIV?

Profoundly immunosuppressed

HIV is classified according to clinical conditions and CD4+ counts what is the norm count?

800-1000 CD4+ cells/mm3 of blood

What category of HIV is this:
asymptomatic, persistent lymphadenopathy

Category A

What category of HIV is this:
deficiency of cell mediated immunity

Category B

What category of HIV is this:
The person had AIDS

Category C

Name the 3 top ways HIV is transmitted.

1. Sexual
2. Parenteral
3. Perinatal

What is the top 2 ways a healthcare worker gets HIV?

1. needle stick.
2. infected through exposure of non-intact skin and mucous membranes to blood and body fluids.

What is the name of the CA HIV patients can get?

Kaposi's sarcoma, and malignant lymphomas
they can also have endocrine complications

Labs on some one with HIV:
what would there WBC be?
what would there CD4+ be?


What is the name of the antibody test done to see if pt has HIV? (ELISA). What is the test confirmed by?

Enzyme-Linked Immunosorbent Assay
Western blot

1. This test monitors disease progression in HIV?
2. This test determines presence of HIV?

1. Viral load
2. Viral culture

Drug therapy does what to the virus?

Inhibits, does not kill the virus.

These are nrs dx related to what disease?
-chronic low self esteem
-social isolation
-disturbed thought processes
-impaired skin integrity


Is an altered immunologic reaction to an antigen and it results in a pathologic immune response upon re-exposure to the antigen.


One of the 5 types of hypersensitivity
Rapid hypersensitivity, IgE-mediated reactions

Type I

One of the 5 types of hypersensitivity
Tissue-specific reactions

Type II

One of the 5 types of hypersensitivity
Immune-complex-mediated reactions

Type III

One of the 5 types of hypersensitivity
Cell-mediated tissue reactions

Type IV

One of the 5 types of hypersensitivity

Type V

-This type of hypersensitivity is characterized by the production of IgE after exposure to an antigen.
-caused by release of histamine.
-Re-exposure produce severe allergic reaction.
-Symptoms last about 10 minutes.
-Peak 1-2 minutes.

Type I

Clinical Manifestations of what type of hypersensitivity?
GI tract, the skin and the respiratory tract
-Local anaphylaxis
-Angioedema (cutaneous swelling)
-Allergic rhinitis
-Nasal and conjunctival discharge.
Target tissues are those that contain a large amount.

Type I

Anaphylaxis of what type of hypersensitivity?
-severe rx
-rapid, systemic affecting multiple organs simultanously.

Type I

What should you do to prevent anaphylaxis?

Avoid the allergen, do not choose epipen on the test

A severe fall in systemic blood pressure during an anaphylactic reaction.

Anaphylactic Shock

Interventions for systemic anaphylaxis
Name 9 things

1. Establish airway
2. Epinephrine 0.3-0.5ml
3. Antihistamine to treat angioedema/uticaria
4. Oxygen at 2-6 L/min
5. Aminophylline for bronchospasms it is a steroid pt needs to stay 24 hours.
6. ABG's
7. Pulse ox
8. Suction available
9. CPR may be necessary

What type of hypersensitivity is this?
-Antibody reacts with antigen on surface cells
-Most common IgG and IgM
-Involves activation of complement
Hemolytic anemia (rapid break down of RBC) involves antibodies produced against RBC.
-Transfusion reactions involves antibodies produced against donor blood cells.
-erythroblastosis Fetalis involves maternal antibodies produced against fetal blood cells. ( Mom RH+ and Infant RH- Moms body thinks baby is foriegn and when she has a second baby it will die. They give the mom rogan.

Type II AKA cytotoxic

What would you consider to do with a Type II (cytotoxic) response?

Plasmapheriesis to remove autoantibodies

What type of hypersensitivity is this?
-Antigens cause immune complexes to form in the blood.
-Not organ specific, activates complement and mast cell degranulation-tissue and capillary damage.
serum sickness, glomerulnephritis, systemic lupus erythematous, rheumatoid arthritis.
This is people who have antigen-antibody rx.

Type III (immune complex rx)
treatment is chemo, steroid, ASA

This type of hypersensitivity does not involve antibodies, mediated by sensitized T lymphocytes.
-delayed response (hours-days)
-ex. PPD for TB
-contact dermatitis
-poison ivy
insect stings
transplant rejections

Type IV (cell mediated)

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