111 terms

Adult Health Theory Quiz 2

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types of surgical situations
-admitted to the hospital after surgery
-ambulatory/outpatient/same day surgery
-emergency surgery
-elective surgery
elective surgery
can live without it
ex) hernias
optional surgery
totally by choice
ex) cosmetics
patients at risk for surgical complications
older patients, immunocompromised patients, clotting disorders, coumadin/heparin patients, diabetes, circulatory disorders, genetic predispositions
exploratory surgery
opening the body and taking a look inside to see what was wrong and what could be done about it
laparoscopic surgery
surgical procedures within the abdominal or pelvic region using a laparoscope
endoscopic surgery
a surgical procedure that is performed through very small incisions with the use of an endoscope and specialized instruments
minimally invasive surgery
surgical procedures that use specialized instruments inserted into the body either through natural orifices or through small incisions
robotic surgery
a procedure in which a surgeon uses a robotic surgery system to perform an operation
laser surgery
use of light and energy aimed at an exact tissue location and depth to vaporize cancer cells
bariatric surgery
surgery for obese people
cosmetic surgery
a medical operation to improve a person's appearance
advance directives
A legal document designed to indicate a person's wishes regarding care in case of a terminal illness or during the dying process
who has to get informed consent from the patient
doctor/surgeon and a licensed witness (RN, another Dr)
what age must you be to give informed consent
18
assent vs consent
under 18 vs above 18
2 methods of consent needed
written and verbally
what needs informed consent
any kind of blood product, anything that involves radiation or a needle, invasive procedures
goal of preoperative care
to prevent postoperative complications
preoperative instructions
-diaphragmatic breathing
-coughing/splinting
-leg exercises
-turning to side
-getting out to bed
incentive spirometer
a device used to force the client to concentrate on inspiration and promote full inflation of the lungs, while providing immediate feedback; used particularly after surgery and in lung disorders
-see the ball go up
preventing cardiovascular complications
-be aware of patients at greater risk for DVT
-early ambulation to promote venous return
-anti-embolism stockings
-pneumatic compression devices
-leg exercises
pre-op patient teaching
-pain management
-cognitive coping strategies
-psychosocial interventions
-reduce anxiety
-respect for cultural, spiritual, religious beliefs
immediate preoperative nursing interventions
-skin and bowel prep
-administering preanaesthia medication
-maintaining preoperative record
-transporting patient to pre-surgical area
-attending to family needs
medications affecting surgical experience
-corticosteroids
-insulin
-anticoagulants
-anti-seizure meds
Coumadin antidote
vitamin k
heparin antidote
protamine sulfate
members of intraoperative phase
-patient
-circulating nurse
-scrub role (or technician or RN)
-surgeon
-registered nurse 1st assistant
-anesthesiologist, anesthetist (CRNA)
unrestricted zone
street clothes
semi-restricted zone
scrub clothes and caps
restricted zone
scrub clothes, shoe covers, caps, and masks
surgical asepsis
prevent nosocomial infection
what are the guidelines for surgical asepsis?
all material in conduct with the surgical would or in the sterile field must be sterile
general anesthesia
-combination of IV drugs and inhaled gases
-patient is out and not cognitively aware
-stops nerve conduction
moderate sedation
-formally called conscious sedation
-IV or oral
-awake but not really sure what is going on
-doesn't get rid of pain
regional anesthesia
-epidural
-spinal
-local conduction blocks
-everything below is numbed
local anesthesia
-injection of a solution contain the anesthetic agent (lidocaine, cocaine)
spinal anesthesia
works faster
-goes through dura (outermost shell of spinal cord)
epidural anesthesia
-doesn't pierce the dura
-a little less risky
stages of general anesthesia
-induction
-maintenance of anesthesia
-recovery
depth of anesthesia
-stage 1: analgesia (pain relief)
-stage 2: excitement (combative behavior, hyper)
-stage 3: surgical anesthesia (when they can't feel anything)
-stage 4: medullary paralysis (avoid)
intraoperative complications
-anesthesia awareness (waking up during surgery)
-nausea, vomiting (risk for aspiration)
-anaphylaxis (allergies)
-hypoxia, respiratory complications
-hypothermia
-malignant hyperthermia
adverse effects of surgery and anesthesia
-Allergic reactions, drug toxicity or reactions
-Cardiac dysrhythmias
-CNS changes, oversedation, undersedation
-Trauma: laryngeal, oral, nerve, skin, including burns
-Hypotension
-Thrombosis
OR nurse interventions
-reducing anxiety
-reducing latex exposure
-preventing positioning injuries
-protecting patient from injury
-serving as patient advocate
-monitoring, managing potential complications
positioning factors to consider
-patient should be as comfortable as possible
-operative field must be adequately exposed
-position must not obstruct/compress respirations, vascular supply, or nerves
-extra safety precautions for older adults, patients who are thin or obese, and anyone with a physical deformity
-light restraint before induction in case of excitement
protecting patient from injury
-Patient identification
-Correct informed consent
-Verification of records of health history, exam
-Results of diagnostic tests
-Allergies (include latex allergy)
-Monitoring, modifying physical environment
-Safety measures (grounding of equipment, restraints, not leaving a sedated patient)
-Verification, accessibility of blood
postoperative nursing
period of time from when patients are admitted to the PACU to the follow up when patients are home/fully recovered
nursing management in the PACU
-very fast paced
-provide care for patient until patient has recovered from effects of anesthesia
-patient has resumption of motor and sensory function, is oriented, has stable VS, shows no evidence of hemorrhage or other complications of surgery, and has pain controlled
Responsibilities of the PACU nurse
-Review pertinent information, baseline assessment upon admission to unit
-Assess airway, respirations, cardiovascular function, surgical site, function of CNS, IVs, all tubes and equipment
-Reassess VS, patient status every 15 minutes or more frequently as needed
-Transfer report, to another unit or discharge patient to home
maintaining a patent airway
-Primary consideration: necessary to maintain ventilation, oxygenation
-Provide supplemental oxygen as indicated
-Assess breathing by placing hand near face to feel movement of air
-Keep head of bed elevated 15 to 30 degrees unless contraindicated
-May require suctioning
-If vomiting occurs, turn patient to side
hypopharyngeal obstruction
-airway obstruction
-tongue can obstruct airway
-hyperextend neck to fix
maintaining cardiovascular stability
-monitor all indicators of cardiovascular status
-assess all IV lines (no phlebitis or infiltration)
potential for hypotension, shock (bradycardia)
-potential for hemorrhage
-potential for hypertension, dysrhythmias
renal/urinary system
-intake/output, hydration
-check for urine retention
-consider other sources of output such as sweat, vomiting, or diarrhea stools
-report a urine output less than 30cc/hr
-client is expected to void within 8 hours (if not then catheter may be inserted)
relieving pain and anxiety
-assess patient comfort
-control of environment: quiet, low lights, noise level
-administer analgesics as indicated; usually short-acting opioids IV
-family visit, dealing with family anxiety
controlling nausea and vomiting (post-operative)
-intervene at first indication of nausea
-anti-emetics for meds
-risk of aspiration (pneumonia)
enteral
into GI system
parenteral
under the skin; bypasses the gut
Gastroperesis
when gut completely stops moving (no bowel sounds)
GI system
-30% of patients experience nausea or vomiting after general anesthesia
-peristalsis may be delayed for up to 24 hours
-monitor for bowel sounds
-peristalsis must be present before starting diet
-the best indicator of intestinal activity is the passage of flatus or stool
-complaints of gas pain, abdominal distention
-turn frequently, exercise, ambulation ASAP
neurologic system
-cerebral functioning
-motor and sensory assessment important after epidural or spinal anesthesia
-motor function: simple commands, patient to move extremities
-return of sympathetic nervous system tone: gradually elevates head and monitor for hypotension
salem sump
brand name of a g tube
wound healing
-dressing: surgeon usually removes the original dressing on the first or second day after surgery
-check for drainage and record amount, color, consistency, and odor
-ineffective would healing can be seen most often between the 5th and 10th days after surgery
first (primary) intention healing
-edges of wound approximated
-granulation is not visible and scarring is minimal
-ex) surgical wound
secondary (secondary) intention healing
-gap in wound: granulation tissue must fill in
-extensive tissue loss
-epithelial cells grow over this to form skin
-ex) large gaping wound or pressure ulcer
third (tertiary) intention
-delayed primary intention
-requires suture to close
-delay ensures between injury and approximation
-may be desired in the case of contaminated wounds
systemic factors affecting healing
-nutrition: nutritional deficiencies retard healing
-circulation and oxygenation: hemoglobin levels
-immune cellular function
-immunosuppressive drugs (steroids)
individual factors affecting healing
-age
-obesity
-smoking
-medications
-stress
local factors affecting healing
-nature of the injury
-presence of infection
-local wound environment
golden period of wound management
6-12 hours post injury
complications of wound healing
-hemorrhage and interstitial fluid loss
-hematomas: localized collection of blood
-fistula: abnormal passageway than forms between two organs
-infection (local and systemic): indicated by yellow/black coloration of wound
-dehiscence: total of partial disruption in wound edges
-evisceration: protrusion of viscera through abdominal wound opening
...
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what do you do first for post op patient when emergency
look
outpatient surgery/direct discharge
-give instructions to patient
-make sure patient has someone else to go home with
-patients are not to drive home or be discharge to home alone (sedation, anesthesia may cloud memory and judgement)
alterations in urinary elimination
-undergoing diagnostic testing
-lower urinary tract infection
-urinary incontinence
-urinary retention
-urolithiasis (kidney stones)
-bladder cancer
-urinary diversions
-prostate disease
-undergoing surgery
functional unit of the kidney
nephron
blood pressure/blood volume control
-kidney secretes renin
-renin stimulates angiotensinogen to angiotensinogen 2 (from ACE)
-angiotensinogen is a vasoconstrictor
-aldosterone makes kidney retain salt
-ADH makes kidney retain water
functions of kidney
-RBC production
-Acid-base balance
-BP control
regulation of acid-base/electrolyte balance (esp K+)
-normal serum PH: 7.35-7.45
-reabsorption of bicarbonate (the base)
anuria
urine output less than 50mL/day
bacteriuria
bacteria count greater than 100,000 colonies/mL
dysuria
painful or difficult voiding
frequency
frequent voiding
-more than every 3 hours
polyuria
increased volume of urine voided
hematuria
RBCs in urine
enuresis
involuntary voiding during sleep
incontinence
involuntary loss of urine
nocturia
awakening during the night to urinate
oliguria
urine output less than 0.5mL/kg/hour
urgency
strong desire to void
hesitancy
delay, difficulty in initiating voiding
proteinuria
protein in the urine
diagnostic studies (pg 1562)
-urinalysis and urine culture
-renal function tests
-ultrasonography
-CT and MRI
-nuclear scans
-endoscopic procedures
-biopsies
-IV urography
-retrograde pyelography
-cystography
-renal angiography
Normal specific gravity of urine
1.010-1.025
diabetic urine
-ketones (fat metabolism)
-high blood glucose
24 hour urine collection
-creatinine clearance test (to detect and evaluate presence of renal disease)
-osmolality
-protein levels
-cortisol
intravenous urography
-IVP=intravenous pyelography
-assesses gross kidney size or obstruction
-IV dye given then X-rays taken
-requires bowel prep so bowel contents will not block picture
-normal to feel hot, flushed feeling when dye injected
-not used as often secondary to multiple risks and newer tests
-shows urine flow, NOT blood flow
renal arteriography
-catheter is inserted in femoral artery at groin, to renal artery, dye injected, X-ray pictures
-used to monitor for vascular problems
-looks at blood flow
major risks of RCI
-allergy
-nephrotoxicity
-iodine
-shellfish
renal arteriography risks and nursing interventions
-bleeding: prior to procedure monitor PT/PTT, discontinue anticoagulants
-post: pressure to catheter insertion site
-manual, ice and sand bag every 15 minutes
-bed rest for 6 hours then stand to void or bedside commode
-vital signs every 15 mins for 4 hours
-H+H
-monitor for hematoma
embolus interventions
-Pre: assess pulses, pedal pulses
-Post: monitor for occlusion of femoral artery: 6 p's, monitor distal pulses, notify MD
infection interventions
-insertion of catheter/sterile procedure
-post temp every 4 hours for 2-3 days
-monitor for chills, malaise, WBC
6 P's
pain, pallor, pulselessness, poikilothermia (coldness), paralysis, paresthesia
oscopy
-insertion of a scope into cavity to visualize or treat
-use for bladder wall problems or obstructions
-interventions: NPO, laxatives to clear stool, monitor, anesthesia
-sterile procedure
-monitor temp every 4 hours for 3 days
-local trauma: assess bleeding, pink tinged urine is normal, gross hematuria is not, assess function
-if catheter in place-clots can obstruct it (may need irrigation)
biopsy-insert needle into kidney
-used for unexplained renal problems or renal CA dx
-assess ability to breathe in prone,
-NPO
-sedate patient
-prone position 30-45 minutes
-hold breath on request 15-30 seconds
-sterile procedure
gerontologic considerations
-older adults may intentionally limit fluids to decrease frequency or incontinence
-diminished thirst, need reminding to drink, increased dehydration
-incomplete emptying of bladder, urinary stasis, decreased nerve innervations
-decreased GFR and renal reserve
-decreased drug clearance=increased drug-drug interactions
factors contributing to UTI
-reflux
-immunosuppression
-instrumentation
-anything that causes glucose in the urine
-neurogenic bladder: flaccid and spastic
urinary retention
-inability of the bladder to empty completely
-residual urine: amount of urine left in the bladder after voiding
-causes include age, diabetes, prostate enlargement, pregnancy, neurologic disorders, medications/anesthesia
-chronic retention can lead to UTI, overflow incontinence
normal residual volume in young person
50cc
normal residual volume in adult
less than 100cc
urinary incontinence
-an under diagnosed and underreported problem that can have significant impact on the quality of life and decreases independence, which may lead to compromise of the upper urinary system
-not a normal consequence of aging, but other age-related changes may predispose to the problem
urolithiasis and nephrolithiasis
Calculi (stones) in the urinary tract or kidney
-causes: may be unknown
-depends on location and presence of obstruction or infection
-pain and hematuria
-diagnosis: radiography, blood chemistries and stone analysis
-strain all urine and save stones