oh my god

most important Sx of Compartment Syndrome

pain

For low back pain, is it okay to sleep on the abdomen?

No it’s not

For low back pain, how soon should pt get better?

In 3-4 weeks

For low back pain, what should the pt avoid?

• straining

• prolonged sitting

• bending/twisting

For low back pain, what is the initial treatment?

• NSAIDs

• Tylenol

• muscle relaxors

  • (flexeril)

Do you treat phantom pain?

Yes; phantom pain is real, so treat pain

Pt w/ spine Fx and has bowel and bladder incontinence, is this bad?

This is an emergency.

What do when pts SOB progresses on assessment?

start them on O2

For a pt w/ Hip fx and Bucks traction, what should you assess?

assess pain level and see if it has alleviated

For a closed injury, what is most important to assess

circulation

What to tell mother of 8yo w/ arm cast

tell mom to ice and elevate

For a pt w/ AKA, what position should they maintain at home?

lay on stomach, straighten out leg

Following pt on floor after amputation, what assessment is bad?

bleeding a/o blood in dressing

Pt education for external fixation

teach how to clean hardware and pins

After pts hip is fixed, what should you do for when pt gets out of bed for therapy?

look for order for weight bearing status

When walking w/ crutch:

move injured leg w/ crutch

When walking with cane:

hold cane in opposite arm of injured leg and move injured leg w/ cane

What does progression of patients through various phases of care in a postanesthesia care unit (PACU) primarily depend on?

Condition of patient

Which procedures are done for curative purposes (SATA)?

• Hysterectomy

• Herniorrhaphy

A patient is scheduled for a hemorrhoidectomy at an ambulatory surgery center. An advantage of performing surgery at an ambulatory center is a decreased need for

diagnostic studies and perioperative medications.

Patient-Centered Care: A patient who is being admitted to the surgical unit for a hysterectomy paces the floor, repeatedly saying, "I just want this over." What should the nurse do to promote a positive surgical outcome for the patient?

Ask the patient what her specific concerns are about the surgery.

Many common herbal products taken cause surgical problems. Which herbs listed subsequently should the nurse teach the patient to avoid before surgery to prevent an increase in bleeding for the surgical patient (SATA)?

• Garlic

• Fish oil

• Vitamin E

• Ginkgo biloba

Priority Decision: When the nurse asks a preoperative patient about allergies, the patient reports a history of seasonal environmental allergies and allergies to a variety of fruits. What should the nurse do next?

Ask the patient to describe the nature and severity of any allergic responses experienced from these agents.

During a preoperative review of systems, the patient reveals a history of renal disease. This finding suggests the need for which preoperative diagnostic studies?

Blood urea nitrogen (BUN), serum creatinine, and electrolytes

During a preoperative physical examination, the nurse is alerted to the possibility of compromised respiratory function during or after surgery in a patient with which problem?

Obesity

What type of procedural information should be given to a patient in preparation for ambulatory surgery (SATA)?

• How pain will be controlled

• Any fluid and food restrictions

• Technique and practice of coughing and deep breathing, if appropriate

The nurse asks a preoperative patient to sign a surgical consent form as specified by the surgeon and then signs the form after the patient does so. By this action, what is the nurse doing?

Witnessing the patient's signature

When the nurse prepares to administer a preoperative medication to a patient, the patient tells the nurse that she really does not understand what the surgeon plans to do.

What action should be taken by the nurse?

The nurse should notify the surgeon because the patient needs further explanation of the planned surgery.

When the nurse prepares to administer a preoperative medication to a patient, the patient tells the nurse that she really does not understand what the surgeon plans to do.

What condition of informed consent has not been met in this situation?

Clear understanding of the information

A patient scheduled for hip replacement surgery in the early afternoon is NPO but receives and ingests a breakfast tray with clear liquids on the morning of surgery. What response does the nurse expect when the ACP is notified?

Surgery will be done as scheduled.

What is the reason for using preoperative checklists on the day of surgery?

All preoperative orders and procedures have been carried out and documented.

A common reason that a nurse may need extra time when preparing older adults for surgery is their

diminished vision and hearing.

The nurse is reviewing the laboratory results for a preoperative patient. Which study result should be brought to the attention of the surgeon immediately?

White blood cell (WBC) count of 18,500/μL

The nurse is preparing a patient for transport to the operating room. The patient is scheduled for a right knee arthroscopy. What actions should the nurse take at this time (SATA)?

• Ensure that the patient has voided.

• Verify that the informed consent is signed.

• Complete preoperative nursing documentation.

• Verify that the right knee is marked with indelible marker.

• Ensure that the history and physical examination (H&P), diagnostic reports, and vital signs are on the chart.

What is the physical environment of a surgery suite primarily designed to promote?

• Medical and surgical asepsis

When transporting an inpatient to the surgical department, a nurse from another area of the hospital is able to access which area?

Holding area

Which nursing actions are completed by the scrub nurse (SATA)?

• Prepares instrument table

• Remains in the sterile area of the operating room (OR)

• Passes instruments to surgeon and assistants

What is the primary goal of the circulating nurse during preparation of the OR, transferring and positioning the patient, and assisting the anesthesia team?\

Avoiding any type of injury to the patient

Priority Decision: Upon admission of a patient to the PACU, the nurse's priority assessment is:

respiratory adequacy

A break in sterile technique occurs during surgery when the scrub nurse touches

the mask with sterile gloved hands.

During surgery, a patient is at risk for perioperative positioning injury. What is a common risk factor for this problem?

Musculoskeletal deformities

Which short-acting barbiturate is most often used for induction of general anesthesia?

Methohexital (Brevital)

Because of the rapid elimination of volatile liquids used for general anesthesia, what should the nurse anticipate the patient will need early in the anesthesia recovery period?

Analgesic medication

What is the primary advantage of the use of midazolam as an adjunct to general anesthesia?

Amnestic effect

Monitored anesthesia care (MAC) is being considered for a patient undergoing a cervical dilation and endometrial biopsy in the health care clinic. The patient asks the nurse, "What is this MAC?" The nurse's response is based on the knowledge that MAC

provides maximum flexibility to match the sedation level with the patient and procedure needs.

Spinal block

Injection of agent into subarachnoid space

Epidural block

Injection of anesthetic agent into space around the vertebrae

IV nerve block

Injection of agent into veins of extremity after limb is exsanguinated

The patient will be placed under moderate sedation to allow realignment of a fracture in the emergency department. When the family asks about this anesthesia, what should the nurse tell them?

Patients remain responsive and breathe without assistance

What condition should the nurse anticipate that may occur during epidural and spinal anesthesia?

Hypotension and bradycardia

A patient scheduled for a procedure is expected to receive ketamine (Ketalar). What would be included in patient teaching regarding ketamine?

Hallucinations may occur, so the patient will receive midazolam.

A preoperative patient reveals that an uncle died during surgery because of a fever and cardiac arrest. Knowing the patient is at risk for malignant hyperthermia, the perioperative nurse alerts the surgical team. What is likely to happen next?

Specific precautions can be taken to safely anesthetize the patient.

It is most important to monitor the patient for malignant hyperthermia if the patient received which anesthetic agent?

succinylcholine

Goals for patient safety in the OR include the Universal Protocol. What is included in this protocol?

A surgical timeout is performed just before the procedure is started to verify patient identity, surgical procedure, and surgical site.

How is the initial information given to the PACU nurses about the surgical patient?

A verbal report from the anesthesia care provider (ACP)

To prevent agitation during the patient's recovery from anesthesia, when should the nurse begin orientation explanations?

When the patient first arrives in the PACU

What is included in the routine assessment of the patient's cardiovascular function on admission to the PACU?

Electrocardiographic (ECG) monitoring

With what are the postoperative respiratory complications of atelectasis and aspiration of gastric contents associated?

Hypoxemia

Priority Decision: To promote effective coughing, deep breathing, and ambulation in the postoperative patient, what is most important for the nurse to do?

Provide adequate and regular pain medication

To prevent airway obstruction in the postoperative patient who is unconscious or semiconscious, what will the nurse do?

Position the patient in a side-lying position

While assessing a patient in the PACU, the nurse finds that the patient's blood pressure (BP) is below the preoperative baseline. The nurse determines that the patient has residual vasodilating effects of anesthesia when what is assessed?

A normal pulse with warm, dry, pink skin

Priority Decision: A patient in the PACU has emergence delirium manifested by agitation and thrashing. What should the nurse assess the patient for first?

Hypoxemia

The PACU nurse applies warm blankets to a postoperative patient who is shivering and has a body temperature of 96.0° F (35.6° C). What treatment may also be used to treat the patient?

Oxygen therapy

Which patient is ready for discharge from Phase I PACU care to the clinical unit?

Awake, vital signs stable, dressing is dry and intact, no respiratory depression, SpO2 is 92%

For which nursing diagnoses or collaborative problems common in postoperative patients has ambulation been found to be an appropriate intervention (SATA)?

• Impaired physical mobility

• Impaired airway clearance

• Constipation

• Risk for ineffective tissue perfusion

A patient who had major surgery is experiencing emotional stress as well as physiologic stress from the effects of surgery. What can this stress cause?

Fluid retention

In addition to ambulation, which nursing intervention could be implemented to prevent or treat the postoperative complication of syncope?

Slowly progress to ambulation with slow changes in position.

Which tubes drain gastric contents (SATA)?

• Nasogastric tube

• GI tube

Which drainage is drained with a Hemovac?

Wound drainage

Thirty-six hours postoperatively, a patient has a temperature of 100° F (37.8° C). What is the most likely cause of this temperature elevation?

Normal surgical stress response

The health care provider has ordered IV morphine q2-4hr as needed for a patient following major abdominal surgery. When should the nurse plan to administer the morphine?

After assessing the nature and intensity of the patient's pain

What should be included in the instructions given to the postoperative patient before discharge?

Written information about self-care during recuperation

CASE STUDY: Postoperative Patient

Patient Profile: S.B., a 63-year-old alert and oriented woman, is admitted to the PACU following a cystoscopy for recurrent bladder infections and recent hematuria. The procedure was scheduled as outpatient surgery and was performed under IV sedation.

Postoperative Orders

• Vital signs per routine

• Discontinue IV before discharge

• Patient to void before discharge

• Ciprofloxacin (Cipro) 500 mg PO q6hr for 10 days

• Acetaminophen 300 mg/codeine 30 mg (Tylenol #3) 1 or 2 tabs q3-4hr PRN for pain

• Patient to call office to schedule follow-up appointment

Discussion Questions

1. Priority Decision: What priority nursing actions will be required to progress S.B. toward discharge?

2. Safety: What precautions will be required in ambulating S.B. after surgery?

3. What problems may interfere with discharging S.B. home in a timely manner?

4. How will the nurse determine that S.B

1. Priority nursing actions for this 68-year-old patient are:

(1) observing for changes in mental status and orienting as the patient recovers from the sedating medication,

(2) promoting voiding,

(3) providing oral fluids and intake,

(4) assessing and maintaining airway, breathing, and circulation, and

(5) assessing and treating pain.

2. Syncope is possible because of the effects of the drug and instrumentation of the bladder. The patient should be slowly progressed to ambulation by elevating the head of the bed, then dangling the legs, and then standing at the side of the bed before attempting ambulation. A gait belt may also be used.

3. Inability to void is the most likely problem. The patient could also have respiratory depression or unstable vital signs because of the effects of the drugs or have complications, such as bleeding from the bladder.

4. The nurse can determine this by using standard discharge criteria for PACUs: easily arousable, stable vital signs, no excess bleeding or drainage, no respiratory depression, oxygen saturation >90%, pain, nausea and vomiting controlled in addition to the specific criteria ordered for this patient.

5. In an outpatient setting, this 68-year-old patient also needs to be alert and ambulatory with the ability to provide self-care near the level of preoperative functioning. The patient must be accompanied by an adult to drive her home. No opioids should have been given for 30 minutes before discharge. Discharge instructions should be understood by the patient or a caregiver if needed and include medication side effects.

6. Nursing diagnoses

• Impaired urinary system function; Etiology: cystoscopy

• Acute pain; Etiology: bladder irritation

• Risk for infection; Etiology: incomplete bladder emptying

• Risk for injury; Etiology: sedation

• Lack of knowledge; Etiology

CASE STUDY: Preoperative Patient

Patient Profile C.J., a 44-year-old male construction worker, is scheduled for a bronchoscopy for a biopsy of a right lung lesion. He initially sought medical care for hemoptysis and increasing fatigue. When the nurse asked him to sign the operative permit, he stated that he was not certain if he should go ahead with the procedure because he fears a diagnosis of cancer.

Subjective Data

• Has never been hospitalized

• Has had no medical problems except mild obesity

• Has a cigarette smoking history of 28 pack-years

• Is married with 2 children, ages 6 and 8 years; both children have cystic fibrosis

• Is fearful that his wife will not be able to manage without him Objective Data

• Diagnostic studies: chest x-ray revealed mass in upper lobe of right lung

• Hematocrit 31%

Discussion Questions

1. What factors in C.J.'s background or personal situation may influence his emotiona

1. Influencing factors include the:

(1) family (children with cystic fibrosis who require extra care and expense and concern that the wife will not be able to manage without him);

(2) fear of cancer and the unknown; and

(3) anemia (contributes to fatigue and ability to cope)

2. Three criteria for informed consent:

• Adequate disclosure of the diagnosis; the nature and purpose of the proposed treatment; risks and consequences of the proposed treatment; the availability, benefits, and risks of alternative treatments; and the prognosis if treatment is not instituted.

• Clear understanding of the information provided.

• Voluntary consent is given without persuasion or coercion.

3. Outpatient instructions: when to arrive and the time of the surgery, how and where to register, what to wear and bring, the need for a responsible adult for transportation home after the procedure

General preoperative instruction: information related to preoperative routines and preparation, such as food and fluid restrictions; approximate length of surgery; postoperative recovery

4. Smoking history increases the risk for postoperative respiratory complications; the longer the patient can stop smoking before surgery, the less the risk will be. Mild obesity may contribute to problems with clearance of respiratory secretions and complete expansion of the lungs. The patient should have preoperative instruction about deep-breathing and coughing techniques. Fear of a diagnosis of cancer can alter adaptation and recovery. The nurse can help minimize this risk by providing specific information about the experience and through supportive listening.

5. Nursing diagnoses

• Fear; Etiology: possible diagnosis of cancer

• Difficulty coping; Etiology: shift in family roles

• Impaired health maintenance; Etiology: tobacco use

Collaborative problem

A patient reports shoulder pain when the nurse moves the patient's arm behind the back. Which question would the nurse ask?

Do you have difficulty when you are putting on a shirt?

A patient with left knee pain is diagnosed with bursitis. Which location would the nurse identify as being the site of inflammation?

A fluid-filled sac found at the joint

The nurse notes that a 59-yr-old female patient has lost 1 inch in height over the past 2 years. Which diagnostic test would the nurse plan to discuss with the patient?

Dual-energy x-ray absorptiometry (DXA)

Which information in a 67-yr-old woman's health history would alert the nurse to the need for a focused assessment of the musculoskeletal system?

The patient's mother became shorter with aging.

Which information obtained during the nurse's assessment may indicate a patient's increased risk for musculoskeletal problems?

The patient is 5 ft, 2 in tall and weighs 180 lb.

Which medication information would the nurse identify as a potential risk to a patient's musculoskeletal system?

The patient has asthma requiring frequent therapy with oral corticosteroids.

The nurse finds that a patient can flex the arms when no resistance is applied but is unable to flex against light resistance. How would the nurse document the patient's muscle strength level?

3

After completing the health history, how would the nurse begin to assess the musculoskeletal system?

Observe the patient's body build and muscle configuration.

Which action would the nurse include when performing the straight-leg raising test for an ambulatory patient with back pain?

Lift the patient's leg to a 60-degree angle from the bed.

A patient with severe kyphosis is scheduled for dual-energy x-ray absorptiometry (DXA) testing. Which action would the nurse plan to take?

Explain the procedure to the patient.

A patient has a new order for magnetic resonance imaging (MRI) without contrast to evaluate possible left femur osteomyelitis after hip arthroplasty surgery. Which information indicates the nurse would consult with the health care provider before scheduling the MRI?

The patient has a pacemaker.

The nurse notes crackling sounds and a grating sensation with palpation of an older patient's elbow. How would this finding be documented?

Crepitation

Which finding for a 77-yr-old patient seen in the outpatient clinic is the highest priority for further nursing assessment and intervention?

History of recent loss of balance and fall

Which finding from analysis of fluid from a patient's right knee arthrocentesis would be of concern to the nurse?

Cloudy fluid

Which task can the nurse assign to assistive personnel (AP) who are working in the orthopedic clinic?

Obtain blood sample for uric acid from a patient with gout.

A patient's radiology report describes a fracture of the proximal tibial epiphysis. Which location corresponds to the reported fracture?

Just below the knee

A 28-year-old patient reports anxiety, headaches with dizziness, and abdominal bloating occurring before her menstrual periods. Which action is best for the nurse to take at this time?

Ask the patient to keep track of her symptoms in a diary for 3 months.

A 19-year-old has been diagnosed with primary dysmenorrhea. How will the nurse suggest that the patient prevent discomfort?

Take nonsteroidal anti-inflammatory drugs (NSAIDs) when her period starts.

A 47-year-old woman asks whether she is going into menopause if she has not had a menstrual period for 3 months. The best response by the nurse is which of the following?

"What was your menstrual pattern before your periods stopped?"

A 49-year-old woman is considering the use of combined estrogen-progesterone hormone replacement therapy (HT) during menopause. Which information will the nurse include during their discussion?

HT decreases osteoporosis risk and increases the risk for cardiovascular disease and breast cancer.

A 25-year-old woman who is scheduled for a routine gynecologic examination tells the nurse that she has had intercourse during the last year with several men. The nurse will plan to teach about the reason for

Chlamydia testing.

The nurse is caring for a 20-year-old patient with pelvic inflammatory disease (PID) requiring hospitalization. Which nursing intervention will be included in the plan of care?

Elevate the head of the bed to at least 30 degrees.

A 24-year-old patient with pelvic inflammatory disease (PID) is being treated with oral antibiotics as an outpatient. Which instruction will be included in patient teaching?

Return for a follow-up appointment in 2 to 3 days.

A 32-year-old patient has oral contraceptives prescribed for endometriosis. The nurse will teach the patient to

take the medication every day for the next 9 months.

A 28-year-old patient with endometriosis asks why she is being treated with medroxyprogesterone (Depo-Provera), a medication that she thought was an oral contraceptive. The nurse explains that this therapy

suppresses the menstrual cycle by mimicking pregnancy.

A 28-year-old patient was recently diagnosed with polycystic ovary syndrome. It is most important for the nurse to teach the patient

methods to maintain appropriate weight.