Unit 4 review

You are a nurse working with a pre-op patient. Your patient is unsure of who their surgeon is, what the risks are for this procedure, and the expected outcome. What step on the pre-op checklist was likely missed?

Obtaining informed consent.

Who typically obtains informed consent?

The person performing the procedure.

Your patient was harmed in surgery and the family is pursuing legal action. They claim that the patient was mentally incompetent when signing the informed consent. Will the informed consent hold up in court if this turns out to be true?

No. Informed consent is a legal document with legal standing only if the patient is an adult, alert and oriented, and mentally competent.

During the preop assessment on your patient it is determined that they have cardiovascular disease. What vital sign will be monitored in surgery?

Blood pressure. Big drop in surgery can cause renal disease.

What intervention needs to be closely monitored in postoperative patients with COPD?

Delivery of O2. A “normal” amount could be too much for a COPD patient.

Why is it important to determine if a preop patient has a history of renal and/or liver disease?

This could affect their fluid balance as well as medication (anesthesia) breakdown.

An endocrine disease like diabetes could signal a concern for what during surgery?

Glucose levels going out of range, especially in longer procedures.

How does penicillin work against bacteria?

Inhibits cell wall synthesis

How do Cephalosporin’s work against bacteria?

inhibits cell wall synthesis

How do Carbapenem’s work against bacteria?

Inhibit cell wall synthesis

How do Aminoglycosides work against bacteria?

Inhibits protein synthesis. (PAME, Please(protein synthesis) Ask (aminoglycosides) M(macrolides)E(erythromycin))

How do Macrolides work against bacteria?

Inhibit protein synthesis.

How do Sulfonamides work against bacteria?

Inhibit DNA/Folic acid

How do Quinolones work against bacteria?

Inhibit DNA/Folic acid

What kind of antibiotic is amoxicillin?

Penicillin (PCN)

If you are one of the many who have an allergy to this antibiotic, it becomes apparent right away. What antibiotic is it?

Penicillin (PCN)

How many generations of Cephalosporin’s are there?

5

Why are there different generations of Cephalosporins?

Each generation is increasingly effective

Pharmaceutical class for cefazolin (Ancef)

First generation cephalosporin

Pharmaceutical class for cephalexin (Keflex)

First generation cephalosporin

Pharmaceutical class for cefepime (Maxipime)

Fourth generation cephalosporin

meropenem (Merrem) is what kind of antibiotic?

Carbapenem

Which antibiotic has the broadest antibacterial action of any antibiotic?

meropenem (Merrem)

What antibiotic is reserved for complicated infections?

meropenem (Merrem)

What kind of antibiotic is gentamicin?

Aminoglycoside

What kind of antibiotic is tobramycin?

Aminoglycoside

What is the major concern with using Aminoglycosides to treat infection?

can cause ototoxicity and nephrotoxicity

erythromycin is what kind of antibiotic?

macrolide

Bactrim is what kind of antibiotic?

Sulfonamide

ciprofloxacin (Cipro) is what kind of antibiotic?

Quinolones

levofloxacin (Levaquin) is what kind of antibiotic?

Quinolones

What antibiotic is it common for patients to develop an allergy to?

bactrim (sulfonamides)

Your patient is on an anticoagulant but is scheduled for surgery in the near future. What is a concern with this?

Anticoagulants thin the blood which would increase bleeding during/after surgery.

A patient taking diuretics prior to surgery would be at risk for what?

Complications such as shock due to an imbalance in fluid status.

You are caring for a patient post op and are told that their blood pressure dropped drastically during the procedure. What kind of medication taken prior to the surgery could have caused this?

Tranquilizers and/or benzodiazepines

What kind of medication is flagged as a risk in preop assessment but is unable to be discontinued ahead of time?

Corticosteroids

Your patient is getting ready for surgery. They are currently taking antibiotics for a bacterial infection. Does this pose a risk?

Yes. Antibiotics may react with muscle relaxants in anesthesia and can cause respiratory paralysis.

During a preop assessment you notice that medical/surgical history and medications have been documented. What else needs to be included to get a full picture for the patient?

Nutrition, alcohol/drug use, ADL’s and occupation, coping patterns/support system.

A nurse is trying to educate her patient on expectations for recovery post op. How many days of recovery can the patient expect per day of being disabled?

3 days of recovery for every day disabled

What is a nurses primary role in the preop phase of surgery?

Ease anxiety by providing education using therapeutic communication.

How often does a nurse typically assess a patients pain post op?

Q2H. Every two hours.

Is dependence and addiction a big concern in preop planning?

No. The main goal is to manage pain appropriately in the immediate future.

What are post op respiratory cares a nurse can educate their patient on?

Incentive spirometry, deep breathing, coughing while splinting the incision.

A nurse has finished their pre-op education. What statement made by the patient indicates further education is needed?

"I won't have to be physically active until a few days after surgery."

Your patient has surgery in a few days, but their labs show their potassium levels are imbalanced. Will they still be able to have the surgery?

Yes. Electrolyte imbalance can usually be easily fixed via infusions prior to surgery.

Why is malnutrition a risk factor for surgery?

healing will be slower and less effective

Once in the OR there is a “pause” before surgery starts. What is this used for?

Patient’s last chance to retract consent. Last chance for surgeon to make sure it is the right patient, right procedure, right area.

What is the timing of prophylactic antibiotic treatment in surgical patients?

first dose = intraoperative. second dose = 8 hours later. third dose = 8 hours after the second dose.

Your patient came back from the OR an hour ago. When assessing their status you notice that their surgical dressing is soaked through with blood. What is your first intervention?

reinforce the dressing first, and then call service

What kind of wound is this?

Dehiscence

When a wound has dehisced and body organs have started protruding from the wound it’s called…

evisceration

serous drainage is what color?

clear (think blood serum)

sanguineous drainage is what color?

bright red (high RBC) (think sangria wine, red)

serosanguinous drainage is what color?

a mix of clear and red… pink

What does purulent drainage look like?

thick, yellow and/or white

Why are antibiotics used prophylactically during surgery?

Because the body cavity is opening up there is a high risk for infection.

What is the main risk factor in not catching an infection early on in a post-op patient?

Infection can lead to sepsis

What is sepsis?

An widespread immune response to a local infection that can cause inflammation which damages body organs.

What is the timeframe in which sepsis can become an issue in post-op patients?

8-12horus

What is an early sign of shock?

tachycardia

Why are frequent VS so important in post-op patients?

to watch the “trend”. If BP, temp, respir’s/O2, or pulse starts creeping up it’s easier to see when VS are taken frequently.

Besides infection, why is it important to monitor a patient’s temperature post-op?

risk for hypothermia due to OR temp, anesthetics, and length of procedure

What does the nurse need to monitor and asses in the respiratory function of a post-op patient?

breath sounds, O2 sats, rhythm/rate/quality of respirations

CNS monitoring in a post-op patient essentially means return of…

consciousness

What needs to be checked in a post-op patient prior to eating/drinking?

return of the gag reflex, risk for aspiration

What are things to assess and consider when it comes to the fluid status of a post-op patient?

skin turgor, urine output, wound drainage, IV fluid intake

How soon should a nurse encourage movement and getting out of bed post-op?

as soon as possible/same day

Your patient is recovering from surgery and their pulse ox readings have remained in the upper 90’s. Is the nurse safe to assume there is no respiratory distress?

No! Pulse ox is not definitive and does not replace ABG’s

An incomplete expansion or collapse of alveoli with retained mucus is called….

Atelectasis

When auscultating your patients lungs you hear crackling, and notice that their lips are turning blue. What are some immediate nursing interventions?

Positioning (not laying down), C&DB, incentive spirometer

What is known as the “pulmonary toilet” and what is it used to prevent/treat?

To prevent/treat atelectasis. Interventions: activity, O2, positioning, C&DB, incentive spirometer, nebulizer

Atelectasis includes retained mucous of the alveoli due to ineffective expansion and/or collapse, while pneumonia effects the alveoli by way of what three things?

Inflammation, infectious process, or aspiration

Signs of pneumonia include:

Increased temperature, productive cough, crackles/wheezes, pain/dyspnea

The main difference in warning signs for pulmonary embolus compared to other respiratory complications are:

tachycardia

What three respiratory interventions can a nurse DO for the patient rather than instruct the patient to do?

Chest physiotherapy, postural drainage (head down/gravity), and suctioning

What are the most commonly used respiratory meds?

Bronchodilators

What do bronchodilators do for the respiratory system?

Open narrowed airways

What do mucolytics do?

Loosen thick secretions

Corticosteroids reduce what in the body?

Inflammation

What kind of respiratory treatment goes deepest into the lungs?

Nebulizers

What’s the difference in administration between MDI’s and DPI’s?

Metered dose inhalers administered with compression, dry powder inhaler is breath activated

Your patient is back from surgery but becomes cold/clammy, anxious, has decreased urine output, frank bleeding and increased pulse. You realize this is likely due to a hemorrhage. What nursing interventions will you do?

Apply pressure to the site and prepare patient to return to surgery.

Your post op patients blood pressure drops and their heart rate increases. You are concerned that they are experiencing hypovolemic shock. What interventions can you perform?

Stop any obvious bleeding, contact service, lay patient flat with feet elevated (return blood to core), apply O2, maintain temp, and administer meds to decrease bleeding.

Where is the common site for DVT?

Legs

Your patient has been bed bound and begins experiencing pain and cramping in their calf. On assessment you notice the area is red and warm. What do you suspect is happening and what are interventions you can perform?

DVT. Measure extremity, administer meds, prevent from traveling (no massage).

Do medications given for DVT get rid of the blood clot?

No. They prevent it from getting bigger. Body will absorb the clot eventually.

What is the post op diet based on?

Progression of GI function

What is the post op diet progression?

Clear liquid, full liquid, soft, general

What signals progression in GI function post op?

Bowel sounds, passing gas, distention resolved, no vomiting/diarrhea

Your patient has been NPO for 3 days. What should you prepare them for regarding nutrition?

To receive enteral or parenteral nutrition. (NG or NJ or IV)

If a patient is NPO post op and has an NG tube what else can you expect will be connected?

Suction (LIS/LCS)

An infection becomes systemic when what symptoms are present?

Fever, tachycardia

Why is monitoring I&O so important in post op patients?

Patients may experience urine retention due to lasting effects of anesthesia slowing things down. In order to prevent infection we want to monitor I&O to ensure there’s no retention.

When evaluating I&O in your post op patient you see a trend of a higher intake and lower output. What might your next intervention be?

assess PVR (post void residual). If high, may have to place catheter to fully empty bladder and prevent infection

Why is it important to understand a patients normal bowel routine in regards to post op care?

If it’s normal for them to go a few days without having a BM it may not be as big of a cause for concern if there is no BM for a few days post op. Always check bowel sounds to ensure their function has returned.

What are the most common HCAI?

CAUTI, intubation/aspiration pneumonia, surgical site infection, sepsis from bad IV

What kind of infection is clostridioides difficile classified as?

Superinfection, caused by antibiotic usage

Your patient is on contact precautions due to an active C. diff infection. You see someone exit the room and use hand sanitizer. Is this sufficient?

No. Spores are not killed by hand sanitizer. MUST wash hands with soap and water.

What symptoms are associated with C. diff?

Watery diarrhea, cramping/pain, foul odor, fever.

What antibiotic is often combined with other meds to keep it effective?

PCN. Other meds used to inhibit bacterial enzymes that break down PCN.