nur 206 exam 5

diagnosis

determining extent of condition

cure

eliminating/repairing condition

palliation

alleviate s&s without a cure

prevention

remove something that could be an issue

cosmetic improvement

altering physical apperance

exploration

determining extent of disease

-ectomy

removal of

-lysis

destruction of

-orrhaphy

repair/suture

-oscopy

looking into

-ostomy

creation of an opening

-otomy

cutting into

-plasty

repair/construction of

elective surgery

carefully planned event

decreased occurrence of HAI'

outpatient

emergency surgery

unexpected surgery

benzodiazepines

decrease anxiety + induces sedation

anticholinergic

reduces secretions

opiods

decreases pain + anesthetic needs

antidiabetics

stabilize blood glucose

antiemetics

decrease nausea

antibiotics

prevents post op infections + hx arrythmias, joint surgery, wound contamination possibilities

ambulatory surgery

teach back, restrict fluids

informed consent

active, shared decision-making process between physician and recipient of care

informed consent COMPONENTS

adequate disclosure, pt must show a clear understanding BEFORE receiving sedation, consent must be voluntarily consent

emancipated minors

undergo due diligence to make sure they can give full consent

who cannot give consent

minors, unconscious, or mentally incompetent

true medical emergency

can override need to obtain consent

what can next of kin do

give consent when immediate medical tx is necessary

unrestricted

street clothes interact those in scrubs attire

semi-resricted

staff in clean surgical attire: shoe covers, surgical head cover, mask, face shield

restricted

surgical suite/operating room; sterile core; air ventilation is controlled

preoperative holding area

pt is identified before/surgery, before being released, as well as transferred to an inpatient room

what can of air pressure prevents air from preventing the OR

positive air pressure

what is controlled in the OR

temperature + humidity > very cold to limit bacteria growth

scrub nurse

prepares and manages sterile field

circulating nurse

documents and facilitates progress of procedure

what is the surgeon responsible for

getting medical hx + physical assessment, directing preop testing, postop management, obtaining informed consent, and leads the surgical team

surgeon assistant

holds retractors to expose surgical areas, helps with hemostasis or suturing

rnfa

collabs with surgeon + pt, requires formal education/certification

anesthesia care provider

provides airway + administers anesthetic + manages vital life functions

what questions are asked to the pt

name + dob

circulating nurse (during surgery)

focuses on assessments, reassessments, and adjusting plan of care to promote best surgical outcomes (gives callouts)

surgical asepsis

eliminates ALL pathogens (dressing changes, catheters, central line)

medical asepsis

reducing # of pathogens (handwashing)

handwashing

from distal to proximal (plane of each individual finger > palms > forearms)

if using alcohol based surgical hand scrub

wash w/ soap + water before applying product (rub until dry)

when is client positioned

after anesthesia has been given

local anesthesia

numbs a small, specific area of the body (topical/injection)

regional anesthesia

numbs a specific region of the body by blocking certain nerves/nerve bundles (epidural, spinal, peripheral nerve block)

general anesthesia

numbs the entire body/loss of consciousness (requires advanced airway management + loss of consciousness)

anaphylactic reactions

hypotension, tachycardia, bronchospasm, pulmonary edema

malignant hyperthermia

w/ skeletal muscle rigidity = death, hypoxemia, cardiac problems (family hx possible genetic manifestation)

phase 1

take out endotracheal tube, identify problems, pt is still “out of it”

phase 2

ambulatory observation (less monitoring)

extended observation

pt is stable but little monitoring is still needed

laryngeal edema, spasms, retained thick secretions, tongue falling back

airway obstruction

aspiration, atelectasis, bronchospasms, pulmonary edema, pulmonary embolism (pneumonia can develop quickly)

hypoxemia

to be considered hypoxemia it has to be

abg <60 mmHg or pulse ox <90%

depressed cna, ventilator, pain, poor respiratory muscle tone

hypoventilation

how often to use incentive spirometer

10x/hr while awake

fluid retention

lasts 1-3 days which can increase bp and decrease urine output

syncope

occurs d/t postural hypotension and pt ambulation

highest risk for syncope

older adults, immobile for long periods

early ambulation

increases vital capacity + supports normal respiration

s&s of delirum

restlessness, disorientated, thrashing, shouting

if delirium occurs first, suspect

hypoxia

pocd

decline in pt cognitive function (can happen for weeks-months after surgery)

pocd possible risks

older adults, preexisting cognitive impairment, duration of anesthesia, infections

delirium can result from

pain, f&e imbalances, hypoxemia, drugs, no sleep, overstimulation

vs monitoring phase I

every 15 min or more until stabilized

vs monitoring phase II

less often (can vary often)

dangerous bp

systolic bp <90 mmHg or >160 mmHg

dangerous pulse

<60 bpm or <120 bpm

acute pain

<3 months, usually an event took place, goes away over time

chronic pain

>3 months; unknown cause + doesnt go away

nociceptive pain

stimulus damages normal tissue (somatic/visceral pain)

somatic pain

muscles, joints, ligaments (arthritis)

visceral pain

internal organs, tumor, obstruction (appendicitis)

neuropathic pain

pain affecting the nerves

cancer pain

involves compression/nerve involvement

breakthrough pain

transient, moderate to severe pain that occurs in patients with stable chronic pain

referred pain

pain that resides somewhere else but follows the nerve pathway (like pain in left arm during mi)

phantom pain

pain that persists due to autonomic nervous system dysfunction (amputation)

pain stereotype w/men

unlikely to report pain or use other tx

pain stereotype w/women

experience more chronic pain, report high levels of pain (pain more generalized)

what does nociceptive pain feel like

sharp, ache, throbbing, dull, cramping

what does neuropathic pain feel like

burning, numbing, shooting, stabbing, electric shock, itchy

most common side effect with using pain killers

constipation so use stool softeners/fiber

how long does it take for urine output to normalize

2 days

normal urinary output post anesthesia

25-50 ml/hr = 600-1200 ml/day

what to expect in the 1st 24 hours after surgery

lower urine output (800-1500 ml)

when do most people void

within 6-8 hours

expected drainage from incision site

small amount of serous drainage

how often to check wound

15-30 min, expected to decrease over hours-days

who changes the first dressing

surgeon (report if excess drainage noted)

reinforced dressing

placing another dressing on top of the original dressing

written discharge criteria

having a written form + verbal form