MedSurg Exam 1 Perioperative & Neurologic Care

What are the three stages of perioperative care?

Preoperative Care, Intraoperative Care, Postoperative Care.

When does the preoperative stage begin and end?

It begins when the decision for surgery is made and ends when the patient is transferred to the surgical suite.

What is included in the preoperative checklist?

Documentation, assessment, physical preparation, educational needs, informed consent, NPO status, skin prep, and pre-op medications.

What is the purpose of informed consent in the preoperative stage?

It must be signed by the patient or power of attorney, ensuring the patient understands the procedure.

What is the NPO status requirement before surgery?

Patients should be NPO for 6-8 hours, but this may vary.

What types of medications should be discontinued before surgery?

Anticoagulants, NSAIDs, and hypertensive medications (case by case).

What should be done to reduce patient anxiety before surgery?

Provide education and therapeutic communication.

What is the role of the nurse during the intraoperative phase?

The nurse's role is to ensure patient safety.

What attire is required to enter the surgical suite?

Surgical scrubs with hair covered and a mask.

What is a surgical time out?

A verification process to ensure the correct patient, procedure, surgeon, position, equipment, and imaging studies.

What does surgical asepsis refer to?

Sterile technique aimed at preventing the spread of pathogens.

What are expected side effects of anesthesia?

Sedation, altered level of consciousness, nausea/vomiting, and headache.

What are the five stages of general anesthesia?

Induction, Intubation, Maintenance, Emergence, Recovery.

What is malignant hyperthermia and its treatment?

A medical emergency characterized by tachycardia and fever; treated with Dantrolene and cooling the patient.

What is important for maintaining skin integrity during surgery?

Patient repositioning.

What are some safety risks during the intraoperative phase?

Fire risk, malignant hyperthermia, positioning-related injury, surgical site infection, and retained surgical items.

What is the focus of the postoperative stage?

Monitoring patients closely to ensure recovery and avoid serious complications.

What should be documented regarding pre-op lab work?

It should be on the chart and the surgeon notified of any abnormalities.

What should be done with removable items before surgery?

Anything that can be removed should be taken off to reduce the risk of electrical burns.

What is the importance of vital signs before transferring a patient to surgery?

To ensure the patient's stability and readiness for surgery.

What is the significance of having suction available during intubation?

To manage any secretions or complications that may arise during the procedure.

What are the phases of PACU and their expected findings/actions?

1. Intense monitoring 2. Preparation for discharge 3. Discharge criteria met/waiting for bed or to leave.

What is the priority assessment in PACU?

Airway and respiratory status.

What does an Aldrete Score of 8-10 indicate?

The patient is ready to transfer to another unit or be discharged home.

What post-operative labs should be monitored?

CMP, Hct/Hgb, pH, PTT, electrolytes, PT, INR.

What are expected abnormal post-operative findings?

Decreased bowel sounds, soft blood pressure, tachycardia, decreased respiratory rate, change in LOC, nausea/vomiting, slight increase in temperature.

What should be checked if a patient is vomiting post-operatively?

Bowel sounds.

What are early signs of hypoxia?

Restlessness, Anxiety, Tachycardia/Tachypnea (RAT).

What are late signs of hypoxia?

Bradycardia, Extreme Restlessness, Dyspnea (BED).

What are possible post-operative problems and how can they be addressed?

Respiratory depression, pain, bleeding.

What important supplies should be available post-operatively?

Emergency equipment, suction, code cart.

What are ways to ensure the patient completes interventions that decrease the risk of complications?

Premedicate and educate.

How can dehiscence and evisceration be prevented?

By splinting.

What interventions can avoid complications post-operatively?

Early ambulation, incentive spirometry, turning, coughing, and deep breathing.

What should post-operative education include?

When to ask for pain medication, what to expect in physical therapy, drain care, unit education, safety topics, and discharge education.

What are the risk factors for DVT?

Age, lack of movement, injury, being overweight, smoking.

What is the priority assessment for a potential head injury?

Glasgow Coma Scale (GCS).

How can you identify someone having neurological issues?

Change in level of consciousness (LOC).

What are the risk factors for stroke (CVA)?

Smoking, diabetes, family history, clotting disorders, TBI, hypertension, drug use, gender, age over 55, atherosclerosis.

What are the effects of left brain damage?

Right body weakness, impaired speech and language, slow performance, visual field deficits, awareness of deficits, depression, anxiety.

What are the effects of right brain damage?

Left body weakness, spatial-perceptual deficits, impulsivity, short attention span, impaired judgment.

Who can receive treatment for ischemic strokes and what is the treatment?

Patients with ischemic strokes can receive TPA within 3 hours of symptom onset.

What is the initial test for stroke diagnosis?

CT scan as soon as possible.

What are key interventions for a client with a stroke?

Administer medications, perform bedside swallow screen, elevate HOB, place feeding tube, aspiration and bleeding precautions, frequent repositioning, passive ROM.

What are the risk factors for seizures?

Fevers, genetics, head trauma, cerebral trauma, stopping antiepileptics, infections, stroke (24 hrs post), tumor, hypoxia, substance withdrawal, electrolyte imbalances.

What causes seizures?

Abrupt excessive discharge of neurons causing changes in consciousness.

What are the types of seizures?

Generalized seizures (both hemispheres, may begin with an aura) and tonic-clonic seizures (begins with muscle stiffness and loss of consciousness).

What is clonic movement?

The jerking of extremities.

What characterizes myoclonic seizures?

Brief jerking or stiffness of extremities.

What happens during atonic seizures?

Muscle tone is lost.

What are partial or focal seizures?

Seizures that occur in one cerebral hemisphere and may involve random body spasms with or without consciousness.

What is status epilepticus?

A medical emergency involving seizure activity lasting more than 5 minutes.

What are common treatments for seizures?

Antiepileptic medications and surgical interventions.

What should you do when a patient is seizing?

Call the rapid response team, protect the patient from injury, maintain airway, and document times.

What are some seizure precautions for family education?

Prioritize airway patency and client safety, know how to keep the patient safe, and when to call for help.

What is meningitis?

Inflammation of the meninges caused by a virus or bacteria.

What is encephalitis?

Acute inflammation of the brain.

How do we test for meningitis and encephalitis?

Through lumbar puncture, CT, or MRI.

What are the treatment options for meningitis and encephalitis?

Droplet precautions, reduce fever, manage increased intracranial pressure (ICP), seizure precautions, fluids, anti-seizure medications, and antibiotics.

What are subjective findings of meningitis?

The worst headache ever, nuchal rigidity, and photophobia.

What are objective findings of meningitis?

Fever, chills, nausea, vomiting, positive Kernig's and Brudzinski's signs, altered level of consciousness (ALOC), tachycardia, seizures, and hyperactive deep tendon reflexes (DTR).

What are the stages of Parkinson's disease?

1. Slight tremors on one side; 2. Symptoms worsen affecting both sides; 3. Loss of balance and slowness; 4. Severe symptoms limiting independence; 5. Confined to wheelchair or bed.

What are common symptoms of Parkinson's disease?

Pill rolling, stooped posture, muscle rigidity, tremors at rest, bradykinesia, and akinesia.

What is the treatment for Parkinson's disease?

Medications (anticholinergics, dopamine receptor agonists, carbidopa-levodopa) and surgery (stereotactic pallidotomy).

What education should be provided to patients with Parkinson's disease?

Medication compliance, safety precautions, and psychosocial support.

Is Alzheimer's disease reversible?

No, it is a non-reversible type of dementia.

What is Alzheimer's disease?

A progressive neurodegenerative disease of the central nervous system.

What happens to proteins in nerve cells of the brain leading to memory loss?

They get tangled and die.

What are the symptoms of mild cognitive impairment?

Memory lapses, losing actions, difficulty concentrating, but activities of daily living (ADLs) are still okay.

What characterizes moderate cognitive impairment?

Forgetting one's history, difficulty performing normal tasks, personality changes, sleep disturbances, wandering, and possible episodes of incontinence.

What are the symptoms of severe cognitive impairment?

Losing the ability to converse, needing assistance with ADLs, incontinence, losing awareness of the environment, possible cessation of movement, and choking which can lead to pneumonia.

What nursing interventions can help patients with cognitive impairment?

Encourage ADLs, reorient as needed, maintain a safe environment, ensure adequate nutrition, speak calmly, provide emotional support, and minimize napping.

What is Multiple Sclerosis (MS)?

An autoimmune disorder that affects nerve cells in the brain and spinal cord, attacking the myelin sheath and interrupting nerve transmission.

What are common symptoms of Multiple Sclerosis?

Fatigue, dizziness, pain, tingling, diplopia, vision loss, optic neuritis, dysphagia, tinnitus, nystagmus, bowel and bladder changes, cognitive changes, and electric shock sensations with head movement.

What nursing interventions are important for patients with Multiple Sclerosis?

Check visual acuity, speech patterns, and swallowing; encourage fluid and calorie intake; help with coping; promote a safe home environment; and conserve energy.

What is Myasthenia Gravis?

An autoimmune disorder that decreases acetylcholine sensitivity, leading to muscle weakness and fatigue.

What are the initial symptoms of Myasthenia Gravis?

Droopy eyelids, diplopia, difficulty with facial expressions, slurred speech, weak arms and legs, and complications in breathing.

What is the priority nursing intervention for Myasthenia Gravis?

Monitoring airways.

What determines the deficits experienced by patients with spinal cord injuries?

The site and type of injury to the spinal cord.

What are the effects of a cervical spinal cord injury?

Can lead to trouble with fine motor movements to quadriplegia.

What is autonomic dysreflexia and why is it a medical emergency?

It is caused by massive imbalanced reflex sympathetic discharge, often due to stimuli like a full bladder or pressure sores, and can lead to sudden hypertension and other serious symptoms.

What are the signs and symptoms of autonomic dysreflexia?

Sudden hypertension, bradycardia, headache, anxiety, nausea, diaphoresis, flushed skin, and vasoconstriction.

What are common triggers for Trigeminal Neuralgia?

Activities that cause movement of the face, such as eating, brushing teeth, or shaving.

What is the primary symptom of Trigeminal Neuralgia?

Sudden pain across the face.

What is Intracranial Pressure (ICP)?

The pressure and volume built up in the brain.

How is ICP diagnosed?

Initially with a CT scan.

What is a critical nursing intervention for managing ICP?

The goal is to reduce pressure, which includes elevating the head of the bed and monitoring for drainage.

What are some clinical manifestations of increased ICP?

Changes in vital signs (Cushing's triad), changes in level of consciousness, headache, seizures, vomiting, changes in speech, posturing, and eye changes.

What is Cushing's triad?

Increased blood pressure, decreased pulse, and irregular respirations.

What should be avoided to help manage ICP?

Flexing muscles such as the abdomen and hips.

What are some nursing interventions for patients with spinal cord injuries?

Use log roll when turning, place a cervical collar, monitor for autonomic dysreflexia, and monitor bowel and bladder.

What is Uhthoff's sign?

Temporary changes in vision, often associated with Multiple Sclerosis.