Exam 1

diagnostic surgery

surgery can establish whether a person has a particular illness, disease or condition

curative surgery

removing part or all of the cancerous/impaired organ or tissue and a small amount of healthy tissue around it.

reparative surgery

restores your body after an injury, disease, or it corrects defects you were born with.

reconstructive/ cosmetic surgery

restore normal appearance and function to body parts malformed by a disease or medical condition/ pt wants body to look different

palliative surgery

targeted to make a patient’s symptoms less severe, thus make the patient’s quality of life better despite negligible impact on the patient’s survival.

emergent surgery

need to do right away

ex: burst appendix

urgent surgery

not going to die but need done soon

ex: gallstones

required surgery

need to have it within weeks/months

ex: enlarged thyroid

elective surgery

should have it, but you can choose

ex: bad keloid

optional surgery

nonessential, but something someone wants

ex: cosmetic

nurse role with informed consent

make sure patient understands and ask if they have any questions

can an emancipated minor sign their own consent

yes

SSI

surgical site infection

normal BMI

18-24.99

incentive spirometry should be done

10 times every 1-2 hours

if there is blood loss more than 500 cc, what should be given?

blood transfusion

anesthesiologist/ RNA role

vitals, anesthesia, entubation

circulating nurse role

manager of OR, flow of surgery, documents, helps monitor, guards aseptic technique, instrument and sponge count

scrub nurse role

hands instruments to surgeon, instrument and sponge count

turn patient every __ hours

2

general anesthesia

\-knocked out

\-can be inhaled or IV

regional anesthesia

\-awake

\-can be epidural or spinal

moderate sedation

\-conscious sedation

\-30 min/ 1 hour

\-reduces anxiety and controls pain during diagnostic or therapeutic procedures

ex) midazolam (Versed) or Propofol (Diprivan)

monitored anesthesia care

hooked to monitor, given as needed

local anesthesia

numbing

(-caines)

\-may be given in combo with epinephrine

\-central (spinal) or peripheral (infiltration, nerve block, topical)dan

stage I anesthesia

beginning anesthesia (sensitive to environment)

stage II anesthesia

excitement (vital signs go up, may be crying, shouting)

stage III anesthesia

surgical anesthesia (knocked out)

stage IV anesthesia

medullary depression (code blue)

muscle relaxants

cause paralysis

anticholenergic drugs

reduce secretions in respiration

anti-emetics

anti-nausea

ondanetron (Zofran) and promethazine (Phenergan)

after spinal anesthesia

spinal headache can happen, so lay flat on bed

malignant hyperthermia treated by

dantrolene sodium

goals of PACU

\-reorient patient

\-no complications

\-stable VS

\-recover from anesthesia

\-airway

\-cardio stability

\-relieve pain and anxiety

\-control nausea and vomiting

post-operative phases

phase I: intensive care

phase II: self-care hospital, or extended care

phase III: prepare for discharge

early signs of hemorrhage

blood pressure increases

pulse goes up

late signs of hemorrhage

BP drops (below 90 systolic)

how often are vitals taken in the PACU

q15 x 4

q30 x 2

q1 x 4

q2h

q4h

Aldrete score

out of 10

need 7 or above to discharge

activity (2)

respiration (2)

circulation (2)

consciousness (2)

O2 sat (2)

\
need controlled nausea/vomiting and pain before they can be discharged, regardless of score

what is elevated FIRST if there’s breathing or respiratory problems

pulse

how to prevent respiratory complications

* positioning


* deep breathing
* incentive spirometer
* splinting
* early ambulation

how to promote adequate cardiac output

* assess surgical site, tubes, drains
* I + O monitoring
* urine less than 30 mL and hour (>0.5 mg/kg/hr)
* prevent shock
* fluid replacement
* vasopressors (dopamine & epinephrine) increase BP
* blood transfusion

signs of fluid overload

\-HTN

\-tachycardia

\-SOB (crackles, fluid in lungs)

how to relieve or reduce pain

* pain is to be expected
* use of pain scale
* non-pharmacologic pain relief
* IV pain meds (PCA pump, morphine sulfate)
* PO pain meds (acetaminophen, ibuprofen, oxycodone)

before you give opioids, check ___ ____

respiratory rate

acetaminophen

\-no more than 4g in 24 hours

\-hepatoxic (damages liver)

opioids

\-constipate

\-slow breathing

\-decreases LOC

\-pruritus

sudden increase in drainage and bulging at incision site is a sign of

evisceration

what to do if evisceration happens

put sterile wet dressing on incision

who is at higher risk of evisceration and dehiscence

obese patients

wound care

\-reinforce

\-assess

\-change the dressing

\-prevent infection, dehiscence, or evisceration

\-HIGH protein

\-vitamin C (needed for collagen synthesis), B complex, A, K

\-electrolytes (magnesium, copper, zinc)

\-water

signs of wound infection

* fever
* increased WBC
* hot to the touch
* odor
* purulent drainage

patients are NPO after surgery until they

pass gas

not passing gas for 2 days is a

cause for concern

do not give food after surgery until

you can hear bowel sounds, because they might develop paralytic ileus

patient should be within __ hours after foley removal

6-8

not voiding may be due to

low cardiac output

confusion may be indicative of

* blood loss
* low O2 sat
* low glucose

potential respiratory post-op complications

* atelectasis
* pneumonia
* pulmonary embolism

potential cardiovascular post-op complications

* shock
* thrombophlebitis

potential neurologic post-op complications

* confusion
* stroke

potential skin post-op complications

* hematoma
* infection
* dehiscence
* evisceration

potential gastrointestinal post-op complications

* constipation
* paralytic ileus

potential urinary post-op complications

* urinary retention
* UTI

perfect Glascow Coma Scale score

15

normal WBC count

4,500-11,000/ c.u mm

normal hematocrit (Hct) males

42-52%

normal hematocrit (Hct) females

35-47%

normal hemoglobin (Hgb) male

13-18 g/dL

normal hemoglobin (Hgb) female

12-16 g/dL

normal platelet count

150,000-450,000/ cu.mm

normal BUN level

10-20 mg/dL

normal creatinine (Cr) level

0\.7-1.4 mg/dL

normal GFR

>59 mL/min/1.73cm^2

normal potassium (K+) level

3\.5-5.0 mEq/L

normal sodium (Na+) level

135-145 mEq/L

normal magnesium (Mg++) level

1\.3-2.3 mg/dL

normal calcium (Ca++) level

8\.5-10.5 mg/dL

normal A1C (glycosylated hemoglobin)

4\.4-6.4%

normal urine specific gravity

1\.002-1.030

normal prothrombin time (PTT)

9-12.5 sec

normal activated partial thromboplastin time (aPTT)

20-39 sec

alpha cells secrete

glucagon

beta cells secrete

insulin

glycogenesis

breakdown of glucose

gluconeogenesis

synthesis of glucose from non-carb like lactic acid, glycerol, amino acids

type 2 diabetes

* unable to use insulin to use glucose due to insulin resistance (receptor not locking into cells)
* hereditary, obesity, inactivity, age
* relative insulin deficiency, loss of insulin, insulin resistance
* occurs at later age
* ketosis-resistant (rare)
* oral hypoglycemic agents (OHA)
* non-insulin dependent DM

type 1 diabetes

* unable to use glucose due to low insulin
* autoimmune beta cell destruction
* absolute insulin deficiency
* occurs at younger age
* ketosis prone (have to use fat for energy instead, ketones are byproduct)
* insulin dependent DM

gestational diabetes in 2nd or 3rd trimester are at risk for

type 2 diabetes

diabetes risk factors

non-whites

hyperlipidemia

cigarette smoking

elevated CRP

women who have delivered infants 9+ lbs

cardinal signs of diabetes

polyuria

polydipsia

polyphagia

fasting blood glucose diabetes diagnostic value

≥126 mg/dL

normal fasting blood glucose

70-100 mg/dL

random blood glucose diabetes diagnostic value

≥200 mg/dL

2 hour oral/IV glucose tolerance test (GTT) diabetes diagnostic value

≥200 mg/dL

glycosylated hemoglobin (A1C) over 3-4 months diabetes diagnostic value

>6.5% (want this below 7.0% for DM pts)

what does a persons A1C mean

average # of times a patient has been hyperglycemic

1 unit of insulin for every

15g of carbs

normal cholesterol level