Med surg 2 exam 1

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What are the three primary types of surgeries?

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1

What are the three primary types of surgeries?

Emergent, urgent, and elective

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2

What is the preoperative phase?

patient's first experience with surgical services

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3

What is the intraoperative phase?

preop checklist, operation, transfer to recovery

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4

What is the postoperative phase?

recovery unit, patient is stable to go home or hospital room

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5

What are the priorities during the perioperative experience?

safety requiting teamwork and interprofessional communications

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6

What 3 organizations oversee pt safety in the perioperative area?

The joint commission(TJC), the association of perioperative registered nurses(AORN), and the world health organization(WHO)

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7

The joint commissions universal protocol is?

preventing wrong site, wrong procedure and wrong person surgery

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8

What is the three sections of the universal protocol?

-The procedural time-out (done in the OR) -the procedural site marking (done in the Pre-op area) -the procedural time-out(done in the OR)

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9

What are the types of consent forms a patient may need to complete prior to surgery?

-informed consent -anesthesia consent -blood or blood products consent

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10

What are the three zones in the surgical suite are?

unrestricted zone, semi-restricted zone, and restricted zone

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11

What are the priorities of the OR RN?

-Surgical scrub -surgical attire -sterile set up(aseptic technique) -traffic flow/surgical suite occupants -skin preparations -antibiotics prophylaxis(within 1 hour prior to incision)

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12

What are the four standard positions commonly used for surgical procedures?

supine, prone, lateral and lithotomy

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13

What is anesthesia?

induced state of partial or total loss of sensory perception, with or without loss of consciousness

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14

What are the complications of anesthesia?

hypotension, malignant hyperthermia, fluid and electrolyte imbalances

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15

What is phase one of the pacu?

involves the nursing care provided in the immediate post-anesthesia period. stabilize the pt vitals, wake the patient fully and pain control

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16

what is phase two of the pacu?

focus on pt. discharge to an extended-care environment or home

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17

what is phase three of the pacu?

extended observation

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18

The CNS is made up of?

the brain and the spinal cord

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19

The PNS is made up of?

cranial nerves, spinal nerves, and the ans

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20

What are the 4 focus areas that assess a pts level of consciousness using the Glasgow Coma Scale

Cognitive, cranial, motor, and sensory

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21

What does the mini mental status examination measure?

a patients cognitive function

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22

What information can a cranial nerve assessment provide?

shows neurological impairment due to disease or trauma to the brain

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23

What is the required safety for the joint commission?

-national patient safety goals -comprehensive surgical goals -universal protocol

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24

What is the required safety for the WHO?

comprehensive surgical checklist

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25

What is the required safety for AORN?

-comprehensive surgical checklist -guidelines for practice

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26

What medication will the patient continue to take even if they are going to surgery?

beta blocker

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27

When does the H & P need to be completed?

within 30 days

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28

When does the H & P addendum need to be completed?

within 24 hours

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29

What is cardiac clearance?

all patients over 50 years of age need an ECG

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30

What does a nurse need to do for patient preparation of surgery?

-iv access -bowl and bladder preparation -a pregnacy test for women of childbearing age -removal of jewelry, prosthetics and clothing -inform anesthesia and surgical team of implants -surgical site preparation(showering, hair removal, site marking) -medications given (beta-blocker, benzos, and antimetics)

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31

what do you use the shave skin prior to surgery?

electric clipper (never a razor due to risk of microcuts)

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32

What is surgical attire?

caps, masks, gloves, eyewear, surgical gown, hospital only shoes

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33

What is induction?

iv access and place monitors, infusion of narcotics/ muscle relaxants, induction with sodium pentothal(propofol, ketamine or etomidate), adequate sedation

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34

what is intubation?

place and secure airway

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35

what is maintenance?

maintain patient using balanced anesthesia

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36

what is emergence?

suction patient to decrease the chance of laryngospasm and aspiration, reverse residual muscle relaxant, provide oxygen to wash out inhalation agents, remove airway when patient is breathing on his or her own and follows commands

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37

what is recovery?

patient transported to pacu or intensive care unit, vital signs monitored and oxygenation continued until stable

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38

Early signs and symptoms of malignant hyperthermia

-unexplained increas in CO2

  • unexplained tachycardia or arrhythmia(usually v-tach) -masseter muscle rigidity(after administration of Succinylcholine)

  • generalized flushing and warm skin -mixed respiratory and metabolic acidosis -hyperkalemia

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39

Late signs and symptoms of malignant hyperthermia

-hyperthermia( can increase 1 degree C every few minutes) -hypoxemia -cyanosis and skin mottling -coagulapathy( disseminated intravascular coagulation) -myoglobinuria from rhabdomyolysis( causing dark urine) -kidney failure

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40

What is used for the treatment of malignant hyperthermia?

Dantrolene Sodium (Ryanodex)

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41

What is dehiscence?

A separation of the wound incision

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42

What is evisceration?

protrusion of visceral organs through a wound opening

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43

What is the Aldrete Score?

a measurement of recovery after anesthesia. monitors activity, respiration, circulation, consciousness, and o2 saturation. 10 is the best score. need 9/10 to be discharged

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44

What is general anesthesia?

causes loss of sensation, consciousness, reflexes and memory

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45

What is regional anesthesia?

causes reducation of sensation in selected parts of the body due to blockage of peripheral nerves or spinal cord. (local conduction or field block, epidural, spinal or nerve block)

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46

What is local anesthesia?

topical application of an anesthetic agent to the skin or mucous membrane. can refer to any anesthesia that is not monitored

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47

What is stage 1 of general anesthesia?

beginning analgesia and relaxation. might feel dizzy and detached

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48

what is stage 2 of general anesthesia?

client might feel delirious, act excited and can be loud or crying

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49

What is stage 3 of general anesthesia?

operative anesthesia, surgical anesthesia, sensation lost, client cannot hear, pupils small but reactive

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50

What is stage 4 of general anesthesia?

dangerous level of anesthesia, vital organ function is depressed to the point of respiratory failure and cardiac arrest. death can occur

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51

What is the parasympathetic response?

rest and digest, constricts pupils, stimulates saliva production, decreases heart rate and cardiac contractility, constricts bronchi, stimulates stomach, stimulates urination, promotes erection of genitals

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52

what is the sympathetic response?

fight or flight, dilates pupils, inhibits saliva, dilates bronchi, increases heart rate and cardiac contractility, stimulates epinephrine and norepinephrine, stimulates glucose, inhibits stomach, inhibits urination, promotes ejactulation and vaginal contractions

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53

concious

awake with appropriate speech and behavior

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54

confusion

disorientation, bewilderment, difficulty following commands

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55

lethargic

sleepiness; slow and delayed response to stimulus

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56

obtundation

Somnolence with drowsiness between sleep states, lessened interest in environment, slowed responses to stimulation

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57

stupor

minimal movement without stimulus, requires strong vigorous stimulus and then drifts back to unresponsiveness

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58

coma

not arousable and unresponsive

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59

What is the Glasgow Coma Scale?

-A brain injury severity scale that assesses depth and duration of impaired consciousness and coma. -Used by clinicians to gauge deterioration or improvement at the emergent and acute stages of brain damage or lesions. -Predicts ultimate functional outcome. 15 is the best score

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60

atrophy

decrease in muscle mass

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61

paresis

slight or incomplete paralysis

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62

plegia

complete loss of muscle function

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63

contraction

shortening or tightening of a muscle

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64

involuntary movements

uncontrolled movements

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65

spasm

involuntary nuscle contraction

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66

spacticity

increased muscle tone that creates stiff movement

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67

what is the normal plantar response?

toes down (flexion)

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68

What is the Babinski sign?

dorsiflexion of the big toe and fanning of other toes

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69

What are the three primary signs that indicate an increase in intracranial pressure (Cushing's triad)?

increased systolic bp, decreased pulse, decreased respiration

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70

What are the three primary signs of shock?

decreased bp, increased pulse, increased respirations

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71

automatism

motor activity usually occurring when cognition is impaired

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72

Aura

a subjective ictal phenomenon that may precede and observable seizure

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73

clonic

jerking, either symmetric or asymmetric, that is regularly repetitive and involves the same muscle groups

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74

epilepsy

disease of the brain with at least two unprovoked seizures...

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75

myoclonic

sudden, brief involuntary single or multiple contracts of muscles

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76

Myoclonic-tonic-clonic

one or a few jerks of limbs bilaterally, followed by tonic-clonic seizure

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77

seizure

a transient occurrence of signs and symptoms due to abnormal excessive neuronal activity in the brain

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78

tonic

a sustained increase in muscle contraction lasting a few seconds to minutes

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79

tonic-clonic

a sequence consisting of tonic followed by a clonic phase

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80

What are signs and symptoms of seizure?

confusion, aura, sudden falls, staring, uncontrollable jerking movements, strange sensations and emotions, loss of consciousness or awareness

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81

What are signs of meningitis?

brudzinski sign and kernig sign

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82

What is Brudzinski's sign?

as the neck is flexed there is stretch on the inflamed meningse and the knees flex involuntarily to decrease pain

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83

What is kernigs sign

as the hip and knee are flexed and then straightened there is pain in the hamstring

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84

What are the results of meningitis?

CSF is cloudy(bacterial) or clear(viral), elevated WBC, elevated protein, decreased glucose(bacterial), elevated CSF pressure

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85

What is encephalitis?

inflammation of the brain

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86

what are symptoms of encephalitis?

headache, fever, confusion, stiff neck, and vomiting

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87

What are treatments for encephalitis?

antivirals, anticonvulsants, and corticosteroids

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88

What is Parkinson's disease?

Movement disorder caused by the death of cells that generate dopamine in the basal ganglia and substantial nigra.

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89

What are the symptoms of parkinsons?

resting tremor, slowed movement, rigidity of facial muscles, and shuffling gait, and reduction in capacity for language

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90

What is multiple sclerosis?

a neuromuscular disorder that results in uncoordinated muscle movement, is caused by the damage of myelin sheath.

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91

S/S of multiple sclerosis

limb weakness, loss of coordination and balance, loss of sensation, speech impediment, mental changes, visual disturbances, muscle spasms, tinnitus

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92

What is the first sign of increase in intercranial pressure?

change in LOC

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93

What is autonomic dysreflexia?

spinal cord injury at T-6 or higher. vasodilation above causes increased bp, flushed face, headache, distended neck veins, decreased heart rate and increased sweating. vasoconstriction below becomes pale, cool and no sweating

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94

What is myathenia gravis?

autoimmune disease that attacks nicotinic receptors- results in paralysis

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95

What is trigeminal neuralgia?

a nerve disorder that causes a stabbing or electric-shock-like pain in parts of the face.

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96

What is an ischemic stroke?

a stroke caused by a blockage

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97

What is a hemorrhagic stroke?

A stroke caused by bleeding into the brain

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98

What is the health stroke scale?

tool used by healthcare providers to objectively quantify impairment caused by stroke. 0=no stroke 21-42=severe

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99

S/S of increased intracranial pressure

changes in LOC, impaired eye movement, decreased motor function, headache, seizures, cushings triad, vomiting, changes in speech

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100

how to calculate mean arterial pressuer

diastolic *2 +systolic= total/3 =map

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