Med surg 2 exam 1

What are the three primary types of surgeries?

Emergent, urgent, and elective

What is the preoperative phase?

patient's first experience with surgical services

What is the intraoperative phase?

preop checklist, operation, transfer to recovery

What is the postoperative phase?

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

What are the priorities during the perioperative experience?

safety requiting teamwork and interprofessional communications

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)

The joint commissions universal protocol is?

preventing wrong site, wrong procedure and wrong person surgery

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)

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

What are the three zones in the surgical suite are?

unrestricted zone, semi-restricted zone, and restricted zone

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)

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

supine, prone, lateral and lithotomy

What is anesthesia?

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

What are the complications of anesthesia?

hypotension, malignant hyperthermia, fluid and electrolyte imbalances

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

what is phase two of the pacu?

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

what is phase three of the pacu?

extended observation

The CNS is made up of?

the brain and the spinal cord

The PNS is made up of?

cranial nerves, spinal nerves, and the ans

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

Cognitive, cranial, motor, and sensory

What does the mini mental status examination measure?

a patients cognitive function

What information can a cranial nerve assessment provide?

shows neurological impairment due to disease or trauma to the brain

What is the required safety for the joint commission?

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

What is the required safety for the WHO?

comprehensive surgical checklist

What is the required safety for AORN?

-comprehensive surgical checklist
-guidelines for practice

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

beta blocker

When does the H & P need to be completed?

within 30 days

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

within 24 hours

What is cardiac clearance?

all patients over 50 years of age need an ECG

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)

what do you use the shave skin prior to surgery?

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

What is surgical attire?

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

What is induction?

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

what is intubation?

place and secure airway

what is maintenance?

maintain patient using balanced anesthesia

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

what is recovery?

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

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

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

What is used for the treatment of malignant hyperthermia?

Dantrolene Sodium (Ryanodex)

What is dehiscence?

A separation of the wound incision

What is evisceration?

protrusion of visceral organs through a wound opening

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

What is general anesthesia?

causes loss of sensation, consciousness, reflexes and memory

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)

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

What is stage 1 of general anesthesia?

beginning analgesia and relaxation. might feel dizzy and detached

what is stage 2 of general anesthesia?

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

What is stage 3 of general anesthesia?

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

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

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

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

concious

awake with appropriate speech and behavior

confusion

disorientation, bewilderment, difficulty following commands

lethargic

sleepiness; slow and delayed response to stimulus

obtundation

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

stupor

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

coma

not arousable and unresponsive

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

atrophy

decrease in muscle mass

paresis

slight or incomplete paralysis

plegia

complete loss of muscle function

contraction

shortening or tightening of a muscle

involuntary movements

uncontrolled movements

spasm

involuntary nuscle contraction

spacticity

increased muscle tone that creates stiff movement

what is the normal plantar response?

toes down (flexion)

What is the Babinski sign?

dorsiflexion of the big toe and fanning of other toes

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

increased systolic bp, decreased pulse, decreased respiration

What are the three primary signs of shock?

decreased bp, increased pulse, increased respirations

automatism

motor activity usually occurring when cognition is impaired

Aura

a subjective ictal phenomenon that may precede and observable seizure

clonic

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

epilepsy

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

myoclonic

sudden, brief involuntary single or multiple contracts of muscles

Myoclonic-tonic-clonic

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

seizure

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

tonic

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

tonic-clonic

a sequence consisting of tonic followed by a clonic phase

What are signs and symptoms of seizure?

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

What are signs of meningitis?

brudzinski sign and kernig sign

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

What is kernigs sign

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

What are the results of meningitis?

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

What is encephalitis?

inflammation of the brain

what are symptoms of encephalitis?

headache, fever, confusion, stiff neck, and vomiting

What are treatments for encephalitis?

antivirals, anticonvulsants, and corticosteroids

What is Parkinson's disease?

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

What are the symptoms of parkinsons?

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

What is multiple sclerosis?

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

S/S of multiple sclerosis

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

What is the first sign of increase in intercranial pressure?

change in LOC

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

What is myathenia gravis?

autoimmune disease that attacks nicotinic receptors- results in paralysis

What is trigeminal neuralgia?

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

What is an ischemic stroke?

a stroke caused by a blockage

What is a hemorrhagic stroke?

A stroke caused by bleeding into the brain

What is the health stroke scale?

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

S/S of increased intracranial pressure

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

how to calculate mean arterial pressuer

diastolic *2
+systolic= total/3 =map