Fundamentals of PN 160 Test 2: Pre-Operative Nursing Concepts and Procedures, Exams of General Surgery

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Fundamentals of PN 160 Test 2

Surgery - ANS: Employs operations in the treatment of disease or injury elective vs urgent vs emergent surgery - ANS: You want vs Needs vs ASAP Pre-operative Phase (before surgery) - ANS: -Thorough health assessment -Ask for complete of medications -Educate patient on procedure -Need baseline vital signs -Pre-op teachings need to be done to reduce patient anxiety -Know patient allergies Urinalysis - ANS: analysis of urine, ruling out infection Complete blood count - ANS: CBC, hemoglobin, RBC, WBC blood chemistry profile - ANS: a series of tests in which the individual chemical elements of the blood are analyzed PT/INR - ANS: prothrombin time/international normalized ratio (coumadin working right- how fast blood is clotting) PTT - ANS: partial thromboplastin time (heparin working right- how fast is blood clotting) Patient teachings for surgery - ANS: -Assess patient anxiety, help them relax

-Amount of anesthesia needed -Post-surgical pain -Corticosteroid production -avoid close ended questions (yes no questions) you want to have open ended questions and communication Topics to include in preoperative teachings - ANS: -Patient is aware of risks or possible complications (informed consent) -GI preparation (want GI tract empty) -Skin preparation -Know latex allergie -Respiratory preparation -Cardiovascular considerations -Urinary considerations -Pain control infromed consent - ANS: Telling the patient what medical procedure will be performed, the expected outcome, and the possible complications. Patient must be alert when giving us permission Nurse is the witness GI Preparation teaching for surgery - ANS: -NPO status -Needs to be hydrated -Cleanse bowl before surgery to lesson chance of infection Latex allergy for surgery - ANS: Know if your patient has a latex allergy, if so make sure you know what happens when the patient is in contact with latex

Skin preparation for surgery - ANS: may order hair removal Respiratory preparation for surgery - ANS: -Teach coughing and deep breathing techniques -Split -Repositioning -Incentive Spirometer: 8-10 times an hour -Larger #, larger expansion of lungs Cardiovascular preparation for surgery - ANS: -Risk of blood clots (thrombus, embolus) -Leg exercises -Early ambulation -Drinking water Urinary considerations for surgery - ANS: -Bladder tone is decreased with anesthesia -Urinate after 8 hours, monitor for distension -Monitor inputs + outputs -Foley Cath removed ASAP to prevent infection Pain control for surgery - ANS: -Scale 1-10 (subjective) -Teach non pharmacological techniques (walking, stretching, warm/cold compress therapy) -Possible patient control analgesic pump (PCA) Tubes in surgery - ANS: -NG tube -Wound drainage -IV tubes

-O2 therapy -Foley cath -Jackson pratt drain (pulls away drainage) -Chest tubes Pre-operative medications - ANS: -Reduce patient anxiety -Decreases the amount of anthesia needed -Reduces respiratory tract secretions -Ativan, Vallum, Versed, Morphine, Zantac, Zofran, Ancef, Solu-medrol, Hepran, coumadin Coumadin for surgery - ANS: -Check PT/INR -Ask about history of clots -INR (range 2-3) (in healthy pt 1.1 or anything below is normal) -antidote: Vitamin K Heparin - ANS: -Check PTT -20-36 seconds to clot -antidote: Protamine solfate Final verification (TIME OUT) - ANS: -Correct patient -Correct procedure -Correct site Normal GI changes in a older adult - ANS: *decreased saliva production

Dehiscence - ANS: Bursting open of a wound, especially a surgical abdominal wound Evisceration - ANS: The displacement of organs outside of the body. Prednisone - ANS: steroid, helps treat diseases with inflammation Acid base balance - ANS: the equilibrium in the body between acid and base concentrations heart failure nursing interventions - ANS: *Monitor vital signs *Note signs of respiratory distress or pulmonary edema *Monitor s/s of left sided VS right sided heart failure *Increase in abdominal girth and total weight *Ausculate the lung fields to detect crackles *Sleep *Assess for depression fluid volume deficit - ANS: Dehydration in which the fluid intake of the body is not sufficient to meet the fluid needs of the body What helps the body maintain balance - ANS: homeostasis Primary prevention examples - ANS: immunizations, pollution control, nutrition, exercise Addison's disease - ANS: occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone

S/Symptoms: Symptoms tend to be non-specific and include fatigue, nausea, darkening of the skin, and dizziness upon standing. Hypoxia - ANS: lack of oxygen Hypoxia Signs and Symptoms - ANS: rapid pulse, elevated BP; rapid, deep respirations, dyspnea; increased restlessness/anxiety/confusion; substernal or intercostal retractions, nasal flaring; pallor, fatigue, cyanosis (later) nasal cannula - ANS: A device that delivers low concentrations of oxygen through two prongs that rest in the patient's nostrils. Nasal Cannula use - ANS: *Position Patient in fowlers or semi fowlers position *Auscultate lung sounds for s/s of hypoxia *Fill humidifier with distilled water *Attach nasal cannula tubing to flowmeter *Adjust flowmeter to 6-10 L/min to flush tubing and prongs with oxygen *Adjust flow rate to prescribed amount *Place nasal prongs into each nostril of the patient in the direction that the prongs are curved Respiratory Acidosis - ANS: pH: below 7. PaCO2: Above 45 Needs oxygen S/Symptoms: Muscle weakness Unconsciousness Convulsions Headache

Drowsiness/Dizziness Papulations (needs oxygen) V Fib Respiratory Alkalosis - ANS: pH: Above 7. PaCO2: Below 35 Breathing hard/body working so hard S/Symptoms: Light headedness Numbness Tingling Sweating Nausea/Vomiting Papulations Metabolic Acidosis - ANS: pH below 35 HCO3: below 22 Diarrhea S/Symptoms: Headache Confusion Nausea/Vomiting Drowsiness Metabolic Alkalosis - ANS: pH: Above 45 HCO3: Above 26 Vomiting

S/Symptoms: Dizziness Tingling in fingers/toes Headache Confusion Lethargy Normal Potassium (K+) Levels - ANS: 3.5- Hyperkalemia - ANS: excessive potassium in the blood (above 5) Hypokalemia - ANS: deficient potassium in the blood (below 3.5) Sodium (Na+) Normal levels - ANS: 135-145 mEq/L Hypernatremia - ANS: high sodium (sodium level above 145) Hyponatremia - ANS: deficient sodium in the blood (sodium level below 135) Magnesium (Mg+++) normal levels - ANS: 1.5-2. Hypermagnesemia - ANS: excess of magnesium in the extracellular fluid (Mg level above 2.5) Hypomagnesemia - ANS: insufficient amount of magnesium in the extracellular fluid (Mg level below 1.5) Chloride (CL) normal levels - ANS: 96-106 mEq/L

Hyperchloremia - ANS: an excess of chloride in the blood plasma (CL above 106) Hypochloremia - ANS: deficiency of chloride in the blood plasma (CL level below 96) Phosphorus Normal Level - ANS: 2.4-4. Hyperphosphatemia - ANS: excessive phosphate in the blood (level above 4.1) Hypophosphatemia - ANS: below-normal serum concentration of inorganic phosphorus (level below 2.4) Calcium (Ca++) normal level - ANS: 8.5- Hypercalcemia - ANS: excessive calcium in the blood (Ca level above 10) Hypocalcemia - ANS: deficient calcium in the blood (Ca level below 8.5) Secondary prevention examples - ANS: Screenings, redirectional therapies, medications tertiary prevention examples - ANS: Treatment of major depression, reducing disruption of family processes, and suicide prevention, rehabilitation