Post-Operative Care and Complications, Exams of Nursing

Download Post-Operative Care and Complications and more Exams Nursing in PDF only on Docsity! INP sessions 4 &5 midterm Questions with complete solutions Surgical consent - correct answer- pt must be fully alert and aware of what is contains when signing - done by surgeon - protects health care facility and caregivers/ and from unwanted procedures Restrictions: - minor ( unless legally emancipated ) - LOC must be fully alert and awake - No meds that could alter cognition - Mental competance; no dementia or psychotic pts - Intoxication/street drugs General anesthesia - correct answer- loss of sensation with loss of consciousness - skeletal muscle relaxation - analgesia - elimination of somatic, autonomic, and endocrine responses (cough, vomiting, sympathetic nervous system) - acts on CNS, causing loc, sensation, reflexes, pain - drug combinations achieve these effects without excessive CNS depression Complications: - coughing - laryngospasm - bronchospasm - increased secretions - resp depression Conscious Sedation anesthesia - correct answer- retains person's ability to maintain own airway and respond appropriately to commands - achieves level of emotional and physical acceptance of painful procedures - midazolam (amnesia) and fentanyl(pain) - used for reduction of joints/bones and in certain procedures Regional anesthesia - correct answer- loss of sensation in body region without loss of consciousness when specific nerve or group of nerves is blocked with administration of local anesthetic - epidural/spinal - numbs 1/2 body - observe closely for signs of ANS blockade; bradycardia, hypotension, N/V, increased incidence of headache associated with spinal anesthetisia - monitor for nerve damage and return of sensation Local anesthesia - correct answerLocal: may be administered topically, by local infiltration, and by nerve blocking techniques - loss of sensation without loss of consciousness INP sessions 4 &5 midterm Questions with complete solutions - topically, little systemic absorption, rapid recovery, little residual hangover, possible discomfort, hypotension, tachycardia - Complications: toxicity, tissue damage, allergic reactions - intracutaneously, SC - Eg. lidocaine Nerve Block - correct answerAnesthetic is injected, often to a group of nerves, called a plexus or ganglion, that affects a specific organ or body region - trigeminal nerve blocks; face - opthalmic nerve block; eyelids and scalp - supraorbital nerve block; forehead - brachial plexus block, elbow block, and wrist block; shoulder, arm, hand, elbow and wrist - femoral blocks; the affected hip and leg; knee sx, hipsx, caution with ambulation Spinal anesthesia - correct answer- injection of agent into CSF in subarachnoid space - usually L2 and below, cant move or feel their legs - may become hypotensive from vasodilation - usually bupivacaine or lidocaine - dermatones - monitor post op Monitor: - resp distress - ax for drainage: CSF, dangerous, headaches and other symptoms - ax site for hematoma, can cause compressed BV and nerve - ax for itchiness; side effect of diphenhydramine - ax for urinary retention - keep person in supine position for first few hours; keeps CSF circulating, reps Side effects of spinal anesthetic - correct answer- postdural puncture headache; CSF leaks, lay down supine - itchiness - hypotension d/t increased venous relaxation and decreased peripheral vascular resistance resulting in decreased cardiac output - urinary retention Dissociative anesthesia - correct answer- interrupts brain pathways while blocking sensory - client appears catatonic - profound analgesia that lasts into post-op period - used in diagnostics not requiring muscle relaxation - characterized by analgesia and amnesia with minimal effect on respiratory function - the pt can swallow and open eyes but does not process information Epidural Block - correct answer- injection of agent into epidural space INP sessions 4 &5 midterm Questions with complete solutions - make sure you measure first void post op - scan q4h if not voiding - if scan is between 200-400mls, then the pt needs to void, or perform an in/out catheter Post-op complication: Circulatory system - correct answer- hemorrhage, hypovolemic shock, thrombophlebitis, thrombus, embolus, may have an unnoticed MI or CVA - thrombophlebitis: inflammation of veins; formation of blood clots - thrombi; clots that cling onto blood vessel walls - emboli; thrombi that break loose and flow with the blood; it can go to the lungs, heart SCD (sequential compression device) - correct answer- used to PREVENT dvt - dont use if they already have one - if left off for more than 2 hour you need Dr order to re-apply bc what if a clot has formed by then - Dr. order for removal as well Pain - correct answeran unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage Somatic pain - correct answer- caused by activation of pain receptors in either the body surface or musculoskeletal tissue - incision site pain post-op, surface Visceral pain - correct answer- deep pain - pain felt from internal organs when either damage or injury has occured - kidney stones/epigastric pain Neuropathic pain - correct answer- caused by injury or malfunction to the spinal cord and peripheral nerves - pinched nerve Idiopathic pain - correct answer- pain of unknown origin - term Drs use for chronic long term pain lasting 6 months or longer with no identifiable cause Post-op pain management - correct answer- PCA - distraction - hypnosis - imagery - relaxation - effective communication PCA (pt controlled analgesia) - correct answer- allows pt to admin own IV analgesia - there is special machine that is programmed to that specific pts needs - additional to the ordered IV infusion - loading/bolus dose INP sessions 4 &5 midterm Questions with complete solutions - PCA dose - lockout time interval - check q4h by RN, monitored by LPN - resp sedation scale, LOC, resp depression Pain slows healing, by providing PCA it will: - reduce stress response - reduce BP - reduce fatigue - improved circulation - early return to oral nutrition - early ambulation Qualification for PCA - correct answer- cognitive, physically and psychologically capable of understanding the concepts of PCA and handling the procedure necessary to obtain pain relief -less than ideal pts; pts with resp depression d/t obesity, asthma, sleep apnea, or use of concurrent drugs that potentiate opiates Barriers to pain management (TAD) - correct answer- Tolerance: state of adaptation characterized by the need for higher doses of analgesia - Addiction: complex neuro condition charcterized by a drive to obtain and take substances for other than prescribe - Dependance: physiological response to ongoing exposure to opioids that results in withdrawal syndrome when the drug is abruptly stopped; tremors What affects wound healing in surgical pts - correct answer- infx - aging - HIV, cancer: low WBC, immunocompromised - diabetes - obesity: fat tissue, hard to heal, less blood supply - smoking; vasoconstriction, atherosclerosis - Prednisone: increases BG, decreases immune response - blood thinners - abx: kills good bacteria, build resistance over time - edema: risk for injury What effects wound healing in post-op pts - correct answer- immobility - nutrition - N/V - cold - pain - O2 - infx Surgical wound cleanliness: INP sessions 4 &5 midterm Questions with complete solutions Clean (class 1) - correct answer- operative wound clean - non traumatic, with no inflamation encountered - no break in sterile technique - resp, gi, gu tracts not entered Clean-contaminated (Class 2) - correct answer- non traumatic wound with minor break in sterile technique - gi, resp, gu tracts entered, without significant spillage - includes: transection of appendix, cholycystic duct in the absence of infected bile or urine, hysterectomy, emergency C-section involving pre ruptured membranes on trial of labour Contaminated (class 3) - correct answer- operative wound contaminated - major break in sterile technique - gross spillage from GI tract - entrance into GU or bilary tracts when infected urine or bile is present Dirty-Infected (class 4) - correct answer- stab wound - operative wound dirty - fecal contamination - foreign body - operative wound with acute bacterial inflammation or perforated viscus (loss of contents, perforated GI wall) - operative wound where clean tissue is transected to gain access to an abscess or collection of pus Post-op wound complications - correct answer- Hemorrhage: greatest risk in first 24- 48hrs, watch for hematoma and bleeding on drsg and under pt - Hypovolemic shock: dehydration - Dehiscence: re-opening of wound, not an emergency, cover with sterile drsg, wound care with 2ndary intention - Evisceration: dehiscence that causes abd organs to protrude out, emergency, immediately place sterile saline soaked gauze over tissues, observe for shock, NPO from this moment on - Infx: not emergency but addressed urgently - Necrosis - Fistula: abnormal passage b/ween 2 organs or b/ween an organ and outside the body Maintenance and promotion of lung expansion - correct answer- positioning: reduces pulmonary stasis, maintains ventilation and oxygenation - incentive spirometry: encourages voluntary deep breathing INP sessions 4 &5 midterm Questions with complete solutions What do you do if pt is complaining of pain in their abd and they are on continuous suction? - STOP - have them walk around - start again - Dr order needed for removal Hypoxia - correct answerLow oxygen saturation of the body, not enough oxygen in the blood - S/S early: restlessness, irratibility, lethargy, tachypnea, tachycardia, dyspnea on exertion - S/S late: cyanosis, dyspnea at rest, use of accessory muscles, hypotension, cool clammy skin Indications for chest tube - correct answer- Pneumothorax: collapsed lung - Hemothorax: blood in the lung - Pleural effusion: fluid in the lungs - Chylothorax: lymph fluid, someone with TB - Empyema: pus, infx, pneumonia, thoracic sx Tension pneumothorax - correct answer- develops when a lung or chest wall injury is such that it allows air into the pleural space but not out of it; one way valve - air accumulates and compresses the lung, eventually shifting the mediastinum, compressing the contralateral lung, increasing intrathoracic pressure enough to decrease venous return to the heart, causing shock - Causes: mechanical ventilation, simple pneumothorax with lung injury that fails to seal following penetrating/blunt chest trauma, failed central venous cannulation - PIC line goes into heart, may puncture a lung - S/S: tracheal shift, hypotension, tachycardia, hypoxia, chest pain, jugular vein distention Flail chest - correct answer- life-threatening medical condition when a segment of rib cage breaks due to trauma and becomes detached from the rest of the chest wall - permits it to move independently: move in with inspiration and out with expansion - paradoxical breathing S/S: severe dyspnea, cyanosis, tachypnea, tachycardia, paradoxical movement of the chest - ventilation impaired, pt becomes hypoxemic contusion of underlying lung tissue may cause fluid to accumulate in alveoli - rib fractures may cause tear in pleura, may cause pneumo or hemothorax - overall loss of chest wall stability INP sessions 4 &5 midterm Questions with complete solutions Chest tube drainage systems - correct answer- traditional chest drainage unit (CDU): consists of collection chamber, water seal chamber, suction control, drains large amts of fluid or air - smaller lighter portable CDU: mechanical one way valve, for drainage only - heimlich valve: one weay flutter valve, only drains out air when pt exhales - indwelling pleural catheter: drains fluid only, can be done at home q1-2 days or when SOB Chest tube insertion - correct answer- done in pts room, interventional radiology, or OR - local anesthetic (sometimes) pt often feels ++ pressure and discomfort as tube is inserted - sterile procedure - pt will quickly notice ease in breathing once lung is re-expanded - position pt for comfort depending on side to be inserted, tube will be anchored with a suture - insertion site will have an occlusive drsg applied - connections securely taped - chest Xray to confirm position and lung re-expansion Risks/complications of chest tube - correct answer- bleeding - infx - SC emphysema: trapped air in sc layer of skin, swelling in the face, neck and chest, feels like rice krsipies so you would palpate - Bronchopleural fistula Chest tube safety kit - correct answer- kept with the CDU/pt at ALL times; hanging on IV tubes - sometimes come pre-prepared depending on unit - contains: 2 smooth edged forceps, sterile water, occlusive drsg, 2 packages sterile, 1 pair of clean gloves Trouble shoot with suction - correct answer- if the orange ball is not floating in the window, that means the suction on the WALL is not high enough - turn up the suction on the wall until the orange ball is floating in the window - ax for air leaks: dangerous; can lead to tension pneumothorax if not fixed, can cause SC emphysema, you will see excess bubbling in the water seal chamber; air leak; bubbling to keep the negative pressure, your RN should be notified - high negative pressure: caused by vigorous coughing, deep breathing, laying on tubing, release high negativity by depressing black button on top of device and observing for dropping fluctuation water seal CDU positioning - correct answer- the cdu should always be located below the pt, especially on gravity - there should be no dependant loops in the tubing preventing proper drainage - no kinks, compression, obstructions INP sessions 4 &5 midterm Questions with complete solutions - in line blue clamp should always be OPEN positioned at the bottom of tubing; otherwise you can cause resp distress Clamping chest tubes - correct answerDONT CLAMP CHEST TUBES UNLESS... - dr's order (usually when pt is doing better, to trial whether chest tube is ready to come out yet or not) - changing CDU system (full of drainage, air leak in system)when assessing for air leaks if chest tube becomes detached from CDU; start from tubing closest to pt first and work your way downwards - no bubbling, go further down tube to see where air leak is What do you do when chest tube is removed accidentally - correct answer- call physician stat - air leak present: cover chest tube site with a light gauze drsg tape on 3 sides; periodically lift unsecured portion of drsg during exhalation to let air exit intrapleural space - air leak absent (fluid only): cover chest tube site with occlusive drsg - monitor VS and assess for s/s of resp distress What is pt becomes confused while on CBI - correct answer- check sodium levels, maybe infx Your pt is diabetic and scheduled for abd sx under a general anesthetic later this morning. His orders include his usual insulin dose to be given now at 0700 hours. What will you do? - correct answer- hold insulin if his BS is not at a safe level, because you dont want him to go through hypo/hyperglycemia while in surgery what are advantages of conscious sedation - correct answer- reduced fear and anxiety - amnesia - elevation of pain threshold - stable VS, rapid recovery why are leg exercises beneficial for a post-op client - correct answer- reduces vascular and pulmonary complications - maintain join mobility - promote venous return to heart - prevent DVT On inhalation and exhalation with negative pressure, what will happen to the water level in the water seal chamber? - correct answer- Inhalation: increase - Exhalation: decrease (water level will increase) What is the time interval for changing chest tube drsgs - correct answer- every 3 days or as needed