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MIDTERMS (NSG124 — PAINSURG), Exams of Advanced Education

Walden UniversityAdvanced Education

MIDTERMS (NSG124 — PAINSURG) 2024

Typology: Exams

2024/2025

Available from 11/20/2024

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alex-david-32 🇺🇸

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MIDTERMS (NSG124 — PAINSURG)
Intraoperative Phase - Begins when the client is transferred to operating table and ends
when the client is admitted to the post-anesthesia care unit, also called the post-
anesthetic room or recovery room.
Identification of surgical client.
Assessment of client's status.
Verification of the information in the preoperative checklist. - What do we assess in
patients during the intraoperative phase? (3)
Physiological
Psychological
Physical - What are the three components we assess in the client status?
Anxiety related to expressed concerns due to surgery.
Risk for perioperative injury related to environmental conditions in the OR.
Risk for injury, related to anesthesia and surgery.
Disturbed sensory perception related to general anesthesia.
Risk for fluid deficit related to bleeding.
Risk for aspiration related to depressants of endotracheal tube.
Risk of latex surgery response due to possible exposure of latex in OR environment. -
Provide at least three analysis or nursing diagnosis in related to internal operative
phase.
Introduce yourself.
Address patient by name warmly and frequently.
Provide explanations.
Encourage questions and answer them.
Provide comfort measures. - What are the ways to reduce the anxiety of the patient?
asleep/awake - Preventing Intraoperative Positioning Injury: depression should be in as
comfortable position as possible, whether ???/???.
operative field - Preventing Intraoperative Positioning Injury: The ??? ??? must be
adequately exposed.
vascular supply - Preventing Intraoperative Positioning Injury: An awkward position,
undue pressure on the body part, or use of stirrups or traction, should not obstruct the
??? ???.
patient — anesthesia - Protecting the Patient from Injury: Correct ??? and the planned
surgical procedure and type of ???.
Iodine & Latex - What are the most common allergies encountered in the OR?
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MIDTERMS (NSG124 — PAINSURG)

Intraoperative Phase - Begins when the client is transferred to operating table and ends when the client is admitted to the post-anesthesia care unit, also called the post- anesthetic room or recovery room. Identification of surgical client. Assessment of client's status. Verification of the information in the preoperative checklist. - What do we assess in patients during the intraoperative phase? (3) Physiological Psychological Physical - What are the three components we assess in the client status? Anxiety related to expressed concerns due to surgery. Risk for perioperative injury related to environmental conditions in the OR. Risk for injury, related to anesthesia and surgery. Disturbed sensory perception related to general anesthesia. Risk for fluid deficit related to bleeding. Risk for aspiration related to depressants of endotracheal tube. Risk of latex surgery response due to possible exposure of latex in OR environment. - Provide at least three analysis or nursing diagnosis in related to internal operative phase. Introduce yourself. Address patient by name warmly and frequently. Provide explanations. Encourage questions and answer them. Provide comfort measures. - What are the ways to reduce the anxiety of the patient? asleep/awake - Preventing Intraoperative Positioning Injury: depression should be in as comfortable position as possible, whether ???/???. operative field - Preventing Intraoperative Positioning Injury: The ??? ??? must be adequately exposed. vascular supply - Preventing Intraoperative Positioning Injury: An awkward position, undue pressure on the body part, or use of stirrups or traction, should not obstruct the ??? ???. patient — anesthesia - Protecting the Patient from Injury: Correct ??? and the planned surgical procedure and type of ???. Iodine & Latex - What are the most common allergies encountered in the OR?

Surgical Position - The position of the client during a surgical procedure, which is essential to the maintenance of client safety. Optimal visualization of andaccess to the surgical site. Optimal access to IV lines and monitoring devices. Protection of the client from harm (anatomic and physiological considerations). - The client's surgical position should provide: (3) Positioning - ??? is performed after anesthesia is induced and before surgical draping of the client. Supine Trendelenburg Reverse Trendelenburg Lithotomy Sims/Lateral Prone - What are the six surgical positions? Supine - Flat on bed. One arm positioned at the side of the table with the hand placed palm down, the other hand is carefully positioned on the arm board. Supine - Used for most abdominal surgery. Trendelenburg - Flat on bed but head and body are lowered. The patient is held in position by padded shoulder braces. Trendelenburg - Used for surgery on lower abdomen and pelvis. Obtain good exposure by displacing the distance into upper abdomen. Reverse Trendelenburg - The body is laid flat on the back with the head higher than the feet. Reverse Trendelenburg - Used in thyroidectomy, laparoscopic gallbladder and biliary tract surgery. Lithotomy - Flat on back with legs and thighs flexed. Position is maintained by placing stirrups. Lithotomy - Used for nearly all perennial, rectal and vaginal cervical procedures. Sims/Lateral - Patient is placed on non-operative side with air pillow 12.5 to 15 cm thick under the loin, the upper leg extended and the lower leg is flexed at the knee. Sims/Lateral - Used for kidney, chest, and hip surgery

20 - 30 mins - How long is the duration of topical application? Local Infiltration - Injected intracutaneously and subcutaneously into the tissues at and around the incisional site to block peripheral sensory nerve stimuli at their origin. intracutaneously and subcutaneously - Injected ??? and ??? into the tissues at and around the incisional site to block peripheral sensory nerve stimuli at their origin. Epinephrine - Local anesthesia is often administered in combination with ???. Epinephrine - This constricts blood vessels which prevent rapid absorption of the anesthetic agents and fast prolong its local action. Seizures - Rapid absorption of local anesthetic agents into the bloodstream could cause ???. Regional Anesthesia - An anesthetic agent is injected around the nerves, so that region supplied by these nerves are anesthesized. Regional Anesthesia - It only knows the portion of the body which will be operated on. Nervel Block Epidural Anesthesia Spinal Anesthesia - What are the types of regional anesthesia? Nerve Block - Technique in which the anesthetic agent is injected into and around a nerve or small nerve group, that supplies sensation to a small area of the body. Epidural Anesthesia - It is achieved by injecting a local anesthetic agent into the epidural space surrounds the dura mater of the spinal cord. Epidural Anesthesia - This is commonly used for surgery of the lower limbs, and also a popular anesthetic during labor. Absence of Headache - What is an advantage of epidural anesthesia that can result from spinal anesthesia? This can produce severe hypertension, respiratory depression, and arrest. - What are the disadvantages of epidural anesthesia? Spinal Anesthesia - It is an extensive conduction nerve block that is produced when a local anesthetic agent is introduced into the subarachnoid space at the lumbar level usually between L4 and L5. L4 & L5 - At what lumbar levels is spinal anesthesia, usually introduced into?

Spinal Anesthesia - This produces anesthesia of the lower extremities, perineum and lower abdomen. Headache - Common disadvantage of spinal anesthesia. Spinal Anesthesia - Anesthesia used for cesarean section. Lidocaine (Xylocaine) Mepivacaine (Carbocaine) Bupivacaine (Marcaine) Etidocaine (Duranest) Procaine (Novocaine) Tetracaine (Pontocaine) - What are the common anesthetic agents? (6) Lidocaine & Mepivacaine - Which anesthetic agent administers via TOPICAL or INJECTION? Bupivacaine (Marcaine) - Which anesthetic agent administers via INFILTRATION, PERIPHERAL NERVE BLOCK, or EPIDURAL? Etidocaine (Duranest) - Which anesthetic agent administers via INFILTRATION or BLOCK? Procaine (Novocaine) - Which anesthetic agent administers via SUBCUTANEOUSLY, INTRAMUSCULARLY, INTRAVENOUSLY, or SPINAL? Tetracaine (Pontocaine) - Which anesthetic agent administers via TOPICAL, INFILTRATION, or NERVE BLOCK? Lidocaine (Xylocaine) & Mepivacaine (Carbocaine) - Which anesthetic agent has the advantages of RAPID, LONGER DURATION OF ACTION (compaired to Procaine) & FREE FROM LOCAL IRRITATIVE EFFECT? Bupivacaine (Marcaine) - Which anesthetic agent has the advantage of DURATION IS 2 - 3 TIMES LONGER THAN LIDOCAINE OR MEPIVACAINE? Procaine (Novocaine) & Tetracaine (Pontocaine) - Which anesthetic agent has the advantages of LOW TOXICITY and INEXPENSIVE? Lidocaine (Xylocaine) & Mepivacaine (Carbocaine) - Which anesthetic agent has the disadvantages of OCCASIONAL IDIOSYNCRASY? Bupivacaine (Marcaine) - Which anesthetic agent has the disadvantage of USE CAUTIOUSLY IN PATIENTS WITH KNOWN DRUG ALLERGIES OR SENSITIVITIES?

Close OR door & keep room quiet. - What are the nursing responsibilities for induction stage? (2) Excitement Stage - Identify the Stage: Characterized variously by struggling, shouting, talking, singing, laughing or crying. Excitement Stage - Identify the Stage: Increased your respiratory and pulse rate. Excitement Stage - Identify the Stage: Pupils may dilate. Assist in restraining the patient. - What is the nursing responsibility for the Excitement Stage? Operative Stage (Surgical Anesthesia) - Identify the Stage: Anesthesia is completely established. Operative Stage (Surgical Anesthesia) - Identify the Stage: Patient is unconscious, and lies quietly on the table. Operative Stage (Surgical Anesthesia) - Identify the Stage: Respirations are regular pulse rate and volume are normal. Operative Stage (Surgical Anesthesia) - Identify the Stage: Pupils are small, but contract when exposed light. Assist in positioning the patient. Begin skin preparation. Prepare operative site. Observe for signs and symptoms. - What are the nursing responsibilities in the Operative Stage (Surgical Anesthesia)? (4) Danger Stage (Medullary Depression) - Identify the Stage: Reach only win too much anesthesia has been administered. Danger Stage (Medullary Depression) - Identify the Stage: Respirations become shallow, pulse is weak and thready, and the pupils become widely dilated. Danger Stage (Medullary Depression) - Identify the Stage: Cyanosis may be observed and death may follow, if without prompt treatment. Assist in CPR. Provide emergency equipment. Establish airway. - What are the nursing responsibilities for the Danger Stage (Medullary Depression)? (3) Hypnosis - Artificial sleep.

Amnesia - Partial or total loss of memory. Analgesia - Inability to feel pain. Amnesia Analgesia Hypnosis Relaxation - Effects of Anesthesia: Halothane Enflurane Isoflurane Sevoflurane Desflurane - What are the types of volatile liquid inhalation anesthetic agent? Nitrous Oxide (N2O) Oxygen (O2) - What are the type of gas inhalation anesthetic agent? Nausea & Vomiting Anaphylaxis Hypoxia & other Respiratory Complications Hypothermia Malignant Hyperthermia - What are the potential intraoperative complications? Nausea & Vomiting - May affect patients during intraoperative. If gagging occurs, the patient is turned to the side and the head of the table is lowered. Medications for this is Ondacitron. Anaphylaxis - Anaphylactic reaction can occur in response to many medication, such as latex or other substances. Anaphylaxis - The reaction may be immediate or delayed. It is a life-threatening acute allergic reaction. Hypoxia & other Respiratory Complications - Inadequate ventilation, occlusion of the airway, inadvertent intubation of the esophagus, and hypoxia are significant potential complications associated with general anesthesia. Hypoxia and Other Respiratory Complications - Identify which potential interoperative complications is this nursing intervention for: Peripheral perfusion is checked frequently and pulse. Oximeter values are monitored continuously. Hypothermia - During anesthesia, the patient's temperature may fall. Glucose metabolism is reduced as a result metabolic acidosis may develop.