Open-Ended questions Med Surg test 1

mattisensept's version from 2017-06-05 00:02

Section 1

Question Answer
What are the 2 degrees of surgery urgency?Emergency and elective
What are the 6 types of surgery?Diagnostic, curative, restorative, palliative, cosmetic, preventive
What is diagnostic surgery?Obtain or form a diagnosis. Ex: biopsy
Cosmetic surgery Revise or change the texture, configuration ore relationship of contiguous structures of any feature of the human body
Palliative surgeryRelief of symptoms or improvement in quality of life; usually in patients with an incurable disease or illness
Curative surgery Designed to eliminate a health problem (removal of tumor)
Restorative surgery Purpose is to restore function
2 types of stressors involved with surgery Physiological stress response (fight or flight) and the psychologic stress response
3 stages of surgery Preoperative, intraoperative, postoperative
What are the 8 major factors affection surgical risk Age, nutrition, infection, chronic disease, ETOH & drug abuse, meds, disability, smoking
What are the 3 main things performed during the preoperative assessment1) Identify and correct problems that might increase surgical risks, 2) establish baseline data for comparison in intra and post operative phases, 3) Anticipate postop complications
What are the 5 parts of pre-op nursing mangement? 1) Pre-op teaching, 2) informed consent, 3) Psychological preparation, 4) physical preparation, 5) immediate preoperative nursing interventions
What is involved in preoperative teaching?1) setting goals to decrease anxiety and facilitate recovery, 2) teaching considerations 3) Information such as clarification of procedures, exercises, pain relief, coughing and deep breathing techniques

Section 2

Question Answer
Criteria for informed consent 1) voluntary consent, mentally competent & legal age, adequate disclosure of procedure, intentions, complications & alternatives, sufficient comprehension by pt-termenology, an authorized witness
Immediate nursing interventions 1) Pre op meds, 2) preop checklists
3 Common preop medications Narcotics- meperdine (demerol) and morphine 2) sedatives- decobarbital (seconal, 3) Anticholinergics: Glycopyrrolate (robinul) and astropine
What is included in the pre op checklist1) Test results on pt. chart, 2) check pt. ID band, 2) VS, 4) Remove clothing, 5) instruct pt to empty bladder, 6) administer preop meds, 7) remove nail polish, jewelry, prosthesis
What are the 2 physical environmental areas? Holding area and operating room
What is special about the air in an operating room? Special ventilation system that filers the air to reduce the bacteria count
Members of the surgical team 1) patient, 2) anesthesiologist 3) surgeon 4) scrub role 5) RN first assistant 6) circulating nurse
Intraoperative goals No aspiration, adequate cardiac output, adequate tissue perfusion, no injury
Types of anesthesia Conscious sedation, general anesthesia, regional anesthesia, local infiltration
Conscious sedationModerate sedation, depressed level of consciousness that does not impair the patient
General anesthesia pt. is unconscious, needs alot of care and pt. advocate
Effects of anesthesia Analgesia, muscle relaxation, loss of reflexes, decreased LOC
Methods of administration of general anesthesia Inhalation and IV
Common types of inhalation general anesthesia Nitrous oxide, halothane (fluothane), and enflurance (ethrane)
Common types of intravenous general anesthesia Sodium thiopental (pentathol)
What are some adjuncts to anesthetics?Neuromuscular blocking agents: succinylcholine (anectine) and pancuronium (pavulon)
What are the intravenous general anesthetics primarily used for?As induction agents, but may be used alone in short procedures
Regional anesthesia typesNerve block of particular area of the body, epidural & spinal
What are the effects of regional anesthesiaProduce loss of sensation/movement in treated area, pt. maintains consciousness

Section 3

Question Answer
What is the role of circulation nurse during pre op phaseVerify consent, surgical site, offer comfort and emotional support
Circulating nurse role during intraop phase?Position pt. for sx, padding, documentation, acts as pt. advocate help monitor VS, observes for breaks of aseptic technique, counts sponges and instruments, reports progress to family, specimens to lab
Circulating nurse role during post op phase?Reports to recovery room
Gerontological considerations during the intraoperative phase Lithotomy position can increase risk for blood clot in legs, proper padding important, skin very thin, hearing/mobility problems, normally require less anesthesia and pain med, be aware of any health probs like dementia
Complications during the intraoperative phase of surgery vomiting, hypothermia, hypoxia, anaphylactic reactions, malignant hyperthermia
What is malignant hyperthemia Genetic, involves muscle cells- have specific receptors that trigger this pt. appears appox. 20 min into sx- symptoms of tachycardia, muscle rigidity, then temp elevation
What should be administered ASAP when signs of malignant hyperthemia manifest?Dantrolene sodium (skeletal muscle relaxant) and sodium bicarbonate
What does the PACU nurse report?Surgical procedure, type of anesthesia, VS, complications, fluid status, catheter/drains/packs/dressing, drug administration in PACU, time last got pain meds
What are the primary concerns for the patient when arriving in post op? Respiratory status and VS
What is the unit nurses responsibility in post-opAssess respiratory status and VS, performs hear to toe, review post op orders.
What are predisposing factors for atelectasis/pneumonia 1) history of resp. problems 2) thoracid or high abd surg 3) age 4) obesity 5) smoking 6) severe post op pain 7) postop immobility
What are predisposing factors for DVT 1) lower abd sx. 2) hx. of venous problems 3) dehydration, fluid loss, 4) prolonged postop immobilization
What are some standard discharge instructions1) dietary restrictions, 2) activity limitations, 3) medication teaching 4) wound care, 5) possible complications to watch for
What are some predisposing factors for risk for infection 1) obesity, 2) diabetes, 3) malnutrition, 4) old age, 5) steroids
What 2 things should be encouraged in the diet of a post op patient Protein and vitamin C
What are signs of a parlyric ileus Absent bowel sounds, no passage of flatus, abdominal distension, K levels low

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