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NRSG 327 PERIOPERATIVE CARE & COMPLICATIONS- TEST
QUESTIONS WITH CORRECT ANSWERS
Surgical consent -- Answer โโ The surgeon is responsible for obtaining this. If pt. does not understand the procedure, or has further questions for the surgeon, refer the matter back to surgeon. Informed consent -- Answer โโ Grounded in autonomy Disclosure -- Answer โโ Patient has received all information Capacity -- Answer โโ Patient's ability to understand Voluntariness -- Answer โโ No coercion or manipulation Expressed consent -- Answer โโ A type of consent in which a patient gives verbal or nonverbal authorization for provision of care or transport. Implied consent -- Answer โโ Type of consent in which a patient who is unable to give consent is given treatment under the legal assumption that he or she would want treatment. Representation Agreement Act -- Answer โโ - Legal contract that is designed to allow adults to arrange in advance who may make decisions about their healthcare if they become no longer capable of making decisions independently
- Duties of a client's representative: act honestly, take into account wishes and instructions of the client, act within authority granted, keep proper records of properties and liabilities Power of Attorney -- Answer โโ A document that appoints another person to deal with your business and property and to make financial and legal decisions for you Advanced directive -- Answer โโ A written instruction that gives or refuses consent to healthcare in the event the adult later becomes incapable of giving the instruction at the time the healthcare is required Substitute decision maker qualifications -- Answer โโ - Be at least 19
- Have been in contact with adult during preceding 12 months
- Have no dispute with adult
- Be capable of giving, refusing or revoking consent
- Be willing to comply with duties in section 19 Malignant hyperthermia -- Answer โโ A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs.
- Usually occurs with succinylcholine, especially in conjunction with inhalation agents. Usually occurs under general anesthesia bu may also occur in recovery
- Other triggers: trauma, heat, stress
- Can result in cardiac arrest and death Malignant hyperthermia S/S -- Answer โโ - Hyperthermia
- Rigidity of skeletal muscles
- Increased HR and RR
- Hypercarbia
- Ventricular dysrhythmias Malignant hyperthermia treatment -- Answer โโ Dantrolene
b. Airway: assess for LOC, look, listen (able to speak clear sentences) c. Breathing: color, WOB, accessory muscles, adventitious sounds d. Circulation: skin color, warmth, moisture, palpate pulses e. Disability: quick pain assessment f. Environment: safety equipment g. Full set of vitals h. Pain: LOTARPS/PQRSTU i. Head/neck, chest, abdomen, extremities reduced diet before/after surgery -- Answer โโ Affects a patient's risk for perioperative complications by:
- Risk for malnutrition leading to impaired wound healing
- Electrolyte imbalances leading to cardiac changes
- Dehydration leading to neurological changes and thromboembolism use of anesthetic or sedatives -- Answer โโ Affects a patient's risk for perioperative complications by:
- Risk for respiratory complications (respiratory depression, hypoventilation, aspiration)
- reduced mobility, leading to increased risk for skin breakdown, thromboembolism, impaired healing, loss of muscle mass
- Falls
- Drug side effects: N/V, allergy, MH, loss of muscle mass Surgical incision -- Answer โโ Affects a patient's risk for perioperative complications by:
- risk for infection leading to risk for sepsis and shock
- Bleeding leading to risk for hypotension, hypovolemia, shock
- Wound dehiscence
- Thromboembolism Use of IV fluids -- Answer โโ Affects a patient's risk for perioperative complications by:
- i. Risk for fluid/electrolyte imbalances including hypervolemia, pulmonary edema, HF, hypovolemia, shock ii. Electrolyte imbalances leading to neurological or cardiac changes iii. IV complications including phlebitis, infiltration, hematoma, infection, air embolism Pain -- Answer โโ Affects a patient's risk for perioperative complications by:
- Reduced mobility = risk for skin breakdown, thromboembolism, impaired healing, loss of muscle mass
- Hypoventilation = risk for respiratory infection, hypoxia, organ damage
- Delirium
- Stimulation of SNS including HTN, tachycardia, tachypnea = further risk for CVS complications (MI, stroke) Use of analgesic medications -- Answer โโ Affects a patient's risk for perioperative complications by:
- Drug side effects (urinary retention, N/V/C, respiratory depression, reduced kidney function, dizziness - can lead to:
- Fluid and electrolyte imbalances, reduced mobility, falls, impaired healing Wind -- Answer โโ - Causes fever most commonly on POD 1- 2
- Refers to atelectasis
- Treated by encouraging incentive spirometry q1h Water -- Answer โโ - Causes fever POD 3- 5
- Refers to UTIs Walking -- Answer โโ - Causes fever POD 4- 6
- Development of DVT which may cause low-grade fever
- Encourage ambulation, anticoagulants Wound -- Answer โโ - Causes fever POD 5- 7
- Polyuria in hyperglycemia
- Diaphoresis
- Fluid shifts Post-op hypovolemia S/S -- Answer โโ - Increased HR
- Orthostatic hypotension
- N/V
- Restlessness
- Anxiety
- Confusion
- Weak, thready pulse
- Cool extremities
- Decreased BP
- Urine output < 30mL/h
- More than 40% loss of blood volume = shock
- Hct: close to normal; sodium: close to normal Post-op hypovolemia treatment -- Answer โโ - Treat cause
- Replace fluids
- Transfusion
- Oxygen
- Vasopressors
- Monitor ABCs
- lower HOB
- Maintain IV site
- Monitor mental status
- VS
- Urine output for signs of shock Virchow's Triad -- Answer โโ a. Venous stasis
i. Caused by immobility, paralysis, immobilization, obesity, varicose veins, age >65, HF, increased viscosity b. Vessel wall i. Caused by trauma, surgery, pacing wires, CVC, dialysis access catheters, local vein damage, repetitive motion injury, atherosclerosis leading to plaque rupture c. Coagulation i. Caused by calcium, pregnancy, BCP, septicemia, different blood disorders Pulmonary embolism -- Answer โโ Risk factors for this include:
- Over 40
- Obesity
- Surgery
- Ortho trauma
- Immobility
- CVC
- Sepsis
- HF
- Inflammatory conditions
- Previous VTE
- First-degree relative with VTE
- Blood clotting problems
- Varicose veins
- Pregnancy
- HTC/BCP
- Smoking
- Diabetes Thromboembolism -- Answer โโ Treatment for this includes: a. Anti-coagulants i. Prevents new thrombus formation or prevents pre-existing thrombus from growing larger
i. Vit K antagonist ii. Long term INR normal is 2-3 usually target is 3- 5 iii. Vitamin K is given if INR too high IV or FFP iv. Vitamin K: dark green leady veggies f. Nursing management: i. aPTT ii. Hemoglobin iii. Hematocrit iv. Platelets g. Managing anticoagulants: i. Heparin IV pump ii. Calculations based on weight iii. Warfarin PT or INR h. Anticoagulant contraindications: i. Active bleed, blood coagulation issues, aneurysm, trauma, ETOH, surgery or eye, spinal cord or brain, severe liver/kidney disease, CVA recent, open ulcerative wound, post-partum period, infection i. Thrombolytics: i. Causes lysis of a thrombin clot ii. Advantages: less long Factors that may determine perioperative myocardial ischemia and infarction -- Answer โโ a. Decreased myocardial O2 supply i. Hypoxemia: changes in pulmonary function, weaning from ventilator ii. Reduced BP: left ventricular dysfunction, hypovolemia, systemic vasodilation iii. Coronary vasospasm: enhanced platelet aggregation, hypercoagulability, impaired fibrinolysis b. Increased myocardial demand i. Increased myocardial wall stress: hypervolemia, rise in BP, rise in end-diastolic left- ventricular pressure
ii. Dysrhythmia: Arrhythmias: elevation in plasma catecholamines, withdrawal of B- blockers, hypotension, postoperative pain iii. Changes in body temperature
