Download Surgical Stress Response, Post-Op Care, and Complications and more Exams Nursing in PDF only on Docsity!
NRSG 327 WEEK 2 TEST QUESTIONS WITH CORRECT
ANSWERS
Surgical stress response: 3 components -- Answer ✔✔ SNS RAAS Pancreas SNS: organs and components -- Answer ✔✔ Brain, heart, pancreas, kidneys, GI/GU Alpha and beta receptors Alpha and beta, what do they govern -- Answer ✔✔ - Alpha: Smooth muscles move, pupils dilate, BP, HR, RR up
- Beta 1: One Heart - HR and BP
- Beta 2: 2 Lungs - impacts airways - bronchi dilates, RR increases RAAS system: What's the conversion? -- Answer ✔✔ RAAS: Renin, angiotensinogen, angiotensin I and II, system. Angiotensinogen converts renin to angiotensin I, ACE converts to angiotensin II, angiotensin II impacts BP, elevating it. How does the pancreas respond to stress -- Answer ✔✔ Pancreas: BGL raises in surgery due to the stress response. Release of insulin! - know if pt is diabetic, BGL will change PACU - what is it, how does it differ from med/surg? -- Answer ✔✔ Post-Anesthesia Care Unit, come to recover post-op Critical care - need advanced training Different SoP, documentation
Gives report to med/surg Complications in PACU can happen in med/surg Ward ready criteria for PACU, vitals and non ABCs -- Answer ✔✔ Postop VS, hemodynamically stable Pain, N/V controlled Ward ready criteria for PACU, ABCs -- Answer ✔✔ A: (should be able to maintain their own airway), B: (below 6L, don't want them on a NRM), C: Stable Post-op assessment: A -- Answer ✔✔ •Airway - open, patent. Assess by checking speech, signs of breathing. Post-op assessment: B -- Answer ✔✔ •Breathing - check SpO Post-op assessment: C -- Answer ✔✔ •Circulation - Vascularity: Pulses, cap refill, edema, coloration, warmth, movement HR, BP Post-op assessment: D -- Answer ✔✔ •Disability/Dextrose/Discomfort (LOC): LOC, BGM, Pain scale Post-op assessment: E -- Answer ✔✔ •Environment: Room temp, shivering Post-op assessment: F -- Answer ✔✔ •Full set of VS Post-op assessment: G -- Answer ✔✔ •Give comfort: Pharm or non-pharm interventions Post-op assessment: H -- Answer ✔✔ •Head-to-toe assessment: Do the full assessment
Post-op complication: Pain - impacts -- Answer ✔✔ Slows recovery, less mobility Post-op complication: Pain - 4 questions to ask to help determine what and how much you are giving -- Answer ✔✔ 1.Substance use? Increases tolerance 2.Kidney fxn - nephrotoxicity and GFR can prolong meds in system 3.AE/allergy to med? 4.Size of pt impacts dosage Most common analgesic meds -- Answer ✔✔ Opioids: Morphine, hydromorphone, fentanyl, T Non-opioid: Acetaminophen NSAIDs: Ketorolac Pain assessment -- Answer ✔✔ We assess pain: LOTARPS, PQRST
- We want to know the nature of the pain, where it is, when it began, how severe, Post-op complication: N/V assessment -- Answer ✔✔ Nausea is subjective: Use a scale, just like pain. Vomiting is objective: You can assess amount, color, odor, frequency, Post-op complication: N/V - Causes and tx -- Answer ✔✔ Causes: Odors, anesthetics, pain, food, fluid loss (HoTN), Tx: Management of the cause, anti-nausea medications, peppermint oil, Post-op complication: Blood loss: Assessment -- Answer ✔✔ Symptomatic signs would be very significant: Feeling faint, dropping BP, rising HR, nausea Compare with baseline, as it may be a normal response to trauma
What surgeries are expected to have a lot of blood loss and what don't? -- Answer ✔✔ Abdominal surgery has a lot, most visceral surgeries will Others for bones, scopes, bypasses - won't Blood loss tx -- Answer ✔✔ Direct pressure, - CALL FOR HELP Vitals, blood products infused ASAP •If they start crashing - call a CODE Post-op complication: Fever - 5Ws that can impact it -- Answer ✔✔ Wind, water, walking, wound, wonder drugs Wind: -- Answer ✔✔ Respiratory system, atelectasis. This can happen very quickly! Water: -- Answer ✔✔ GU: UTI risk. POD 3- 5 Walking: -- Answer ✔✔ DVT makes walking painful: POD 4- 6 Wound: -- Answer ✔✔ Post-op infections can come from wounds Wonder drugs: -- Answer ✔✔ Just like wunderwaffe, these things can come with debilitating side effects Post-op complication: Electrolytes, labs -- Answer ✔✔ Hypokalemia: Potassium, think heart - dysrhythmia Hyponatremia: Sodium, think brain - delirium How will: Hgb, RBC, Hct, Renal, WBC labs be affected postop? -- Answer ✔✔ Hgb, RBC down, d/t bleed Hct can vary Renal: Bypass hits renal fxn, down
What does 'T' in AEIOUTIPS stand for? -- Answer ✔✔ Trauma What does the second 'I' in AEIOUTIPS represent? -- Answer ✔✔ Insulin What does 'P' in AEIOUTIPS refer to? -- Answer ✔✔ Poisoning or psychosis What does 'S' in AEIOUTIPS indicate? -- Answer ✔✔ Stroke, seizure, or syncope Hypervolemia assessment findings: -- Answer ✔✔ •↑ volume You'll find edema, JVD, heightened BP •Treatment: Albumin to pull fluid back into vessels so they can be peed out with diuretics Hypovolemia assessment findings -- Answer ✔✔ ↓ volume Dropping BP, pale, cool skin, tenting and dehydration, neurological deficits Treatment: Replacing fluid with boluses, Tx for thromboembolic -- Answer ✔✔ Anticoagulants Heparin Warfarin Anti-coagulants - do they thin the blood? -- Answer ✔✔ No, they delay clotting time Purpose of anti-coagulants -- Answer ✔✔ Prevent new and existing thrombus growth, fracturing Pulmonary embolism, the two types and causes -- Answer ✔✔ •Thrombotic: from DVT, AF •Embolic: from fat, amniotic, air, sepsis
S/S of a pulmonary embolism, what does it depend on? -- Answer ✔✔ Depend on the size of thrombus and the area where the occlusion occurs What factors reduce myocardial O2? -- Answer ✔✔ Hypoxia ↓BP Coronary vasospasm What factors increase myocardial demand? -- Answer ✔✔ ↑ myocardial wall stress Dysrhythmia Changes in body temperature
