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NSG 331 Exam #1 Questions With Complete Solutions peroperative phase when the person decides to have surgery until the OR table could last months roles of a preoperative nurse complete physical exam history allergies pre-op checklist labs informed consent preoperative assessment baseline vitals psychologic status physiologic factors surgical site home meds review results of diagnostic studies culture and ethical factors consent form signed intraopertive phase While they are in the OR with an emphasis on safety
postoperative phase PACU until follow-up visit Factors that increase surgery risk Age Obesity Malnutrition Dehydration Cardiovascular & respiratory disease Diabetes (trouble with delayed healing) Renal &liver disease (trouble with metabolize medications) Alcoholism Nicotine use how long should nicotine us be suspended before surgery 6 weeks Medications that need to be stopped before surgery Anticoagulants Diuretics Phenothiazines MAOI's body system reiview Confirms the presence or absence of disease alerts to areas to closely examine provide essential data to determine specific preoperative tests
specifics on the procedure arrival time, registration, parking, what to wear, what to bring, and the need for an accompanying care giver specific regarding food intake (NPO the night before elective surgery) Day of surgery nurse responsibilites verification of allergies and medication consent form preoperative teaching assessment and pt findings verified completion of labs and diagnostic studies all preoperative orders completed baseline vitals prep skin encourage patient to void preop check list common preoperative meds antibiotics anticholinergics antidiabetics benzos beta blockers histamine 2 receptor antagonist opioids sensory information
what the patient will see, hear, smell, and feel during surgery process information general information regarding the flow/order of the procedure procedural infromation specific and detailed information regarding surgery intraoperative surgical nurse role preparation of the room maintains aseptic technique checks mechanical and electrical equipment surgical time out preps patient monitors draping aids in anesthesia induction records/charts prepares, records, labels, and sends specimen measures fluid and blood output counts equipment facilitates transfer to PACU gives hand off report intraoperative potential complication anaphylactic reactions malignant hyperthermia anaphylactic reaction prevention
malignant hyperthermia treatment dantrolene optimize oxygenation and ventilation discontinue anesthesia Dantrolene slows metabolism reduces muscle contractions mediates the catabolic processes associated with MH intraoperative safety concerns infections physical trauma physiological effects of surgery fire in the OR wrong site, procedure, or surgery anesthesia risks PACU priorities obtain hand off report assessment of airway and breathing hand off report general information patient history intraoperative management intraoperative course
holding area (intra-op) · Surgical Care Improvement Project (SCIP) measures to implement here · Drug administration · Patient warming- (bear hugger) cold rooms to decrease infection · Application of sequential compression devices (SCDs) Circulating nurse · Preps room & Monitors asepsis · Conducts pre-procedure verification, the "surgical time out" · Assesses, comforts patient, reviews chart, documents events · Assists with anesthesia (application of monitoring devices) · Responsible for patient positioning · Conducts surgical site prep · Verifies and counts equipment · Monitors and documents fluid losses · IS IN CHARGE of patient safety and asepsis in OR Scrub Nurse Sterile activities · Gowns and gloves other members of surgical team · Prepares instrument table, assists with draping · Participates in "surgical time out" · Passes instruments to surgeon · Verifies and counts equipment
· Preventing Hypothermia · Preparing Surgical Site medical asepsis -clean technique includes procedures for reducing the number of organisms present and preventing the transfer of organisms. Surgical asepsis sterile technique prevents contamination of an open wound, serves to isolate the operative area from the unsterile environment, and maintains a sterile field for surgery. Post-op recovery · Hand-off Report · After surgery · Assessments · Priority breathing · Discharge · Going home-What to look for PACU recovery room · Phase I: immediate post OR, acute monitoring · Phase II: most common for ambulatory surgery pts · Extended observation: minor surgical procedures ACP gives verbal report to PACU nurse (History, meds, vitals, blood loss, unexpected events)
· Managing respiratory and circulatory function · Breathing and heart rate a priority · Pain control · Temperature control · Managing surgical site post Discharge from the PACU · If inpatient, report is called to the unit nurse · The ambulatory surgery Patient Must: · Be mobile · Be alert · Have pain, nausea/vomiting under control · Be stable and near pre-op functional level · Have a driver and someone at home to help Have teaching completed Discharge instructions · Are given verbally and in writing · Wound care · Pain management/scripts · Diet · Activity · What to report (ie: elevated temp, etc) · When and where follow up appointment scheduled
cancer screening Colorectal cancer screening Colonoscopy fecal occult blood test Breast cancer screening mammogram Cervical cancer pap smear Prostate cancer Prostate-specific antigen (PSA) Warning signs of cancer CAUTION C hange in bowel or bladder habits o A sore that does not heal o U nusual bleeding or discharge o T hickening or a lump in the breast or elsewhere o I ndigestion or difficulty swallowing o O bvious change in a wart or mole o N agging cough or hoarseness
Biopsy sample of the blood tissue removed from the suspected cancerous tumor, most definitive diagnosis Percutaneous biopsy · tissue obtained through the skin either by a small incision or using a needle, special needles can aspirate fluid or they can aspirate bone marrow, or obtain a core/punches sample from the tumor endoscopic biopsy · esophagus, stomach, or colon. When the tumor cant be easily reached Surgical biopsy · Sometimes done as a surgical procedure to remove the tumor. Removing a section of the colon that is blocked by the tumor and taking a sample of that Post biopsy concerns Bleeding Pain Infection Classification of cancer o Determines if they are begnin or malignant o Malignant needs to include the histology or the origin of the
§ T: tumor size and invasiveness § N: presence or absence spread to regional lymph node § M: metastasis General complications of cancer malnutrition loss of taste obstruction vena cava compression of spinal cord third spacing SIADH hypercalcemia tumor lysis syndrome cardiac tamponade rupture of carotid artery obstruction vena cava symptoms early: back pain seizures compression larynx decrease cardiac output obstruction vena cava treatment radiation and chemotherapy compression of spinal cord symtpoms
early: back pain paralysis urinary retention constipation compression of spinal cord treatment IV corticosteroid (reduce swelling) radiation (reduce tumor size) surgery (spine stabilization) hypercalcemia (in bone cancer) immobility and dehydration can lead to worsening hypercalcemia hypercalcemia (in bone cancer) complications paralytic ileus renal failure dehydration ECG changes hypercalcemia (in bone cancer) management increased hydration biphosphonate drugs loop diuretics tumor lysis sydrome
chemotherapy IV route problems performed by a chemo certified nurse concerns for extravasation of vesicants damages tissue and lead to pain, infection and tissue loss concerns for venous access problems infiltration of irritants central line associated infections precautions remains in place for 48 hours pt should be instructed to use a separate toilet, double flush, and abstain from sex oral chemotherapy emphasis on client education (how, when, safe handling, SE) gloves should be worn Debulking When the tumor has spread into an area where it cannot be all be removed safety or on a vital organ then the surgeon can use this approach to remove as much as possible of that tumor followed by chemotherapy and or radiation Chemotherapy Certified Nurse (Chemo Administration IV) Responsibility for monitoring the patient during chemotherapy administration rests with any nurses providing patient care external radiation (beam)
risk for exposure to skin and surrounding healthy tissue immobilization devices and skin markers used External radiation (beam) short term side effects erythema Erythema treatment use lotion avoid heat and sunlight External radiation (beam) long term side effect desquamation Desquamation treatment use bandage to protect and absorb drainage internal (brachyterapy) readiation implantation of radioactive material directly placed into tumor or near tumor can be permanent or temporary safety precautions: time, distance, and shielding Vesicants chemo drugs that when infiltrated inadvertently into the skin can cause tissue breakdown and necrosis requires immediate attention irritants
