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M6 Op PT/Wound Manag
phase 2 test 3 'operative patient care/wound management'
| Question | Answer |
|---|---|
| Define Anesthesia | loss of sensation, w/o pain |
| Embolus | free-floating blood clot |
| Infarct | blood clot that blocks an artery |
| Informed Consent | educate pt about and they understand the procedure, why they need it, and agree |
| Intraoperative | care during surgery |
| Perioperative | care throughout entire surgical procedure |
| Preoperative | care prior to surgery |
| Thrombus | deep blood clot that stays in one spot |
| M6 responsible for getting informed consent? | no, but is responsible for making sure it's signed |
| Pre-Operative Patient Care | review peroperative lab and diagnostic studies review the client's health history and prep for surgery assess physical needs assess psychological needs assess cultural needs client followed physician's orders |
| Pre-Operative Patient Teaching Done | 1-2 days prior to surgery |
| What is taught in pre-operative patient teaching? | leg position use of side rails splinting frequency coughing exercises |
| Turning Improves: | venous return respiratory function gastrointestinal peristalsis |
| What coughing exercises do | removal of retained mucus from resp tract |
| Deep Breathing Exercises __________ | helps expand collapsed lungs and prevent postoperative pneumonia and atelectasis done 5-10 times/hr |
| Incentive Spirometry | used to encourage deep breathing and prevent atelectasis instruct in proper technique 10 times/day during each waking hour for first 5 days *except immediately before and after meals |
| Leg Exercises | helps prevent circulatory problems 'gas pains' must be individualized repeat 1-2 times hour |
| Early Ambulation | helps patient breathe deeply stimulates circulation urine retention constipation abdominal distention appetite sleep helps people feel less helpless |
| Pain Management | normal part of surgical experience area of major concern for patient and family ordered by physician and admin by nurse usually prn pt ask for meds before severe bowel sounds in 4 quads before admin |
| LPN can give IV morphine push? | NO!!!!! |
| Antiembolism Stockings | Homan's sign apply stockings in supine position abdominal surgeries most at risk pitting edema peripheral cyanosis |
| Sequential Compression Devices | place sleeve under pt's leg with fuller portion at top ensure there are no wrinkles or creases attach tubing to SCD after both sleeves applied assess client periodically |
| Preparing Patient for Surgery | prepare pt's chart using surgical checklist/preoperative checklist assure completion of SF 522 |
| SF 522 | Request for Administration of Anesthesia and for Performance of Operations and other Procedures |
| GI Preparation | NPO after midnight bowel cleanser may be ordered |
| Skin Preparation | shower hair removal |
| Morning of Surgery | complete morning care visit with family record vital signs check proper ID band is on pt check preoperative consent forms are signed and medical records are in order recheck accuracy of surgical checklist administer preoperative meds pt's safety s |
| Intra-Operative Nursing Care Includes | ID pt verbally, nonverbally personal contact awareness of the potential for harm recognition of susceptibility to injury strict adherence to principles of positioning and asepsis |
| 3 Types of Anesthesia | general regional local |
| Half Life | amount of time required for 1/2 of medication to be metabolized |
| Amnesia | not remembering |
| Analgesia | pain relievers |
| Autonomic Stability | sympathetic and parasympathetic medications to control VS |
| Muscle Relaxation | calm and rested, muscles not tensed |
| Anesthesia Made Possible in _____ | 1840s |
| General Anesthesia | used for major procedures results in - immobile, quiet person, unable to recall procedure Admin by inhalation agents or IV anesthestics |
| 3 Stages of General Anesthesia | induction maintenance emergence |
| Adverse Effects of General Anesthesia | malignant hyperthermia uncommon but potentially fatal signs: rapid rise in temp, tachycardia, tachypnea, muscle rigidity increased risk: children, adolescents and those with skeletal or muscular abnormalities |
| Clinical Uses of Moderate Sedation | procedures requiring moderate (conscious) sedation preoperative sedation doesn't necessarily cause complete loss of consciousness |
| Reversal Agents for Moderate Sedation | naloxone - narcotics romazicon/flumazenil - benzodiazepines anticholinesterases - reverses effects of neuromuscular blocking agents |
| Local or Regional Anesthesia | loss of sensation in a specific area of body no loss of consciousness usually patient is sedated 2 major categories: central, peripheral |
| Central Anesthesia | spinal epidural |
| Peripheral Anesthesia | nerve block infiltration anesthesia topical anesthesia |
| Spinal Anesthesia | intrathecal/subarachnoid anesthetic agent is delivered to the subarachonoid space proper patient position significant complication from SAB is headache |
| Epidural | local anesthetic delivered to the epidural space located between dura and overlying connective tissue commonly used in labor and delivery |
| Nerve Block | done under ultrasound by anethesiolgist can be single shot or infusion post-op pain |
| Infiltration Anesthesia | put into specific and numbs area around 1 tiny nerve, vasoconstriction |
| Topical Anesthesia | eye drops hemmorroid cream cytocanespry |
| Intra-Operative Patient Care in Moderate/Conscious Sedation | reduce fear and anxiety quick recovery requires careful monitoring routinely used for procedures that don't require complete anesthesia |
| Common Agents used in Moderate Sedation | opioids sedatives/benzodiazepines combinations of medications |
| Monitoring Patient Receiving Conscious Sedation | identify baseline information and risk factors continuous monitoring by RN during procedure post procedure assessment: discharge instructions |
| Members of Surgical Team | surgeon anesthesiologist anesthetist scrub nurse circulating nurse |
| Surgical Risk Factors and Potential Complications | infection - catheters, drains, surgical wound burns hypothermia hyperthermia bleeding/hemorrhage pressure sores trauma injuries |
| Immediate Post-operative Phase | airway breathing consciousness circulation system review |
| How Often Vital Signs Take in PACU | minimum every 15 minutes |
| Spinal Anesthesia Used For | lower abdominal pelvic procedures lower extremity procedures urology procedures surgical obsterics |
| Risks for Spinal Anesthesia | migration: drug, amount, pt position vasodilation/decrease in BP respiratory paralysis |
| Post Anesthesia Patient Care for Spinal Anesthesia | monitor vitals 3-5 minutes level of consciousness level of anesthesia physical assessment proper position |
| Most Important VS for PT of Spinal Anesthesia | respiratory rate and BP |
| Potential Postoperative Complications | N/V aspiration hypothermia/hyperthermia laryngospasm hypoxia hemorrhage pain hypovolemic shock decreased/absent urine output increase/decrease IV input |
| Documentation of Postoperative Phase Assessment | ID patient time patient arrived LOC safety measures VS type of anesthesia given type of procedure meds pre/post-op surgeon output IV's drains dressing discharge/exudate wound packs EBL pain rating O2 Sat nursing staff sig & initials |
| Ways to Prevent Postoperative Respiratory Problems | mobility secretion clearance deep breathing and coughing exercises splint analgesics breath sounds incentive spirometer |
| Circulation in the Later Postoperative Period | move legs frequently and do leg exercises don't use pillows under knees avoid pressure to lower extremities use antiembolism stockings ambulate as ordered heparin SCD |
| Incision Care in Later Postoperative Period | observe for drainage-reinforce if necessary accurate measurement of drainage dehiscence evisceration - 3 days - 2 weeks post op |
| When to give pain medications in post-op patient | every 3-4 hours as needed before pain becomes severe |
| Devices that can be used to control pain | PCA TENS |
| Length of Time Patient Needs to Recuperate from Surgery Depends on | physical and mental prep type and magnitude of surgical procedure |
| When prep for discharge begins | during the preoperative period |
| The major goals of nursing managements are prevention and detection of complications | prevent injury regain independence patient education |
| Pain medication should be timed in relation to? | activities |
| Recovery Period | begins when the pt arrives in the hospital room or a postsurgical unit and full activity is resumed |
| Define Pulmonary Embolism | obstruction of 1+ arterioles originating in venous system |
| S&S of PE | sharp, stabbing chest pain cyanosis anxiety profuse diaphoresis rapid, irregular pulse dyspnea, tachypnea |
| Nursing Interventions for PE | administer O2 have pt sit in upright position reassure and comfort pt monitor VS, EKG, ABGs administer analgesics as ordered initiation of thrombolytic therapy notify charge nurse STAT |
| Define Pneumonia | inflammation of alveoli as a result of an infectious process or foreign material |
| Causes of Pneumonia | aspiration infection depressed cough reflex dehydration immobilization increased secretions from anesthesia |
| S&S of Pneumonia | elevated temperature chills crackles or wheezes on auscultation dyspnea chest pain productive cough |
| Nursing Interventions for Pneumonia | semi-fowler's admin O2 maintain nutritional and fluid status encourage turning, coughing, deep breathing frequent oral hygiene teach proper disposal of tissue and sputum provide for rest & comfort provide emotional support |
| How to Manage/Minimize Risk of Phlebitis/Thromosis | leg exercises every 2 hours or more frequently elastic stockings or bandages (remove at least 1-2 times per day) asses skin temp, color, and capillary refill |
| Hiccups | singultus caused by uncontrolled contraction of diaphragm and rapid closure of the glottis place gentle pressure over eyelids rebreathe into a paper bag administer medications as ordered |
| Nursing Concerns and Interventions - Nutrition | monitor I&O maintain IV fluids assess for dehydration and wight loss provide oral hygiene before and after meals monitor diet tolerance encourage pt to sit upright for meals encourage family participation as necessary |
| Nursing Concerns and Interventions - Nausea and Vomiting | maintain clean environment provide frequent oral hygiene encourage sips of liquids at frequent intervals administer medications as ordered |
| Types of Open Wounds | abrasions avulsions lacerations amputations punctures bite |
| Type of Closed Wounds | contusion crush injury |
| Crush Injuries Seen Most in | farming accidents |
| Phases of Wound Healing | hemostasis inflammatory reconstruction maturation |
| Hemostasis | termination of bleeding |
| Inflammation | initial increase in blood elements water flow out of blood vessel and into vascular space |
| Reconstruction | collagen formation occurs |
| Maturation | 3rd week to 2 years post injury |
| Types of Primary Would Healing | primary intention secondary intention tertiary (delayed primary) intention |
| Wound Complications | abscess adhesion cellulitis dehiscence evisceration extravasations hematoma |
| Bleeding can be caused by ________ | slipped suture dislodged clot coagulation problem trauma |
| S&S of Internal Bleeding | dressing may remain dry increase thirst restlessness rapid, thready pulse decreased BP decreased urinary output cool clammy skin abdomen rigid and distended hypovolemic shock |
| Difference Between Dehiscence and Evisceration | evisceration organs protrude through surgical opening |
| S&S of Infection | purulent (pus) drainage fever tenderness pain edema elevated WBC positive wound culture |
| Factors that Impair Wound Healing | extent of injury type of injury age nutritional status obesity impaired oxygenation smoking drugs diabetes mellitus radiation wound stress |
| Sutures Remain in Usually _____ | 7-10 days |
| Serous Drainage | clear |
| Sanguineous | red with clear streaks |
| Serosanguineous | pink, watery |
| Purulent | brown, yellow, green |
| Open Drains | drainage passes through an open-ended tube into a receptacle or out onto the dressing Penrose drain |
| Closed/Suction Drains | self-contained suction units more efficient than open drains creating vacuum or negative pressure prevents environmental contaminants |
| Jackon-Pratt Drain | used when small amounts (100-200 mL) of drainage anticipated |
| Hemovac Drain | system used for larger amounts (up to 500 mL) of drainage |
| Antibiotic | treatment of bacterial infection slow/retards growth of bacteria |
| Bactericidal | kills bacteria |
| Bacteriostatic | slows/retards growth of bacteria |
| Colonization | bacteria grows and multiplies in a wound |
| Definitive Theory | know what bacteria it is and what will work against it |
| Empiric Therapy | physician decides on what treatment to use without C&S |
| Prophylactic Antibiotic Therapy | treating prior to procedure to prevent infection |
| Subtherapeutic | not getting adequate dosage, etc |
| Superinfection | infection that occurs when antibiotics knock down natural flora |
| Syngeristic Effect | 2+ drugs work together in order to achieve greater effect than individually |
| Gram Positive | stain purple thick cell wall outer capsule |
| Gram Negative | stain red complex cell wall structure more difficult to treat |
| Sulfonamides | primary bacteriostatic interferes with PABA often used to treat UTI and burns |
| Examples of Sulfonamides | sulfisoxasole sulfamethizole mafenide (Sulfamylon) - burns silver sulfadiazine (Silvadene) trimethoprim and sulfamethoxazole (Bactrim) |
| Adverse Reactions of Sulfonamides | Agranulocytosis Thrombocytopenia Aplastic anemia Anoxeria N/V/D Abdominal pain Stomatitis – inflammation of the mouth Crystalluria – crystle formation in urine Leukopenia Uticaria, pruritus Steven-Johnson Syndrome |
| Interactions of Sulfonamides | Increased action of anticoagulants Bone marrow suppression with administration of methotrexate Decreased metabolism of oral hypoglycemic drugs (Orinase) |
| PT and Family Teaching for Sulfonamides | Take as prescribed Take drug on an empty stomach Take with full glass of water Complete the full course Drink at least 8-10 oz. glasses of water a day Keep all follow-up appointments *Sulfasalazine may cause skin or urine to turn orange - yellow col |
| Classifications and Examples of Penicillins | Natural – penicillin G and V Penicillinase resistant – dicloxacillin Aminopenicillins – ampicillin, amoxicillin Extended-spectrum – piperacillin B-Lactamase Inhibitor – Augmentin, Unasyn |
| Uses of Penicillins | UTI’s intra-abdominal infections, meningitis gonorrhea, syphilis respiratory infections |
| Adverse Reactions of Penicillins | Mild nausea Vomiting Diarrhea Sore tongue or mouth (glostitis) Fever Pain at injection site |
| PT Allergic to Penicillin Most Likely Also Allergic to | cephalosporins |
| Pseudomembranous Colitis | causative org. C syphlasil, abd cramping & pain, bloody stool |
| Interactions of Penicillins | May interfere with effectiveness of birth control pills Decrease effectiveness when administered with tetracyclines May increase bleeding risk when taken with anticoagulants Penicillins should be given 1 hour before or 2 hours after meals |
| Patient and Family Teaching for Penicillin | Similar to Sulfonamides To reduce risk of superinfection, take yogurt or buttermilk (keep flora in gut) Women should consider additional contraceptive measures |
| Generation of Cephlosporins best against gram positive. Gram negative | first third |
| First-Generation of Cephalosporins | cefadroxil (Duricef) cefazolin (Ancef) |
| Second-Generation of Cephalosporins | cefaclor (Ceclor, Ceclor CD) cefotetan (Cefotan) cefoxitin (Mefoxin) |
| Third-Generation of Cephalosporins | cefixime (Suprax) cefoperazone (Cefobid) ceftriaxone (Rocephin) |
| Adverse Reactions of Cephalosporins | N/V/D Pruritis, urticaria HA Dizziness Stevens-Johnson syndrome Nephrotoxicity |
| Interactions of Cephalosporins | Risk of nephrotoxicity (increased toxic levels in kidneys) increases when administered with aminoglycosides May increase bleeding risk when taken with anticoagulants Most cephalosporins may be taken without regard to food |
| PT and Family Teaching of Cephalosporins | Similar to penicillins Avoid drinking alcohol when taking and for 3 - 7 days after completing therapy |
| Use of Tetracyclines and Macrolides | cholera, Rocky Mountain spotted fever, typhus and some skin and soft tissue infection (acne) in which penicillin is contraindicated |
| Adverse Reactions of Tetracyclines and Macrolides | N/V/D Epigastric distress Stomatitis photosensitivity |
| Contraindications of Tetracyclines and Macrolides | children under 9 pregnant |
| Interactions of Tetracyclines and Macrolides | Antacids impair absorption Increase effects of anticoagulants and digoxin Decreases effectiveness of oral contraceptives |
| PT and Family Teaching of Tetracyclines and Macrolides | given on an empty stomach with few exceptions and are not to be taken with dairy products Avoid exposure to the sun or any type of tanning |
| Fluoroquinolones | ciprofloxacin (Cipro) levofloxacin (Levaquin) gatifloxacin (Tequin) |
| Uses of Fluoroquinolones and Aminoglycosides | Lower respiratory infections Skin infections UTI’s STD’s |
| Adverse Reactions of Fluoroquinolones and Aminoglycosides | Nausea Diarrhea HA Abdominal pain or discomfort Dizziness Photosensitivity Superinfection / pseudomembranous colitis |
| Interactions of Fluoroquinolones and Aminoglycosides | taken with cimetidine may interfere with elimination risk of seizures when taken with NSAID’s nephrotoxicity if admin with a cephalosporin risk of ototoxicity if admin with a loop diuretic risk of neurotoxicity if admin soon after general anesthetics |
| Adverse Reactions of Fluoroquinolones and Aminoglycosides | Nephrotoxicity (chephlosporins) Ototoxicity – can cause damage to cranial nerve VII, early det. may be reversed Neurotoxicity N/V Anorexia Rash Urticaria |
| PT and Family Teaching of Fluoroquinolones and Aminoglycosides | same as other anti-infectives tendinitis, such as pain or soreness in the leg, shoulder, or back of heel ringing in the ears or difficulty hearing, numbness or tingling, and change in urine output. May be permament |
| Aminoglycosides | gentamicin (Garamycin) neomycin (Mycifradin) streptomycin tobramycin (Nebcin) blocking a step in protein synthesis |
| Uses of Aminoglycosides | gram negative organisms Poorly absorbed, useful in suppressing GI bacteria Bowel prep Hepatic coma – liver starts to fail and amonia levels increase |
| ____________and aminoglycosides chemically inactivate each other and should not be physically mixed | penicillins |
| Erythromycin may ________ hepatic metabolism of other drugs | decrease |
| Extended-spectrum penicillins and some ___________ may increase the risk of bleeding with anticoagulants, thrombolytic agents, antiplatelet agents | cephalosporins |
| ________________absorption is decreased by antacids, bismuth subsalicylate, iron salts, sucralfate, and zinc salts | Fluoroquinolone |
| Systemic Antifungals | amphtericin B cholesteryl sulfate (Amphotec) fluconazole (Diflucan) ketoconazole (Nizoral) |
| Topical Antifungals | butenafine (Lotrimin Ultra) clotrimazole (Lotrimin) ketoconazole (Nizoral) miconazole (Lotrimin AF, Maximum Strength Desenex / Monistat–Derm) nystatin (Mycostatin) terbinafine (Lamisil AT) tolnaftate (Tinactin) |
| Systemic Adverse Reactions of Antifungals | headache N/V/D hypokalemia |
| Topical/Local Adverse Reactions of Antifungals | burning, itching, local hypersensitivity reactions |
| PT and Family Teaching for Antifungals | Proper use of medication form. Continue medication as directed for full course of therapy, even if feeling better. Report increased skin irritation or lack of therapeutic response |
| acyclovir | Zoyirax |
| amantadine | Symmetrel |
| ribavarin | Virazole |
| Helminthiasis | invasion of the body by worms |
| Uses of Antihelmintics | pinworms roundworms hookworms whipworms |
| mebendazole | Vermox |
| pyrantel | Antiminth |
| Common Antimalarials | hydroxychloroquine (Plaquenil) quinine (quinine sulfate) |
| How long antimalarials should be taken prior to exposure to area. After returning. | 2 weeks 4 weeks |
| 5 Categories of Non-Opioid Analgesics | salicylates - Aspirin acetic acid derivatives - Toradol COX 2 inhibitors - Celebrex enolic acid derivatives - Mobic, Feldene propionic acid derivatives - Naproxen, Ibuprofen |
| Acetaminophen - Tylenol is/is not considered an NSAID | is not |
| How Non-Opioids Work | inhibiting the enzyme that's necessary for prostaglandin synthesis |
| Therapeutic Dose for Salicylates | 10-20 |
| Opioid Analgesics | originated from opium poppy plant |
| Classifications of Opioid Analgesics | memeridine-like drugs - Demerol, Fentanyl methadone-like drugs - Darvon morphine-like drugs - Morphine, Codeine, oxycodone |
| Opioid Antagonists Reversal Agents | Naloxone (Narcan) Naltrexone (ReVia) |
| Reversal Agent for Benzodiazapines | Romazicon (Flumazenil) |
| Preoperative Medications | reduces anxiety, the amount of anesthetic used and respiratory tract secretions |
| Types of Anesthesia Medications | general - Etomidate, Propofol, Fentanyl, Ketamine regional - Bupivicaine, Lidocaine, Tetracaine, Procaine moderate sedation - Demerol, Morphine, sedatives/Benzodiazapines, combinations |
| Steps in Suture Removals | 1. verify orders 2. ID pt 3. explain procedure 4. wash hands 5. expose incision 6. discard old dressing 7. wash hands 8. open kit 9. clean/sterile gloves 10. remove staple/suture 11. report unexpected outcomes 12. document |
| Responsibilities of the Circulating Nurse | prepare OR arrange supplies sends for PT visits PT pre-op performs/confirms assess checks med. record assists in trans pos. PT on table places conduct. pad counts instruments assist scrub nurse prepare PT skin assists in arranging table cont. |
| Responsibilities of Scrub Nurse | hand scrub sterile gloves and gown arranges supplies checks instruments counts instruments w/ circ. nurse gowns and gloves surgeons maintain sterile field corrects aseptic tech observes progress hands instruments ID and handle specimens maintai |
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ealongo
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