Glossary of Medical 2 Surgical
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- Association of Operating Room Nurses (AORN)
- first nursing organization to develop structure, process, and outcome standards defined by ANA.
- The standards of perioperative nursing include?
- administrative practice; clinical practice; professional performance; quality improvement
- AORN has since been changed to?
- Association of Perioperative Registered Nurses
- What is ambulatory surgery?
- outpatient surgery, short-stay surgery, or same-day surgery
- Describe PS-1 (Physical Status)?
- a normal healthy client
- Describe PS-2?
- a client with a mild systemic disease; a 48 yo smoker needing an EDG
- Describe PS-III?
- a client with a severe systemic disease that limits activity but is not incapacitating;
43 yo asthmatic 280 lb needs EDG
- Describe PS-IV?
- a client with a severe systemic disease that is a constant threat to life; 54 yo renal dialysis pt needing colonoscopy
- Describe PS-V?
- a moribund client who is not expected to survive 24 hours with/without the operation; ejected MVA victim needing cranial, abdominal, and thoracic injury
- Describe PS-VI?
- a client declared brain dead whose organs are being removed for donor purpose
- Describe E?
- Emergency operation
- What are the characteristics of a PS-1 which is a normal healthy client?
- No physiological, biological, organic disturbance
ex: 24 yo male needing repair of facial laceration
- What are the characteristics of a PS-II which is a client with a mild systemic disease?
- Cardiovascular disease with minimal restriction on activity
- What are the characteristics of a PS-III which is a client with severe systemic disease that limits activity but is not incapacitating
- Hypertension, obesity, diabetes mellitus
- What are the characteristics of a PS-IV which is a client with a severe systemic disease that is a constant threat to life?
- CV or pulmonary disease that limits activity; severe diabetes with systemic complications; history of myocardial infarction, angina pectoris, or poorly controlled HTN
- What are the characteristics of a PS-V which is a moribund client not expected to survive 24 hours with/without operation?
- Severe cardiac, pulmonary, renal, hepatic, or endocrine dysfunction
- What are the characteristics of a PS-VI which is a client declared brain dead whose organs are being removed for donor purpose?
- clients may have a wide variety of dysfunctions that are being managed to optimize blood flow to the heart and organs (e.g., aggressive fluid replacement and blood pressure medications)
- What are the characteristics of E which is emergency operation?
- Surgery is done as a last recourse of resuscitative effort; major multisystem or cerebral trauma, ruptured aneurysm, or large pulmonary embolus
- Assessment for surgical procedures are (18 fond campers)?
- alcohol ingestion
perceptions of surgery
substance abuse and use
- How does CHF affect surgical candidate?
- there might be a further decline in cardiac function which can be thwarted
by giving IV at a slower rate or by giving a diuretic after blood transfusion
- Name 6 risk factors of surgical procedures?
fluid and electrolyte imbal.
- What are two major risk factors for infants undergoing surgery?
- maintaining normal circulatory blood volume which makes it difficult to meet increased oxygen demands...also dehydration or overhydration depending on rate fluids are replaced
- Name surgical care aspects of child's surgical care?
(a, risk factors, age)
- seizure treatment
excessive blood loss
dehydration vs overhydration
- How many calories per day does a patient require following surgery? (a, risk factors, nutrition)
- 1500 kcal/day, esp. vitamins A and C, and zinc which facilitate wound healing
- How does malnutrition in a surgical patient affect healing? (a, risk factors, nutrition)
- anesthesia tolerance poor
nitrogen balance negative
blood clotting mechanisms
wound healing poor
multiple organ failure
(potential for poor)
- How does obesity (bariatric) affect surgical risks? (a, risk factors, obesity)
- reduces ventilatory and cardiac function
- What diseases are common in obese patients?
- What conditions are commonly seen in bariatric patients?
(a, risk factors, obesity)
- How does obesity affect wound healing?
- fatty tissue structure contains a poor blood supply which slows delivery of nutrients, antibodies, and enzymes; thick adipose layer also hard to suture and susceptible to dehiscence
- Complications from previous surgeries include? (a, previous surgeries)
- motion sickness and
nausea and vomiting
which increase the risk for aspiration
- The patient's perception and understanding of surgery may induce? (a, P&U)
- True or False? All meds (herbal too) are discontinued postoperatively unless doctor orders? (a, medications)
- It is critical to assess what type of allergies in surgical patients? (a, allergies)
contact (ex. tape, ointments, solutions)
- What postoperative care is important to smokers and ALL
preop teaching programs?
(a, smoking habits)
- deep breathing exercises which include:
"huff" coughing diaphragmatic breathing incentive spirometry positive expiratory pressure
- How does alcohol affect surgical healing? (a, alcohol ingestion)
- increases anesthetic needs due to cross-tolerance;
poor wound healing due to malnourishment; at risk for liver disease, portal hypertension, esophageal varices; delirium tremens
- Review of emotional health of surgical patient may reveal that patient feels?
- fear, anxiousness and powerlessness
- How does self-concept affect surgical outome? (a, self-concept)
- hinders ability to adapt to stress of surgery and aggravates feelings of guilt or inadequacy
- What types of surgery can affect body image, mainly sexuality? (a, emotional health)
- breast removal
prostate gland removal
- When assessing emotional health of surgical patient, determine? (3)
- What is the body's physiological response to surgical stress?
- activation of endocrine system results in release of hormones and catecholamines (epinephrine, NE) which increases blood pressure, heart rate, and respiration; platelet aggregation also occurs
- Physical exam for surgery should include?
- general survey
head and neck
thorax and lungs
heart and vascular system
- The surgical nursing assessment should complement?
- surgeon's and anesthesia provider's assessment
- The surgical nursing assessment should include the following? (hav light nn)
- The surgical nurse should take baseline preoperative vital signs and compare with post-operative vital signs?
- to rule out fluid and electrolyte imbalance
- When assessing head and neck, the nurse should inspect soft palate and nasal sinuses for?
- Palpate for cervical lymph node enlargement to rule out possibility of?
- local or systemic infection
- Inspect jugular veins for distention to?
- rule out excess fluid buildup in circulatory system or failure of heart to contract efficiently
- Note oral mucosa, identifying
loose or capped teeth as they may be?
- dislodged during endotracheal intubation.
- Inspect skin before surgical procedure to?
- discern increased risk of skin tears after lying for hours or sliding on OR table.
- If surgical nurse auscultates wheezing preoperatively, the patient may be at risk for further airway narrowing due to?
- certain anesthetics which cause laryngeal muscle spasm...notify doctor.
- Acceptable capillary fill occurs in?
- less than 2 seconds
- Assess abdomen for?
regular bowel movements?
color and consistency of
- If client is to receive spinal anesthesia, nurse should assess?
- gross motor function and strength preoperatively. Nurse needs to be aware that client will only return to pre-op strength.
- What is a complete blood count?
- peripheral venous sample of blood measuring
- What conditions might a CBC reveal? (bio)
- blood volume low
(surgeon may order replacement)
- Normal rbc count in men?
- 4.7 - 6.1 million/mm3
- Normal rbc in women?
- 4.2 - 5.4 million/mm3
- Normal hemoglobin in men?
- 14 - 18 g/100 ml
- Normal hemoglobin in women?
- 12 - 16 g/100 ml
- Normal hematocrit in men?
- 42% - 52%
- Normal hematocrit in women?
- 37% - 47%
- Normal white blood count in adults and children older than 2 years?
- 5,000 - 10,000 /mm3
- Serum electrolytes include?
- bicarbonate (HCO3-)
- Normal range for bicarbonate (HC03-)?
- 21 - 28 mEq/L
- Normal range for chloride (Cl)?
- 98 - 106 mEq/L
(chloride is feverish)
- Normal range for potassium (K)?
- 3.5 - 5.0 mEq/L
- Normal range for sodium (Na)?
- 136 - 145 mEq/L
- Imbalanced serum electrolytes may indicate need for?
- IV fluid replacement preoperatively. Use peripheral venous sample of blood
- Coagulation studies include?
- APTT - activated partial
INR - International
PT - prothrombin time
(These values reveal clients at risk for bleeding tendencies and thrombus formation)
- Normal PT level?
- 11 - 12.5 seconds
- Normal INR level?
- 0.76 - 1.27
- Normal APTT level?
- 30-40 seconds
- Normal platelet level?
- 150,000 - 400,000 /mm3
- Serum creatinine measures?
- ability of kidneys to excrete creatinine, by-product of muscle metabolism, assesses renal function
- An elevated creatinine can indicate?
- renal failure
- Normal serum creatinine level for men?
- 0.6 - 1.2 mg/100 ml
- Normal serum creatinine level for women?
- 0.5 - 1.1 mg/100 ml
- Normal blood urea nitrogen (BUN level)?
- 10 - 20 mg/100 ml
- BUN measures?
- ability of kidneys to excrete urea and nitrogen indicates renal function
- An elevated BUN may indicate?
- dehydrated client; preop IV fluid replacement may be needed
(normal BUN 7-20 mg/dl
- Normal fasting glucose level?
- 70 - 105 mg/100 ml
- A glucose check may be acquired by?
- finger stick or peripheral blood sample; treat abnormal levels pre-op and post-op
- Common diagnostic studies for hepatic disease?
- coagulation studies
liver enzymes (ex: AST)
- Common diagnostic studies for diuretics include?
- Common diagnostic studies for steroids include?
- Common diagnostic studies for anticoagulants include?
- coagulation studies
- Common diagnostic studies for cardiovascular disease include?
- Common diagnostic studies for pulmonary disease include?
- Common diagnostic studies for CNS disease are?
- Common nursing diagnoses relevant to surgical client?
- acute pain
deficient knowledge (specify)
delayed surgical recovery
disturbed body image
disturbed sleep pattern
impaired physical mobility
impaired skin integrity
ineffective airway clearance
ineffective breathing pattern
risk for deficient fluid
risk for imbalanced body temp
risk for infection
risk for latex allergy
risk for perioperative-
- Critical thinking assessment for surgical clients include?
- coping skills
pre-op dx tests
previous surgical experience
client's previous experience
physical exam focused on
client's history and
results of preoperative
- Critical thinking planning for surgical clients include?
- pre-op instructions for
client and family
consult other hcp's
provide coping therapies
risk reduction therapies
- Planning phase of the nursing process includes? (3)
- continuity of care
goals and outcomes
- In the PLANNING phase, OUTCOMES established for each goal of care provide?
- MEASURABLE behavioral evidence; OUTCOMES ARE MEASURABLE
- In the PLANNING phase, setting PRIORITIES requires?
- clinical judgment to prioritizing nursing diagnoses and interventions based on the assessed unique needs of each client.
- In the PLANNING phase, CONTINUITY OF CARE for surgical patients mean?
- guiding the patient pre-op and post-op
- In the IMPLEMENTATION process for surgical intervention, the nurse provides?
- a complete understanding of surgery and prepares client physically and psychologically
- IMPLEMENTATION for surgical clients involves? (6)
- acute care
preparation on day of surgery
- It's the __________ responsibility to explain the surgical procedure and obtain the informed consent.
- Health promotion activities during preop phase focus on?
- health maintenance
prevention of complications
support of possible rehab
- A nurse pre-warns (reduces anxiety) client that he may have a sore throat following surgery due to? (preoperative teaching)
- endotracheal tube
- A nurse pre-warns (reduces anxiety) client that he may have sensations of blurred vision postop due to? (preoperative teaching)
- ointment being placed in client's eyes to prevent corneal damage
- Understanding of the surgical experience includes the following? (8 preoperative teaching)
- Client cites:
feelings regarding surgery
postop activity resumption
pain relief measures
postop monitoring & therapies
postop unit & location of
family during surgery &
reasons for preop instruct.
surgical procedures & postop
time of surgery
- When giving preop instructions concerning breathing, the nurse should?
allow pt practice
return to re-evaluate
- Equipment needed when demonstrating post-op exercises are?
- pillow or wrapped blanket
positive expiratory pressure
(PEP) device and nose clip
- The pillow used when demonstrating postop exercises is used to?
- splint surgical incisions during coughing
- When assessing client's risk for postop respiratory complications, review medical history for?
- chest wall movement
chronic pulmonary conditions
ex: emphysema, asthma
history of smoking
presence of reduced hgb
- Why does general anesthesia predispose client to respiratory problems?
- because lungs are not fully
inflated during surgery..
cough reflex is suppressed..
mucus collects in airway
- Postop, patient may have trouble coughing and deep breathing because?
- there is reduced lung volume due to general anesthetic
- Postop, patient is at greater risk to develop?
- respiratory complications if other chronic lung conditions are present
- Smoking damages?
- ciliary clearance
increases mucus secretions
- Reduced hemoglobin level can lead to?
- inadequate oxygenation
- Preop, nurse should get a baseline chest expansion measurement to?
- compare postop measurement with
- Older clients, active cancer patients, and clients immobilized for more than 3 days are most at risk for?
- DVTs or thrombus formation
- Signs of thrombus formation may include?
- localized tenderness along
distribution of venous
swollen calf or thigh
calf swelling more than 3 cm
compared with other leg
collateral superficial veins
- For thrombus formation to occur, there must be simultaneous? This event may occur following general anesthesia.
- True or false? Positive Homan's sign indicates DVT?
- When teaching diaphragmatic breathing, have client hold slow, deep breath for?
- 3 counts, exhale slowly, and repeat 3 to 5 times...patient to take 10 slow, deep breaths every hr while awake during postop period until mobile
- To perform incentive spirometry or positive expiratory pressure therapy, have patient sit in which position?
- semi-Fowler's or high Fowler's position
- "Huff" coughing or forced expiratory technique when using PEP therapy accomplishes what?
- promotes bronchial hygiene by increased expectoration of secretions
- When done appropriately ((with fingers (splint/support) or pillow over incision)), controlled coughing exercises will cause incisional injury? True of false
- Practicing turning exercises
- reduces risk of vascular and pulmonary complications
- Preop leg exercises are done by?
- rotating each ankle alternating with dorsiflexion and plantar flexion of both feet in supine position
- If in pain, patient may request pain medication 30 minutes before postop exercises. True or false?
- A client may receive the following preop to relieve anxiety and promote sleep?
- Restoril (temazepam)-
- Routine procedures surgical nurse provides in preparation for a day of surgery are? (10)
- administering preop meds documentation
eliminating wrong site and
wrong procedure surgery
hair and cosmetics
performing special procedures
preparing bowel and bladder
removal of prosthesis
- If patient has been NPO before surgery, mouth may be dry. Nurse may offer?
- mouthwash and toothpaste and
water and instruct patient
not to swallow
preop meds which may cause
- An indwelling catheter may be placed in the pre-op client just before surgery if?
- surgery is long
incision is in lower abdomen
- Essential documentation that must be in chart before client goes to OR?
- pertinent laboratory results
current client documentation
- Preop or "on call" meds are given AFTER consent form signed and are used to treat?
- amount of anesthesia
risk of n & v and resultant
respiratory tract secretions
- Products that may contain latex and which surgical candidate may be allergic to include?
- adhesive tape
endotracheal tube cuffs
rubber stoppers on bottles
- Localized signs and symptoms of latex allergy?
anything from flat or raised
red patches to
vesicular, scaling, or
rhinitis and/or rhinorrhea
- Life threatening symptoms of latex allergy include?
focal or generalized
by increased capillary
permeability leading to
circulatory collapse and
- Define "Time Out"?
- conducted just before surgery whereby all team members are present and client is again identified along with indelibly marked side and site of surgery
- The qualification of a circulating nurse MUST be?
- an RN
- In the nursing process, EVALUATION for surgery includes?
- Ask if the client's
expectations are being
Evaluate the client's
knowledge of surgical
procedure and planned
Have the client demonstrate
Observe behaviors or
nonverbal expressions of
anxiety or fear
- What does the circulating nurse do?
- Assists surgeon & surgical
team by operating non-
supplies, verifies sponge
and instrument counts and
maintains accurate and
complete written records
Assists with endotracheal
intubation and blood
Establishes & implements
intraop plan of care
Evaluates the care
Monitors sterile technique
and safe OR
Provides for continuity of
Reviews preop assessment
- The qualifications of a scrub nurse may be?
licensed practical nurse
- What does the scrub nurse do?
- maintains sterile field
during surgical procedure
assists with applying sterile
hands surgeon instruments
counts sponges and instru-
- Four types of anesthesia used in the OR are?
- Define general anesthesia?
- an immobile, quiet client who doesn't recall surgical procedure
- The 3 phases of anesthesia?
- General anesthesia is called for when?
control of ANS
- Define induction?
- includes administration of agents and endotracheal intubation
- Define maintenance?
- includes positioning the client
- Define emergence?
- anesthetics are decreased and client begins to awaken
- Define palliative surgery?
- reduces intensity of disease; performed to relieve symptoms of a disease process, but does not cure; makes the client more comfortable
nerve root resection
- Define cosmetic surgery?
- reconstructs the skin and underlying structures; can be elective, urgent, or emergent; performed primarily to alter or enhance personal appearance
revision of scars
- Surgical procedures are categorized according to? (5)
- anatomic location
degree of risk
extent of surgery
reason for surgery
urgency of procedure
- Reasons for surgery include?
- Urgency of surgery? (3)
- Degree of risk of surgery?
- Extent of surgery?
- Define diagnostic surgery?
- performed to determine the origin and cause of a disorder or the cell type for cancer
ex: breast biopsy
- Define curative surgery?
- performed to resolve a health problem by repairing or removing the cause
- Define restorative/reconstructive surgery?
- restores function; performed to improve a client's functional ability
ex: total knee replacement
- Define elective surgery?
- planned for correction of a nonacute problem
ex: cataract removal
total joint replacement
- Define urgent?
- <necessary, but not necessarily emergency> requires prompt intervention; may be life threatening if treatment is delayed more than 24-48 hrs
ex: acute cholecystitis
kidney or ureteral
<removal of gallbladder>
- Define emergent?
- NOW! requires immediate intervention because of life-threatening consequences
gunshot or stab wound
<repair of perforated
- Define minor surgery?
- procedure without significant risk; often done with local anesthesia
implantation of a venous
access device (VAD)
incision and drainage
- Define major surgery?
- procedure of greater risk, usually longer and more extensive than a minor procedure
lymph node dissection
mitral valve replacement
- Define simple surgery?
- only the most overtly affected areas involved in the surgery
- Define radical surgery?
- extensive surgery beyond the area obviously involved; is directed at finding a root cause
ex: radical hysterectomy
- A diabetic client may need a more extensive bowel preparation because?
- of decreased intestinal motility
- Problems from anesthesia occur most commonly in what body system?
- cardiovascular due to hemodynamic changes and response to anesthesia possibly resulting in MI
- <Surgical risk factors of the aged's cardiovascular system include?>
- <decreased cardiac output
increased blood pressure>
- <Nursing interventions and rationales for the aged's cardiovascular system are?>
- <1) Determine normal activity levels and note when the client tires...knowing limits helps prevent fatigue
2) Monitor vital signs, peripheral pulses, and capillary refill....having baseline data helps detect deviations>
- <Surgical risk factors of the aged's respiratory system include?>
- <reduced vital capacity
loss of lung elasticity
decreased oxygenation of
- <Nursing interventions and rationales for the aged's respiratory system are?>
- <1) teach coughing and deep breathing exercises...
pulmonary exercises help prevent pulmonary complications
2) monitor respirations and breathing effort...having baseline data helps detect deviations>
- <Surgical risk factors of the aged's renal/urinary system include?>
- <decline in glomerular
decreased blood flow to
reduced ability to excrete
- <Nursing interventions and rationales for aged's renal
and urinary system are?>
- <1) assess overall hydration and monitor I & O...ongoing assessment helps detect fluid and electrolyte imbalances and decreased renal function
2) assist frequently with toileting needs, especially at night....frequent toileting helps prevent incontinence and falls>
- Risk factors of the aged's neurologic system include?
- <decreased ability to adjust
to changes in surroundings
slower reaction time>
- <Nursing interventions and rationales for the aged's neurological system are?>
- <1) orient client to surroundings
2) allow extra time for teaching client
3) provide for client's safety
...an individualized preop teaching plan is developed on the basis of the client's orientation and neurologic deficits and safety measures help prevent falls and injury>
- <Risk factors of the aged's musculoskeletal system are?>
- <Increased incidence of deformities related to osteoporosis or arthritis>
- <Nursing interventions and rationales of the aged's musculoskeletal system are?>
- <1) assess the client's mobility...interventions help prevent complications of immobility
2) teach turning and positioning; encourage ambulation; place on fall precautions, if indicated
...safety measures help prevent injury>
- Name 7 routine preop meds?
- Nursing interventions for preop antidysrhthmic meds?
- obtain baseline ECG
assess peripheral circulation
- Nursing interventions for preop antihypertensives?
- assess for hypotension during transfer and turning
- Nursing interventions for preop corticosteroids?
- continue steroid therapy
assess for signs of
assess for subtle signs of
infection and bleeding
monitor wound healing,
support incision area
with binders, and splint
wound when client is
turning, coughing, and
- Nursing interventions for preop anticoagulants?
- monitor coagulation studies
monitor signs of bleeding
gradually d/c 24-48 hours
have an antidote for warfarin
ex: vitamin K for heparin
protamine sulfate for
- Nursing interventions for
- assess for seizures
pad siderails of bed
place suction equipment
- Nursing interventions for glaucoma meds?
- check with physician about
d/c'ing Humorsol at least 2
weeks before surgery
monitor respiratory status
and cardiac output
assess for increased intra-
- Nursing interventions for antidiabetic agent?
- monitor serum glucose levels
administer antibiotics and other intermittent meds in NS
instead of dextrose , or as facility prescribes
- Define autologous donations?
- patient donates 2-4 units of own blood up to 5 weeks before surgery, hgb greater than 11 g/dl, and doctor's recommendation;
last donation can't be made within 72 hours before surgery
- Define directed blood donation?
- family and friends donate blood exclusively for patient
- Red blood cell stimulation can be accomplished with?
- epoetin alpha
- Specific considerations when planning care for the older preop client includes?
- Increased, decreased or
fall with injury
surgery and anesthesia stress
- Define oliguria?
- scant amount of urine
- Surgery increases metabolic rate and depletes which vitamins and electrolytes needed for wound healing and blood clotting?
- B vitamins
- How can a surgical nurse detect poor nutritional status?
- brittle nails
dry or flaky skin
hair changes (dull, sparse,
decreased skin turgor
decreased serum protein
abnormal serum electrolyte
- Define procurement for transplant?
- removes an organ
- Define constructive surgery?
- restores function of congenital anomalies
- <Anesthesia is an induced state of partial or total loss of consciousness. The purpose is to?>
- <*block nerve impulse
*promote muscle relaxation
*sometimes achieve a
controlled level of
- <What happens to general anesthesia in the body?>
- <*most are metabolized by the liver
*excreted by the kidneys
*interactions can occur
with other drugs that the
patient has received>
- <Define general anesthesia?>
- <a reversible loss of consciousness induced by inhibiting neuronal impulses in several areas of the CNS>
- <General anesthesia results in?>
- <*analgesia (pain relief or suppression)
*amnesia (memory loss of the surgery)
*unconsciousness and loss of muscle tone and reflexes>
- <General anesthesia is used in surgery for?>
- <Stages of general anesthesia are?>
- <Stage 1 analgesia & sedation
Stage 2 excitement, delirium
Stage 3 operative level
Stage 4 DANGER>
- <Define Stage 1 of general anesthesia?>
- <analgesia & sedation is a dizzy and drowsy feeling;
hearing is exaggerated>
- <Define Stage 2 of general
- <excitement and delirium; loss of consciousness to loss of eyelid reflex; irregular breathing, involuntary movements, vomiting or laryngospasm may occur>
- <Define Stage 3 of general anesthesia?>
- <operative level; loss of reflexes, depressing of vital functions; sensations are lost; patient can't hear; jaw relaxed>
- <Define Stage 4 of general anesthesia?>
- <DANGER; respiratory failure, cardiac arrest, possible>
- Nursing interventions and rationales for Stage I are?
- keep discussions to a minimum (hearing exaggerated);
position with safety belts;
close OR doors, dim lights,
- Nursing interventions and rationales for Stage II are?
- avoid auditory and physical stimuli; protect extremities; assist anesthesiologist or CRNA with suctioning as needed
- Nursing interventions and rationales for Stage III are?
- assist anesthesiologist or CRNA with intubation; scrub patient skin over operative site
- Nursing interventions and rationales for Stage IV are?
- prepare for and assist in treatment of cardiac and/or pulmonary arrest; document occurrence in client's chart
- <Administration of general anesthesia by inhalation does what?>
- <causes shivering after surgery because of effects on hypothalamus;
blankets won't stop shivering, but will give comfort>
- <Define nitrous oxide?>
- the most commonly used agent and is usually given with oxygen; it's a colorless and odorless gas that provides analgesia>
- <Explain IV anesthetic agents?>
- <injected through an IV line and into diluted into blood; it remains at high enough levels in brain, kidney, and liver>
- <Name 3 types of IV anesthetic injections?>
- <How are IV anesthetic barbituates used in surgery?>
- <acts on CNS; most common one is thiopental sodium (Pentothal); acts within 30 seconds; monitor vital signs continuously as it depresses breathing and cardiac function>
- <How are IV anesthetic ketamine (ketalar) used in surgery?>
- <a dissociative anesthetic agent (one that promotes a feeling of separation of dissociation from the environment) rapid onset of trancelike, analgesic state; often used for diagnostic and short surgical procedures);
emergence reactions are common during recovery (24hrs); may help to give patient small doses of diazepam (Valium)>
- <How is Propofol (diprivan)
used in surgery?>
- <a short-acting; minimal n&v; hypnosis occurs in less than 1 minute; drug eliminated rapidly and client responsive within 8 minutes after infusion ends>
- <Adjuncts to general anesthesia are?>
- <How are hypnotics used as adjuncts to general anesthesia?>
- <may be used as part of IV conscious sedation for short diagnostic procedures; higher doses of medazolam can induce general anesthesia; may be used during surgery along with regional or local anesthesia>
- <Name hypnotics used as adjuncts to general anesthesia?>
- <benzodiazepines such as:
diazepam (Valium, Vivol,
- <What are the effects of hypnotics as adjuncts to general anesthesia?>
- <Adverse effects of hypnotics as adjuncts to general anesthesia include?>
- <apnea (temporary cessation
- <Name opiods used as adjuncts to general anesthesia?>
- <fentanyl (Sublimaze)
morphinen sulfate (Statex)>
- <How are opioids used as adjuncts to general anesthesia?>
- <reduced dosages are used for older clients, clients with a circulatory problem (ex: heart failure) and debilitated clients)>
- <What are the effects of opiods as adjuncts to general anesthesia?>
- <*provides pain relief AFTER
- <What is the potency relationship between Fentanyl and Morphine?>
- <Fentanyl is 75 to 125 times more potent than Morphine>
- <Define balanced anesthesia?>
- <a combination of IV drugs and inhalation agents used to obtain specific effects>
- <What is balanced anesthesia used for?> (haamr)
- <to provide:
reduced reflexes with
minimal disturbance of
- <When is balanced anesthesia most advantageous?>
- <provides safe and controlled anesthetic delivery, especially for older and high-risk clients>
- <What are some balanced anesthesia combinations?>
- <*thiopental for induction
*nitrous oxide for amnesia
*morphine for analgesia
*pancuronium for muscle
- <What systems are affected by general anesthesia?>
- <Undesirable outcomes of surgery include?>
*fluid and electrolytes are
out of balance which is due
to large amounts of IV
- <How does positioning put the patient at risk perioperatively?>
- <*Poor body positioning puts patient at risk for pressure ulcer formation.
*Good body positioning can prevent obstruction of circulation, respiration, and nerve conduction.>
- <Common surgical positions include?>
- < dorsal recum. (mostcommon)
- How is padding used when positioning patients for surgery?
- Circulating nurse pads, coordintes transfer to OR bed, assessing skin integrity, and adds extra padding as needed.
- Factors influencing TIMING of repositioning of patient by circulating nurse on OR table?
- age and size
pain on movement if client
- Factors influencing ACTUAL position of repositioning of patient by circulating nurse
- age, size, and weight
any pulmonary, skeletal, or
muscular limitations, such
as arthritis, joint
replacements, or emphysema
specific procedure being
- <Surgical patient's skin can be impaired. Nursing interventions for this include?>
(3 at skin level
1 at body level)
- <*plastic adhesive drape
*skin closures, sutures,
*insertion of drains
*application of dressing
*transfer of client from the
operating room table to a
- Define absorbable sutures?
- *digested over time by body enzymes
*catgut, plain gut and chromic gut are types of natural absorbable sutures
*natural and synthetic absorbable sutures are absorbed in about 2 weeks
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