Surg (Wes)
Terms
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- What is routinely checked after surgery that is affected by hemorrhage?
- Hemoglobin and Hematocrit
- What are the normal hemoglobin levels?
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F: 12-16 g/dl
M: 14-18 g/dl - What are the normal hematocrit levels?
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F: 37-47%
M: 42-54% - What is the normal range for bicarbonate in blood?
- 22-26 mEq/L
- What is the normal range for CO2 in venous blood?
- 22-30 mEq/L
- What is the normal range for O2 saturation?
- 95-98%
- What is ABLATIVE surgery?
- removal of a diseased part
- What is PALLIATIVE surgery?
- reduces intensity of a disease
- What are the three levels of surgery regarding urgency?
- 1. Elective (optional), 2. Urgent (must be done soon), 3. Emergent (must be done immediately)
- What are the purposes of anesthesia?
- Block nerve impulse, suppress reflex, relax muscles, achieve a controlled level of unconsciousness
- When is sterile technique used?
- In any procedure that compromises skin integrity or that involves contact with mucus membranes
- What are the four stages of anesthesia?
- 1. Analgesia and sedation 2. Excitement, delirium 3. Operative level 4. DANGER, code
- What is the main concern for a patient that has been administered Pentothal?
- Respiratory and cardiac depression, VS are to be monitored until drug is eliminated
- What is the main safety concern for a patient under the influence of Ketamine?
- Possible fall, safety measures or Valium is used to control effects
- What are important concerns for a patient under the influence of Ativan or Valium?
- Respiratory depression, apnea
- Which opioid should not be used for elderly patients?
- Demerol. Alternatives: Fentanyl, morphine
- What is a high concern for patients on opioids?
- Respiratory depression
- What are three common neg side effects in surgery?
- 1. Bleeding 2. Fluid & electrolyte imbalance (due to the large amount of IV fluids administered) 3. Inflammation
- What are some red flags in a patient's history when heading into surgery?
- ALLERGIES, Hypo/hyperthermia, hypo/hypertension, Hypovolemic shock, Renal failure, Electrolyte imbalances, Dysrhythmias, Chronic heart failure, Paralytic ileus, Acute urinary retention, DVT, Pulmonary embolism, Atelectasis, Pneumonia, Laryngeal edema, GI bleeding, Anemia
- What is the normal range for PT (prothrombin time) and what is its significance?
- 11-12.5 seconds, how quickly a clot is formed on a wound, used to measure the effects of anticoagulants (Heparin, Coumadin)
- What are post surgery vital signs compared with?
- pre surgery vital signs (baseline)
- What are main areas of post op assessment?
- Vital signs (esp. respirations), Integrity of surgical area (any bleeding?), Neuro, Comfort level, IV fluid status (30cc/hr is standard), I&O, once stabilized assess for readiness for discharge
- In post op, how often are vital signs monitored?
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every 15mins x 4
every 30mins x 4
every 1hr x 2
every 4hr x 24-48hr - How would you prevent dehiscence of a wound?
- Move patient carefully, instruct them to move carefully, use a pillow for pressure support of a wound in case of coughing
- Describe two general types of drains.
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1. Gravity - fluid flows freely from surgical site (Penrose, T-tube)
2. Closed wound drainage systems - fluid is extracted by means of a pump (Hemovac, Jackson-Pratt) - What are Montgomery straps?
- Used for frequent dressing changes, prevent skin irritation from frequent tape removal
- What are some factors that contribute to poor wound healing and infection?
- Malnutrition, inhibited circulation
- What are some special considerations for an obese patient undergoing surgery?
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- Decreased ventilatory and cardiac function
- Poor wound healing due to low blood circulation in fatty tissue
- Greater chance of evisceration (external exposure of organs through incision) - What are the physiologic reasons for surgical complications in patients with COPD or that smoke?
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- Cilia and membranes hypoactive
- Lining of airways hypertrophied
- Alveoli less compliant - What are some surgical complications in patients with diabetes, heart disease, liver and renal disease?
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- Diabetes - impaired wound healing, glucose levels
- Heart disease - anesthetics depress cardiac function, healing requires increased cardiac output
- Liver/Renal - elimination and excretion of drugs - What is the normal pH of blood?
- 7.35-7.45
- What would a urine output of less than 30cc/hr indicate?
- Kidney complications
- Post op GI and excretory assessments?
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- Abdominal distention
- Paralytic ileus
- Nausea and vomiting (very common)
- Urinary retention
- Urinary tract infection - How often should NG drainage be assessed?
- every 8hr...do not alter NG tube without order from surgeon
- How many days after surgery will ineffective wound healing be able to be observed?
- 5-10 days
- When does pain level usually reach peak after surgery?
- 2nd day (patient more active, alert)
- What are some interventions for impaired gas exchange?
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- Airway maintenance
- Position patient on side or turn head to prevent aspiration
- Breathing exercises
- Encourage mobilization asap - What are the reasons for a drain?
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- Provides exit route for air, blood, and bile
- Prevents deep infections and abscess formation - A couple treatments for potential or present wound infection?
- Antibiotics, irrigation
- Some teaching points in avoiding infection after discharge?
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- Regular dressing care
- Proper nutrition
- Meds
- Progressive increase in activity level
- Use of proper body mechanics - Some diagnoses for post op?
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- Impaired physical mobility
- Impaired skin integrity
- Disturbed body image - When setting priorities for treatment what is the standard reference?
- Maslow
- Treatments that prevent DVT?
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- Leg excercises
- TED stockings
- Early ambulation
- Positioning
- Anticoagulants
- Fluid intake - What is the greatest risk after surgery for an infant?
- Dehydration (hypothermia is also a large risk)
- What are some important factors to consider when gathering data preop?
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- Age
- Current meds, drugs
- Medical history, CARDIAC and PULMONARY
- Previous surgery and anesthesia (complications?)
- Blood donations
- Discharge planning - What are some preop lab assessments?
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- Urinalysis
- Blood type and crossmatch
- H&H
- PT
- Electrolyte levels
- Pregnancy test
- Chest x-ray
- EKG - What is the nurse's role regarding teaching preop?
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1. Clarify facts and dispel myths the client or family may have about surgery
2. Tell the patient what to expect for post op - The client is to be NPO for __ to __ hrs before surgery.
- 6-8
- Name some herbs that affect BP.
- Garlic, Motherwort, Feverfew (important not to overlook in preop assessment)