Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
97 Cards in this Set
- Front
- Back
-Increased respiratory rate
-Crackles over lung area -Elevated temp -Productive cough -Chest pain |
Atelectasis or Pneumonia
|
|
-Restlessness
-Dyspnea -Hypertension -Tachy -Diaphoretic -Cyanosis |
Hypoxia
|
|
-Dyspnea
-Sudden sharp chest or upper abd. pain -Cyanosis -Tachy -A drop in blood pressure |
Pulmonary Embolism
|
|
-Restlessness
-Weak and rapid pulse -Hypotension -Tachypnea -Cool clammy skin -Reduced urine output |
Hemorrhage or Shock
(If shock, elevate the legs) |
|
-Vein inflammation
-Aching or cramping pain -Vein feels hard and cordlike -Elevated temp |
Thrombophlebitis
|
|
-Nausea and vomiting immediately post op
-Abdominal distension -Absence of bowel sounds or flatus |
Paralytic Ileus
|
|
The post op period lasts from when to when?
|
From the OR to the last follow up with the surgeon
|
|
A primary consideration of the immediate post op pt. is to maintain ______ and _______
|
ventilation and oxygenation
|
|
Keep the head of the post op pt. elevated ____ to _____ degrees unless contraindicated
|
15 to 30
|
|
List the classifications of hemorrhage and the time frame for each
|
Primary- at surgery
Intermediary- 1st few hours when rise of normal blood pressure dislodges a clot Secondary- Some time after when suture slips |
|
Replacement of blood is indicated if the blood loss exceeds ______
|
500 mL
|
|
List the 3 mechanisms of wound healing
|
first, second and third intention.
1st- In OR, sterile, edges well approximated 2nd- Infection, abscess, edges not approximated 3rd- Deep wounds, not sutured, wound vac possible |
|
List the criteria for discharge from the PACU unit
|
Uncompromised pulmonary function
Stable vitals Oriented X4 Good pulse ox Urine 30 mL Minimal pain and nausea |
|
How often are vital signs done on the immediate post op pt?
|
Every 15 minutes
|
|
Evidence of post op wound infection is not usually evident before the ______day
|
5th
|
|
Name a scoring system commonly used to determine a pt's readiness for discharge out of PACU
|
Aldrete score
|
|
Classic signs of hypovolemic shock
|
Pallor
Cool, moist skin Rapid resp. Cyanosis Rapid, weak thready pulse Decreasing pulse pressure Lowering blood pressure Concentrated urine |
|
What is pulse pressure?
|
Systolic minus Diastolic
|
|
What criteria is used to determine those at high risk for PONV
|
Female
Nonsmoker History of motion sickness Surgery longer than 2 hours |
|
What is the difference between medical and surgical asepsis?
|
Medical
-Reduces pathogens -"Clean technique" -Used w/ meds, enemas, tube feedings, and daily hygiene Surgical -Eliminates pathogens -"Sterile technique" -Used in dressing changes, cath, and surgical procedures |
|
What drugs are off limits preop?
|
Aspirin
Antidepressant Steroid NSAID's |
|
When does perioperative period begin and end?
|
Transfer to OR table and ends with admission to PACU
|
|
Why do the elderly need lower doses of meds?
|
Decrease organ function
Inefficient liver enzymes |
|
Who is responsible for setting up the sterile field?
|
The scrub nurse
|
|
What is the circulating nurse responsible for?
|
Pt. advocate
Counts w/ scrub nurse Prepares legal document r/t surgical procedure |
|
Who is the RNFA responsible to?
|
The surgeon
|
|
Tracrium
Nimbex Zemuron Norcuron |
Neuro blockers- Intermediate muscle relaxants. Commonly used for intubation
|
|
Sublimaze (Fentanyl) *Most common
Morphine Sulfate Ultiva Sufenta |
Opiod Analgesics- Surgical analgesia
|
|
Versed (Midazolam)
Valium (Diazepam) Diprivan (Propofol) Pentothal (Thiopental Sodium) |
IV Anesthetics- Induction and maintenance of anesthesia
|
|
Which anesthetic is used for induction?
|
Diprivan
|
|
What is Phenergan used for?
|
Prevents nausea
Used w/ pain meds post op Mild sedation |
|
What drug reverses neuromuscular blockers?
|
Neostigmine
|
|
Fluothane
Ethrane Forane Ultrane |
Inhalation volatile liquids- General anesthesia
|
|
Char. of stage 1 anesthesia
|
Still conscious
Ringing or Buzzing in ears Feeling that limbs cant be moved Warm Detachment |
|
Char. of stage 2 anesthesia
|
Excitement
Pupils dilated (Can be contracted w/light) Struggling can occur Rapid pulse Abnormal resp. Stage can be avoided if administered smoothly and quickly |
|
Char. of stage 3 anesthesia
|
Surgical Anesthesia
Unconscious Pupils dilated but reactive Normal resp. and pulse Ranges from light to deep |
|
Char. of stage 4 anesthesia
|
Medullary depression
*Too much anesthesia Shallow resp. Pulse is weak and thready Pupils widely dilated and unreactive |
|
How does the anesthetist gauge level of anesthesia?
|
Pupils
BP Resp. Cardiac rates |
|
What is the most critical phase of anesthesia?
|
Induction
|
|
Order of anesthetization in the brain (For General)
"Could Hamper My Speaking Mechanism" |
Cerebral cortex
Hypothalamus Midbrain Spinal Cord Medulla |
|
With regional anesthesia, which fibers are affected first?
|
Sympathetic (smallest fibers)
Next is sensory, followed by Motor (thickest myelin sheath) |
|
Occurs with injection of a local into or around a nerve or group of nerves
|
Nerve block
|
|
Where is a spinal injected into?
|
Subarachnoid space
|
|
Which anesthesia is not dependent on the pt's position for level of anesthesia?
|
Epidural
Higher doses are used and slower onset |
|
With spinal anesthesia, what is the order of loss of sensation?
|
Feet and perineum first
Then legs and abdomen Sympathetic (Autonomic) Sensory (Pain) and then Motor **Comes back in reverse |
|
Order of return of Motor and Sensory Functioning After Regional Anesthesia
"The Pain Will Come Momentarily" |
Touch
Pain Warm Cold Move |
|
How many units of packed cells do you give for every 1 unit of plasma?
|
4
Packed cells don't have clotting factors |
|
Advantage of general anesthesia
|
You can control the airway
|
|
Disadvantage of general anesthesia
|
You don't know how they will metabolize
|
|
What is the preferred method of anesthesia for the elderly?
|
Regional
|
|
What is Ketamine?
|
PCP
|
|
Which route of administration is most easily controlled?
|
Inhalation
|
|
Common Local conduction blocks
|
Brachial Plexus
Paravertebral Transsacral (Caudal) |
|
Another term for Conscious Sedation
|
Moderate Sedation or "Mod Sed"
|
|
When is conscious sedation used?
|
Endoscopy
Cardiac cath Closed fractures Angiography |
|
Char. of Malignant Hyperthermia
|
Hereditary
May occur 24 hours after surgery Temp can go up a degree per minute Increased Ca leads to increased muscle contractions |
|
What is used to treat Malignant Hyperthermia?
|
Dantrium
?Dantrolene |
|
What is the reversal drug for Versed and Valium?
|
Romazicon
|
|
Why is local anesthesia commonly combined with local/regional block?
|
The anesthesia causes the sedation and the block causes muscle paralysis
|
|
What are the main differences between Mod Sed and Monitored Anesthesia Care (MAC)?
|
Airway intervention may be required and ventilation may be inadequate
|
|
What is it that nerve blocks do not do?
|
Cause sedation or relieve pain
|
|
What is a common nerve block agent and it's reversal drug?
|
Curare
Reversal- Neostigmine |
|
What is DIC?
|
Disseminated Intravascular Coagulation
Life threatening Thrombus formation Unknown cause May occur with major surgery or shock Affects coagulation proteins causing hemorrhage |
|
What is the first indicator of Malignant Hyperthermia?
|
Tachycardia
|
|
No Epi where?
|
Fingers nose and toes
|
|
Blood loss causes Alk or Aci?
|
Acidosis
|
|
Who has last say on meds?
|
Anesthesia
|
|
What are key indicators of complications in the elderly?
|
Pre op condition and level of function
|
|
Beginning and end of pre op
|
Decision to have surgery and transfer onto the OR table
|
|
Beginning and end of intra op
|
Pt transferred to OR table and admission to PACU
|
|
Beginning and end of post op
|
Admission to PACU and follow up evaluation
|
|
Carpal Tunnel is what kind of surgery?
|
Elective
|
|
When is the antibiotic administered?
|
1 hr. prior to incision
|
|
What drugs are commonly used for conscious sedation?
|
Versed or Fentanyl
|
|
What does Atropine do?
|
Speeds up the heart
|
|
What distance is surgical asepsis?
|
Within 2 ft.
|
|
How is an epidural like topical?
|
They both coat the nerves
|
|
Why do we use a stool softener after surgery instead of a laxative?
|
Laxative will affect electrolytes
|
|
What is the last sense to go with anesthesia?
|
Hearing
|
|
What is the minimum percentage of O2 needed?
|
21%
|
|
If BP is down, what can a nurse give to raise pressure?
|
IV fluids
|
|
Why do we add Epi with local?
|
Causes vasoconstriction and keeps it local
|
|
What may be a side effect of being in surgery for 3 to 4 hours?
|
Decreased gaseous exchange from CNS depression
|
|
What does an oral airway do?
|
Keeps tongue pulled forward and away from trachea
**Not the same as Endotracheal Tube |
|
What is the shock position?
|
Flat on back, feet elevated 20 degrees, knees straight
|
|
What is compartment syndrome?
|
Fluid buildup between fascia and muscle
|
|
Rate of absorption by route?
|
IV
IM SQ PO |
|
Five sites for IM injections
|
Deltoid
Rectus Femoris Vastus lateralis Ventrogluteal Dorsogluteal |
|
How much air for an air lock?
|
0.2 mL
|
|
What are the four components of pharmacokinetics?
|
Absorption
Distribution Metabolism Excretion |
|
What is physiologic reserve?
|
the ability of an organ to return to normal function
|
|
What are the three surgical zones?
|
Unrestricted-street clothes
Semirestricted-scrubs and caps Restricted-Sterile |
|
How many air exchanges per hour in OR?
|
15 positive pressure
|
|
Where is local anesthesia injected?
|
Into the tissues
|
|
Usual surgery position
|
Dorsal recumbent
*(Lower Abdomen - Trendelenberg) *Sims for renal *Lithotomy for perineal |
|
Safe distance suction tip?
|
6-8 inches
|
|
For spirometer, how many deep breaths per hour?
|
10
|