Term
| pt at risk for malignant hyperthermia |
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Definition
| can be anesthetized with minimal risk if appropriate precautions are taken |
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Term
| tx for malignant hyperthermia |
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Definition
| prompt administration of dantrolene (Dantrium); slows metabolism, corrects acidosis, and corrects body temp |
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Term
| s/s malignant hyperthermia |
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Definition
| tachycardia, tachypnea, hypercarbia, and ventricular dysrhythmias; MH is diagnosed AFTER hypermetabolism is ruled out; rise in body temp is NOT and early sign of MH; can result in cardiac arrest and death |
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Term
| meds that can potentially cause MH |
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Definition
| succinylcholine (anectine) used w/ inhalation agents is the primary trigger. May manifest in the recovery period as well as during surgery. |
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Term
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Definition
| (sedative-hypnotic); widely used for pre-mediation before surgery for the amnesic effects, for concious sedation, and as supplemental IV sedation during local and regional anesthesia; also used for post-op anxiety and agitation |
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Term
| opiods can cause dose-related |
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Definition
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Term
| complications with inhaling agents |
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Definition
| coughing, laryngospasms, bronchospasm, increased secretions, and repiratory depression |
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Term
| most common position used for surgery |
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Definition
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Term
| when positioning patient for surgical procedure... |
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Definition
| provide correct skeletal alignment; prevent undue pressure on nerves and skin over bony prominences; provide for adequate thoracic excursion; prevent occlusion of arteries and veins; provide modesty; recognize previously stated aches, pains, or deformities |
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Term
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Definition
| wear only sterile gloves and gowns; only parts of gown are considered sterile (frome chest to table level); only sleeves to 2 inches above elbow are sterile; table are only considered sterile at table top level |
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Term
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Definition
| responsible for any on-site med direction of any nonphysician who participates in delivery of anesthesia |
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Term
| specific questions r/t details of the surgical procedure or anesthesia are referred to |
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Definition
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Term
| perioperative nurse activities |
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Definition
| counts sponges, needles and instruments, and passes instruments to surgeon (anticipating his needs) |
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Term
| How is the OR controlled? |
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Definition
| geographically, enviromentally, and bacteriologically; it is normally adjacent to the PACU |
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Term
| Methods in OR to prevent infection |
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Definition
| filters and controlled airflow; positive air pressure in OR, the functional design facilitates the practice of aseptic technique by OR team |
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Term
| family/friend allowed to wait w/ pt in holding area to |
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Definition
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Term
| pt. should voide before pre-op meds are given |
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Definition
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Term
| glasses and hearing aids should be returned to pt. when? |
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Definition
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Term
| Can a signed consent form be withdrawn at any time if the patient's desire changes |
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Definition
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Term
| pt. should have a responsible adult present prior to surgery for |
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Definition
| transportation home after surgery |
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Term
| all patients should receive instruction about deep breathing, coughing, and moving PRIOR to surgery because |
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Definition
| they might not want to do these things post-operatively if they aren't taught the rationale for them pre-operatively |
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Term
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Definition
| predisposes pt to wound dehisence, infection, and incisional herniation |
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Term
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Definition
| may prolong effects of anesthetic agents |
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Term
| garlic, ginger, ginko biloba, ginseng |
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Definition
| may cause increased bleeding |
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Term
| nurse should stress that recreational drug use could affect type and amount of anesthesia, and patients will normally |
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Definition
| respond honestly once informed of the risks |
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Term
| if the pt requires additional info, or if anxiety seems excessive... |
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Definition
| surgeon should be informed |
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Term
| surgeon should be informed immediately if pt might be pregnant because of |
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Definition
| possible fetal and maternal exposure to anesthesia |
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Term
| catastrophic reactions can be avoided if latex sensitivity is |
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Definition
| determeined BEFORE the surgical procedure |
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Term
| data obtained during the pre-op assessment: |
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Definition
| history and physical exam, allergies, urinalysis, CBC, serum electrolytes, ECG and chest x-ray, PREGNANCY TEST (if applicable), blood tranfusion consent, blood type |
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Term
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Definition
| scrub hands and arms, don sterile gown and gloves, touch items only in the sterile field |
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Term
| pre-op circulating nurse will: |
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Definition
| remain in unsterile field, implement activities that require touching unsterile items and the patient |
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Term
| what technique is used in the OR? |
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Definition
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Term
| priority care in the PACU includes |
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Definition
| monitoring and management of respiratory and circulatory function, pain, temp, and surgical site |
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Term
| phase 1 in post-op care should begin with |
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Definition
| evaluation of the airway, breathing, circulation status of the pt; during the initial assessment, signs of inadequate oxygenation and ventilation should be identified. Any evidence of compromise requires prompt intervention. |
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Term
| the greatest value of pulse oximetry is to |
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Definition
| provide an early warning of hypoxemia and significant reduction of arterial blood gases. However, it has not been shown to affect the outcome of anesthesia recovery |
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Term
| who is the only person allowed to release the patient from the PACU |
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Definition
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Term
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Definition
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Term
| unless contraindicated by the surgical procedure, the unconcious pt. is positioned |
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Definition
| in the lateral "recovery" position. this keeps the airway open and reduces risk of aspiration if vomiting occurs. |
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Term
| the concious patient in the PACU is positioned in |
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Definition
| supine position with the head of the bed elevated. This position maximizes expansion of the thorax by decreasing the pressure of the abdomen on the diaphragm |
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Term
| In the PACU, deep breathing is encouraged to |
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Definition
| facilitate gas exchange and to promote the return to conciousness |
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Term
| In the PACU, once the pt. is more awake, deep breathing and coughing techniques help the patient |
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Definition
| prevent alveolar collapse and move respiratory secretions to larger airway passages for expectoration |
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Term
| splinting an abdominal incision with a pillow or a rolled blanket provides |
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Definition
| support to the incision and aids in coughing and expectoration of secretions |
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Term
| ambulation should be aggressively carried out when? |
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Definition
| as soon as the physician approval is given |
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Term
| adequate and regular analgesic meds should be provided because |
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Definition
| incisional pain often is the greatest deterrent to pt. participation in effective ventilation and ambulation |
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Term
| hemorrhage most often occurs internally, requiring assessment for |
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Definition
| changes in LOC and vital signs. |
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Term
| If there is no response to fluid administration when treating hypotension...then |
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Definition
| cardiac dysfuntion should be considered to be the cause |
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Term
| DVT may form in leg as result of |
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Definition
| inactivity, body position, and pressure; all of which can lead to venous stasis and decreased perfusion |
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Term
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Definition
| older adults, obese patients, and immobilized patients |
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Term
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Definition
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Term
| pulmonary embolism can be detected by |
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Definition
| tachypnea, dyspnea, tachycardia (particularly if the pt is already receiving oxygen therapy); chest pain, hypotension, hemoptysis, dysrhythmias, and heart failure |
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Term
| superficial thrombophlebitis |
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Definition
| may develop in a leg vein as a result of venous stasis or i the arm vein as result of IV irritation |
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Term
| if the post-op patients BP gradually drops during several consecutive readings... |
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Definition
| inform the ACP or surgeon |
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Term
| treatment of hypotension should always begin with |
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Definition
| oxygen therapy to promote oxygenation of hypoperfused organs |
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Term
| because the most common cause of hypotension in fluid loss, |
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Definition
| IV fluid boluses should be given to normalize BP |
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Term
| Most important general nursing measure to prevent post-operative complications is |
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Definition
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Term
| walking helps post-op patient by |
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Definition
| increasing muscle tone, improves GI and urinary tract function; stimulates circulation, which prevents venous stasis and speeds wound healing; increases vital capacity and maintains normal respiratiory funciton |
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Term
| most effective way to prevent DVT is |
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Definition
| heparing or LMWH in combination with antiembolism stockings |
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Term
| if pt. feels faint during ambulation, nurse should |
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Definition
| assist patient to chair or ease patient to the floor; pt. should remain there til recovery is evident by BP stability and then be helped back to bed |
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Term
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Definition
| "waking up wild", can include restlessness, agitation, disorientation, thrashing, shouting; may be caused by anesthesia, hypoxia, bladder distention, pain, electrolyte abnormalities, or the patient's state of anxiety. HYPOXIA SHOULD BE EXPECTED FIRST. |
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Term
| most common cause of post-op agitation in the PACU is |
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Definition
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Term
| once hypoxemia has been ruled out as cause of post-op delerium, what may prove beneficial in controlling agitation and providing for patient and staff safety? |
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Definition
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Term
| what is the most reliable indicator of pain? |
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Definition
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Term
| what provides the most rapid relief of post-op pain? |
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Definition
intravenous opioids (administered slowly)
P.389 under nursing implementation |
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Term
fever may occur during anytime of post-op period. Temp variation post-op provides valuable info about pt's status.
know Table 20-6 p. 390 |
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Definition
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Term
| a milde temp elevation up to 100.4 deg during the first 48 hours post-op usually relfects the |
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Definition
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Term
| a moderate temp elevation (higher than 100.4 deg) post-op is commonly caused by |
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Definition
respiratory congestion or atelectasis
and is less frequently caused by dehydration |
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Term
| after 48 hours post-op, a moderate to marked temp elevation (higher than 99.9 deg) is usually caused by |
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Definition
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Term
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Definition
| fever will spike in afternoon and evening and return to near-normal levels in the morning |
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Term
| what do you do if there is abnormal or excessive drainage and a significant change in vital signs? |
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Definition
notify the physician
p. 392 bottom right |
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Term
| clinical manifestation of infection |
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Definition
redness, swelling, pain, fever, increased wbc's
p. 393 |
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Term
| if healing is by primary intention |
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Definition
| little or no drainage is present and no drains are in place. a single-layer dressing or no dressing is sufficient |
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Term
| during discharge from the PACU: |
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Definition
vital signs should be obtained, pt status should be compared to report provided by PACU. documentation of the transfer is then completed, followed by a more in-depth assessment. post-op orders and appropriate nursing care are then initiated
p. 393 |
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Term
| ambulatory surgery discharge: requirements for discharge |
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Definition
| overall, pt must be stable and near the level of pre-op functioning for discharge from the unit |
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Term
| ambulatory surgery discharge: what the nurse must do |
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Definition
| nurse must carefully determine not only readiness for discharge, but home care needs of the individual. determine availability of assistive personnel, access to pharmacy, access to phone in event of emergency, and access to follow-up care |
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Term
| planning for discharge and follow up care: |
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Definition
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