1
Q
what is the purpose of a chest tube
A
- is a one-way drainage device that helps remove air and fluid to establish normal vacuum pressure
- is inserted into the pleural space
2
Q
what is the chest tube size used for air removal
A
12-20 French tube
3
Q
what is the chest tube size for blood and large air
A
24-40 French tube
4
Q
what are the indications for chest tube
A
pneumothorax - air in the pleural space
hemothorax - blood in the pleural space
pleural effusion - excessive fluid in the pleural space
chylothorax - lymphatic fluid in the pleural space
empyema - pus in the pleural space (could be infection)
5
Q
what is the most important risk and complication for chest tubes
A
subcutaneous emphysema
6
Q
what are the risks and complications of a chest tube
A
- bleeding
- infection
- subcutaneous emphysema
- bronchopleural fistula
7
Q
what is subcutaneous emphysema and what causes it
A
- air trapped inside subcutaneous layer
- feels like rice krispies
- outline with sharpie to see if it goes higher
- report to doctor
cause:
- trauma
- infection
- pneumothorax
8
Q
what is the LPN scope of practice relating chest tubes
A
LPN’s can monitor
9
Q
what are the different chest tube drainage systems
A
- traditional chest drainage unit (CDU)
- small portable (CDU)
- heimlich valve
- indwelling pleural catheter
10
Q
CDU positioning should be…
A
below the patients chest especially when draining with gravity
11
Q
chest tube assessments
A
- assess dressing (dry and intact, if drainage present, shadowing)
- SC emphysema (outline with sharpie if it is high)
- site to source
- assess the drainage unit
- ensure safety kit is also within the room
12
Q
what are the 4 types of anesthesia
A
general - loss of sensation and consciousness
local - loss of sensation at the site topically applied
regional - loss of sensation in an area of the body
conscious sedation - used for procedures that don’t need complete anesthesia (patient is able to breath on their own)
13
Q
what are the 3 types of regional anesthesia
A
spinal
nerve block
epidural
14
Q
spinal anesthesia
A
- injected into CSF in the subarachnoid space
- numbs lower half (waist down) L2 and below
- used in C-sections
- automatic, sensory, and motor blockage
- may become hypotensive due to vessels widening
15
Q
side effects of spinal anesthesia “hi-hu”
A
postural puncture headache (lay pt flat)
itchiness
hypotension
urinary retention
16
Q
nerve block
A
- anesthesia that is injected to group of nerves
trigeminal - blocks face nerves
ophthalmic - blocks eyelids
supraorbital - blocks forehead
brachial - blocks shoulder, arms, hands, wrists, and elbow
femoral - blocks leg and hip
17
Q
epidural anesthesia
A
- injected into the epidural space
- doesn’t enter CSF
- often used in childbirth
18
Q
post-op complications for respiratory system
A
pneumonia
- fluid/pus in the lungs
cause: immobility and not strengthening the lungs with DB+C exercises
s/s:
- dyspnea
- fever
- productive cough
atelectasis
- collapsed alveoli due to gas unable to enter or leave
cause: not moving or coughing after surgery
s/s:
- crackles
- wheezing
- absent breath sounds
- low SPO2
hypoxemia
- low o2 in the blood
cause: pneumonia, atelectasis, and airway obstruction
s/s:
- restlessness
- cyanotic
- dyspnea
- decreased LOC
19
Q
pre-op risk factors
A
age
nutrition
obesity
immunocompromised
fluid and electrolyte imbalances
pregnancy
drugs/smoking/alcohol
20
Q
post-op complications wounds
A
infection
- invasion of pathogens
cause: poor hand hygiene and aseptic technique
s/s:
- drainage
- warmth
- redness
- fever and chills
21
Q
what is dehiscence of a wound
A
surgical wound re-opens up
22
Q
what is evisceration of a wound
A
body organ protrudes out of wound
23
Q
post-op complications for gastrointestinal
A
peristalsis/paralytic ileus
immobility of intestines
cause: opioids, abdominal surgery, and anesthesia
s/s:
- n/v
- abdominal pain
- decreased bowel sounds
- constipation
24
Q
post-op complications for urinary
A
urinary retention
unable to empty out bladder so urine accumulates
cause: opioids, anesthesia
s/s:
- no void in 6-7 hours
- slight dribbling
- bladder distention
25
post-op complication circulatory system
thrombophlebitis
inflammation of the vein with clot formation
cause: immobility, dehydration, pressure on veins
s/s:
- pain and tenderness
- warmth
- facial grimacing upon palpation
26
post-op complications nervous system
intractable pain
constant pain that doesn't go away
cause: post-op surgery and nerve damage
s/s:
- restlessness
- facial grimacing
- tense muscles
27
nociceptive pain also contains...
somatic and visceral pain
28
what are the different types of pain
somatic
visceral
neuropathic
idiopathic
chronic
acute
29
what is acute pain
- most severe in first 48 hours after surgery
- lasts usually less than 3 months
- has an identifiable cause
- ax if pt needs PCA
- administer IV and PO opioid analgesics
30
- what pain lasts 6 months or longer
- neuropathic due to nerve damage
- has no identifiable cause
chronic pain
31
what pain is due to damage to the internal organs
referred pain from kidney stones will cause back pain, or a heart attach will cause jaw and radiating arm pain
visceral
32
what is somatic pain
- you know where it hurts
- pain from joints, muscles, bones, and incision site
ex post-op site at pain, or pain from fractured wrist
33
what is neuropathic pain
- nerve pain due to spinal cord malfunction
like pinched nerve, diabetes neuropathy
34
what is idiopathic pain
pain with no cause like certain headaches or back pains
35
what are reasons for post op pain
- positioning during surgery
- immobility
- surgical procedure
- pressure sores
36
what are acute pain s/s
- diaphoresis (excessive sweating)
- hypertension
- tachycardia/ tachypnea
37
pain felt at location distant from site, heart attach will cause jaw and radiating arm pain
referred pain
38
pain that is surface level, and just under the skin like paper cut and pain to site after surgery
superficial/cutaneous
39
pain that spreads from from original site (sciatica pain or toothache)
radiating pain
40
pain originating from inside the tissues like joint and bone pain
deep pain
41
pain assessment
- OPQRSTUV
- assess pain q hour
- ask pt to rate pain from 1-10 during rest and movement
42
what is a PCA pump
- patient controlled analgesia that allows patient to administer on own pain meds
- patient must be physically, cognitively, and psychologically
- machine is programmed to patients needs
- when control is green medications can be taken by patient but if not green then lockout time in place
43
what way can pain meds be given
oral
sublingual or buccal
transdermal
IV/SC/IM
epidural
rectal
PCA
44
what are scheduled medications
given at a certain time decided by physician like acetaminophen 1mg PO Q6H
45
what is PRN or breakthrough meds
given to patient as needed or when they have breakthrough pain prescribed by physician in a range like hydromorphone 2-4mg PO PRN
46
what does opioids do and list adverse effects
- decreases anxiety and pain, promotes sedation
adverse effects:
- respiratory depression
- N/V
- hypotension
- constipation
-confusion
types of opioids
codeine, hydromorphone, and morphine
47
what is malignant hyperthermia
- life threatening reaction to anesthesia that causes increase in temperatures and stiffness of the body
- inherited meaning passed on from mom or dad
- can result in death
48
s/s of malignant hyperthermia
- tachycardia/ tachypnea
- rise in temp
- hypercarbia (increase co2)
49
intra-op risk factors
bleeding disorders
- at risk for excessive bleeding if taking anticoagulants monitor closely
heart disease
- cardiac complications related to anesthesia/stress of surgery
chronic respiratory disease
- increases risk of pulmonary complications and hypoventilation
liver disease
- impaired wound healing, experience drug toxicity (weak liver)
diabetes mellitus
- greater risk for infection and body heals more slowly
50
what is bronchospasm
narrowing of the bronchial tubing
s/s:
- SOB
- chest tightening
- decreased SPO2
51
what is airway obstructive
blockage of the airway
s/s:
- dyspnea
- cyanosis
- wheezing
52
what is atelectasis
collapsed lung (alveoli)
s/s:
- absent breath sounds
- shallow breathing
- low SPO2
- crackles/wheezing
53
what is hypothermia
drop in the bodies core body temperature
s/s:
- weak pulse
- shallow breathing
- cyanotic
54
what is hemorrhaging
loss of large amounts of blood in short period of time highest risk in first 24-48 hours after surgery
s/s:
- hypotension
- tachypnea, tachycardia
- cool clammy skin
- restlessness,
- reduced urine output
55
what is dumping syndrome
where foods quickly bypass the stomach and moves into the small intestines
S&S
- abdominal cramps
- diarrhea10-30min after meals
56
what is dysrhythmias
abnormal heart rhythms
57
what is fast HR faster than 100 beats per min
tachycardia
58
what is healing by 1st intention
- clean incision
- edges are approximated
- incision closed right after surgery
59
what is healing by 2nd intention
- wound is left open bc it cant be healed
- forms scar tissue
- wound heals from bottom up
- prolonged healing
60
what is healing by 3rd intention
- left open for several days
- potentially infected wound
- leave cut open while patient is on antibiotic therapy
61
what is the most common type of shock
hypovolemic shock
62
what are the s/s of hypovolemic shock
- tachycardia/tachypnea
- cool, clammy skin, pale skin
- hypotension
- diaphoretic
63
NI for wound dehiscence
- cover with sterile gauze
- call for help
64
what NI are used for evisceration
- use a saline soaked gauze to cover area
- get help
- ensure pt is NPO bc they would be going into immediate surgery
65
what is hypoxia, list the early and late signs and symptoms
low o2 going to the tissues
early:
- anxiety
- confusion
- restlessness
late:
- cyanosis
- cool clammy skin
- use of accessory muscles when breathing
- hypotension
- arrhythmias
66
what is the nasal prongs/cannula used for
- gives little extra boost
- gives 28-32% O2
- 2-4L per min
67
what is a simple face mask
- used short term in urgent situation
- gives 5-8L per min
- delivers 35-50% o2
68
what is a venturi mask
- high flow device
- helps COPD patients who need constant O2
- 4-12L per min
- delivers 24-60% o2
69
what is a non-rebreather mask
- low flow device
- gives 85% o2
- applied and ordered by RT
- must give more than 10L min
70
normal pH balance
7.35-7.45
71
what is respiratory acidosis and what causes it
lungs can't remove CO2 so it builds up causing blood to become acidic
caused by
- pneumonia
- COPD
- drug overdose
- asphyxia (absence of oxygen in the body)
- drowning
72
what are the s/s of respiratory acidosis
- hypoventilation
- drowsiness, fatigue
- headache
- hyperkalemia
- pH less than 7.35
- dyspnea (difficulty breathing)
73
what is respiratory alkalosis and causes
low CO2 (Paco2) in blood causing high pH
caused by
- hyperventilation
- excessive breathing
- anxiety
74
what are the s/s for respiratory alkalosis
- seizures
- hyperventilation
- tingling and numbness of extremities
- hypokalemia
- pH more than 7.45
75
what is chest physiotherapy
way to clear out the airways like deep breathing and coughing, draining the lungs, and percussions
76
what is percussion's
tapping the chest in a forceful and steady beat manner, should sound hallow
77
what is a lavage
irrigation of the stomach (contents are LEAVING)
78
what is gavage
introducing contents to the stomach (contents like tube feedings are GOING in)
79
what are the most common types of NG tubes
- salem sump tubes
- dobhoff tube
80
what are feeding tube complications
- aspiration
- N/V
- dumping syndrome
- fluid and electrolyte imbalance
- hyperglycemia if good is entering stomach
- hypoglycemia if contents are being taken out
81
assessments of a NG tube
- site to source
- patency
- drainage
- ax nares and skin integrity
- measure the NG tube
82
true or false
you need doc order to remove NG tube
true
83
A patient is receiving an intravenous infusion of 0.45% sodium chloride. The nurse knows that this solution is:
1. Isotonic
2. Hypotonic
3. Hypertonic
4. Concentrated
2
84
An older patient is receiving intravenous fluids to treat dehydration. When she complains of shortness of breath, your assessment reveals a 20-point increase in her systolic blood pressure and a heart rate of 100 beats per minute. The most likely cause of these findings is:
1. Shock caused by deficient fluid volume
2. Anxiety associated with hospitalization
3. Fluid volume excess related to fluid overload
4. Renal failure caused by circulatory collapse
3, hypertension, tachycardia, and SOB are linked with too much fluid in the lungs
85
The greatest danger of irrigating an obstructed intravenous line is:
1. Embolism
2. Trauma to the blood vessel
3. Rupture of the cannula
4. Infusion site irritation
1, embolism is a traveling clot = life threatening
86
An older adult who is scheduled for a surgical procedure expresses fear that he is too old for surgery and asks what you think. Your response should be based on the knowledge that:
1. Older adults are twice as likely to have surgical complications as younger people.
2. An older adult in good health is likely to do just as well in surgery as a younger person.
3. For most older adults, the risks of surgery are too great to justify any possible benefits.
4. Older adults who have chronic health problems are poor candidates for surgery.
2
87
A patient is recovering from a surgical procedure that was done using spinal anesthesia. The PACU nurse assesses whether the patient has sensation and movement in his legs. Why is this data especially important?
1. Regional anesthesia can impair blood flow to the extremities, causing gangrene.
2. The patient cannot move the extremities despite feelings of pain or pressure.
3. The extremities are susceptible to injury because movement returns before sensation.
4. The effects of regional anesthesia may persist for several weeks.
3 if patients moves around without sensation they could hurt their legs nd not feel shit
88
In the PACU, a patient’s vital signs are as follows: temperature 98°F (36.66°C), pulse 66 beats per minute and regular, respirations 14 breaths per minute, blood pressure 100/56 mm Hg. Which other piece of information is most important to allow the nurse to evaluate these vital signs?
1. Medications given during surgery
2. Length of time under general anesthesia
3. Whether the patient is having pain
4. Patient’s preoperative vital signs
4 to compare the baseline with now findings
89
During the shift hand-off, the nurse is informed that a postoperative patient reportedly has a paralytic ileus. The nurse should anticipate which of the following? (Select all that apply.)
1. The patient will be unable to walk.
2. A nasogastric tube and suction may be in place.
3. Bowel sounds should be auscultated.
4. The patient will be limited to a liquid diet.
5. Blood transfusions will probably be needed
2,3,4
90
A patient with an abdominal incision reports that his dressing is soaked with drainage and that he felt a pulling sensation when getting out of bed. On inspection, the nurse observes that a loop of intestine is protruding from the open wound. The appropriate action is to:
1. Have the patient lie flat in bed.
2. Gently reapply the surgical dressing and call the physician.
3. Administer a dose of prescribed opioid analgesic for pain.
4. Apply saline-soaked gauze and cover with a sterile, dry dressing.
4, keep the organ from drying and becoming infected
91
Pain is best defined by the:
1. Patient
2. Nurse
3. Physician
4. Physiologist
1
92
When patients take opioid analgesics, the nurse’s first priority is to monitor which of the following?
1. Bowel elimination
2. Hydration
3. Respiratory status
4. Urinary elimination
3
93
You witness a serious auto accident in which a driver slammed into the steering wheel. While waiting for emergency medical services (EMS) to arrive, the driver develops respiratory distress. You observe that a part of the rib cage moves inward with inspiration and outward with expiration. Which of the following describes this pattern?
1. Paradoxical movement
2. Tension pneumothorax
3. Compensatory breathing
4. Cheyne-Stokes respirations
1.
94
Measures to prevent PE (pulmonary embolism) in postoperative patients include which of the following? (Select all that apply.)
1. Apply compression stockings as ordered.
2. Assist with range-of-motion exercises.
3. Enforce bed rest until wound healing is complete.
4. Support the legs with pillows to promote circulation.
5. Encourage ambulation as soon as permitted.
1,2,5
95
what are INR and PTT
- both are tests to see how fast blood clots
- higher the number slower the clotting, lower the number greater chance of clot formation
INR= 0.8-1.2
PTT= 25-35
96
class I of a clean surgical wound
clean
no trauma
no break in sterile field
clean wound
ex knee replacement
97
class II of contaminated surgical wound
clean-contaminated
non-traumatic wound with break in sterile field
enters GI/GU/resp
like: EENT surgeries, GI surgery with no leakage
98
class III of contaminated surgical wound
contaminated
major break in sterile field
spill from GI track
like bowel perforation
99
class IV of contaminated surgical wound
dirty- infected
wound is alr dirty before surgery
fecal contamination
foreign body
like pus, abscess from rupture or infected wound
100
Preoperative medications typically include: (Select all that apply.)
1. Sedative-hypnotic agent
2. Opioid analgesic
3. Antiemetic agent
4. Anticholinergic drug
5. Nonsteroidal antiinflammatory drug
1,2,3,4,
101
INP 400
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