Procedures

Question 1

Laminectomy

Answer 1

• Removal of vertebral spinous processes
• Indications
  
  • To treat nerve root compression
    
    • S/S (3 Ps)
      
      • Pain
      • Paresthesia (numbness/tingling)
      • Paresis (muscle weakness)

Question 2

Laminectomy Locations

Answer 2

• Locations
  
  • Cervical (neck)
    
    • Pre-op assessment
      
      • Breathing (primary), movement of upper extremities
  • Thoracic (upper back)
    
    • Pre-op assessment
      
      • Cough (tests abdominal muscles) and bowel sounds
  • Lumbar (lower back)
    
    • Pre-op assessment
      
      • Urine output and legs

Question 3

Laminectomy Post-op

Answer 3

• # 1 post-op answer
  • → always log roll your patient
• Activity
  
  • Do not dangle/sit on side of the bed
  • Allowed to walk, stand and lie down without restrictions
  • Limit sitting 20-30 min at a time
• Complications
  
  • Cervical
    
    • Watch for pneumonia
  • Thoracic
    
    • Watch for pneumonia and paralytic ileus
  • Lumbar
    
    • Watch for urinary retention
• Laminectomy w/fusion
  
  • bone graft from the illiac crest (hip)
  • Of two sites, which has the most:
    
    • Pain? - hip
    • Bleeding/Drainage? - hip
    • Risk for infection? - hip/spine
    • Risk for rejection? - spine

Question 4

Laminectomy Restrictions

Answer 4

• Restrictions (6 weeks)
  
  • Don’t sit for longer than 30 minutes
  • Lie flat and log roll for 6 weeks
  • Lifting restrictions - no more than 5 lbs
  • No driving
• Restrictions (permanent)
  
  • Can never lift by bending at the waist (use knees)
  • Cervical can never lift objects above their heads
  • No horseback riding, off-trail biking, jerky rides

Question 5

Cytoscopy

Answer 5

• Visualization of the urethra and bladder
• Pre-op
  
  • encourage fluids
  • Given valium and demerol pre-procedure
• Post-op
  
  • encourage fluids
  • expected findings (just document
    
    • Bladder spasm
    • Burning
    • urinary frequency
    • pink-tinged urine
  • Fall in BP and tachycardia sign of hemorrhage

Question 6

EEG

Answer 6

• Wash hair before probes are attached
• Wash hair after
• At least 4-5 hours of sleep the night before
  
  • → can be sleep deprivation eeg
• NPO not necessary
• Try not to move during the procedure
• Eliminate caffeine for 24 hours before test

Question 7

EGD

Answer 7

• Way to visualize esophagus, stomach and duodenum
• Other purposes
  
  • Remove polyps
  • Take specimens
  • Coagulate bleeding vessels
• Can not be done on an uncooperative client
• Can be sedated with valium
• NPO after midnight
  
  • can eat when gag reflex returns (xylocaine given)
• Complications
  
  • Perforation of gut
  • Aspiration secondary to emesis
  • Respiratory arrest (valium)

Question 8

Dialysis

Answer 8

• Dialysis
  
  • Renal failure 3x/week
    
    • 4-6 hours per session
• Hemodialysis
  
  • Disequilibrium syndrome
    
    • when fluid is exchanged too quickly
    • Change in LOC
    • NV
    • HA
    • Twitching
• AV Shunt
  
  • can only be used for a few weeks