Study Guide 1

Question 1

Common causes of pre-operative anxiety & your interventions:

Answer 1

Lack of knowledge - provide information about what to expect, inform the surgeon if more information needed or anxiety is excessive

religious/spiritual conflict - communicate with pt

Question 2

Interventions for common fears:

1. Death
2. Pain & Discomfort
3. Mutation / Body alteration
4. Disruption of life functioning
5. Anesthesia

Answer 2

1. Death- Notify HCP for strong fear of death, they may delay the surgery
2. Pain & Discomfort - notify ACP & surgeon if fear is extreme, teach to ask for analgesics before pain comes severe + pain intensity scale
3. Mutation / Body alteration - listen and asses with an accepting attitude
4. Disruption of life functioning - consult with pt, caregiver, social worker, spiritual advisor etc
5. Anesthesia - infirm ACP immediately to talk the pt

Question 3

Nurses Assessment of the pre operative Patient

Answer 3

1. Baseline Data
2. Determine psychological status
3. Determine physiological factors directly related or indirectly related to surgery
4. Participate in marking of the surgical site
5. Review all pre operative diagnostic test SHARE THIS INFO WITH HCP
6. Determine religious / ethical factors
7. Determine if pt received enough info from surgeon for informed consent and witnessed

Question 4

What is the goal of the pre operative assesment

Answer 4

Identify risk factors that can cause intraoperative and postoperative complications

Question 5

Nurse pre operative intervention: MEDICATIONS

Answer 5

All pt drugs are identified, implemented, any changes in the medication plan, and monitor pt for potential interactions and complications

Ensure pt discontinued all herbs 2-3 prior to surgery and tell HCP about any pt herbs.

Document all medications and current use. Ask about recreational drug use stressing that it effects the type of anesthesia needed.

Question 6

What is the nurses job regarding a pre-operative pt’s valuables

Answer 6

Return all pt valuables to a caregiver or secure according to agency policy.

Electrocautery surgery = jewelry and piercing removed

Hearing aids= left in place for pt to follow instructions
Glasses= removed and returned ASAP post op

Question 7

What can’t the unlicensed worker do?

Answer 7

Asses, admin, explain or teach. They can monitor and alert the nurse of changes.

Question 8

Who determines an appropriate schedule and dose of the patients drug routine before and after surgery

Answer 8

The ACP this is why it’s important to communicate with the entire surgical team about pt meds

Question 9

Explain: Scrub Nurse v.s Circulating Nurse

Answer 9

SN:

• follow surgical hand antisepsis procedure
• gowned and gloved in sterile attire
• remain in the sterile field

CN:

• remains in the unsterile field
• no sterile attire

BOTH: May be licensed practical/vocational nurse or a surgical technologist. If the circulating nurse is not an RN an RN MUST BE ACCESSIBLE AT ALL TIMES

Question 10

Every time a pt is transferred to another professional what needs to be handed off?

Answer 10

Use SBAR format for clear consistent communication

Question 11

Surgeons responsibilities for the pre operative pt

Answer 11

• pre op medical history and physical assessment (surgical interventions, choice of surgical procedure, pre operative testing and discussing risk and alternatives to surgery)
• patient safety and management in the OR
• post op management of the pt

Question 12

Who is the surgeons assistant and what are they responsible for ?

Answer 12

Can be a physician or under direct supervision of the surgeon a RN first assistant or physicians assistant.

• may preform some aspect of surgery under direct surgeon supervision
• usually holds retractors and assist with stitching

Question 13

Duties of the Anesthesia Care Provider (ACP)

Answer 13

• medically manage pt who’s unconscious or insensible to pain and emotional stress during surgical and medical procedure
• protect functions and vital organs
• manage pain, cardiopulmonary resuscitation, pulmonary problems and critically ill pt in special care units

Question 14

Responsibilities of a Nurse Anesthetist?

Answer 14

• pre anesthetic assessment
• develop and implement a plan for deserving anesthesia
• selecting and staring a plan for anesthesia delivery
• selecting and starting planned anesthetic technique
• select, obtain, and administer anesthesia, adjunct drugs and fluids
• manage airway and pulmonary status, emergence and recovery from anesthesia
• select, apply, insert noninvasive and invasive monitoring devices
• release/discharge from PACU
• order, start, modify pain relief
• ## respond to emergency situations

Question 15

Routes for general anesthesia

Answer 15

IV and Inhalation

Question 16

Nursing Interventions: After a neuromuscular blocking agent is used.

Answer 16

• if intubated: monitor return of muscle strength, level of consciousness and ventilation
• maintain airway: monitor rate and rhythm of respiration until pt is able to cough and muscle strength returns
• non depolarizing reversal agent and emergency respiratory support equipment available
• monitor temp and muscle strength levels in correlation with temp

Question 17

Temperature after surgery:

1) up to 12 hours
2) first 48 hours
3) after first 48 hours (day 3 and later)

Answer 17

1) HYPOTHERMIA: 96.8
(b/c anesthesia effects and body heat loss during surgery)

2) Mild Elevation: 100.4
(inflammatory response to surgical stress)

3) Elevation: 100
(Infection)

Question 18

Your patient has just come from surgery. When monitoring cardiovascular what abnormal findings would cause you to call the ACP or surgeon?

Answer 18

• Systolic = under 90 or over 160
• pulse is less than 60 or greater than 120
• pulse pressure narrows
• BP decreAses or increases over several consecutive readings
• Changes in heart rhythm

Question 19

Post op you pt is hypotension accompanied by normal pulse and warm, dry, pink skin. What should you do?

Answer 19

Continue observation. This is a sign or residual vasodilation effects of anesthesia.

Question 20

Your post op patient is hypotension followed by rapid, weak pulse and their skin is cold, clammy and pale. What should you do?

Answer 20

This indicates impending hypovolemic shock. Treatment is needed immediately.

Question 21

What herbs can increase bleeding?

Answer 21

Garlic
Vitamin E
Ginkgo
Fish oils

Question 22

Name the normal lab values as well as hypo/hyper values:

1. Potassium

Answer 22

1. Potassium: 3.5-5, hypo -3.5, hyper +5
2. Calcium: 8.6-10.2, hypo -8.6, hyper 10.2
3. Phosphate 2.4-4.4
4. Magnesium: 1.5-2.5

Question 23

Hyperkalemia:

1. Manifestations
2. Nursing interventions

Answer 23

1. Tired, irritable, muscle weakness/tone loss, cramps, paresthesia, decreased weakness, ab cramps, diarrhea, vomiting, confusion, irregular pulse and tetany.
2. Eliminate oral and parental potassium intake
   - increase elimination of potassium KAYEXALATE removes 1 mEq of k / gram
   - insulin & beta adrenergic agonist removes potassium from ECF to ICF
   - stabilize cardiac membranes with IV calcium chloride or CALCIUM GLUCONATE

Question 24

When potassium levels are mild and kidneys are function it may be helpful to: (prevent hyperkalemia)

Answer 24

• withhold all potassium

- Administer fluids and loop or thiazide diuretics

Question 25

Causes for hypokalemia

Answer 25

Abnormal losses from either the kidney or GI tract. Rarely a nutritional issue.

Question 26

Hypokalemia: 1. Manifestations 2. Nursing Interventions

Answer 26

1. Soft flabby muscles, leg cramps, paralytic ileus, shallow respiration, weak irregular pulse, constipation, hyperglycemia. +fatigue, muscle weakness, paresthesia, decreased reflexes, 2. Oral or IV potassium chloride usually only given if the urine output is at least 0.5mL/kg - never give push or undiluted b/c bolus - invert bag several times to ensure even distribution in the bag - do not add to pre-existing IV bags to prevent bolus

Question 27

Nursing diagnosis for Hypo/Hyperkalemia and Hypercalcemia What complication do they also share.

Answer 27

Risk for: 1) electrolyte imbalance Hypokalemia: r/t else's potassium loss Hyperkalemia: r/t excessive retention or cellular release of potassium Hypercalcemia: r/t excessive bone destruction 2) activity intolerance Kalemia: related to muscle weakness Hypercalcemia: r/t generalized muscle weakness 3) injury Hyperkalemia: muscle weakness Hypokalemia: " and hyporflexia Hypercalcemia: neuromuscular and sensorium changes Potential complications: dysrhythmias

Question 28

Hypercalcemia: 1. Manifestations 2. Nursing interventions

Answer 28

1. Lethargy, weakness, fatigue, decreased memory and reflexes, increased b/p, confusion, psychosis, anorexia, nausea, vomiting, bone pain, fractures, polyuria, dehydration, nephrolithiasis, seizure and coma 2. Have pt drink 3000 to 4000 mL of liquid to promote renal excretion of Ca. Administer saline, a biphosphonate (when caused by malignancy) and calcitonin.

Question 29

Hypocalcemia: 1. Manifestations 2. Nursing interventions 3. Nursing diagnosis

Answer 29

1. Weak, fatigue, depression, irritability, confusion, hyperflexia, muscle cramps, decreased BP, numb and tingling extremities and around mouth, chvotsek sign, trousseau sign, laryngeal and bronchial spasms, tetany and seizures 2. Main goal = rx underlying cause - IV calcium gluconate 3. Risk of: electrolyte imbalance (decreased PTH level), injury (tetany and seizures) - Ineffective breathing pattern (r/t laryngospasms) - Acute pain (sustained muscle contractions) - potential complications: fracture, r arrest

Question 30

Hyperphosphatemia & Hypophosphotemia: | Lab values and clinical manifestations d

Answer 30

Values: hyper +4.4, hypo -2.4 Hyper manifestations: - *a symptomatic unless calcium binds with phosphate Hypocalcemia Numb & tingling around mouth and extremities Hyperflexia and *muscle cramps *Tetany, *parsenthesias, *seizures calcium-phosphate percipatates in skin, soft tissue, cornea viscera, blood vessels Hypo manifestations: CNS depression Muscle weakness: respiratory muscle weakness Polyneuropathy, seizures Cardiac problems (Dysrithmias, heart failure) Osteomalacia, rickets - Rhabnomylysis

Question 31

Nursing interventions: 1) hyperphosphatemia 2) Hypophosphotemia

Answer 31

1) tread underlying cause, restrict intake of high phosphorus foods and fluids (dairy products), phosphate-binding agents, hemodialysis for severe 2) mild = increase food rich food in phosphorus or phosphate supplements symptomatic = IV sodium phosphate or potassium phosphate

Question 32

Hypermagnesemia: 1. Manifestations 2. Nursing interventions

Answer 32

1. Manifestations: deep tendon reflexes are lost followed by muscle paralysis and coma. Respiratory and cardiac arrest can occur. 2) symptomatic - IV ca gluconate - avoid magnesium containing drugs and limit diet intake (green vegetables, nuts, bananas,oranges, BP,chocolate) - with normal renal function: increase fluids and diuretics - impaired renal function = dialysis

Question 33

HYPOMAGNESEMIA 1) manifestations 2) nursing intervention

Answer 33

1) cardiac dysrhythmias

Question 34

``` Normal ABG: PH PaCo2 Hco3 / bicarbonate: PaO2 SaO2 Base excess ```

Answer 34

``` 7.35-.45 35-45 22-26 80-100 95+ +/- 2 ```

Question 35

Acid-base imbalances | Respiratory and Metabolic

Answer 35

R: Alkalosis - high ph low paco2 Acidosis - opposite M: Alkalosis - high ph high paco2 Acidosis - opposite Hco3 low or matches ph = m. Acidosis is primarily problem

Question 36

Hyper hypo magnesium manifestations and interventionis

Answer 36

Hyper: lethargy, drowsy, weak muscle, Urinary retention,n/v, deminished deep tendon reflexes, flush warm skin (especially face), decreased pulse & b/p Hypo: confusion Muscle cramps, tremors seizure, vertigo, hyperactive tendon reflexes, chovstek abd trouusseaus sign, increased p and no