HA Exam 4

Reconstruction

Rebuild tissue Skin graft

What measures do you think would be implemented to stop the complication of shock?

Stop bleeding, apply pressure, replenishing blood volume, notify surgeon, IV line with isotonic fluids, provide support, take pt to ICU if not already there.

Normal urine output/hr

30 mL/hr

Phosphorus

2.5 - 4.5

Number of bones in the body

206

Contracture

- An abnormal flexion and fixation of a joint caused by muscle atrophy and shortening - Contracture of the joint above the amputation is a common complication

Hemovac Drain

- a closed drainage system in which a soft drain is attached to a springlike suction device

Penrose Drain

- a flat, thin, rubber tube inserted into a wound to allow for fluid to flow from the wound; it has an open end that drains onto a dressing

Documentation Intra-op

Sponge/needle counts, medication administration, RN is also runner, getting supplies, medication, looking at drains, RN responsible for specimen collection

Muscle Grade

0 - No muscle contraction 1 - Can feel contraction of muscle but there is no movement of limb 2 - Passive ROM 3 - Full ROM against gravity 4 - Full ROM against some resistance 5 - Full ROM against full resistance

Calcium

4.5 - 5.5 mEq/L

Alkaline Phosphatase (ALP)

42 - 136 U/L Slight increase with age To assist in the diagnosis of liver and bone disease

Which client muscle strength assessment data is consistent with a score of 3 on the muscle-strength scale?

Active movement against gravity but not against resistance

Infection risk: Post-op

Administer antibiotics as ordered, dressing changes as needed, coughing and deep breathing (prevent complications such as pneumonia and atelectasis)

Ketorolac

Caution in pts >65

Time period when bleeding risk is increased r/t anticoagulants (coumadin/NSAIDS/heparin) May need blood consent before surgery

Intra-op, and post-op

An older adult male client asks about the risks of having osteoporosis. Which response would the nurse make?

You might consider having a bone density test Rationale: Osteoporosis is not restricted to females; it is a potential major health problem of all older adults. A bone mineral density measurement assess the mass of bone per unit volume of how tightly the bone is packed. Exercise may decrease the occurrence of, but will not prevent, osteoporosis; a regimen including wt bearing exercises is advised. A small frame is at risk of osteoporosis.

JP Drain

abbreviation for Jackson-Pratt drain; - suction drain with tubing inside the body and a bulb reservoir which, when squeezed empty, applies suction and pulls fluid out of the body; used in thoracic or abdominal surgery - Empyt bulb at least 3x/day and more as needed - Milk tube 2x/day, then empty

They're going to move the device, then the ______ extremity first, followed by the ______ extremity.

affected/strong

outpatient surgery

operative procedures performed on clients who return home the same day, performed on patients of optimal health and who's recovery is expected to be uneventful Ex: laparoscopic, used for diagnosis, biopsies, cataracts

Diagnostic

Used to determine or confirm diagnosis Biopsy

Skeletal x-ray

Used to identify the structure and density of bone

Skeletal X-ray

Used to identify the structure and density of bones.

Bone Density (Dexa)

Used to look at bone density and overall strength of bone specifically with osteoporosis

Bone density or DEXA scan

Used to look at bone density, the overall strength of the bone. This is done in patients that have osteoporosis

Treatment: Gout

Used to terminate acute attacks and reduce uric acid levels. Medications: NSAIDs, colchicine, corticosteroids Prophylactic: Allopurinol (helps keep serum levels under control. Comp/alternative: Vit E, amino acids, acupuncture, diet (dark berries)

RF (rheumatoid factor)

>1:80 titer To primarily assist in diagnosing rheumatoid arthritis

The nurse is caring for a variety of clients. In which client is it most essential for the nurse to implement measure to prevent pulmonary embolism?

A 59-year-old who had a knee replacement Rationale: Clients who have had a joint replacement have decreased mobility; they are at risk for developing thrombophlebitis, which may lead to pulmonary embolism if the clot becomes dislodged into the circulation. A history of thrombocytopenia leads to a decreased ability to clot, so it increases the risk of bleeding but decreases the risk of a thrombus or embolus.

Why assess for herbs/vitamins/OTC/illegal substances?

May cause complications intra-op or post-op, may interfere or react with anesthesia or pt may have a tolerance built up d/t drug use.

Treatment: Rheumatoid Arthritis

Medications: NSAIDs (aspirin, ibuprofen, naproxen, meloxicam, oral corticosteroids (teach pt.'s s/s of infection), DMARDS: disease modifying antiviral drugs that slow and prevent the progression; Methotrexate and Humira Nonpharmacological: Rest and exercise (balanced program), PT, OT, regular rest periods, strength training, low impact exercises, moist heat and cold, baths for stiffness/aches, assistive devices/splints, encourage well-balanced diet, surgery for replacement

Treatment: Osteoarthritis

Medications: NSAIDs, acetaminophen, corticosteroid injections and opioids ROM, used heat and ice, balance between exercise and rest, assistive devices (teach how to use devices), dietary program (how to lose wt. what they need to eat), rehab/therapy/surgery, joint replacement, joint arthroplasty

Treatment: Osteoporosis

Medications: Used to preserve bone mass and increase overall bone density. (Bisphosphonates-current drug choice for prevention and treatment) Alendronate, zoledronic acid. Diet: Increase Vit D and calcium (fish, fresh milk, milk products, dark vegetables OJ) -Encourage exercise and make lifestyle changes.

Dantrolene

Muscle relaxer used to treat malignant hyperthermia

Emergency Surgery

Must be done immediately to preserve life, a body part, or function

RN

Must complete primary and initial education, the primary assessment, the plan of care and the transfer of care.

Lyme Disease

An inflammatory disease transmitted by a tick, characterized by a bullseye lesion. The body is infected at the site of the tick bite- 30 days migration period. Manifestations: Can mimic rheumatoid arthritis, flu like symptoms, rash, chills, fatigue Complications: Chronic recurrent arthritic and neurological issues

Post-op complications

N/V, uncontrolled pain, shock, hemorrhage, delayed wound healing, DVT, PE, PNA, atelectasis, urinary retention, altered bowel habits

Informed consent

Need for procedure, explain purpose, outcome, risks, benefits, likelihood of successful outcome, alternative treatments, right to refuse treatment or withdrawal consent

Anticholinergics: Atropine Sulfate, Glycopyrrolate, Scopolamine + PPIs

Reduces oral and respiratory secretions to decrease risk of aspiration, decreases vomiting and laryngospasm. Monitor for confusion, restlessness and tachycardia, prep pt to expect a dry mouth

INR + PT

Assessing clotting times -associated with coumadin (Warfarin) therapy

UAP

Assist with tasks and take vitals

Treatment: Joint Trauma

Reduction of the joint. May need surgery, RICE. Our priority is to rehab them, treat their pain, have them use appropriate use of that injured area.

Discharge

Need to be tolerating food/liquids, need to be within 10% of perioperative vitals, pain is controlled, able to stand/walk, voided, clear mental function, family/support person/guardian understands instructions, ensure bowel sounds are present, and teach back method.

Fibromyalgia

Autoimmune and endocrine system disorder: chronic syndrome characterized by pain stiffness and tenderness. It is a complex syndrome involving the central nervous system Manifestations: Onset of chronic achy pain, H&P and presentation of symptoms Treatment: Aerobic exercises, stretching, daily rest is key Medications: Tricyclic antidepressants, SSRI, Cymbalta, Lyrica, Tramadol for pain (This can often be debilitating for pts)

Post Joint replacement

CPM, passive ROM (post knee-maintain ROM), SCDs (sequential compression devices), assistive devices: handrails, shower chair, shoehorn, tongs, grippers, walker, cane.

Most surgical pts are required to refrain from eating meals or drinking milk for _____ hours before surgery and drinking clear liquids for ____ hours before surgery.

6/2

CPK

94% - 100%

Fractures

A break in the continuity of the bone. You can have an open versus closed. Open: skin is open Closed: skin intact Manifestations: You'll see a deformity, pain, swelling, numbness, guarding spasms, any complications such as compartment syndrome.

Shock

A life-threatening condition: Altered level of consciousness, restlessness, tachycardia, tachypnea, hypotension, pulses thready

Outpatient disadvantages

A lot of information in a short amount of time, if something goes wrong, the pt. may be transferred to the hospital.

Gout

A metabolic disorder: an inflammatory arthritis triggered by the crystallization of urate within the joint, caused from too much uric acid in the body. High levels of uric acid in the blood and deposits of the uric acid crystals in the joints. Manifestations: Acute = Joints of the great toe, ankle, knee and wrist. Painful, they're going to be red, hot, swollen and tender, have fever, chills, elevated WBC and sedimentation rate. Advanced = Tophi (urate deposits in the tissues), joint stiffness, limited ROM.

Universal Protocol

A procedure in which the surgical team affirms the identity of the patient, correct procedure, and location (side), marks the procedure site, perform a timeout, verification of informed consent, and other documents necessary to proceed with the surgery.

Bone Scan

A radioisotope medication is injected and uptake is increased within the bone tissue, if osteomyelitis, osteoporosis or bone cancer are present.

CT/MRI

A three-dimensional picture of the bone. It can show trauma, abnormalities, look for tumors, cysts, herniated discs. It's a more in-depth picture. Assess for allergies and if the pt has any metal implants

Which action would help prevent venous thrombosis in a client during the perioperative period

Administer SQ heparin injections Assist the client to don antiembolism stockings Apply pneumatic compression devices to the legs Rationale: Actions that prevent post-op venous thrombosis include administration of anticoagulant meds such as Heparin, use of anti-embolism stockings and use of pneumatic compression devices. Thrombolytic medications dissolve clots rather than prevent them and are typically not used for venous thrombosis because of the high bleeding risk associated with their use. Bed rest leads to venous stasis of blood and increases venous thrombosis risk.

LPNS

Administer medication, reinforce education

Pre-Op Assessment

Age, medications/substances (herbs, OTC, vitamins), medical hx, cardiac hx, pulmonary hx, hx of previous surgeries/anesthesia experiences, anticoagulants, blood type/crossmatch + blood consent, risk factors, delayed wound healing hx, hx of post-op N/V, vitals for baseline data, Labs, and ensure pt has received adequate info from surgeon to make informed decision and if consent is signed and witnessed, chest x-ray of heart and lungs to establish baseline.

Palliative

Alleviating symptoms without curing the underlying cause Cancer pts- ex: bowel resection

Opioids: Morphine, Fentanyl, Hydrocodone, Oxycodone, Tramadol

Allows for pain control, decreases anxiety and allows for reduced anesthesia dose. Monitor for respiratory depression, safety ambulating

Treatment: Lyme disease

Antibiotic therapy, NSAIDs for pain, effective joints need supportive care

Pre-op Medications

Antibiotics, benzodiazepines, opioids, antacids, antiemetic, anticholinergics

How will you treat uncontrolled pain and nausea?

Antiemetic (Ondansetron) NSAIDs, deep breath, peppermint oil, cool cloth to head NPO pre=op can prevent N/V

Prophylactic: Post joint replacement

Aspirin, NSAIDs, enoxaparin SQ (Lovenox), and heparin SQ

Nausea and uncontrolled pain

Assess by asking the pt (subjective data) Pain scale, stick to one scale, do not switch d/t convenience

PT/PTT/INR

Assess for bleeding if decreased. Monitor for thrombus or embolism.

Which nursing intervention is correct for a client in skeletal traction?

Assess the pin sites at least every shift and as needed Rationale: Nursing care for a client in skeletal traction may include assessing pin sites every shift and as needed. The needed wt. for a client in skeletal traction is prescribed by the PCP, not as desired by the client. The nurse also would ensure that the knots are not tied to the pulley and move freely. The performance of ROM is indicated for all joints except the one proximal and distal to the fracture because this area is immobilized by the skeletal traction to promote healing and prevent further injury and pain.

Postoperative Care

Assess vitals (w/in 10% of pre-op baseline), neurovascular checks, CMS (circulation/motion/sensation), pedal pulses, incision site, I&O, drain management, PT, OT, incentive spirometer, SCDs to help prevent DVT, CPM (continuous passive motion), rehab, safety instructions, device use/instructions

What if the dressing is saturated, leaking through?

Assess, look at the drainage, reinforce, document findings

Repetitive use injury

Carpal tunnel: The canal through which the flexor tendons and medial nerve passes from the wrist to the hand. It occurs when the canal is narrowed and you have an irritation of the nerve.

Foot disorders

Cause pain and difficulty walking Manifestations: Deformity, pain, inflammation, mortens neuroma, pain/burning in nature Ex: Bunions, hammertoe, morton's neuroma, plantar fasciitis Treatment: Focused on pain relief, appropriate footwear, and pt education.

Systemic Lupus Erythematosus

Chronic and progressive autoimmune disorder that affects all body systems. Cells and tissue damage is caused by antibody deposits in connective tissue. Manifestations: Painful, swollen joints, muscle pain, unexplained fever, red butterfly rash on the face, sensitivity to sun light(UV rays), enlarged lymph nodes Diagnosis: Antibody test, sedimentation rate will be elevated

Rheumatoid Arthritis

Chronic, systemic autoimmune disorder: inflammation of connective tissue in the joints. Manifestations: Inflammation, fatigue, non-specific joint aches and stiffness, and characterized by remissions and exacerbations. Diagnosis: Elevated c-reactive proteins, elevated sedimentation rate (both d/t inflammation), x-ray, synovial fluid analysis (arthrocentesis)

What are some priorities with drain management?

Cleansing around the drain with prescribed solution, normal saline

What is a normal diet advancement after surgery?

Clear liquids -> full liquids -> regular diet

How do we compare dressing from shift to shift?

Color, amount, odor, look at previous shifts documentation

Complications: Fractures

Compartment syndrome, Infection, DVT and delayed bone healing

Dishiscence

Complete separation of wound edges = Assess, cover w/dry sterile gauze and call HCP

ESR (Sedimentation Rate)

Confirmation of inflammation anywhere in the body: >22mm/hr

The nurse finds a client on the floor, crying for help, with signs of a hip fracture. Which action would the nurse take first?

Immobilize the affected extremity Rationale: The nurse would immobilize the affected extremity first. Further damage and internal bleeding could occur if the extremity is not immobilized. Clients do experience pain with a hip fracture and will require pain medication; however, the emergency management for a fractured him is to immobilize the extremity. The nurse will need to notify the PCP, but the priority is to immobilize the extremity.

Cardiac hx

Increased risk of stroke, hemorrhage, hypotension, venous thrombus, or pulmonary emboli. Pre-op meds given to keep cardiac function at baseline if there is a hx of cardiac disorders.

Antacids: Sodium Citrate

Increases pH and reduces volume/secretion of gastric fluid in pts. with GERD and or trauma (given pre-op)

C-Reactive Protein

Indicates a nonspecific inflammatory response

Changes with aging

Decreased bone density, increased bone prominence, kyphotic posture, cartilage degeneration, decreased ROM, muscle atrophy, slowed movement

Outpatient advantages

Decreased psychological stress Decreased exposure to nosocomial infections Economic benefit Less separation anxiety, especially for kids Reduced time loss from work

Benzodiazepines: Diazepam, Lorazepam, Midazolam

Decreases anxiety, produces sedation and amnesia affect. Monitor for respiratory depression, hypotension, drowsiness and lack of coordination.

Osteoarthritis

Degenerative joint disease leading to the cause of pain and disability in older adults, characterized by progressive loss of joints, cartilage, joint inflammation, stiffness, and loss of joint motion. Manifestations: Gradual and slow progression, joint pain and stiffness, deep ache. Pain will be associated with the use of the joint and it is relieved by rest. Diagnosis: H&P, x-rays and MRI

Surgical complications

Dehiscence, evisceration, thromboembolism, hypothermia, surgical site infection, adverse cardiac events, malignant hypothermia, hemorrhage, shock, DVT, pneumonia, pulmonary embolism, atelectasis, decreased bowel sounds, urinary retention, N/V.

Which initial action would the nurse take when obtaining consent for surgery?

Determine whether the client's knowledge level is sufficient to give consent Rationale: Informed consent means that the client must comprehend the surgery, the alternatives, and the consequences. Describing the risks involved in the surgery is not within nursing's domain. Although obtaining a signature is routine, explaining that obtaining the signature is routine for any surgery does not determine the client's ability to give informed consent. Although witnessing the client's signature will be done, the nurse first would assess the client's knowledge of the surgery.

Diagnostic assessments

EKG/ECG, chest x-ray

Antiemetics: Ondansetron, Metoclopramide

Enhances gastric emptying and affects the vomiting center in the brain. Prevents N/V post-op and is given pre-op.

Nursing Care: Post-op

Focus: airway, vitals, mental status, emotional support, pain control, assessing for malignant hypothermia Once transferred to recovery, monitor general appearances, vitals, full head to toe assessment, LOC, pain, N/V, dressing, incision, fluids, diet, drains

Intra-op Care

Focus: take place OR to recovery room, environmental safety, pt. positioning, pt. support, evaluating pt. outcomes Universal protocol timeout occurs

Intraoperative Medications

General anesthesia: IV or inhalation, produces central nervous system depression and amnesia affect Pro: Rapidly excreted and quick reversal Con: Circulatory/respiratory/renal side effects = N/V, hypothermia, groggy feeling

Malignant hyperthermia

Genetic disorder triggered by anesthesia medications that cause hyper metabolism within the body raising the body temp up to 109 degrees. Manifestations: Tachycardia, tachypnea, muscle stiffness, escalating temperature. Treatment: Administer 02, IV fluids, meds, cooling interventions Medication: Dantrolene

Antibiotic: Cefazolin

Given to prevent surgical site infections, and reduce overall mortality - orthopedic and general surgeries. Assess for allergies

Osteoarthritis

Goal: Moderation Risk Factors Modifiable: Repetitive joint use, too much or too little exercise, excessive wt., inactivity Non-modifiable: Age, genetics, previous joint damage

Uric Acid

Gout Critical = > 12 mg/dL

Diagnosis: Gout

H&P, presentation of symptoms, and uric acid level: >8.5 mg/dL

Assess pre-op

H+P, physical 1 month prior to surgery, assessment 1 hr before surgery to get okay from surgeon that it is safe to proceed

pt preperation

Hair removal, positioning, skin prep, urinary cath depending on surgery

Which nursing action would be contraindicated for a client with a newly applied long leg plaster cast?

Handling the cast with fingertips Rationale: Handling the cast with fingertips before it is dried may create indentations that can cause pressure. Elevating the casted extremity on a pillow will help reduce edema. Drying the cast with a fan and leaving the cast exposed to air will increase air flow that facilitates drying of the cast.

Scleroderma

Hardening of the skin. A chronic issue characterized by deposits of excess collagen in the skin and organs. Manifestations: Shiny taunt and hyper pigmented skin

Labs

INR, PT, PTT, electrolytes (K+, Cl-, Na+), U/A, CBC (determine underlying infections), baseline H&H, WBCs, type/cross match with blood consent, pregnancy test (general anesthesia may be altered, elective surg will be canceled)

Platelet count

If decreased, assess for bleeding at incision site, drainage tubes and for hematomas.

A1c

If decreased, monitor for hypoglycemia, notify surgeon if glucose is out of parameters

After a total knee replacement, a client will be using a continuous passive motion device. Which effective therapy goal identified by the client would indicate to the nurse that teaching was effective?

Improve joint flexion Rationale: A continuous passive motion device is used most commonly after knee replacement to gradually increase knee flexion without wt. bearing or strain. Because it provides passive ROM, muscle tone is not affected. A continuous passive motion device is not used to prevent tissue breakdown. Because muscles are not contracting, venous stasis is not prevented.

Ambulatory surgery

Includes outpatient, same-day, or short-stay surgery that does not require an overnight hospital stay

Warning signs of SLE flare

Increased fatigue, pain, more pain, rash, headache, fever and dizziness

Compartment syndrome

Increased pressure within the compound, confined space, and it constricts structures within. This is why we educate people when they have casts to check for numbness and tingling, and if the extremity is cool.

Pulmonary hx

Increased risk of developing pneumonia or atelectasis. Monitor and assess I&O, vitals and report hypoxia. Maintain airway, and monitor for respiratory depression. Have pt cough and deep breath, incentive spirometer, early ambulation post-op

A newly hired nurse is delegated the task of developing a care plan for a diabetic client who just returned from surgery after undergoing amputation of the leg. Which task in the care plan is inappropriate according to guidelines?

Instructing the licensed practical nurse to monitor vital signs Rationale: The LPN's scope of practice includes monitoring vitals signs in clients with a stable condition. Instructing the LPN to monitor the vital signs of a client in an acute condition is inappropriate according to the guidelines. Administering antidiabetic medication to a diabetic client who underwent amputation would be done by the RN because the condition of the client is acute. The RN is responsible for assessing the blood glucose levels of the clients who underwent amputation. The LPN is instructed to change the dressing at the amputation site.

Purpose of surgery

Invasive procedure to treat/diagnose/repair/ alternate feature/ restore function

Insulin

Is generally withheld when the pt is NPO, but depending on the anticipated length of the surgery, the dose may be adjusted for the previous evening as well as the morning of surgery. Under anesthesia, manifestations of hypoglycemia are absent, so withholding the morning of surgery when the pt is NPO is advisable.

Which assessment finding would the nurse consider abnormal

Joint crepitation Muscular atrophy Tenderness of the spine

Preoperative Care

Knowledge assessment (know why they're having it), ROM, restrictions, teach respiratory hygiene, coughing deep breathing and spirometer, pain control, skin prep (chlorhexidine wash), antibiotics

Blood tests

Looking at the calcium, uric acid, alkaline phosphatase (ALP), rheumatoid factor.

180 mg/dL

Maintain a blood glucose ________ throughout the perioperative period, for better healing, fewer infections and shorter hospital stays.

Positioning: Post joint replacement

Maintain prescribed position using splints, immobilizer, or abduction pillow. Wt. bearing restrictions (know their activity), flexion restrictions, toilet risers, device use teachings, CPM, ROM.

Carpal Tunnel

Manifestations: Nighttime pain, numbness and tingling of the thumb and index finger. Diagnosis: Done through the H&P and presentation of manifestations. Treatment: Surgery, hand therapy (PT), pain control and corticosteroids

Conscious sedation

Moderate sedation; amnesia affect Pts maintain own airway and can follow commands -need to have a reversal agent on hand

Risk Factors of Osteoporosis

Modifiable: Low estrogen or testosterone levels, dietary deficiency (Vit D or Calcium), use of corticosteroids, inactivity, smoking and alcohol use. Non-Modifiable: Age, family hx, female, thin small frame

H&H

Monitor O2, vitals and assess for bleeding. Increased = dehydration, excessive plasma loss, polycythemia Decreased = fluid overload, excessive blood loss, anemia

WBC

Monitor for inflammation, drainage, temp and pulse. Use strict standard precautions. May signify infection if increased

Carbon dioxide

Monitor respiratory status and ABDs

Sodium and chloride

Monitor serum levels, I&O, assess for peripheral edema, and effects of perioperative diuretic therapy

Potassium

Monitor serum levels, cardiac and neurological function, and for perioperative diuretic therapy.

BUN

Monitor urinary output and wound healing. Increased = renal dysfunction Decreased = malnutrition

Which actions would the registered nurse (RN) assign to a licensed practical nurse caring for the client with a cast or traction?

Monitoring skin integrity around the cast Marking circumference of any drainage on the cast Checking color, temperature, capillary refill and pulses distal to the cast Rationale: The role of a LPN while caring for the client with a cast or traction is monitoring skin integrity around the cast, marking circumference pof any drainage on the cast and checking color, temperature, capillary refill and pulses distal to the cast. The RN teaches the client and the care giver ROM exercises and instructs the family members on how to assist the client with cast care.

Serous

Mostly clear portion of blood, slightly yellowish/thin

How do you know your pt is ready for diet changes?

No N/V, bowel sounds present and presence and pt flatulates.

Regional/epidural anesthesia

No perceived pain d/t medications installed around the nerve which blocks the nerve impulses Pros: Pain control, up and walking sooner, quicker, effective, less adverse reactions Cons: Anxiety is not altered, leaking CSF, HTN -monitor respiratory status

Glucose parameters

Notify MD if: <70 or >180

Perioperative nursing

Nursing care provided for the patient before, during, and after surgery

Dietary approaches to help with wound healing?

Nutrition/hydration status maintenance, dairy, protein, vitamin C, calcium, electrolyte balance

Surgical risk factors

Obesity, malnutrition, age, socioeconomic status, NPO time frame.

Arthrocentesis

Obtain synovial fluid from joint for diagnosis or remove excess fluid, needle inserted and fluid aspirated out

Intraoperative

Occurring during the course of a surgical procedure

Surgical methods

Open, laparoscopic or robotic

Postoperative medications

Oral, IV, suppository - unable to rid post-op pain completely, but should provide adequate relief of pain b/c it helps the pt cough and deep breath, and helps with early ambulation Narcotics, NSAIDs, (watch for bleeding),

Amputations

Partial or the total removal of an extremity caused by trauma or chronic issues (such as PVD). Complications: Phantom pain, infection, delayed wound healing, contractures, extend the joint and perform ROM.

Which action by a client who requires an above-the-knee amputation for peripheral arterial disease best indicates emotional readiness for the surgery?

Participates in learning perioperative care Rationale: Active participation in learning self-care indicates emotional acceptance of the need for surgery and planning for the future after surgery.

PCEA

Patient controlled epidural analgesic - have parameters, can sometimes push it on demand - basal rate.

Postoperative

Period of time immediately following the surgery

Preoperative

Pertaining to the period before a surgical operation, usually from the time the decision to have surgery is made to the time the patient is transferred to the operative table

Assessing skeletal muscle system

Physical assessment, deformities, muscle grade, strength, equality, swelling, redness and range of motion

Normal temp of 96.8 - 99.5

Reduces infection, ischemia, cardiac mobility and surgical bleeding

Osteoporosis

Porous bones. Loss of bone mass which leads to fragile bones and an increased risk of fractures. Manifestations: Loss of height, curvature of the spine, low back pain, often present with fractures. Diagnosis: Bone density or DEXA scan.

Amputations: Contractures

Position pt to lay prone to decrease risk that often occurs above the affected area. Laying prone increases blood flow to the muscles and prevents this complication, elevate stumps as indicated to promote venous return and decrease edema.

Time period when there is an increased risk of aspiration d/t N/V

Post-anesthesia/post-op

Total hip replacement

Prevent flexion or abduction of affected leg. No flexion, greater than 90 degrees, no bending down.

What interventions would you implement to prevent urinary retention/altered bowl habits?

Provide privacy, assist to the bathroom, males stand to void, bladder scan, assess, I&O, and administer stool softners

PCA

Pt controlled analgesic- uses regulated, they are in control of it within parameters.

Who can legally provide consent for a procedure/surgery?

Pts that are alert and orientated

Who can't legally consent for a procedure/surgery?

Pts with active power of attorney, minors and pts that have a guardian.

Goal for musculoskeletal trauma

RICE (Rest, Ice, Compression, Elevation)

Bone scan

Radioisotope medication injected and uptake increased within the bone tissue if osteomyelitis, porosis or bone cancer present

Ablative

Removal of diseased tissue or organ Amputation, appendectomy

Wound Interventions

Replace dressing as necessary to keep surrounding skin dry and encourage further drainage, document amount/color/consistency/odor, empty devices avoiding contamination of drain/drain plug, assess condition of incision, maintain pt nutrition/hydration status.

Transplant

Replace tissue/organ to restore function

A toddler has just had a cast applied for a fractured wrist. The wrist and elbow are immobilized. Which information would the nurse include in the home care instructions before discharge?

Report swelling of fingers Elevate casted arm when the child is standing Rationale: When swelling of the fingers occurs, the cast may become too tight, resulting in neurovascular damage; permanent damage can occur in 6 to 8 hours. The casted arm should be in a sling when the child is upright to promote venous return. Rest with elevation of the extremity is recommended; strenuous activity should be avoided for several days. Joints above and below the cast should be moved to maintain flexibility. The casted arm should be elevated when the child is resting to promote venous return.

Hemorrhage

Restlessness, anxiety, tachycardia, cool, pale, decreased urine output, frank bleeding.

Hypothermia

Risk during surgery, use warming blankets and limit skin exposure Surgical suits reduce temp in the room to reduce the risk of infections and bacteria growth

Thromboembolism

Risk of bleeding post op-DVT or PE Give low dose Heparin, early ambulation, TEDs/compression

Joint trama

Rotator cuff injuries, knee injuries, dislocations.

Never events

Serious but preventable surgical errors (that should never occur) Foreign object retained, DVT following surgery, surgical site infection 7 Categories - Surgical or procedural events - Product or device events - Patient protection events - Care management events - Environmental events - Radiologic events - Criminal events

What is normal for a post-op dressing?

Serous drainage. (Mostly clear/yellowish)

Sanguineous

Serum and RBCs, thick, reddish, most common type of uncomplicated surgical wound drainage

Which action would the nurse teach a client to avoid after a total hip replacement?

Sitting in a low chair Rationale: Excessive flexion of the hip, such as that caused by sitting in a low chair, can cause dislocation of the femoral head. Climbing stairs should not cause undue strain on the operative site. Stretching exercises should be encouraged as long as no extremes of position are implemented. The client is permitted to lie prone for more than 15 minutes; lying prone should be encouraged because it prevents hip flexion contractures.

Which of theses lunches should a nurse suggest for the client who has a body cast?

Smoked turkey sandwhich, chocolate pudding and milk

SLE care management

Supportive care, avoid exposure to UV rays Medications: NSAIDs, acetaminophen, immunosuppressant agent, topical corticosteroids

Who is responsible for information given to a pt preoperative?

Surgeon

Who are the members of the surgical team?

Surgeon, surgical assistant, anesthesiologist/CRNA, circulating nurse, scrub/surg tech.

Urgent Surgery

Surgery that is not an emergency, but must be done within a reasonably short time frame to preserve health

Elective Surgery

Surgery that is recommended but can be omitted or delayed without catastrophe

As a part of an informed consent, a surgeon explains the details of the surgery and related to the client care. The nurse leader witnesses the complete process. The nurse leader would ensure the surgeon provided which information to the client?

Surgical procedure Name of the surgeon Explanation of the possible risks Rationale: Informed consent must be done according to legal guidelines. It is an authorization by the client to perform a surgery or procedure on them. The details about the procedure of the surgery must be provided. It also informs the client of the name of the person who is performing the procedure. A description of the possible risks of the procedure is conveyed through informed consent. The name and type of anesthetic medication to be used may not be included in the informed consent. The name of the staff members involved in the surgery may not be a part of the informed consent.

Treatment: Scleroderma

Symptomatic treatment, support the affected tissues Medications: Immunosuppressive agents and corticosteroids.

For a client who had knee replacement surgery, which assessment finding gathered by the nurse is an example of subjective data?

The clients pain is 7 on a scale to 1 to 10

In order to go home from day surgery

Tolerate fluids/foods, vitals stable within 10% of preop baseline, pain controlled, be able to stand/walk, void, and understand post-op instructions

Universal Protocol Timeout

The procedure is initiated as a _______and takes place after the patient has been positioned, prepped, and draped but before the first incision.

Sprain

The stretch/stretching or tear of a ligament surrounding the joint.

Preoperative Care

Therapeutic support and care Pediatric: tour, population props, demonstrate to help reduce anxiety, confirm consent has been signed, labs, vitals, head to toe assessment, ensure pt has been NPO for 6+ hrs, allergies, surg site is marked, remove jewelry, remove dentures, make-up removed, provide skin prep (chlorothiazide washes)

Strain

This is a stretching injury to the muscle or muscle tendon when it's forced to extend

Arthroscopy

This is an endoscope procedure to look at the interior structure of the joint; can also be used to fix or repair tendons or muscles.

Contusion

This is bleeding into the soft tissues; the skin is intact and you have large amounts of bleeding which leads to a hematoma

Surgical attire

To facilitate infection control cross contamination that reduces bacterial shedding

Treatment: Fracture

Traction: Pulling and straightening, forced return or maintain bone function. Provide pincare, assess surrounding skin. Assess for CMS (compartment syndrome manifestations), assess for pedal pulse. Ropes and pulleys: Used to maintain that pulling force in the direction of the traction. Ensure nothing is obstructing or laying on the ropes or pulley system. Weights: Ordered by the physician, never remove the wts. for bed changes or position changes, they always remain on. Casts: A ridged device to immobilize affected area. Assess CMS, drainage, hotspots. Educate pt. to report changes in sensation and to avoid sticking anything down the cast to itch the skin. Keep it clean and dry.

A client is diagnosed with carpal tunnel syndrome. Teaching for this client is primarily focused on which of the following?

Use of hand splint

ECG

Used during pre-op assessment for pts over 40 or have a cardiovascular disease.

Construction

Used to build tissue that is absent Cleft lip

Ultrasound

Used to create an image of internal body structures such as muscles, tendons and ligaments

U/A

Used to detect abnormal substances (protein/glucose/RBC or bacteria), notify surgeon if abnormalities are detected

Post-op med. considerations

Vitals, mental status, labs, bleeding hx, respiratory assessment, N/V (could be from pain meds), auscultating bowel sounds, encourage movement N/V is a not an allergy, it is a side effect NSAIDs and ketorolac most common

Purulent

WBCs, tissue debris, bacteria, results from an infection, it is thicker, color and smell vary depending on bacteria

Evisceration

Wound separates and viscera protrude d/t: poor wound healing, obesity, malnutrition, steroid use, DM = Assess, cover with gauze soaked in sterile saline and report to HCP, position pt to minimize strain on incision.

Medication reconciliation

the process of comparing a patient's medication orders to all of the medications that the patient has been taking. Complete hx, interactions, dose, frequency, when pt took the med last, herbs/vit/OTC use, continue or discontinue and when to continue postoperatively.