Peri Op & musculoskeletal test

Carpal tunnel syndrome (CTS)

common condition in which the median nerve in the wrist becomes compressed, causing pain and numbness usually occurs in the thumb, index finger, and the middle finger ~ women older than 50 y/o the most common type of repetitive stress injury (RSI) chronic condition

loridosis

common finding in adults with abdominal obesity (sway back)

Open/ compound fracture:

complete break of the bone and the bone protrudes through the skin, which can lead to osteomyelitis (infection).

Myelogram:

involves the injection of contrast medium (dye) or air into the subarachnoid space of the spine to assess any disk problems. Some spinal fluid is removed before the injection occurs. After the injection is done, elevate the patient's head of the bed following post-op.

Bone Mineral Density ("dexus scan"):

is a painless procedure that measures bone mass to diagnose for osteoporosis. Most women have this test done after going through menopause due to their decreasing calcium levels and increased osteoporosis risk. A baseline scan should be done every 2-3 years to check if osteoporosis is onsetting.

Electromyogram (EMG):

is a test for muscle contraction. First do a lower muscle neuron assessment. Then the needle is inserted into a muscle to see if a reaction occurs. No pre-sedatives or caffeine within 24 hours of the test and the patient is to remain awake during testing.

Acute Osteomyelitis signs & symptoms

• Fever; temperature usually above 101°F • Swelling around the affected area • Erythema (redness) of the affected area • Tenderness of the affected area • Bone pain that is constant, localized, and pulsating; intensifies with movement • Abscess (pus)

Chronic Osteomyelitis signs & symptoms

• Foot ulcer(s) (most commonly) • Sinus tract formation • Localized pain • Drainage from the affected area

Hypercalcemia (increased calcium) may indicate?

• Metastatic cancers of the bone • Paget's disease • Bone fractures in healing stage

Hypocalcemia (decreased calcium) may indicate?

• Osteoporosis • Osteomalacia

Predisposing Factors of Carpal Tunnel Syndrome

• Pregnancy • Premenstrual cycle • Menopause • Diabetes mellitus • Thyroid Dysfunction

Clinical Manifestations of Carpal Tunnel Syndrome

• Weakness (especially in the thumb) • Burning pain (causalgia) • Numbness • Impaired sensation • Clumsiness in performing fine hand mvmnts • ~paresthesia (painful tingling) **Sensory changes usually occur weeks or months before motor manifestations.

treatment for fat embolism

bedrest gentle handling oxygen hydration possibly steroid therapy fracture immobilization

when is discharge planning started?

before surgery

stage 1 of bone healing

within 24 to 72 hours after the injury, a hematoma (inflammation) forms at the site of the fracture because the bone is extremely vascular.

Your role as a nurse is _______ when dealing with a consent form?

witness

arthrogram

x-ray study of a joint after contrast medium (air or solution)

what are the 3 phases of postnesthesia? (the time the pt spend in each phase depends on their health status)

Phase 1: right after surgery (~ in the PACU/ICU) Phase 2: prepares the pt for care in the step down unit Phase 3: "extended care environment" for cont. care needs

where do the circulating nurse & anesthetist review the pts medical recods?

in the holding area of the OR

types of anesthesia

inhilation IV balanced local

examples of urgent surgery?

intestinal obstruction bladder obstruction kidney/ ureteral stones bone fracture eye injury acute cholecystitis

The nurse is preparing the preoperative client for surgery. The following statements that indicate the client is knowledgeable about his impending surgery, except: "After surgery, I will need to wear the pneumatic compression device while sitting in the chair" "The skin prep area is going to be longer and wider than the anticipated incision" "I cannot have anything to drink or eat after midnight on the night before the surgery" "To ensure my safety, a 'time out' will be conducted in the operating room"

"After surgery, I will need to wear the pneumatic compression device while sitting in the chair" The pneumatic compression device is worn during bed rest, not during ambulation. The informed consent document should be signed before preoperative medication administration and before the client enters the operating room

what is the drug of choice for malignant hyperthermia?

"Dantrolene" sodium (2-3mg/kg) a skeletal muscle relaxant

AREA: thigh/ leg surgery

(a little more than half of body) from belly button - all the way down the foot

what is insufflation?

(important part of MIS) injecting gas/ air into the body cavity before surgery to seperate organs & improve visualization BUT it can also contribute to complications and pt discomfort

continuous sutures

(interlocking stitch) one long sting of stiches, does not stop

AREA: hip surgery

(only on one side) from belly button - knee

AREA: foot/ lower leg surgery

(only one side) from mid thigh - all the way down the foot

AREA: ankle/ foot/ toe surgery

(only one side) from the knee down

the 4 steps to perform "Splinting of the Surgical Incision"

(unless coughing is contraindicated) -place pillow/ towel/ folded blanket over your surgical incision & hold the item firmly in place -take 3 slow, deep breaths to stimulate your cough reflex -inhale through your nose, & exhale through your mouth -on your 3rd deep breath, cough to clear secretions from your lungs while firmly holding pillow/ towel/ folded blanket against your incision

signs & symptoms of blood clot embolism

**same as fat embolism EXCEPT NO PETECHIAE

types of surgeries? (5)

-DIAGNOSTIC: to determine cause of disorder/ cancer -CURATIVE: resolve a health problem by repairing or removing the cause -RESTORATIVE: to improve a pts functional ability -PALLIATIVE: to relieve symptoms of a disease process (but does not cure) -COSMETIC: to alter or enhance personal appearance

types of urgency of surgeries? (3)

-ELECTIVE: planned/ nonacute problem -URGENT: needs prompt intervention (may be life threatening if delayed 24-48hrs) -EMERGENT: needs immediate intervention/ is life threatening

degree of risk for surgery? (2)

-MINOR: w/o major risk (often use local anesthesia) -MAJOR: @ greater risk (usually longer & more extensive)

complications of fractures

-acute compartment syndrome -cushing syndrome -hypovolemic shock -fat embolism -infection -chronic complications (ischemic necrosis/ delayed union)

what should the nurse do for an older pt before/ during surgery?

-allow glasses, dentures, hearing aids until anesthesia has started -small pillow under pts neck -lift pts into position (dont slide) -position joint carefully as to not cause more pain -pad bony prominence -use warming devices to prevent hypothermia -cover pts head and feet -warm IV fluids -monitor Is & Os / blood loss

signs & symptoms of fat embolisms

-alt mental status* -low arterial oxygen levels* (hypoxemia) -dyspnea* -tachypnea* (↑ resp) -non-palpable red/brown petechiae* (over neck/ arms/ chest) -angina -crackles -↑ pulse _↑ temp -↓ SaO2

What all is included in the NPSGs? universal protocol National Patient Safety Goals they are the responsibility of every health care worker there

-correct ID (2 indications) -correct procedure -correct site (side)

what is a circulating nurse or "circulators" doing after the surgery?

-documents & counts all sponges/ sharps/ instruments/ drains/ catheters/ length of surgery -informs PACU (postanesthesia care unit) of an ETA or any special needs for the pt

the 4 steps to perform "Expansion Breathing"

-get in a comfy upright position with your knees slightly bent (bent knees ↓ tension on abdominal muscles & resp. resistance) -place your hands on each side of your loer rib cage, just above the waist -take a deep breath through your nose, using your shoulder muscles to expand your lower rib cage outward during inhalation -exhale, concentrating 1st on moving your chest, then on moving your lower ribs inward, while gently squeezing the rib cage & forcing air out of the base of your lungs

what are some emergency care things we can do for a pt experiencing malignant hyperthermia? p247

-give 2-3mg/kg of Dantrium -cooling techniques (iced saline IV/ cooling blanket/ bags of ice/ lavage open cavities with iced NS) -insert foley to monitor Is & Os -give IV fluids to keep output above 2 mL/kg/hr -transfer pt to ICU -cont to monitor pt for 24 hrs -refer pt/ family to Malignant Hyperthermia Association of the US (mhaus.org)

what 4 leg exercises can help prevent DVT's postop?

-lay @ 45° angle, lift leg, hold for a couple seconds, repeat -flex feet (pointing toes), then bend ankle (bringing toes toward you) -make circles with toes (rotating ankles) -bend your knee, & push ball of foot into bed/floor until your thigh muscles contract, repeat

what pts are at a greater risk for a VTE/DVT leading to a pulmonary embolism? (if the clot breaks off & travels to the lungs)

-obese pts -pts older than 40 y/o -cancer -↓ mobility/ immobile -pts who have a spinal cord injury -pts taking oral contraceptives -pts with a history of VTE/ DVT/ PE/ varicose viens/ edema -pts who smoke -pts with ↓cardiac output -pts with hip fractures/ total hip or knee replacements

in the post op period, pts are still at risk for what?

-pneumonia -shock -cardiac arrest -respiratory arrest -clotting/ VTE/ DVT -GI bleeding

treatment for blood clot embolism

-preventive measures (leg exercises/ stockings) -bedrest -oxygen -possibly mechanical ventilation -anticoags -thrombolytics -possibly surgery

what is a circulating nurse or "circulators" doing during the surgery?

-protects the pts privacy -ensures the pts safety -monitors traffic in the room -asses the amount of urine & blood loss -ensures the surgical team keep a sterile technique -reports findings to the surgeon & anesthesiologist -anticipates the pts & surgical team's needs (giving supplies/ equipment) -communicates info about the pts status to family members during long/ unique procedures -documents care/ events/ interventions/ findings

what is a circulating nurse or "circulators" doing leading up to the surgery?

-registered nurses who coordinate, oversee, & are involved in the pts nursing care in the operating room -they coordinate all activities in the OR -they set up the OR, ensures necessary supplies (including blood products), and diagnostic support are available -they make sure all the equipment gathered is safe and works properly -they make up the OR table (with gel pads, safety straps, armboards, heating pads, warming blankets) -acts as the holding area if there is not one -greets the pt & reviews findings with the holding nurse (provides comfort/ reassurance) -assists with transferring pts to the OR table & positions them & pads the bony prominences -assists the anesthesiologist -insert a foley cath if needed -apply test equipment -"prep"/ scrub the surgical site before being draped

the 5 steps to perform "Deep (Diaphragmatic) Breathing"

-sit upright on the edge of the bed/chair, placing your feet on the floor/stool (or in Fowlers/ semi-fowlers position after surgery) -take a gentle breath through your mouth -breath out gently & completely -then take a deep breath through your nose/ mouth & then hold this breath for 5 seconds -exhale through your nose/ mouth

consent implies that the pt has sufficient information to understand what?

-the nature of & reason for surgery -who will be performing the surgery & who will be there -all available options & the risks with each one -the risk associated with the surgery and the potential outcomes -the risks with the use of anesthesia

what is the scrub nurse's job?

-to set up the sterile field/ equipment/ instruments -hand them to the surgeon during operation

what is included in the post op handoff report?

-type of surgery -type of anesthesia used -allergies -health issues -vital signs -type & amount of IV fluid -estimated blood loss (EBL) -complications -special requests -location & type of incision/ dressing/ drains/ catheters -Is & Os -prosthetic devices -positioning

what are some factors that influence the selection of what kind of anesthesia is chosen for a pt? (9)

-type/ duration of procedure -area of the body having surgery on -safety issues to reduce injury (ex: airway management) -if the surgery is an emergency or not -options for pain management for afterwards -how long since the pt ate, drank, or had drugs -position the pt needs to be in for surgery -if the pt needs to be alert/awake during surgery -how the pt has reacted to anesthesia in the past

norm creatinine level

0.5-1.2 mg/dL

norm international normalized ratio (INR)

0.7-1.8

examples of diagnostic surgery?

biopsy exploratory laparotomy arthroscopy

Displaced fracture

bone breaks and displaces (shifts) inside the body.

Oblique fracture

bone breaks diagonally

Spiral fracture

bone is twisted apart.

BMD

bone mineral density

ligaments

bone to bone

genu varum

bowlegged

AREA: gynecologic surgery

box around perineal area

SCIP infection- 1,2,3,4,6,9,10

1- give prophylactic antibiotic one hour prior to surgery (to make blood bactericidal) 2- figure out what prophylactic antibiotic to give the pt (given to pts with increased risk for infection) 3- DC the prophylactic antibiotic within 24hrs after surgery 4- cardiac pts with diabetes alert MD if above 200mg/dL 6- do not use razors to shave (use clippers/ chemicals) 9- take out urinary catheter postop day 1 or 2 (never leave in for over 48hrs) 10- Notify surgeon or anesthesiologist if BG is above 200 mg/dL

SCIP VTE- 1,2

1- use DVT prophylaxis devices for pts at risk (ex: compression socks/ mechanical compression devices/ Lovanox) 2- give VTE prophylaxis 24hrs before - 24hrs after surgery

norm blood urea nitrogen (BUN) level

10-20 mg/dL

norm prothrombin time (PT/ pro time) level

11-12.5 seconds or

norm total hemoglobin level

12-18 g/dL

The nurse is caring for a first day postoperative surgical client. Prioritize the patient's desired dietary progression. Arrange in sequence the dietary progression from 1 to 4: 1. Full liquid; 2. NPO; 3. Clear liquid; 4. Soft 1, 2, 3, 4 2, 3, 1, 4 2, 1, 4, 3 4, 3, 2, 1

2, 3, 1, 4 The client's status is NPO immediately after surgery. Desired diet progression advances to clear liquid, full liquid, soft and finally a regular diet as tolerated by the client

RA **

35-45 yrs Inflammatory Bilateral (multiple) Systemic

the CDC defines surgical site infections as occurring when?

30 days post op

norm partial thromboplastin time activated (aPTT)

30-40 seconds

norm hematocrit level

35%-52%

POSTOPERATIVE

BEGINS WITH ADMISSION TO THE RECOVERY AREA & CONTINUES UNTIL THE CLIENT RECEIVES A FOLLOW-UP EVALUATION AT HOME OR IS DISCHARGED TO A REHABILITATION UNIT

PREOPERATIVE

BEINGS WITH THE DECISION TO PERFORM SURGERY & CONTINUES UNTIL THE CLIENT REACHES THE OPERATION AREA

A student is caring for clients in the preoperative area. The nurse contacts the surgeon about a client whose heart rate is 120 beats/min. After consulting with the surgeon, the nurse administers a beta blocker to the client. The student asks why this was needed. What response by the nurse is best? a. A rapid heart rate requires more effort by the heart. b. Anesthesia has bad effects if the client is tachycardic. c. The client may have an undiagnosed heart condition. d. When the heart rate goes up, the blood pressure does too.

A Tachycardia increases the workload of the heart and requires more oxygen delivery to the myocardial tissues. This added strain is not needed on top of the physical and emotional stress of surgery. The other statements are not accurate. 219

NPO? (foods & liquids)

6 or more hrs of easliy ingested solid food 2 hrs for clear liquids

norm glucose (fasting)

70-110 mg/dL (less than 200)

what should the O2 sat stay above in the PACU?

95% (or the pts presurgery baseline)

A clinic nurse is teaching a client prior to surgery. The client does not seem to comprehend the teaching, forgets a lot of what is said, and asks the same questions again and again. What action by the nurse is best? a. Assess the client for anxiety. b. Break the information into smaller bits. c. Give the client written information. d. Review the information again.

A Anxiety can interfere with learning and cooperation. The nurse should assess the client for anxiety. The other actions are appropriate too, and can be included in the teaching plan, but effective teaching cannot occur if the client is highly anxious. 233

The perioperative nurse manager and the postoperative unit manager are concerned about the increasing number of surgical infections in their hospital. What action by the managers is best? a. Audit charts to see if the Surgical Care Improvement Project (SCIP) outcomes were met. b. Encourage staff on both units to provide peer pressure to adhere to hand hygiene policy. c. Hold educational meetings with the nursing and surgical staff on infection prevention. d. Monitor staff on both units for consistent adherence to established hand hygiene practices

A The SCIP project contains core measures that are mandatory for all surgical clients and focuses on preventing infection, serious cardiac events, and venous thromboembolism. The managers should start by reviewing charts to see if the guidelines of this project were implemented. The other actions may be necessary too, but first the managers need to assess the situation. 216

A nurse is concerned that a preoperative client has a great deal of anxiety about the upcoming procedure. What action by the nurse is best? a. Ask the client to describe current feelings. b. Determine if the client wants a chaplain. c. Reassure the client this surgery is common. d. Tell the client there is no need to be anxious.

A The nurse needs to conduct further assessment of the clients anxiety. Asking open-ended questions about current feelings is an appropriate way to begin. The client may want a chaplain, but the nurse needs to do more for the client. Reassurance can be good, but false hope is not, and simply reassuring the client may not be helpful. Telling the client not to be anxious belittles the clients feelings. 222

A client is on the phone when the nurse brings a preoperative antibiotic before scheduled surgery. The circulating nurse has requested the antibiotic be started. The client wants the nurse to wait before starting it. What response by the nurse is most appropriate? a. Explain the rationale for giving the medicine now. b. Leave the room and come back in 15 minutes. c. Provide holistic client care and come back later. d. Tell the client you must start the medication now.

A The preoperative antibiotic must be given within 60 minutes of the surgical start time to ensure the proper amount is in the tissues when the incision is made. The nurse should explain the rationale to the client for this timing. The other options do not take this timing into consideration and do not give the client the information needed to be cooperative. 234

A nurse assesses a client in the preoperative holding area and finds brittle nails and hair, dry skin turgor, and muscle wasting. What action by the nurse is best? a. Consult the surgeon about a postoperative dietitian referral. b. Document the findings thoroughly in the clients chart. c. Encourage the client to eat more after recovering from surgery. d. Refer the client to Meals on Wheels after discharge.

A This client has signs of malnutrition, which can impact recovery from surgery. The nurse should consult the surgeon about prescribing a consultation with a dietitian in the postoperative period. The nurse should document the findings but needs to do more. Encouraging the client to eat more may be helpful, but the client needs a professional nutritional assessment so that the appropriate diet and supplements can be ordered. The client may or may not need Meals on Wheels after discharge. 222

PROCEDURAL SEDATION

A STATE IN WHICH THE CLIENT IS FREE OF PAIN, FEAR, & ANXIETY & CAN TOLERATE UNPLEASANT PROCEDURES

Outpatient (ambulatory)

A pt who gets a surgery then returns home later the same day (same day surgery SDS) <24hrs

Inpatient

A pt who is admitted for a day or more for a surgery (same day admission SDA)

what are some indications of poor fluid/ nutritional status?

brittle nails muscle wasting dry/ flaky skin ↓ skin turgor dull/ sparse/ dry hair orthostatic hypotension ↓ serum protein levels

Following an amputation, the advantage to the client for an immediate prosthesis fitting is: A- Ability to ambulate sooner B- Less change of phantom limb sensation C- Dressing changes are not necessary D- Better fit of the prosthesis

A- Ability to ambulate sooner

Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus? A- Acute respiratory distress syndrome B- Migraine like headaches C- Numbness in the right leg D- Muscle spasms in the right thigh

A- Acute respiratory distress syndrome

The nurse is caring for the client who is going to have an arthrogram using a contrast medium. Which of the following assessments by the nurse are of highest priority? A- Allergy to iodine or shellfish B- Ability of the client to remain still during the procedure C- Whether the client has any remaining questions about the procedure D- Whether the client wishes to void before the procedure

A- Allergy to iodine or shellfish

After a computer tomography scan with intravenous contrast medium, a client returns to the unit complaining of shortness of breath and itching. The nurse should be prepared to treat the client for: A- An anaphylactic reaction to the dye B- Inflammation from the extravasation of fluid during injection. C- Fluid overload from the volume of the infusions D- A normal reaction to the stress of the diagnostic procedure

A- An anaphylactic reaction to the dye

The nurse has an order to get the client out of bed to a chair on the first postoperative day after a total knee replacement. The nurse plans to do which of the following to protect the knee joint: A- Apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting B- Apply an Ace wrap around the dressing and put ice on the knee while sitting C- Lift the client to the bedside change leaving the CPM machine in place D- Obtain a walker to minimize weight bearing by the client on the affected leg

A- Apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting

The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of the following nursing diagnoses for this client? A- Diversional activity deficit B- Powerlessness C- Self care deficit D- Impaired physical mobility

A- Diversional activity deficit

Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED in a stable condition with vital signs within normal limits, alert and oriented with good coloring and an open fracture of the right tibia. When assessing the client, the nurse would be especially alert for signs and symptoms of which of the following? A- Hemorrhage B- Infection C- Deformity D- Shock

A- Hemorrhage

Which of the following would the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury? A- Homan's sign B- Pain C- Tenderness D- Leg girth

A- Homan's sign

The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse uses a: A- Pillow to keep the right leg abducted during turning B- Pillow to keep the right leg adducted during turning C- Trochanter roll to prevent external rotation while turning D- Trochanter roll to prevent abduction while turning

A- Pillow to keep the right leg abducted during turning

Which nursing intervention is appropriate for a client with skeletal traction? A- Pin care B- Prone positioning C- Intermittent weights D- 5lb weight limit

A- Pin care

In order for Buck's traction applied to the right leg to be effective, the client should be placed in which position? A- Supine B- Prone C- Sim's D- Lithotomy

A- Supine

The nurse is teaching the client who is to have a gallium scan about the procedure. The nurse includes which of the following items as part of the instructions? A- The gallium will be injected intravenously 2 to 3 hours before the procedure B- The procedure takes about 15 minutes to perform C- The client must stand erect during the filming D- The client should remain on bed rest for the remainder of the day after the scan

A- The gallium will be injected intravenously 2 to 3 hours before the procedure

The nurse is caring for a client with a gout. Which of the following laboratory values does the nurse expect to note in the client? A- Uric acid level of 8 mg/dl B- Calcium level of 9 mg/dl C- Phosphorus level of 3 mg/dl D- Uric acid level of 5 mg/dl

A- Uric acid level of 8 mg/dl

Osteoarthritis

Progressive deterioration and loss of cartilage and bone in one or more joints. Most common arthritis major cause of disability. "osteoarthrosis" or "degenerative disease" (DJD)

subcutaneous emphysema

bubbles under the skin because of air trapping (can happen with a closed fracture)

Late Manifestations RA

Joint • Deformities (swan neck or ulnar deviation) • Moderate to severe pain and morning stiffness (hot showers can help pt) Systemic • Osteoporosis • Severe fatigue • Anemia • Weight loss • Subcutaneous nodules • Peripheral neuropathy • Vasculitis • Pericarditis • Fibrotic lung disease • Sjogren syndrome • Kidney disease • Felty's syndrome

A student nurse asks why older adults are at higher risk for complications after surgery. What reasons does the registered nurse give? (Select all that apply.) a. Decreased cardiac output b. Decreased oxygenation c. Frequent nocturia d. Mobility alterations e. Inability to adapt to changes

ANS: A, B, C, D Older adults have many age-related physiologic changes that put them at higher risk of falling and other complications after surgery. Some of these include decreased cardiac output, decreased oxygenation of tissues, nocturia, and mobility alterations. They also have a decreased ability to adapt to new surroundings, but that is not the same as being unable to adapt. 220

A client is clearly uncomfortable and anxious in the preoperative holding room waiting for emergent abdominal surgery. What actions can the nurse perform to increase comfort? (Select all that apply.) a. Allow the client to assume a position of comfort. b. Allow the clients family to remain at the bedside. c. Give the client a warm, non-caffeinated drink. d. Provide warm blankets or cool washcloths as desired. e. Pull the curtains around the bed to provide privacy.

ANS: A, B, D, E There are many nonpharmacologic comfort measures the nurse can employ, such as allowing the client to remain in the position that is most comfortable, letting the family stay with the client, providing warmth or cooling measures as requested by the client, and providing privacy. The client in the preoperative holding area is NPO, so drinks should not be provided. 233

A nurse is caring for several clients prior to surgery. Which medications taken by the clients require the nurse to consult with the physician about their administration? (Select all that apply.) a. Metformin (Glucophage) b. Omega-3 fatty acids (Sea Omega 30) c. Phenytoin (Dilantin) d. Pilocarpine hydrochloride (Isopto Carpine) e. Warfarin (Coumadin)

ANS: A, C, D, E Although the client will be on NPO status before surgery, the nurse should check with the provider about allowing the client to take medications prescribed for diabetes, hypertension, cardiac disease, seizure disorders, glaucoma, anticoagulation, or depression. Metformin is used to treat diabetes; phenytoin is for seizures; pilocarpine is for glaucoma, and warfarin is an anticoagulant. The omega-3 fatty acids can be held the day of surgery. 228

A student nurse is caring for clients on the postoperative unit. The student asks the registered nurse why malnutrition can lead to poor surgical outcomes. What responses by the nurse are best? (Select all that apply.) a. A malnourished client will have fragile skin. b. Malnourished clients always have other problems. c. Many drugs are bound to protein in the body. d. Protein stores are needed for wound healing. e. Weakness and fatigue are common in malnutrition.

ANS: A, C, D, E Malnutrition can lead to poorer surgical outcomes for several reasons, including fragile skin that might break down, altered pharmacokinetics, poorer wound healing, and weakness or fatigue that can interfere with recovery. Malnutrition can exist without other comorbidities. 222

A nurse recently hired to the preoperative area learns that certain clients are at higher risk for venous thromboembolism (VTE). Which clients are considered at high risk? (Select all that apply.) a. Client with a humerus fracture b. Morbidly obese client c. Client who underwent a prolonged surgical procedure d. Client with severe heart failure e. Wheelchair-bound client

ANS: B, C, D, E All surgical clients should be assessed for VTE risk. Those considered at higher risk include those who are obese; are over 40; have cancer; have decreased mobility, immobility, or a spinal cord injury; have a history of any thrombotic event, varicose veins, or edema; take oral contraceptives or smoke; have decreased cardiac output; have a hip fracture; or are having total hip or knee surgery. Prolonged surgical time increases risk due to mobility and positioning needs. 231

A nurse working in the preoperative holding area performs which functions to ensure client safety? (Select all that apply.) a. Allow small sips of plain water. b. Check that consent is on the chart. c. Ensure the client has an armband on. d. Have the client help mark the surgical site. e. Allow the client to use the toilet before giving sedation.

ANS: B, C, D, E Providing for client safety is a priority function of the preoperative nurse. Checking for appropriately completed consent, verifying the clients identity, having the client assist in marking the surgical site if applicable, and allowing the client to use the toilet prior to sedating him or her are just some examples of important safety measures. The preoperative client should be NPO, so water should not be provided. 216

A new perioperative nurse is receiving orientation to the surgical area and learns about the Surgical Care Improvement Project (SCIP) goals. What major areas do these measures focus on preventing? (Select all that apply.) a. Hemorrhage b. Infection c. Serious cardiac events d. Stroke e. Thromboembolism

ANS: B, C, E The SCIP project includes core measures to prevent infection, serious cardiac events, and thromboembolic events such as deep vein thrombosis. 216

A nursing instructor is teaching students about different surgical procedures and their classifications. Which examples does the instructor include? (Select all that apply.) a. Hemicolectomy: diagnostic b. Liver biopsy: diagnostic c. Mastectomy: restorative d. Spinal cord decompression: palliative e. Total shoulder replacement: restorative

ANS: B, E A diagnostic procedure is used to determine cell type of cancer and to determine the cause of a problem. An example is a liver biopsy. A restorative procedure aims to improve functional ability. An example would be a total shoulder replacement or a spinal cord decompression (not palliative). A curative procedure either removes or repairs the causative problem. An example would be a mastectomy (not restorative) or a hemicolectomy (not diagnostic). A palliative procedure relieves symptoms but will not cure the disease. An example is an ileostomy. A cosmetic procedure is done to improve appearance. An example is rhinoplasty (a nose job). 218

The patient had undergone thyroidectomy. Which of the following are the earliest signs of poor tissue perfusion and poor respiratory function? Cyanosis, lethargy Fast, thready pulse, bradypnea Apprehension and restlessness Faintness, pallor

Apprehension and restlessness The earliest signs of poor tissue perfusion and poor respiratory function are apprehension and restlessness. The brain is the first organ affected by poor tissue perfusion and oxygenation. This also results from stimulation of the sympathetic nervous system

bone spurs (osteophytes)

As cartilage in the bone beneath the cartilage begin to erode the joint space Narrows and bone spurs form

The patient had undergone total hip replacement. He complains of pain in the operative site. Which of the following is the appropriate initial nursing action? Administer the ordered analgesic Instruct the patient to do deep breathing and coughing exercises Assess the patient's pain level and vital signs Change the patient's position

Assess the patient's pain level and vital signs The first nursing action in managing pain is to assess the patient's pain level and vital signs. This is to determine the amount of analgesic to be administered as prescribed. Assessment is done before implementation

drugs used for: sedatives/ hypnotics/ anxiolytics/ opioid analgesics/ anticholinergic agents

Atarax / Vistaril lorazepam (Ativan) Versed morphine / hydromorphone

Which of the following drugs is administered to minimize respiratory secretions preoperatively? Valium (diazepam) Phenergan (promethazine) Atropine sulfate Demerol (Meperidine)

Atropine sulfate Atropine Sulfate, an anticholinergic, minimizes respiratory secretions preoperatively. It helps aspiration of secretions

A client waiting for surgery is very anxious. What intervention can the nurse delegate to the unlicensed assistive personnel (UAP)? a. Assess the clients anxiety. b. Give the client a back rub. c. Remind the client to turn. d. Teach about postoperative care.

B A back rub reduces anxiety and can be delegated to the UAP. Once teaching has been done, the UAP can remind the client to turn, but this is not related to relieving anxiety. Assessing anxiety and teaching are not within the scope of practice for the UAP. 233

A client has been given hydroxyzine (Atarax) in the preoperative holding area. What action by the nurse is most important for this client? a. Document giving the drug. b. Raise the siderails on the bed. c. Record the clients vital signs. d. Teach relaxation techniques.

B All actions are appropriate for a preoperative client. However, for client safety, the nurse should raise the siderails on the bed because hydroxyzine can make the client sleepy. 234

An inpatient nurse brings an informed consent form to a client for an operation scheduled for tomorrow. The client asks about possible complications from the operation. What response by the nurse is best? a. Answer the questions and document that teaching was done. b. Do not have the client sign the consent and call the surgeon. c. Have the client sign the consent, then call the surgeon. d. Remind the client of what teaching the surgeon has done.

B In order to give informed consent, the client needs sufficient information. Questions about potential complications should be answered by the surgeon. The nurse should notify the surgeon to come back and answer the clients questions before the client signs the consent form. The other actions are not appropriate. 226

A client has a great deal of pain when coughing and deep breathing after abdominal surgery despite having pain medication. What action by the nurse is best? a. Call the provider to request more analgesia. b. Demonstrate how to splint the incision. c. Have the client take shallower breaths. d. Tell the client a little pain is expected.

B Splinting an incision provides extra support during coughing and activity and helps decrease pain. If the client is otherwise comfortable, no more analgesia is required. Shallow breathing can lead to atelectasis and pneumonia. The client should know some pain is normal and expected after surgery, but that answer alone does not provide any interventions to help the client. 230

A nurse is giving a client instructions for showering with special antimicrobial soap the night before surgery. What instruction is most appropriate? a. After you wash the surgical site, shave that area with your own razor. b. Be sure to wash the area where you will have surgery very thoroughly. c. Use a washcloth to wash the surgical site; do not take a full shower or bath. d. Wash the surgical site first, then shampoo and wash the rest of your body.

B The entire proposed surgical site needs to be washed thoroughly and completely with the antimicrobial soap. Shaving, if absolutely necessary, should be done in the operative suite immediately before the operation begins, using sterile equipment. The client needs a full shower or bath (shower preferred). The client should wash the surgical site last; dirty water from shampooing will run over the cleansed site if the site is washed first. 228

A postoperative client has an abdominal drain. What assessment by the nurse indicates that goals for the priority client problems related to the drain are being met? a. Drainage from the surgical site is 30 mL less than yesterday. b. There is no redness, warmth, or drainage at the insertion site. c. The client reports adequate pain control with medications. d. Urine is clear yellow and urine output is greater than 40 mL/hr.

B The priority client problem related to a surgical drain is the potential for infection. An insertion site that is free of redness, warmth, and drainage indicates that goals for this client problem are being met. The other assessments are normal, but not related to the drain. 230

A nurse is giving a preoperative client a dose of ranitidine (Zantac). The client asks why the nurse is giving this drug when the client has no history of ulcers. What response by the nurse is best? a. All preoperative clients get this medication. b. It helps prevent ulcers from the stress of the surgery. c. Since you dont have ulcers, I will have to ask. d. The physician prescribed this medication for you.

B Ulcer prophylaxis is common for clients undergoing long procedures or for whom high stress is likely. The nurse is not being truthful by saying all clients get this medication. If the nurse does not know the information, it is appropriate to find out, but this is a common medication for which the nurse should know the rationale prior to administering it. Simply stating that the physician prescribed the medication does not give the client any useful information. 234

Early Manifestations of RA

Joint • Inflammation Systemic • Low-grade fever • Fatigue • Weakness • Anorexia • Paresthesias

examples of elective surgery?

cataract removal hernia repair hemorrhoidectomy total joint replacement

A 23 year old female client was in an automobile accident and is now a paraplegic. She is on an intermittent urinary catheterization program and diet as tolerated. The nurse's priority assessment should be to observe for: A- Urinary retention B- Bladder distention C- Weight gain D- Bower evacuation

B- Bladder distention

After falling down the basement steps in his house, a client is brought to the emergency room. His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will first check the client's toes for: A- Increase in the temperature B- Change in color C- Edema D- Movement

B- Change in color

When a client has cervical halter traction to immobilize the cervical spine counteraction is provided by: A- Elevating the foot of the bed B- Elevating the head of the bed C- Application of the pelvic girdle D- Lowering the head of the bed

B- Elevating the head of the bed

The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg. The nurse interprets these finding as indicating which of the following? A- Pulmonary emboli B- Osteomyelitis C- Fat emboli D- Urinary tract infection

B- Osteomyelitis

The nurse is assessing the casted extremity of a client. The nurse assesses for which of the following signs and symptoms indicative of infection? A- Coolness and pallor of the extremity B- Presence of a "hot spot" on the cast C- Diminished distal pulse D- Dependent edema

B- Presence of a "hot spot" on the cast

A young client is in the hospital with his left leg in Buck's traction. The team leader asks the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action is to: A- Anchor the traction B- Prevent footdrop C- Keep the client from sliding down in bed D- Prevent pressure areas on the foot

B- Prevent footdrop

Which of these nursing actions will best promote independence for the client in skeletal traction? A- Instruct the client to call for an analgesic before pain becomes severe. B- Provide an overhead trapeze for client use C- Encourage leg exercise within the limits of traction D- Provide skin care to prevent skin breakdown

B- Provide an overhead trapeze for client use

The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid arthritis is to: A- Reduce fever B- Reduce the inflammation of the joints C- Assist the client's range of motion activities without pain D- Prevent extension of the disease process

B- Reduce the inflammation of the joints

A client has just returned from surgery after having his left leg amputated below the knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under the client's amputated limb. The nursing action is to: A- Leave the pillow as his stump is elevated B- Remove the pillow and elevate the foot of the bed C- Leave the pillow and elevate the foot of the bed D- Check with the physician and clarify the orders

B- Remove the pillow and elevate the foot of the bed

The nurse is caring for the client who had an above the knee amputation two (2) days ago. The residual limb was wrapped with an elastic compression bandage which has come off. The nurse immediately: A- Calls the physician B- Rewrap the stump with an elastic compression bandage C- Applies ice to the site D- Applies a dry sterile dressing and elevates it on a pillow

B- Rewrap the stump with an elastic compression bandage

When evaluating all forms of traction, the nurse knows the direction of pull is controlled by the: A- Client's position B- Rope/pulley system C- Amount of weight D- Point of friction

B- Rope/pulley system

A client is 1 day postoperative after a total hip replacement. The client should be placed in which of the following position? A- Supine B- Semi Fowler's C- Orthopneic D- Trendelenburg

B- Semi Fowler's

A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone 10mg BID for the last two years. The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has A- Headaches B- Tarry stools C- Blurred vision D- Decreased appetite

B- Tarry stools

The nurse is teaching a client with metastatic bone disease about measures to prevent hypercalcemia. It would be important for the nurse to emphasize? A- The need to have at least 5 servings of dairy products daily B- The importance of walking C- The need to restrict fluid intake to less than one liter per day D- Early recognition of tetany

B- The importance of walking

5 P's for assessing the signs of a neurovascular compromise

Pain (that cannot be controlled) Paralysis Paresthesia (tingling) Pallor Pulselessness

things to assess foer the neurovascular status in pts with MS injury?

skin color skin temp movement sensation pulses cap. refill pain

A preoperative nurse is reviewing morning laboratory values on four clients waiting for surgery. Which result warrants immediate communication with the surgical team? a. Creatinine: 1.2 mg/dL b. Hemoglobin: 14.8 mg/dL c. Potassium: 2.9 mEq/L d. Sodium: 134 mEq/L

C A potassium of 2.9 mEq/L is critically low and can affect cardiac and respiratory status. The nurse should communicate this laboratory value immediately. The creatinine is at the high end of normal, the hemoglobin is normal, and the sodium is only slightly low (normal low being 136 mEq/L), so these values do not need to be reported immediately. 223

what is the first step to reduce the risk for surgical infections?

skin preparations (because the skin is the bodies first line of defense)

A client in the preoperative holding room has received sedation and now needs to urinate. What action by the nurse is best? a. Allow the client to walk to the bathroom. b. Delegate assisting the client to the nurses aide. c. Give the client a bedpan or urinal to use. d. Insert a urinary catheter now instead of waiting.

C Although possibly uncomfortable or embarrassing for the client, the client should not be allowed out of bed after receiving sedation. The nurse should get the client a bedpan or urinal. The client may or may not need a urinary catheter. 234

A client who collapsed during dinner in a restaurant arrives in the emergency department. The client is going to surgery to repair an abdominal aortic aneurysm. What medication does the nurse prepare to administer as a priority for this client? a. Hydroxyzine (Atarax) b. Lorazepam (Ativan) c. Metoclopramide (Reglan) d. Morphine sulfate

C Reglan increases gastric emptying, an important issue for this client who was eating just prior to the operation. The other drugs are appropriate for any surgical client. 234

A nurse works on the postoperative floor and has four clients who are being discharged tomorrow. Which one has the greatest need for the nurse to consult other members of the health care team for post-discharge care? a. Married young adult who is the primary caregiver for children b. Middle-aged client who is post knee replacement, needs physical therapy c. Older adult who lives at home despite some memory loss d. Young client who lives alone, has family and friends nearby

C The older adult has the most potentially complex discharge needs. With memory loss, the client may not be able to follow the prescribed home regimen. The clients physical abilities may be limited by chronic illness. This client has several safety needs that should be assessed. The other clients all have evidence of a support system and no known potential for serious safety issues. 221

Which of the following would the nurse assess in a client with an intracapsular hip fracture? A- Internal rotation B- Muscle flaccidity C- Shortening of the affected leg D- Absence of pain the fracture area

C- Shortening of the affected leg

After teaching the client about risk factors for rheumatoid arthritis, which of the following, if stated by the client as a risk factor, would indicate to the nurse that the client needs additional teaching? A- History of Epstein-Barr virus infection B- Female gender C- Adults between the ages 60 to 75 years D- Positive testing for human leukocyte antigen (HLA) DR4 allele

C- Adults between the ages 60 to 75 years

An elderly client has sustained intertrochanteric fracture of the hip and has just returned from surgery where a nail plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is: A- It will be very painful for the client B- The soft tissue around the site will be damaged C- Displacement can occur with flexion D- It will pull the hip out of alignment

C- Displacement can occur with flexion

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would be the nurse most likely to asses: A- Limited motion of joints B- Deformed joints of the hands C- Early morning stiffness D- Rheumatoid nodules

C- Early morning stiffness

When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib (Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac (Voltaren), is that the celecoxib is likely to produce which of the following? A- Hepatotoxicity B- Renal toxicity C- Gastrointestinal bleeding D- Nausea and vomiting

C- Gastrointestinal bleeding

At which of the following times would the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation? A- At bedtime B- On arising C- Immediately after meal D- On an empty stomach

C- Immediately after meal

The client has Buck's extension applied to the right leg. The nurse plans which of the following interventions to prevent complications of the device? A- Massage the skin of the right leg with lotion every 8 hours B- Give pin care once a shift C- Inspect the skin on the right leg at least once every 8 hours D- Release the weights on the right leg for range of motion exercises daily

C- Inspect the skin on the right leg at least once every 8 hours

After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating which of the following? A- A developing infection B- Bleeding in the operative site C- Joint dislocation D- Glue seepage into soft tissue

C- Joint dislocation

The client with right sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the: A- Left hand and placing the cane in front of the left foot B- Right hand and placing the cane in front of the right foot C- Left hand and 6 inches lateral to the left foot D- Right hand and 6 inches lateral to the left foot

C- Left hand and 6 inches lateral to the left foot

A client has sustained a fracture of the femur and balanced skeletal traction with a Thomas splint has been applied. To prevent pressure points from occurring around the top of the splint, the most important intervention is to: A- Protect the skin with lotion B- Keep the client pulled up in bed C- Pad the top of the splint with washcloths D- Provide a footplate in the bed

C- Pad the top of the splint with washcloths

When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse interprets this as suggesting the occurrence of which of the following as most likely? A- Formation of scar tissue interfering with absorption B- Development of pus leading to ischemia C- Production of bacterial growth by avascular tissue D- Antibiotics not being instilled directly into the bone

C- Production of bacterial growth by avascular tissue

The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal traction is applied. Which of these priorities should the nurse include in the care plan? A- Order a trapeze to increase the client's ambulation B- Maintain the client in a flat, supine position at all times. C- Provide pin care at least every hour D- Remove traction weights for 20 minutes every two hours

C- Provide pin care at least every hour

A client presents in the emergency department after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best support this diagnosis. A- The client reports pain in the affected leg B- A large hematoma is visible in the affected extremity C- The affected extremity is shortened, adducted, and extremely rotated D- The affected extremity is edematous

C- The affected extremity is shortened, adducted, and extremely rotated

When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following first? A- The area proximal to the fracture B- The actual fracture site C- The area distal to the fracture D- The opposite extremity for baseline comparison

C- The area distal to the fracture

When the client is lying supine, the nurse will prevent external rotation of the lower extremity by using a: A- Trochanter roll by the knee B- Sandbag to the lateral calf C- Trochanter roll to the thigh D- Footboard

C- Trochanter roll to the thigh

A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate intervention would be to A- Read a story and act out the part B- Watch a puppet show C- Watch television D- Listen to the radio

C- Watch television

AREA: thoracoabdominal surgery

chest down - upper thigh

examples of curative surgery?

cholecystectomy appendectomy hysterectomy

THROMBOPHLEBITIS

CLOT FORMATION WITH VENOUS INFLAMMATION

The nurse is admitting a patient to the operating room. Which of the following nursing actions should be given highest priority by the nurse? Assessing the patient's level of consciousness Checking the patient's vital signs Checking the patient's identification and correct operative permit Positioning and performing skin preparation to the patient

Checking the patient's identification and correct operative permit Checking the patient's identification and correct operative permit should be given highest priority when admitting a patient to the operating room. This ensures that the right patient undergoes the right surgical procedures

Which of the following are not members of the sterile team in the operating room, except: Surgeon Scrub nurse Radiology technician Circulating nurse

Circulating nurse The anesthesiologist and circulating nurse are not members of the sterile surgical team. The surgeon, radiology technician, scrub nurse directly come in contact with the sterile field. They comprise the sterile surgical team

A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication. To detect early manifestations of compartment syndrome, which of these assessments should the nurse make? A- Observe the color of the fingers B- Palpate the radial pulse under the cast C- Check the cast for odor and drainage D- Evaluate the response to analgesics

D- Evaluate the response to analgesics

The diabetic patient who had undergone abdominal surgery experiences wound evisceration. Which of the following is the most appropriate immediate nursing action? Cover the wound with sterile gauze moistened with sterile normal saline Cover the wound with sterile dry gauze Cover the wound with water-soaked gauze Leave the wound uncovered and pull the skin edges together

Cover the wound with sterile gauze moistened with sterile normal saline Wound evisceration should be covered with sterile dressings moistened with normal saline to prevent drying and necrosis of protruding abdominal organs

A preoperative nurse is assessing a client prior to surgery. Which information would be most important for the nurse to relay to the surgical team? a.Allergy to bee and wasp stings b.History of lactose intolerance c.No previous experience with surgery d.Use of multiple herbs and supplements

D Some herbs and supplements can interact with medications, so this information needs to be reported as the priority. An allergy to bee and wasp stings should not affect the client during surgery. Lactose intolerance should also not affect the client during surgery but will need to be noted before a postoperative diet is ordered. Lack of experience with surgery may increase anxiety and may require higher teaching needs, but is not the priority over client safety. 228

Who may be in charge during some types of specialty surgeries? (orthopedic/ cardiac/ opthalmologic surgeries)

specialty nurses they usually provide specific nursing care during surgery (like: assess and recommends equipment)

A client in the PACU with a left below the knee amputation complains of pain in her left big toe. Which of the following would the nurse do first? A- Tell the client it is impossible to feel the pain B- Show the client that the toes are not there C- Explain to the client that the pain is real D- Give the client the prescribed narcotic analgesic

D- Give the client the prescribed narcotic analgesic

The client with an above the knee amputation is to use crutches until the prosthesis is properly lifted. When teaching the client about using the crutches, the nurse instructs the client to support her weight primarily on which of the following body areas? A- Axillae B- Elbows C- Upper arms D- Hands

D- Hands

After teaching the client with severe rheumatoid arthritis about the newly prescribed medication methotrexate (Rheumatrex O), which of the following statements indicates the need for further teaching? A- "I will take my vitamins while I am on this drug" B- "I must not drink any alcohol while I'm taking this drug" C- "I should brush my teeth after every meal" D- "I will continue taking my birth control pills"

D- "I will continue taking my birth control pills"

The nurse is giving the client with a left cast crutch walking instructions using the three point gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the: A- Left leg and right crutch then right leg and left crutch B- Crutches and then both legs simultaneously C- Crutches and the right leg then advance the left leg D- Crutches and the left leg then advance the right leg

D- Crutches and the left leg then advance the right leg

A client with fracture develops compartment syndrome. When caring for the client, the nurse would be alert for which of the following signs of possible organ failure? A- Rales B- Jaundice C- Generalized edema D- Dark, scanty urine

D- Dark, scanty urine

Which of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bandage above the amputation site? A- Elevate the stump B- Reinforcing the dressing C- Calling the surgeon D- Drawing a mark around the site

D- Drawing a mark around the site

To prevent foot drop in a client with Buck's traction, the nurse should: A- Place pillows under the client's heels. B- Tuck the sheets into the foot of the bed C- Teach the client isometric exercises D- Ensure proper body positioning

D- Ensure proper body positioning

When completing the history and physical examination of a client diagnosed with osteoarthritis, which of the following would the nurse assess? A- Anemia B- Osteoporosis C- Weight loss D- Local joint pain

D- Local joint pain

While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all the following conditions. Which assessment finding requires immediate notification of the physician? A- Moderate pain, as reported by the client B- Report, by client, the heat is being felt under the cast C- Presence of slight edema of the toes of the casted foot D- Onset of paralysis in the toes of the casted foot

D- Onset of paralysis in the toes of the casted foot

When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to instruct the client to avoid during the rest periods? A- Proper body alignment B- Elevating the part C- Prone lying positions D- Positions of flexion

D- Positions of flexion

The morning of the second postoperative day following hip surgery for a fractured right hip, the nurse will ambulate the client. The first intervention is to: A- Get the client up in a chair after dangling at the bedside. B- Use a walker for balance when getting the client out of bed C- Have the client put minimal weight on the affected side when getting up D- Practice getting the client out of bed by having her slightly flex her hips

D- Practice getting the client out of bed by having her slightly flex her hips

Which of the following would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc? A- Informing the client that the procedure is painless B- Taking a thorough history of past surgeries C- Checking for previous complaints of claustrophobia D- Starting an intravenous line at keep-open rate

D- Starting an intravenous line at keep-open rate

The client with an above the knee amputation is to use crutches until the prosthesis is being adjusted. In which of the following exercises would the nurse instruct the client to best prepare him for using crutches? A- Abdominal exercises B- Isometric shoulder exercises C- Quadriceps setting exercises D- Triceps stretching exercises

D- Triceps stretching exercises

The nurse has taught the client with a below the knee amputation about prosthesis and stump care. The nurse evaluates that the client states to: A- Wear a clean nylon stump sock daily B- Toughen the skin of the stump by rubbing it with alcohol C- Prevent cracking of the skin of the stump by applying lotion daily D- Using a mirror to inspect all areas of the stump each day

D- Using a mirror to inspect all areas of the stump each day

One method of assessing for sign of circulatory impairment in a client with a fractured femur is to ask the client to: A- Cough and deep breathe B- Turn himself in bed C- Perform biceps exercise D- Wiggle his toes

D- Wiggle his toes

PERIOPERATIVE

DESCRIBES THE ENTIRE SPAN OF SURGERY, INCLUDING BEFORE, DURING & AFTER

stage 4: danger

DO NOT WANT TO GET TO THIS STAGE ↓ vital functions/ resp fail/ cardiac arrest/ apnea/ pupils are fixed & dilated/ possible death **prepare/assist with treatment for cardiac/ pulmonary arrest **document everything in pts charts

what drugs are commonly allowed with a sip of water before surgery?

DRUGS FOR: cardiac disease respiratory disease seizures hypertension

What 3 techniques can you use to loosen secretions/ breath better after a surgery to prevent pneumonia (perioperative respiratory care)?

Deep (Diaphragmatic) Breathing Expansion Breathing Splinting of the Surgical Incison

complications of chronic steroid therapy

Diabetes mellitus Infection fluid and electrolyte imbalances hypertension osteoporosis glaucoma

calculating NG tube drainage formula?

Drainage in collection device — Amount of irrigant =True (actual) amount of drainage

During the first 24 hours after an above-the-knee amputation for vascular disease, nursing priority for stump care would be: Elevating to reduce edema. Initiating fitting for prosthesis. Inspecting for redness and pressure points. Cleansing with soap and water.

Elevating to reduce edema. Elevating to reduce edema is correct because reducing edema will promote healing and prevent complications.During the early postoperative period, pressure would not be the first concern. If edema develops, breakdown will be more likely. Wound will not be cleansed within the first 24 hours. The stump is wrapped securely after surgery, and the dressing would be reinforced if needed.Prosthesis will not be indicated until there has been sufficient healing.

what drugs are giving for moderate sedation?

Etomidate (Amidate) diazepam (Valium) midazolam (Versed) fentanyl (sublimaze) alfentanil (Alfenta) propofol (Diprivan) morphine sulfate

The nurse assesses which of the following clinical manifestations in a client with osteomyelitis? Select all that apply: Fever Petechial Restlessness Night sweats Nausea Cool extremities

Fever Restlessness Night sweats Nausea Osteomyelitis is an infection of the bone characterized by both local and systemic manifestations. Systemic manifestations include fever, chills, night sweats, nausea, malaise, and restlessness.

what begins to form as osteoarthritis progresses?

Fissures, calcifications, & ulcerations develop & the cartilage thins

The patient had undergone spinal anesthesia for appendectomy. To prevent spinal headache, the nurse should place the patient in which of the following positions? Semi-Fowler's Flat on bed for 6 to 8 hours Prone position Modified Trendelenburg position

Flat on bed for 6 to 8 hours To prevent headache after spinal anesthesia, the client should be placed lat on bed for 6 to 8 hours

A postoperative client receives a dinner tray with gelatin, pudding, and vanilla ice cream. Based on the foods on the client's tray, what would the nurse anticipate the client's current diet order to be: Bland diet Soft diet Full liquid diet Regular diet

Full liquid diet A full liquid diet includes and foods that are liquid at room temperature

examples of an emergent surgery?

GSW/ stab wound severe bleeding abdominal aortic aneurysm compound fracture appendectomy

To prevent complications of immobility, which activities would the nurse plan for the first postoperative day after a colon resection? Turn, cough, and deep breathe every 30 minutes around the clock Get the client out of bed and ambulate to a bedside chair Provide passive range of motion three times a day It is not necessary to worry about complications of immobility on the first postoperative day

Get the client out of bed and ambulate to a bedside chair Weight bearing increases the vascular tone and decreases venous stasis, thereby preventing thrombi from developing; the increase in activity increases respiratory expansion and quality of breathing

A client is scheduled for surgery in the morning. Preoperative orders have been written. What is the most important to do before surgery? Remove all jewelries or tape wedding ring Verify that all laboratory work is complete Inform family or next of kin Have all consent forms signed

Have all consent forms signed Consent forms must be signed by the client, family, or guardian with medical power of attorney before any procedure can be done of the client

Which of the following items on a client's presurgery laboratory results would indicate a need to contact the surgeon? Platelet count of 250,000/cu.mm Total cholesterol of 325 mg/dl Blood urea nitrogen (BUN)) 17 mg/dl Hemoglobin 9.5 mg/dl

Hemoglobin 9.5 mg/dl The hemoglobin level is low, and the nurse needs to make sure that the surgeon has the most recent laboratory values before surgery. This client may need transfusion before surgery

Which of the following is most dangerous complication during induction of spinal anesthesia? Cardiac arrest Hypotension Hyperthermia Respiratory paralysis

Hypotension Hypotension is the most dangerous complication of induction of spinal anesthesia. This is due to paralysis of vasomotor nerves

INTRAOPERATIVE

INCLUDES THE ENTIRE SURGICAL PROCEDURE UNTIL TRANSFER TO THE RECOVERY AREA

The OR layout helps prevent what?

INFECTIONS by: -reducing the contaminents in the air -keeping recommended temp & humidity levels -limiting the traffic & activity levels down -use of safety straps for the pt -the OR bed is locked in place -blankets there used for preventing hypothermia -have devices to help prevent skin breakdown

MALIGNANT HYPERTHERMIA

INHERITED DISORDER OCCURS WHEN BODY TEMPERATURE, MUSCLE METABOLISM & HEAT PRODUCTION INCREASE RAPIDLY, PROGRESSIVELY, & UNCONTROLLABLY IN RESPONSE TO STRESS & SOME ANESTHETIC AGENTS

Which of the following factors ensure validity of informed written consent, except: The patient is of legal age with proper mental disposition If the patient is a child, secure consent from the parents or legal guardian The consent is secured before administration of preoperative medications If the patient is unable to write, the nurse signs the consent for the patient

If the patient is unable to write, the nurse signs the consent for the patient These are the factors that ensure validity of a written consent. The nurse may sign as a witness, but she is not legally allowed to sign the consent for the patient They may sign with an X.

A client has been hospitalized after an automobile accident. A full leg cast was applied in the emergency room. The MOST important reason for the nurse to elevate the casted leg is to ? Decrease irritation to the skin Promote the client's comfort Improve venous return Reduce the drying time

Improve venous return Improve venous return is the correct option. Elevating the leg both improves venous return and reduces swelling.

SCIP focuses on what?

Infection prevention, prevention of serious cardiac events, & DVT/VTE

The client is diagnosed with osteoarthritis. Which sign/symptom should the nurse expect the client to exhibit? Waddling gait. Swan-neck fingers. Joint stiffness. Severe bone deformity.

Joint stiffness. Pain, stiffness, and functional impairment are the primary clinical manifestations of OA. Stiffness of the joints is commonly experienced after resting but usually lasts less than 30 minutes and decreases with movement.Severe bone deformity is seen in clients diagnosed with rheumatoid arthritis.A waddling gait is usually seen in women in their third trimester of pregnancy or in older children with congenital hip dysplasia.Swan-neck fingers are seen in clients with rheumatoid arthritis.

effusions

Joint swelling with fluid (especially the knees)

Stage 2: excitement/ delirium

LOC/ regular breathing/ ↓ eyelid reflexes/ can have some involuntary movement of extremities **assist the anesthesiologist with suctioning PRN **stay with pt

The best position for kidney, chest, or hip surgery is: Supine Trendelenburg Lithotomy Lateral

Lateral Lateral position is indicated in kidney, chest, or hip surgery

OA **

Older than 60 yrs Degenerative unilateral (single) Nonsystemic

Lyme disease

Reportable systemic infectious disease from a tick Flu like symptoms Erythema mirgrans (round flat slightly raised rash) Pain and stiffness in muscles and joints ~ 1 bulls eye lesion Symptoms start 3-30 days after the tick bite Treatment: Antibiotics (doxycycline/ amoxicillin/ E-mycin) If not treated: Carditis/ dysrhythmias/ dyspnea/ dizzy/ palpitations/ meningitis/ facial paralysis/ --> arthritis/ fatigue/ memory loss

In the recovery room, the postoperative client suddenly becomes cyanotic. What is the most appropriate nursing action? Start administration of oxygen through a nasal cannula Call for assistance Reposition the head and determine patency of airway Insert an oral airway and suction the nasopharynx

Reposition the head and determine patency of airway It is important to determine if the airway is patent and whether the client is breathing. If there is a lot of mucus and gurgling in the upper airway, the client should be suctioned. The airway must be assessed before determining a course of action

Because a client has bursitis, plans for nursing interventions should include? Rest. Aggressive antibiotic therapy. A high-protein diet. range-of-motion activities.

Rest Bursitis is inflammation of the bursa (small sacs of the connective tissues lined with synovial fluid). Bursitis is generally the result of some kind of mechanical injury and is most successfully treated by rest.

RICE

Rest Ice Compression Elevate

what are the 4 stages of general anesthesia?

Stage 1: sedation/ relaxation Stage 2: excitement/ delirium Stage 3: operative anesthesia/ surgical anesthesia stage 4: danger

A client has bilateral knee pain from osteoarthritis. In addition to taking the prescribed NSAID, the nurse should instruct the client to: Start a regular exercise program Keep legs elevated when sitting Avoid foods high in citrus acid Rest the knees as much as possible to decrease inflammation

Start a regular exercise program A regular exercise program is beneficial in treating osteoarthritis. It can restore self-esteem and improve physical functioning.

The nurse will provide preoperative teaching on deep breathing, coughing and turning exercises. When is the best time to provide the preoperative teachings? Before administration of preoperative medications The afternoon or evening prior to surgery Several days prior to surgery Upon admission of the client in the recovery room

The afternoon or evening prior to surgery The best time to provide preoperative teaching is the afternoon or evening prior to surgery. This time, the patient had finished undergoing different laboratory and diagnostic procedures. Therefore, he/she can now concentrate on the teachings. Teachings given days before surgery may tend to be forgotten. Teachings given before administration of preoperative medications may not be understood anymore because the anxiety level more likely is high during this time

Minimally invasive surgery (MIS) is a common practice & is now the preferred technique from many types of surgeries. what are some examples?

cholecystectomy cardiac surgery splenectomy spinal surgery cancer surgery (lobectomy/ pneumonectomy/ cholectomy)

AREA: head surgery

collar bones up excluding face

examples of palliative surgery?

colostomy nerve root resection tumor debulking ileostomy

Which of the following postoperative patients is at risk for respiratory complications? The obese patient with long history of smoking who had undergone upper abdominal surgery The patient with normal pulmonary function who had undergone upper abdominal surgery An adolescent patient with diabetes mellitus who had undergone cholecystectomy A football player who had undergone knee replacement surgery

The obese patient with long history of smoking who had undergone upper abdominal surgery Obesity and long history of smoking pose high risk for respiratory complications among postop clients. Upper abdominal incision is near the diaphragm. This usually inhibits deep breathing by the client due to anticipation of pain. This factor further contributes to risk for respiratory complications

Phalen's maneuver **used to diagnose CTS

The patient is asked to relax the wrist into flexion or to place the back hands together and flex both wrists at the same time IF CTS: fingers wont touch

Which of the following is experienced by the patient who is under general anesthesia? The patient is unconscious The patient is awake The patient experiences slight pain The patient experiences loss of sensation in the lower half of the body

The patient is unconscious During general anesthesia, the patient is unconscious, with complete analgesia (relief of pain). Loss of sensation in the lower half of the body is experienced by the patient who received spinal anesthesia

The nurse is caring for a patient who had undergone exploratory laparotomy. Which of the following postop findings should the nurse report to the physician? The patient pushes out the oral airway with his tongue The patient's urine output is 20 ml/hr for the past 2 hours The patient's vital signs are as follows: BP = 100/70 mmHg; PR = 95 bpm; RR = 9 minute; T = 36.8°C The patient's wound drainage

The patient's urine output is 20 ml/hr for the past 2 hours Urine output of 20 ml/hour for the past 2 hours should be reported to the physician. Oliguria may indicate postoperative bleeding. The normal urine output is 30 to 60 ml/hour

Tinel's sign **used to diagnose CTS

The same sensation can be created by tapping lightly over the area of the median nerve in the wrist IF CTS: pain

Which of the following assessment data is most important to determine when caring for a patient who has received spinal anesthesia? The time of return of motion and sensation in the patient's legs and toes The character if the patient's respiration The patient's level of consciousness The amount of wound drainage

The time of return of motion and sensation in the patient's legs and toes The most important assessment data to determine in a patient who has received spinal anesthesia is the time of return of motion and sensation in the patient's legs and toes. This indicates recovery from the spinal anesthesia

The nurse, assisting in applying a cast to a client with a broken arm, knows that? The cast material should be dipped several times into the warm water The casted extremity should be placed on a cloth-covered surface The wet cast should be handled with the palms of hands The cast should be covered until it dries

The wet cast should be handled with the palms of hands Handle cast with palms of the hands and lift at 2 points of the extremity. This will prevent stress at the injury site and pressure areas on the cast.

Which of the following is the primary purpose of maintaining NPO for 6 to 8 hours before surgery? To prevent malnutrition To prevent electrolyte imbalance To prevent aspiration pneumonia To prevent intestinal obstruction

To prevent aspiration pneumonia NPO for 6 to 8 hours before surgery prevents vomiting, regurgitation of gastric content. Therefore, this prevents aspiration pneumonia. The primary purpose for maintaining NPO before surgery is to prevent aspiration pneumonia

The nurse is transferring the patient from the postanesthesia care unit to the surgical unit. Which of the following is the primary reason for gradual change of position of the patient? To prevent muscle injury To prevent sudden drop of blood pressure To prevent respiratory distress To promote comfort

To prevent sudden drop of blood pressure Gradual change of the patient's position during transfer primarily prevents sudden drop of blood pressure

A complication of Buck's extension traction would be noted by a nurse if: Dorsiflexion developed in the affected foot. Skin over the fracture site was flushed. Redness and purulent drainage appeared at the pin site. Toes of affected leg became dusky in color.

Toes of affected leg became dusky in color. Buck's is skin traction to the lower leg. Circulatory disturbances and skin abrasions are the most important nursing concerns.Buck's is skin traction, not skeletal traction, which uses pins.Buck's is skin traction using an elastic bandage. The fracture site would not be visible.Buck's uses a foam boot to support the foot of the affected extremity in a dorsiflexed position. This position is, therefore, not a complication.HINT: Choose the option that describes a problem from traction that is applied externally. If too tight, a limb becomes dusky, not flushed.

Gallium

Type of bone scan Most common Can migrate to brain, liver, and breast tissue Bones reabsorb it slowly- so it should be admin 4-6 before the scan Other contrasts should not be given during Pt needs to lie still during the test

Thallium

Type of bone scan ~ used for diagnosis of MI, but can be used ti evaluate cancer in the bones Pt needs to lie still during the test

The nurse is preparing a client for surgery. What is the most effective method for obtaining an accurate blood pressure reading from the client? Obtain a cuff that covers the upper one third of the client's arm Position the cuff approximately 4 inches above the antecubital arm Use a cuff that is wide enough to cover the upper two thirds of the client's arm Identify the Korotkoff sounds, and take a systolic reading at 10 mmHg after the first sound

Use a cuff that is wide enough to cover the upper two thirds of the client's arm To obtain an accurate reading in an adult, the blood pressure cuff should cover the upper two thirds of the client's arm; it should be positioned approximately 2 inches above the antecubital space

PARALYTIC ILEUS

WHEN THE INTESTINES ARE PARALYZED & PERISTALSIS IS ABSENT

how do anesthesiologist rank pts?

based on current health, presence of disease, & disorders P1: totally healthy pt P6: brain dead pt this system is used to estimate potential risks/ outcomes for pts

Greenstick fracture

a break in soft bone that does not completely severe the bone itself (bone is hard to break completely across, like breaking a greenstick).

Nondisplaced fracture (closed)

a break or crack in the bone that does not shift the bone out of place.

what do you start the pts assessment with?

a complete set of vital signs (for baseline data)

interrupted sutures

a series of individual stitches all next to each other

endoscope

a tube that allows viewing & manipulation of internal body (used during MIS) -they may be regid, semirigid, or flexible, & may also have a light on them

causes of primary OA?

aging & genetic factors

what drug would they give a pt if procedures are long, or stress ulcers are likely

an H2 histamine blocker cimetidine (Tagamet) OR ranitidine (Zantac)

what is another easy way to encourage the pt to take deep breaths after surgery?

an Incentive Spirometer (its purpose is to promote complete lung expansion & prevent pulmonary problems)

Ischemia

an inadequate blood supply to an organ or part of the body

what is anesthesia?

an induced state of partial or total loss of sensory perception, with or without loss of consciousness.

Compression fractures

are produced by a loading force applied to the long axis of cancellous bone (commonly occur in the vertebrae of older adults with osteoporosis... VERY painful)

what is the optimal cool room air temp & low humidity level to keep in the OR to help protect from fire hazards?

cool room temp: 68° - 73° low humidity level: 30% - 60%

Eventually the cartilage disintegrates and pieces of the bone and cartilage "float" in the diseased joint causing____?

crepitus a grating sound caused by the loosened bones and cartilage

what are some things facilities can allow the pt to be worn into the surgical suite to prevent embarrassment?

dentures wigs glasses

SCIP CARD- 2

do not abruptly stop beta blockers before surgery (causes more issues than the complications during surgery) drink with a small gulp of water

Stage 1: sedation/ relaxation

drowsy/ dizzy/ ↓ sensation/ exaggerated hearing/ leading to LOC **keep discussions to a minimum (promotes relaxation) **secure pt with safety belt

best tool currently available for a definite diagnosis of osteoporosis

dual x-ray absorptiometry (DXA or DEXA)

signs of malignant hyperthermia

dysrhythmias/ muscle lock up/ ↓ BP/ ↑ breathings/ skin mottling/ cyanosis/ myoglobinuria ** ↑ in CO2 ** ↓ in O2Sat ** tachy ** ↑ temp (111.2°F)

AREA: unilateral chest surgery

entire front chest/stomach & half of back

how often can you do "coughing and splinting" exercises with deep breathing after surgery?

every 1-2 hrs

what is a fat embolism?

fat globules released from yellow bone marrow into the bloodstream within 12-48 hrs after the injury/illness the globules clog small blood vessels that supply vital organs usually from fractures of the long bones

stage 5 of bone healing

final stage of healing, consolidation and remodeling of bone continues to meet mechanical demands. This process may start as early as 4 to 6 weeks after fracture and can continue for up to 1 year, depending on the severity of the injury and the age and health of the patient

AREA: genitourinary surgery

from above bellybutton - mid thigh around perineal area

retention bridges

helps to hold together a larger/ more open wound a cross section for multiple lines of stitching

what kind of surgeries should you avoid doing coughing exercises after?

hernia repair craniotomy (the surgeon will write a "do not cough" prescription")

stridor

high pitched crowing sound

most affected areas of primary OA?

hips, knees, vertebrae, hands

Arthrocentesis:

joint aspiration for synovial fluid analysis, medication (corticosteroid) instillation to help joint inflammation. The nurse should rest the joint after injection and bandage it for the first 24 hours. Informed consent must be given by the patient. The hope is that the aspirated fluid has a white blood cell (WBC) count of less than 200.

causes of secondary OA?

joint injury & obesity athletics over use manual occupations metabolic diseases blood disorders

genu valgum

knock knee

what can a pt with an allergy to avocados, bananas, strawberries, and other fruits also be allergic to?

latex

supine position

laying flat on back

prone position

laying flat on stomach with head to the side

trendelenburg

laying on back with knees slightly bent down

lithotomy position

laying on back, with knees bend @ 90° angle up

lateral position

laying on side with leg on the bottom bent a little for better support

jacknife postion

laying on stomach with arms spread out to sides and legs bend below him (as if kneeling)

examples of cosmetic surgery?

liposuction revision of scars rhinoplasty blepharoplasty

Stage 3: operative anesthesia/ surgical anesthesia

loss of reflexes/ ↓ vital functions/ jaw relaxes/ quiet & regular breaths/ cannot hear/ sensations (pain) are lost **assist the anesthesiologist with intubation **place pt into position **prep skin

osteopenia

low bone mass

arthroscopy

may be used as a diagnostic test or surgical procedure. a fiberoptic tube is inserted into a joint for direct visualization of the ligaments, menisci, & articular surfaces of the joint The knee & shoulder are usually elevated

quantitative ultrasound (QUS)

may be used in determining fractures or bone density

amnesia

memory loss of the surgery

what drug is used for rapid emptying of the stomach?

metoclopramide (Reglan)

if a pt is dabetic what might they decide to do for them before surgery?

might be given a lower dose of intermediate or long-acting insulin (or possibly regular divided into doses throughout the day)

Pathologic fracture

minimal trauma to bone weakened by disease (common with bone cancer).

tendons

muscle to bone

what is the most important thing to asses when they have a musculoskeletal issue?

neurovascular (circ check) palpation of pulses in the extremities below the level of injury and assessment of sensation, movement, color, temperature, and pain in the injured part. If pulses are not palpable, use a Doppler to find pulses in the extremities.

heberdens nodes

nodules at the distal finger joint (OA)

bouchards nodes

nodules at the proximal finger joint (OA)

what does NPO mean?

nothing by mouth (not even water) no smoking (nicotine stimulates GI secretions) *it decreases the risk for aspiration*

what is a blood clot?

obstruction of the pulmonary arteries by blood clots can occur any time ~most fatal complication from MS surgery ~DVT in legs or pelvis

stage 3 of bone healing

occurs as a result of vascular cell proliferation. The fracture site is surrounded by new vascular tissue known as a callus (within 3 to 6 weeks). Callus formation is the beginning of a nonbony union.

stage 2 of bone healing

occurs in 3 days to 2 weeks when granulation tissue begins to invade the hematoma. This then prompts the formation of fibrocartilage, providing the foundation for bone healing.

factors that increase the risk of surgical complications?

older than 65 y/o antihypertensives (BP) tricyclic antidepressants anticoagulants (increase bleeding) NSAIDs (increase bleeding) herbal remedies ↓ immunity diabetes pulmonary disease cardiac disease hemodynamic instability coag defect/ bleeding disorder anemia dehydration hypertension hypotension any chronic diseases drug/ tobacco/ alcohol abuse malnutrition obesity cancer malignancy hyperthermia ↓ than optimal emo rxn to past surgeries past anesthesia complications past post op complications

Impacted fracture

one fragment of the bone is driven into the other fragment.

someone with _____ should not be allowed to participate in surgery?

open wound cold or any infection

where is the OR located in case of emergencies?

out of the mainstream with low traffic flow near the PACU and support services (lab/ blood bank/pathology)

analgesia

pain relief / pain suppression

An older client is hospitalized after an operation. When assessing the client for postoperative infection, the nurse places priority on which assessment? a.Change in behavior b.Daily white blood cell count c.Presence of fever and chills d.Tolerance of increasing activity

people have an age-related decrease in immune system functioning and may not show classic signs of infection such as increased white blood cell count, fever and chills, or obvious localized signs of infection. A change in behavior often signals an infection or on set of other illness in the older client. 221

what does PACU stand for

post anesthesia care unit

what can a pt with a shellfish allergy also be allergic to?

povidone-iodine (for skin cleaning)

what can a pt with an allergy to eggs, peanut, or soy can also be allergic to?

propofol (Diprivan) (an anesthetic/ sedative)

CT scan:

provides a three dimensional (3D) scan, that is mainly used for vertebral and joint scans. Be sure to check the patient allergies because dye is used in a CT scan and can lead to an allergic reaction. (shellfish) Also, any metal on the patient must be removed before the scan. Do not give a CT scan if they have increased creatinine levels. Can do wiht or without iodine

Arthroscopy:

provides an endoscopic exam and is an invasive procedure. The patient must be provided informed consent for this procedure and be NPO (nothing by mouth). After the exam the joint must be restricted from range of motion (ROM) for the first 24 hours. The joint should be elevated, ice should be applied, and weight bearing activities should be limited. Be sure to watch for swelling, increased joint pain, deep vein thrombosis (DVT), and infection.

what information must be verified by all members of the surgical team? (minimum)

pts identity correct side correct site correct pt position agreement on the procedure

Minimally invasive surgery (MIS) is a common practice & is now the preferred technique from many types of surgeries. what are some of the benifits?

reduced surgery time smaller incisions reduced blood loss faster recovery time less pain after the surgery

it has the pts right to______

refuse treatment for any reason (even when refusal might lead to death)

what is the most important assesment to perform after the surgery? (with anesthesia used)

repiratory

Fatigue (stress) fracture

results from excessive strain and stress on the bone (common in recreational and professional athletes).

acute compartment syndrome

serious condition where there is increased pressure in a compartment of the body (muscles/ blood vessels/ nerves)

AREA: forearm/ elbow/ hand surgery

shoulder down

stage 4 of bone healing

the callus is gradually resorbed and transformed into bone. The callus hardens because calcium levels increase and move in. This stage usually takes 3 to 8 weeks.

X-ray:

the most commonly used imaging device to determine density, particularly with joints and vertebrae. Inform the patient that the x ray table is hard and cold and instruct them to remain still. The patient should not have any metal on and should be informed that it can have negative effects if they are pregnant.

what should you keep in mind for a pt with bowel preparations?

the process to prepare their bowels is exhausting, so put them on fall precautions

a specially trained person who is not a nurse may perform _______?

the scrub role they are called "operating room technicians"(ORTs) or "surgical technologists" "certified surgical technologists" (CSTs) usually work in the OR

who has to mark the correct site?

the surgeon

who is responsible for getting the consent form signed before sedation is giving/ the surgery is performed?

the surgeon

since the pt is unable to protect themselves from injury during the surgery, who is responsible to keep them safe?

the surgical team

what is the purpose of anesthesia?

to block nerve impulse transmission, suppress reflexes, promote muscle relaxation, and in some cases, achieve a controlled level of unconsciousness

why do some facilities allow hearing aids into the surgical suites?

to help allow for communication before and after surgery (but make sure that the surgical nurse knows about it so it does not get lost)

Comminuted (fragmented) fracture

top bone pushes into the bottom bone causing it to shatter from extreme force.

examples of restorative surgery?

total knee replacement finger resection

norm WBC count (leukocyte count)

total: 5,000-10,000/mm3

what is regional anesthesia?

type of local anesthesia that blocks multiple peripheral nerves & reduces sensory perception in a specific body region **watch for CNS depression **use a fast acting barbituate for treatment **use epinephrine to prevent cardiac arrest (pts with brady)

what areas would you avoid electrocautery pads placed on?

under where a joint replacement was on bony prominences hair tattoos weight-bearing surfaces pressure points scar tissue metal piercings

what three zones are there to help protectf rom contamination in the OR?

unrestricted semirestricted restricted

what are the most common tests done before surgery?

urinarysis blood type/ screen complete blood count H&H (hemoglobin & hematocrit) clotting studies (PT/ INR/ aPTT/ platelet count) electrolyte levels serum creatinine/ blood urea nitrogen levels (BUN) pregnancy test

what all can and endoscope do?

used for examination obtaining specimens for biopsy organ removal reconstruction blood vessel grafting cutting suturing stapling cauterizing laser surgery

MRI:

uses radio waves and magnetic fields to diagnose musculoskeletal disorders. Remove all metal from the patient (including hearing aids) and keep the IV pole out of range of the scan.

when does the "postoperative period" cease?

when all activity restrictions are lifted (can continue home)

bursitis

when bursae become inflamed

what do you need to consider for an older pt?

↑ chronic illnesses ↑ malnutrition ↑ allergies harder for them to complete ADLs & self-care abilities ↓ able to handle the stress of surgery/ anesthesia ↑ risk of cardiopulmonary complications after surgery risk for change in mental status when admitted (change in routine/ unfamiliar surroundings) ↑ risk for a fall due to surgery

signs & syndromes of compartment syndrome

↑ pressure edema pink tissue pulses present (but unequal) exaggerated pain (not fixed by drugs) pallor flexed posture tense muscles cyanosis tingling numbness paralysis

what can hyerkalemia do to a pt undergoing surgery?

↑ risk for arrhythmias (especially with anesthesia)

what can hypokalemia do to a pt undergoing surgery?

↑risk for digoxin toxicity slows the recovery from anesthesia ↑ cardiac irritability