PN 2003 MIDTERM
Cystoscopy
(endoscopic) visual examination of the urinary bladder
Risk factors for malignant hyperthermia
- Personal or family history of MH - Personal or family history of muscle of neuromuscular disorders (Duchene's or Becker's) - History of dark of cola-colored urine following previous anesthesia or exercise - strong, bulky muscles
Common post op problems
- airway compromise - breathing/respiratory insufficiency - cardiac compromise - neurological compromise - hypothermia - pain, nausea/vomting - wound dehiscence and delayed healing - side effects of analgesia
Caudal block
local anaesthetic injected into sacral hiatus (end bit of epidural)
Spinal anaesthesia mode of delivery
local anaesthetic inserted between L4/5, goes into spinal fluid in (subarachnoid space)
Local anaesthesia mode of delivery
local anaesthetic to specific part of the body, injected or topical
Epidural anaesthesia mode of delivery
local anesthetic injected in epidural space, around L5
Regional anaesthesia mode of delivery
nerve block to a specific area
Neurovascular signs Q shift
neuro assessment done every shift
NPO
nothing by mouth
Interagency transfer
one health facility to another ambulance, taxi, air ambulance (need equipment or IV required) or commercial flight, family member may transfer (if client is stable)
Intra-agency transfer
one unit to another give/receive report and condition of client (know why transfer is happening), ensure safe ABCs and client stability, hook up anything required (O2), notify family
Dysuria
painful or difficult urination
Proper way for PACU nurse to check for patients breathing
place hand above mouth/nose and feel for exhalation as chest movement may not be noticable
Perioperative and nurses role
pre-admission, health history, preparation for OR, diagnostics, pre-anaesthetic medication prior to surgery may be ordered nurses role: teaching!!, stress reduction, history gathering, ensure consent signed, explain pre and post op procedures, explain OR and post op care
What is the leading cause of post op morbidity and mortality and how is it prevented
pulmonary complications, exercise
urodynamics
recording of the force and flow of urine (for voiding problems)
culture and sensitivity (C&S)
shows which antibiotics will be most effective
Why is it important to assess the patient for use of herbal products prior to surgery When should they stop taking them before a surgery
some herbal medications can have potentially lethal interactions or affect blood clotting abilities stop taking 2-3 weeks before
What do xrays of kidney, ureter and bladder reveal
stones, enlarged kidney, tumours
Urge incontinence
sudden desire to urinate eg. UTI
Anuria
suppression or arrest of urine obstruction
How can surgery affect BGL What BGL level is the goal
surgery is stressful and can increase BGL hypoglycemia may develop during anaesthesia or post op from inadequate carbs or excessive administration of insulin if patient develops a post op infection this can lead to hyperglycemia maintain BGL below 200mg/dl
Vesicostomy
surgical stoma of an opening into the bladder (may be formed when ureters are nonfunctional)
Clinical manifestations of malignant hyperthermia
tachycardia, dysrhythmias (particularly ventricular), hypotension, decreased cardiac output
Crossmatch
testing compatibility of the bloods or tissues of a donor and a recipient by mixing them together to determine the absence of agglutination reactions
Nuclear scans
tests using radioactivity
Who is required to ask the client to sign informed consent form for surgery Is anyone else present
the surgeon witness must be present, nurse can be it
What is the emergency treatment of suspected hypopharyngeal obstruction
tilt head back and push forward on the angle of the tongue as if to push the lower teeth in front of the teeth this pulls the tongue forward and opens the air passages
Step down unit
transfer; observation unit
Bladder scan
ultrasound to see how much urine is in the bladder and PRV
reflex urinary incontinence
unexpected voiding without awareness of the need to void spinal cord injury
Functional incontinence
unpredictable, involuntary passage or urine in the presence of normal bladder and urethral function eg. MS, mental deficiencies, ALS
Kock pouch
urinary diversion; surgical creation of a urinary bladder from a segment of the ileum
Ileal conduit
urinary diversion; the ureters are connected to the ileum with a stoma created on the abdominal wall
cutaneous ureterostomy
urinary diversion; the ureters are directed through the abdominal wall and attached to an stoma in the skin
V/S Q4H
vital signs taken every 4 hours
Polyuria
voiding large amounts of urine
Residual urine
volume of urine left in bladder after voiding PVR = post void residual
intravenous pyelogram (IVP)
x-rays of the urinary tract taken after iodine is injected into the bloodstream and as the contrast passes through the kidney, revealing obstruction, evidence of trauma, etc.
Discharge AMA
client decides to leave hospital against medication advice inform of any risk prior to leaving, notify doctor release of responsibility form must be signed by client
Urine examintation
color, clarity, odor, amount pH, specific gravity (sediments), protein, glucose, and ketones micro exam: RBC, WBC, pus, bacteria, crystals and casts
What do CT/MRI scans show
cross sectional views
Oliguria
decreased urinary output compared to intake
Hesitancy
difficulty initiating urination
DNR
do not resuscitate
What do patients do with valuables during preop
don't bring them, lock up or put away whatever is brought, could also leave items with family member
stress incontinence
dribbling of urine with increased abdominal pressure (eg. peeing a little while laughing) treatment is pelvic floor exercises
Nocturia
frequent urination at night
Release of responsibility form
hospital is no longer liable for possible risks when leaving early
retrograde pyelogram
image of the renal pelvis produced by injecting a contrast dye from the bladder to the kidney
What is the rationale for continuous monitoring of airway and breathing upon arrival to the PACU
immediate post op period patient, without adequate ventilation may experience hypoxemia (reduced oxygen) and hypercarbia (elevated CO2, especially those who have undergone prolonged general anesthesia
How often do you check vitals post op
immediately after, then every 15 minutes for the first hour or until stable, every 30 minutes the follow 2 hours and once a hour for the following 4 hours check every 4 hours for 24-48 hours (check orders)
Intrathecal goes where
in subarachnoid space between dura mater and spinal cord
Total incontience
inability to control urination due to cognitive impairment or non-functional urinary sphincter
Special care unit
increasing acuity (ICU, CCU)
General anaesthesia mode of delivery
inhalation or IV
I/O Q4H
input and output assessed every 4 hours
Keep O2 > 92%
keep sats above O2 raise HOB, increase oxygen, deep breathing, suctioning as per orders
Factors of preoperative stress
knowledge deficit causing anxiety, anger, anticipatory grieving (could be loss of limb),
Dribbling
leakage of urine despite voluntary control of urination
Factors affecting urinary elimination
lifestyle, cultural, developmental, physiological, psychosocial
Discharge responsibilities
- assess physical and psychosocial condition - teaching and evaluation (may include family) - instructions/demo - referrals, appointments made, follow up care - discharge data, time, mode of discharge, accompany person - signed release form or ama form
Surgical risks
- chronic resp or cardio disorders - diabetes - renal or liver disease - malnutrition or obesity - certain meds or drug abuse - nicotine or alcoholism
Intermittent (straight) aka in/out purpose and appearance
- drains bladder for short periods of time (5 to 10 sec) - used to obtain a sterile specimen - single lumen no balloon
Patient controlled analgesia
- external infusion pumped used to deliver opioid dose on client demand basis - safety features (key locked) - need for breakthrough pain control
Indwelling catheter (retention/foley) purpose and appearance
- gradual decompression of over distended bladder - continuous drainage - 2 or 3 lumen with baloon
Complications of epidural
- headache - introduced in wrong space
Latex allergy risk factors
- history of anaphylactic reaction of unknown etiology during medical procedure - multiple surgical procedures (especially from infancy) - allergies (particularly kiwi, bananas, avocado, chestnuts, poinsettia plants) - job with daily exposure to latex (medical, nursing, food handler, tire manufacture etc) - asthma
What does urinalysis show
- kidney function - if bacteria is present (what kind and how much)
Post op nursing care
- maintain airway - encourage deep breathing and coughing - promote tissue perfusion - alleviate pain/nausea - urinary elimination, prevent constipation - nothing by mouth until bowel sounds or according to orders - promote mobility and surgical recovery - prevent infection or complications
Post op teaching
- mobility - incentive spirometer (for breathing) - self care/wound care - pain management - follow up and resources - rehab and physical exercises - symptoms to be reported (included infection) - activities allowed and restricted (driving, intercourse) - medications: why when and how to take
Postoperative
- receive client and report condition including relevant preop stats (vitals, lab values, allergies) - medications given - estimated blood loss and replacement fluids - presence of tubes, drains, catheters, wound status, surgical complications
Non pharmacological pain management
- relaxation and guided imagery - distraction - biofeedback (smile) - cutaneous stimulation - herbals
What steps are take if a patient is displaying signs of malignant hypertehermia
- stop procedure/analgesic - give 100% oxygen due to patients hypermetabolic state (increasing oxygen demand and consumption) - muscle relaxants to treat increased muscle contractions (rigidity) - due to hypermetabolic state the patient develops metabolic acidosis which requires administration of sodium bicarbonate
Complications of spinal anaesthesia
- too much too fast to head - headache (lay flat) - hypotension - respiratory depression - arrest
Examples of post op exercise
- turning - deep breathing and coughing - incentive spirometer use - leg exercises
Preoperative assessment checklist
- vital signs - routine hygiene - allergy/ID band checked and on - hospital gown with no nail polish or jewellery, dentures out - consent form signed - charts prepared
Max bladder capacity
1 litre of urine
Size of male urethra
13-16 cm
How many mls in the bladder creates urge to void
200ml
Size of female urethra
3-6 cm
How many mls in the bladder is uncomfortable
300ml
When and why should someone stop taking aspirin before a surgery
7-10 days before because it is a blood thinner
Increased frequency of voiding
<2 hours
IV N/S at 135ml/hr
IV with normal saline 135 ml/hour
Narcan
Naloxone; Opioid antagonist, antidote
Can students act as a witness for a consent form
No, the must have a licensed buddy nurse with them to witness
Wong/baker faces scale
a pain assessment tool that asks patients (often children) to select one of five faces indicating expressions that convey a range from no pain through the worst pain
Advanced directives
a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.
Retention
accumulation of urine in the bladder, unable to empty fully
Take out poley catheter after 24H, assess output prior to removal
before taking out catheter assess the drainage bag for amount, color, clarity, and odor of urine, document accordingly
Epidural catheter goes where
between vertebral canal and dura mater
Components of health history
biological data, chief complaint, history of present illness, systems assessment, lifestyle, psychological data, patterns of health
Hematuria
blood in the urine
Hypopharyngeal obstruction
can happen with after general anaesthetic, back of tongue and back of throat over relax and block air passage worse supine
Clinical manifestations that correlate to hypopharyngeal obstruction
choking, noisy and irregular respirations, decreased O2 sats, and cyanosis of mucous membranes
Normal urine characteristics and production speed
clear yellow, no odor, ~30 ml/hour