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