Med Surg 1 Flashcards
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Questions and Answers

What is the primary purpose of the patient preoperative interview?

  • Provide and clarify info about the surgery (correct)
  • Assess the patient's emotional state and readiness for surgery (correct)
  • Ensure the patient's consent form has been signed and appropriate lab tests are done (correct)
  • Obtain the patient's health information (correct)

    • What are the most common psychological factors?

    Anxiety, fear, and hope.

    What are the important things to ask during a past health history?

    Previous medical problems, last menstrual cycle, obstetric history, inherited traits, family history of cardiac and endocrine diseases, and adverse reactions/problems with anesthesia.

    What are the important systems to look at during a review of systems?

    <p>Cardiovascular, respiratory, neurological, genitourinary, hepatic, integumentary, musculoskeletal, immune, electrolyte status, and nutritional status.</p> Signup and view all the answers

    What are the different physical status ratings for anesthesia administration?

    <p>P1 - normal healthy person, P2 - patient with mild systemic disease, P3 - patient with severe systemic disease, P4 - patient with severe systemic disease that is a constant threat to life, P5 - moribund patient who is not expected to survive without surgery, P6 - declared brain-dead patient whose organs are being removed for donor purposes.</p> Signup and view all the answers

    What is the purpose of ABGs and pulse oximetry?

    <p>Assesses respiratory and metabolic function, O2 status.</p> Signup and view all the answers

    What is the purpose of blood glucose testing?

    <p>Assesses metabolic status, diabetes mellitus.</p> Signup and view all the answers

    What is the purpose of BUN and creatinine testing?

    <p>Assesses renal function.</p> Signup and view all the answers

    What is included in a CBC and what is its purpose?

    <p>RBCs, hemoglobin, hematocrit, white blood count. Assesses immune status, infection.</p> Signup and view all the answers

    What is the purpose of an electrocardiogram?

    <p>Assesses cardiac disease, dysrhythmias.</p> Signup and view all the answers

    Why do we check electrolytes?

    <p>Assesses metabolic status, renal function, diuretic side effects.</p> Signup and view all the answers

    Why do we check HCG?

    <p>Assesses pregnancy status.</p> Signup and view all the answers

    What tests check coagulation studies?

    <p>PT, PTT, INR, platelet count.</p> Signup and view all the answers

    What does a serum albumin test indicate?

    <p>Nutritional status.</p> Signup and view all the answers

    What is the purpose of a type and cross-match?

    <p>See if there is blood available for replacement.</p> Signup and view all the answers

    Why do we get a urinalysis?

    <p>Check renal status, hydration, urinary tract infection.</p> Signup and view all the answers

    The presence of central perfusion is noted by?

    <p>Heart rate and blood pressure measurements within normal limits.</p> Signup and view all the answers

    Cerebral tissue perfusion is indicated by?

    <p>The patient's orientation to time, place, person, and situation; expected bilateral movement and sensation; clear speech; presence of carotid pulses; and absence of carotid bruit.</p> Signup and view all the answers

    Peripheral tissue perfusion is present when?

    <p>The patient's extremities are warm, radial and dorsalis pedis pulse rates are between 60 and 100 beats per minute, cap refill under 3 seconds, absence of continuous pain in fingers and toes, and absence of leg pain when walking.</p> Signup and view all the answers

    What are interventions for people with impaired tissue perfusion?

    <p>Nutrition therapy, activity, exercise, positioning, smoking cessation.</p> Signup and view all the answers

    What are pharmacotherapy options for people with impaired tissue perfusion?

    <p>Vasodilators, vasopressors, diuretics, antidysrhythmics, anticoagulants, and antiplatelet agents, thrombolytics, lipid-lowering agents.</p> Signup and view all the answers

    What are procedures and surgical interventions for people with impaired tissue perfusion?

    <p>Pacemaker insertion, electrical cardioversion, intra-aortic balloon pump, heart valve surgery, cardiac transplant, coronary artery bypass graft, peripheral artery revascularization, stent placement, angioplasty, endarterectomy.</p> Signup and view all the answers

    How do you perform an assessment of gas exchange?

    <p>Check baseline history, check problem-based history, check vital signs, perform inspection, auscultation, check lab tests such as ABGs, CBC, sputum sampling, skin tests, pathological analysis, perform radiologic studies, pulmonary function tests, and bronchoscopy.</p> Signup and view all the answers

    What are the 5 A's and 5 R's for tobacco use?

    <p>A: Ask, advise, assess, assist, arrange. R: Relevance, risks, rewards, roadblocks, repetition.</p> Signup and view all the answers

    What are the nicotine replacement agents?

    <p>All of the above</p> Signup and view all the answers

    What are the non-nicotine agents?

    <p>All of the above</p> Signup and view all the answers

    What are the steps for providing proper patient positioning?

    <p>Correct alignment, prevent undue pressure, provide adequate thoracic expansion, prevent occlusion of arteries and veins.</p> Signup and view all the answers

    What are the commonly used preoperative medications?

    <p>Antibiotics, anticholinergics, antidiabetics, antiemetics, benzodiazepines, beta blockers, histamine antagonists, opioids.</p> Signup and view all the answers

    What are the intravenous agents used for general anesthesia?

    <p>Barbiturates: Thiopental (Pentothal), Methohexital (Brevital), Nonbarbiturate hypnotics: Etomidate (Amidate), Propofol (Diprivan).</p> Signup and view all the answers

    What are the inhalation drugs used for general anesthesia?

    <p>Isoflurane (Forane), Desflurane (Suprane), Sevoflurane (Ultane), Halothane (Fluothane), Nitrous oxide.</p> Signup and view all the answers

    What is the dissociative anesthetic used for general anesthesia?

    <p>Ketamine (Ketalar).</p> Signup and view all the answers

    What are the four adjuncts to general anesthesia?

    <p>Opioids, benzodiazepines, neuromuscular blocking agents, antiemetics.</p> Signup and view all the answers

    What are Phase 1 and Phase 2 of the post-op period?

    <p>Phase 1: PACU, care during immediate post-anesthesia period. Phase 2: Inpatient unit, goal: prepare patient for discharge.</p> Signup and view all the answers

    What does the post-op assessment include?

    <p>ABCs, neurological, genitourinary, gastrointestinal, surgical site, pain, and labs.</p> Signup and view all the answers

    What are the important points of ABC's?

    <p>Airway: patency, artificial airway. Breathing: respiration rate and quality, breath sounds. Circulation: ECG monitoring, vitals.</p> Signup and view all the answers

    What is the number one thing that disrupts the airway?

    <p>Tongue.</p> Signup and view all the answers

    What do you do if someone gets nauseous?

    <p>Turn on side and get an emesis bag.</p> Signup and view all the answers

    What are the nursing interventions for respiratory complications?

    <p>OT therapy, cough and deep breathe, change positions every 1 to 2 hours, early mobilization.</p> Signup and view all the answers

    What is the correct patient position to prevent respiratory complications?

    <p>Lateral recovery position; once conscious - supine.</p> Signup and view all the answers

    What are the nursing interventions to prevent neuropsychological complications?

    <p>Monitor O2 levels, pain management, assess for anxiety and depression, adequate nutrition.</p> Signup and view all the answers

    What is the most common complication of hypertension?

    <p>Target organ damage.</p> Signup and view all the answers

    What is a hypertensive emergency?

    <p>BP above 220/140, develops over hours to days, evidence of target organ damage.</p> Signup and view all the answers

    What drug is used in a hypertensive emergency?

    <p>Sodium nitroprusside.</p> Signup and view all the answers

    What is hypertensive urgency?

    <p>BP above 180/110, develops over days to weeks, no evidence of target organ damage.</p> Signup and view all the answers

    What drug is used in hypertensive urgency?

    <p>Oral agents - captopril, labetalol, clonidine, amlodipine.</p> Signup and view all the answers

    What are the levels for troponin I?

    <p>Negative - 2.3 ng/ml.</p> Signup and view all the answers

    What are the levels for troponin T?

    <p>4%-6% of total creatine kinase.</p> Signup and view all the answers

    What is myoglobin?

    <p>Low-molecular-weight protein that is 99-100% sensitive for myocardial infarction. Rises 30-60 minutes after MI.</p> Signup and view all the answers

    What are the normal levels for myoglobin for male and female?

    <p>Male - 15.2-91.2 mcg/L; Female - 11.1-57.5 mcg/L.</p> Signup and view all the answers

    What is C-reactive protein?

    <p>Marker of inflammation that can predict the risk of cardiac disease and cardiac events.</p> Signup and view all the answers

    What are the levels for C-reactive protein?

    <p>Lowest risk - 3 mg/L.</p> Signup and view all the answers

    What is homocysteine?

    <p>Amino acid produced during protein catabolism which is a risk for cardiovascular disease.</p> Signup and view all the answers

    What are the normal levels for homocysteine for male and female?

    <p>Male - 5.2-12.9 mol/L; Female - 3.7-10.4 mol/L.</p> Signup and view all the answers

    What is b-type natriuretic peptide?

    <p>Causes natriuresis. Elevation distinguishes between cardiac vs. respiratory cause of dyspnea.</p> Signup and view all the answers

    What is the lab value for b-type natriuretic peptide that indicates heart failure?

    <p>Diagnostic for heart failure &gt;100 pg/mL.</p> Signup and view all the answers

    What is NT-Pro-BNP?

    <p>Aids in assessing the severity of heart failure in symptomatic and asymptomatic patients.</p> Signup and view all the answers

    What is the most appropriate initial question for the nurse to ask a preoperative patient?

    <p>What type of surgery are you having and why are you having it done?</p> Signup and view all the answers

    After administering a benzodiazepine preoperatively, which side effects should the nurse monitor for?

    <p>Sedation</p> Signup and view all the answers

    What would the nurse suspect regarding a preoperative patient with elevated hemoglobin and hematocrit?

    <p>Dehydration</p> Signup and view all the answers

    Which activities should the nurse carry out in the preoperative period for a client scheduled for surgery? (Select all that apply)

    <p>Verify the presence of a signed consent form.</p> Signup and view all the answers

    Which patient-related factors contribute to a high degree of risk associated with surgery? (Select all that apply)

    <p>Involvement of vital organs</p> Signup and view all the answers

    For which priority needs should the nurse immediately assess the postoperative patient?

    <p>Vital signs, level of consciousness, presence of pain</p> Signup and view all the answers

    Which indicators suggest an alteration in tissue perfusion in a postoperative patient? (Select all that apply)

    <p>Fluid loss</p> Signup and view all the answers

    What is the purpose of encouraging the patient to move from side to side at least every 2 hours after surgery?

    <p>Let the lungs alternatively achieve maximum expansion</p> Signup and view all the answers

    What would be appropriate outcomes for a postoperative patient with acute pain? (Select all that apply)

    <p>Verbally rates pain as 3 on a 1 to 10 scale</p> Signup and view all the answers

    For what reason would the nurse check the bedclothes underneath a postoperative patient?

    <p>Detect for possible hemorrhage</p> Signup and view all the answers

    Symptoms consistent with abrupt onset of chest pain that worsens with inspiration in a patient who had pneumonia are indicative of what condition?

    <p>Pleurisy</p> Signup and view all the answers

    What condition is suggested by symptoms such as dyspnea and chest pain in a patient with a recent history of sexual assault?

    <p>Panic Attack</p> Signup and view all the answers

    What should the nurse suspect when an elderly patient has recent changes in mental status and low appetite?

    <p>Urinary tract infection</p> Signup and view all the answers

    What is Ted's greatest risk factor for a UTI related to his admission?

    <p>Indwelling urinary catheter</p> Signup and view all the answers

    What indicates effective patient education regarding pneumococcal vaccine for a 65-year-old patient?

    <p>I will need re-vaccination in five years</p> Signup and view all the answers

    Based on urine output and color after surgery, what should the nurse assess for?

    <p>Assess the patient for signs of acute kidney injury</p> Signup and view all the answers

    How will the nurse know patient teaching regarding cast care has been effective?

    <p>I will call my physician if I have an increase in pain or swelling.</p> Signup and view all the answers

    What is the priority action for the nurse before sending a patient to a CT scan with contrast?

    <p>Evaluate the morning creatinine and BUN lab results</p> Signup and view all the answers

    Identify ways to prevent contrast-induced nephropathy. (Select all that apply)

    <p>Avoid multiple procedures over a 24-48 hour time period</p> Signup and view all the answers

    What should be included in an initial assessment for a possible hip fracture? (Select all that apply)

    <p>Muscle spasms of the affected leg</p> Signup and view all the answers

    Which insulin can only be given intravenously?

    <p>Regular</p> Signup and view all the answers

    What nursing actions promote an optimal patient outcome to TPN therapy? (Select all that apply)

    <p>Record daily weights</p> Signup and view all the answers

    What clinical manifestation should the nurse closely monitor in a patient with type 1 diabetes?

    <p>Hypoglycemia</p> Signup and view all the answers

    What laboratory result would be expected when assessing a patient with abnormally low blood glucose concentration?

    <p>Lower than 50-60 mg/dL</p> Signup and view all the answers

    Which laboratory test result would help the nurse assess an elderly patient's nutritional status?

    <p>Pre-albumin level</p> Signup and view all the answers

    What is the appropriate nursing diagnosis for a patient with a Stage I pressure ulcer despite proper repositioning?

    <p>Impaired skin integrity related to the effects of pressure</p> Signup and view all the answers

    What characteristics would be expected in the skin of a normal older adult client? (Select all that apply)

    <p>Fragile skin that is wrinkled</p> Signup and view all the answers

    Which interventions should the nurse include to prevent pressure ulcers in bedridden patients? (Select all that apply)

    <p>Assess the condition of the bed linens frequently, changing whenever damp or soiled.</p> Signup and view all the answers

    Which patient wounds would heal by secondary intention? (Select all that apply)

    <p>A stage 4 pressure ulcer</p> Signup and view all the answers

    What is the purpose of a wet-to-dry dressing on a pressure ulcer?

    <p>Debride the wound</p> Signup and view all the answers

    What significant finding should be reported before a patient undergoes coronary angiography?

    <p>Patient reported an allergy to shrimp</p> Signup and view all the answers

    What menu choice indicates patient education regarding digoxin and furosemide is effective?

    <p>Chicken with baked potato and cantaloupe</p> Signup and view all the answers

    What is the best response to a patient asking about metoprolol after acute myocardial infarction?

    <p>Metoprolol slows your heart rate and decreases the amount of work it has to do so it can heal.</p> Signup and view all the answers

    What conclusion can the nurse draw about a patient with chest pain that was not relieved by rest?

    <p>The patient most likely has unstable angina.</p> Signup and view all the answers

    Study Notes

    Preoperative Assessment

    • Initial question for preoperative patients: "What type of surgery are you having and why?"
    • Benzodiazepine side effects to monitor: anxiety, level of consciousness, sedation.
    • Elevated hemoglobin and hematocrit may indicate dehydration.
    • Preoperative activities include identifying health problems, verifying consent, and assessing effectiveness of teaching.

    Surgical Risk Factors

    • High surgical risk factors include involvement of vital organs and history of respiratory disease or diabetes.
    • Priority assessment in PACU involves vital signs, consciousness, and pain presence.
    • Indicators of altered tissue perfusion: pallor or cyanosis, fluid loss, decreased urinary output.

    Postoperative Care

    • Encourage side-to-side movement every 2 hours to promote lung expansion.
    • Outcomes for acute pain management: absence of nonverbal pain signs, patient rates pain as 3 on a 1-10 scale.
    • Check bedclothes for drainage to detect possible hemorrhage.

    Common Conditions and Symptoms

    • Pleurisy indicated by abrupt chest pain with inspiration post-pneumonia.
    • Panic attack symptoms: dyspnea, choking sensation, chest pain, sweating.
    • Changes in mental status in elderly may suggest urinary tract infection.

    Patient Education and Safety

    • Effective teaching on pneumococcal vaccine indicates need for re-vaccination in five years.
    • Monitor for acute kidney injury in postoperative patients with low urine output and dark urine.
    • Key signs of hip fracture: external rotation, shortening of the affected leg, and muscle spasms.

    Medication Knowledge

    • Regular insulin can only be administered intravenously.
    • TPN therapy requires monitoring vital signs, I&O, weight, and serum electrolytes.
    • Hypoglycemia is the primary concern for patients with type 1 diabetes.

    Nutritional Assessments

    • Pre-albumin level is critical for assessing nutritional status in elderly patients.
    • Stage I pressure ulcer implies impaired skin integrity related to pressure effects.

    Wound Care Management

    • Wet-to-dry dressings are used primarily for debridement of wounds.
    • Secondary intention healing expected in large open wounds like stage 4 pressure ulcers.

    Surgical Considerations

    • Report allergy to shrimp before coronary angiography.
    • Diet post-heart failure should be low in sodium; grilled chicken and vegetables are a good choice.

    Angina Assessment

    • Chest pain not relieved by rest may indicate unstable angina.

    Pharmacological Effects

    • Drugs that decrease preload: Nitroglycerin, morphine, and beta-blockers.

    Anesthesia Preparation

    • Preoperative interview objectives include gathering health history, assessing emotional readiness, ensuring signed consent, and confirming lab tests.
    • Define physical status ratings for anesthesia administration to assess patient risk levels.

    Laboratory Tests Purpose

    • ABGs and pulse oximetry evaluate respiratory and metabolic function.
    • Blood glucose tests assess metabolic status, crucial for diabetic patients.
    • BUN and creatinine tests are vital for renal function assessment.
    • CBC includes RBCs, hemoglobin, hematocrit, and WBC count for overall health assessment.### Immunology and Cardiology Assessments
    • Immune status is assessed to evaluate infection risk.
    • An electrocardiogram (ECG) identifies cardiac diseases and dysrhythmias.
    • Electrolyte testing measures metabolic status and renal function, along with assessing side effects from diuretics.
    • Human chorionic gonadotropin (HCG) levels confirm pregnancy status.
    • Coagulation studies include PT, PTT, INR, and platelet count for blood clotting assessment.

    Nutritional and Blood Tests

    • Serum albumin evaluates nutritional status.
    • Type and cross-match tests ensure availability of compatible blood for transfusion.
    • Urinalysis checks renal function, hydration status, and urinary tract infections.

    Perfusion Assessments

    • Central perfusion is indicated by heart rate and normal blood pressure.
    • Cerebral tissue perfusion is signaled by patient orientation, movement, speech clarity, and carotid pulse presence.
    • Peripheral tissue perfusion checks for warmth in extremities, pulse quality, capillary refill time, and absence of pain.

    Tissue Perfusion Interventions

    • Interventions for impaired tissue perfusion include nutrition therapy, exercise, proper positioning, and smoking cessation.
    • Pharmacotherapy options consist of vasodilators, vasopressors, diuretics, anticoagulants, and thrombolytics.
    • Surgical interventions may involve pacemaker insertion, cardiac surgeries, and revascularization procedures.

    Assessment Procedures

    • Gas exchange assessment combines patient history, vital signs, lab tests, and various diagnostic studies.
    • Tobacco use interventions use the 5 A's for those wanting to quit and 5 R's for those who do not wish to quit.

    Surgical Procedures and Anesthesia

    • Preoperative medications include antibiotics, anticholinergics, antidiabetics, antiemetics, benzodiazepines, beta-blockers, histamine antagonists, and opioids.
    • Intravenous agents for general anesthesia include barbiturates and non-barbiturate hypnotics.
    • Inhalation drugs consist of volatile liquids and gaseous agents, with ketamine being a common dissociative anesthetic.

    Postoperative Care

    • Post-op phases focus on immediate care in the PACU and preparing patients for discharge on the inpatient unit.
    • Assessments post-surgery cover airway, breathing, circulation (ABCs), neurological state, and surgical sites.
    • Airway disruption often stems from tongue obstruction; addressing nausea includes lying the patient on their side.

    Complications and Management

    • Common complications of hypertension involve target organ damage.
    • Hypertensive emergencies feature dangerously high BP with organ damage, treated with sodium nitroprusside.
    • Hypertensive urgencies have high BP without organ damage, managed with oral medications like captopril and labetalol.

    Biomarkers and Heart Failure Indicators

    • Troponin I levels indicate cardiac injury (<2.3 ng/ml negative).
    • Myoglobin is a sensitive marker for myocardial infarction, rising 30-60 minutes post-MI.
    • C-reactive protein serves as an inflammation marker and risk predictor for cardiac events.
    • Homocysteine, an amino acid linked to cardiovascular risk, has specific normal ranges by gender.
    • B-type natriuretic peptide levels >100 pg/mL indicate heart failure.
    • NT-Pro-BNP helps assess the severity of heart failure in patients.

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