Podcast
Questions and Answers
What is the primary purpose of the patient preoperative interview?
What is the primary purpose of the patient preoperative interview?
What are the most common psychological factors?
What are the most common psychological factors?
Anxiety, fear, and hope.
What are the important things to ask during a past health history?
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?
What are the important systems to look at during a review of systems?
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What are the different physical status ratings for anesthesia administration?
What are the different physical status ratings for anesthesia administration?
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What is the purpose of ABGs and pulse oximetry?
What is the purpose of ABGs and pulse oximetry?
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What is the purpose of blood glucose testing?
What is the purpose of blood glucose testing?
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What is the purpose of BUN and creatinine testing?
What is the purpose of BUN and creatinine testing?
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What is included in a CBC and what is its purpose?
What is included in a CBC and what is its purpose?
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What is the purpose of an electrocardiogram?
What is the purpose of an electrocardiogram?
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Why do we check electrolytes?
Why do we check electrolytes?
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Why do we check HCG?
Why do we check HCG?
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What tests check coagulation studies?
What tests check coagulation studies?
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What does a serum albumin test indicate?
What does a serum albumin test indicate?
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What is the purpose of a type and cross-match?
What is the purpose of a type and cross-match?
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Why do we get a urinalysis?
Why do we get a urinalysis?
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The presence of central perfusion is noted by?
The presence of central perfusion is noted by?
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Cerebral tissue perfusion is indicated by?
Cerebral tissue perfusion is indicated by?
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Peripheral tissue perfusion is present when?
Peripheral tissue perfusion is present when?
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What are interventions for people with impaired tissue perfusion?
What are interventions for people with impaired tissue perfusion?
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What are pharmacotherapy options for people with impaired tissue perfusion?
What are pharmacotherapy options for people with impaired tissue perfusion?
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What are procedures and surgical interventions for people with impaired tissue perfusion?
What are procedures and surgical interventions for people with impaired tissue perfusion?
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How do you perform an assessment of gas exchange?
How do you perform an assessment of gas exchange?
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What are the 5 A's and 5 R's for tobacco use?
What are the 5 A's and 5 R's for tobacco use?
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What are the nicotine replacement agents?
What are the nicotine replacement agents?
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What are the non-nicotine agents?
What are the non-nicotine agents?
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What are the steps for providing proper patient positioning?
What are the steps for providing proper patient positioning?
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What are the commonly used preoperative medications?
What are the commonly used preoperative medications?
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What are the intravenous agents used for general anesthesia?
What are the intravenous agents used for general anesthesia?
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What are the inhalation drugs used for general anesthesia?
What are the inhalation drugs used for general anesthesia?
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What is the dissociative anesthetic used for general anesthesia?
What is the dissociative anesthetic used for general anesthesia?
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What are the four adjuncts to general anesthesia?
What are the four adjuncts to general anesthesia?
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What are Phase 1 and Phase 2 of the post-op period?
What are Phase 1 and Phase 2 of the post-op period?
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What does the post-op assessment include?
What does the post-op assessment include?
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What are the important points of ABC's?
What are the important points of ABC's?
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What is the number one thing that disrupts the airway?
What is the number one thing that disrupts the airway?
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What do you do if someone gets nauseous?
What do you do if someone gets nauseous?
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What are the nursing interventions for respiratory complications?
What are the nursing interventions for respiratory complications?
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What is the correct patient position to prevent respiratory complications?
What is the correct patient position to prevent respiratory complications?
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What are the nursing interventions to prevent neuropsychological complications?
What are the nursing interventions to prevent neuropsychological complications?
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What is the most common complication of hypertension?
What is the most common complication of hypertension?
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What is a hypertensive emergency?
What is a hypertensive emergency?
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What drug is used in a hypertensive emergency?
What drug is used in a hypertensive emergency?
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What is hypertensive urgency?
What is hypertensive urgency?
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What drug is used in hypertensive urgency?
What drug is used in hypertensive urgency?
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What are the levels for troponin I?
What are the levels for troponin I?
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What are the levels for troponin T?
What are the levels for troponin T?
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What is myoglobin?
What is myoglobin?
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What are the normal levels for myoglobin for male and female?
What are the normal levels for myoglobin for male and female?
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What is C-reactive protein?
What is C-reactive protein?
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What are the levels for C-reactive protein?
What are the levels for C-reactive protein?
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What is homocysteine?
What is homocysteine?
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What are the normal levels for homocysteine for male and female?
What are the normal levels for homocysteine for male and female?
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What is b-type natriuretic peptide?
What is b-type natriuretic peptide?
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What is the lab value for b-type natriuretic peptide that indicates heart failure?
What is the lab value for b-type natriuretic peptide that indicates heart failure?
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What is NT-Pro-BNP?
What is NT-Pro-BNP?
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What is the most appropriate initial question for the nurse to ask a preoperative patient?
What is the most appropriate initial question for the nurse to ask a preoperative patient?
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After administering a benzodiazepine preoperatively, which side effects should the nurse monitor for?
After administering a benzodiazepine preoperatively, which side effects should the nurse monitor for?
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What would the nurse suspect regarding a preoperative patient with elevated hemoglobin and hematocrit?
What would the nurse suspect regarding a preoperative patient with elevated hemoglobin and hematocrit?
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Which activities should the nurse carry out in the preoperative period for a client scheduled for surgery? (Select all that apply)
Which activities should the nurse carry out in the preoperative period for a client scheduled for surgery? (Select all that apply)
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Which patient-related factors contribute to a high degree of risk associated with surgery? (Select all that apply)
Which patient-related factors contribute to a high degree of risk associated with surgery? (Select all that apply)
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For which priority needs should the nurse immediately assess the postoperative patient?
For which priority needs should the nurse immediately assess the postoperative patient?
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Which indicators suggest an alteration in tissue perfusion in a postoperative patient? (Select all that apply)
Which indicators suggest an alteration in tissue perfusion in a postoperative patient? (Select all that apply)
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What is the purpose of encouraging the patient to move from side to side at least every 2 hours after surgery?
What is the purpose of encouraging the patient to move from side to side at least every 2 hours after surgery?
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What would be appropriate outcomes for a postoperative patient with acute pain? (Select all that apply)
What would be appropriate outcomes for a postoperative patient with acute pain? (Select all that apply)
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For what reason would the nurse check the bedclothes underneath a postoperative patient?
For what reason would the nurse check the bedclothes underneath a postoperative patient?
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Symptoms consistent with abrupt onset of chest pain that worsens with inspiration in a patient who had pneumonia are indicative of what condition?
Symptoms consistent with abrupt onset of chest pain that worsens with inspiration in a patient who had pneumonia are indicative of what condition?
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What condition is suggested by symptoms such as dyspnea and chest pain in a patient with a recent history of sexual assault?
What condition is suggested by symptoms such as dyspnea and chest pain in a patient with a recent history of sexual assault?
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What should the nurse suspect when an elderly patient has recent changes in mental status and low appetite?
What should the nurse suspect when an elderly patient has recent changes in mental status and low appetite?
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What is Ted's greatest risk factor for a UTI related to his admission?
What is Ted's greatest risk factor for a UTI related to his admission?
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What indicates effective patient education regarding pneumococcal vaccine for a 65-year-old patient?
What indicates effective patient education regarding pneumococcal vaccine for a 65-year-old patient?
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Based on urine output and color after surgery, what should the nurse assess for?
Based on urine output and color after surgery, what should the nurse assess for?
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How will the nurse know patient teaching regarding cast care has been effective?
How will the nurse know patient teaching regarding cast care has been effective?
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What is the priority action for the nurse before sending a patient to a CT scan with contrast?
What is the priority action for the nurse before sending a patient to a CT scan with contrast?
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Identify ways to prevent contrast-induced nephropathy. (Select all that apply)
Identify ways to prevent contrast-induced nephropathy. (Select all that apply)
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What should be included in an initial assessment for a possible hip fracture? (Select all that apply)
What should be included in an initial assessment for a possible hip fracture? (Select all that apply)
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Which insulin can only be given intravenously?
Which insulin can only be given intravenously?
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What nursing actions promote an optimal patient outcome to TPN therapy? (Select all that apply)
What nursing actions promote an optimal patient outcome to TPN therapy? (Select all that apply)
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What clinical manifestation should the nurse closely monitor in a patient with type 1 diabetes?
What clinical manifestation should the nurse closely monitor in a patient with type 1 diabetes?
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What laboratory result would be expected when assessing a patient with abnormally low blood glucose concentration?
What laboratory result would be expected when assessing a patient with abnormally low blood glucose concentration?
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Which laboratory test result would help the nurse assess an elderly patient's nutritional status?
Which laboratory test result would help the nurse assess an elderly patient's nutritional status?
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What is the appropriate nursing diagnosis for a patient with a Stage I pressure ulcer despite proper repositioning?
What is the appropriate nursing diagnosis for a patient with a Stage I pressure ulcer despite proper repositioning?
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What characteristics would be expected in the skin of a normal older adult client? (Select all that apply)
What characteristics would be expected in the skin of a normal older adult client? (Select all that apply)
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Which interventions should the nurse include to prevent pressure ulcers in bedridden patients? (Select all that apply)
Which interventions should the nurse include to prevent pressure ulcers in bedridden patients? (Select all that apply)
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Which patient wounds would heal by secondary intention? (Select all that apply)
Which patient wounds would heal by secondary intention? (Select all that apply)
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What is the purpose of a wet-to-dry dressing on a pressure ulcer?
What is the purpose of a wet-to-dry dressing on a pressure ulcer?
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What significant finding should be reported before a patient undergoes coronary angiography?
What significant finding should be reported before a patient undergoes coronary angiography?
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What menu choice indicates patient education regarding digoxin and furosemide is effective?
What menu choice indicates patient education regarding digoxin and furosemide is effective?
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What is the best response to a patient asking about metoprolol after acute myocardial infarction?
What is the best response to a patient asking about metoprolol after acute myocardial infarction?
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What conclusion can the nurse draw about a patient with chest pain that was not relieved by rest?
What conclusion can the nurse draw about a patient with chest pain that was not relieved by rest?
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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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