Preoperative Assessment and Pain Management

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Questions and Answers

What dietary changes should be made for a patient with Crohn's disease?

Avoid nuts, corn, and dairy products (correct)

Incorporate citrus fruits and onions

Increase intake of spicy foods and chocolate

Consume more fiber and whole grains

What is a common sign of Crohn's disease?

Frequent headaches

Dizziness upon standing

Increased appetite

Crampy abdominal pain, particularly after meals (correct)

What should be monitored after bariatric surgery?

Weight gain

Vitamin and mineral imbalances (correct)

Increased caloric intake

Blood sugar levels only

What defines constipation?

Less than 3 bowel movements per week Signup and view all the answers

What is a necessary action for patients with small bowel obstruction?

Decompress the bowel through an NG tube Signup and view all the answers

What electrolyte imbalances are likely to occur due to a proximal small bowel obstruction?

Hypokalemia and hypochloremia Signup and view all the answers

Which of the following symptoms is NOT characteristic of peripheral artery disease (PAD)?

Pain while resting Signup and view all the answers

Which statement about the administration of methotrexate for rheumatoid arthritis is accurate?

Patients should keep an accurate record of dose date and time. Signup and view all the answers

What is the primary cause of metabolic acidosis and alkalosis in patients with a small bowel obstruction?

Vomiting and malabsorption of gastric contents Signup and view all the answers

Which symptom associated with heart failure may be misleading due to its similarity to other conditions?

Shortness of breath (SOB) Signup and view all the answers

What initial signs may a patient with myxedema coma exhibit?

Depression, diminished cognitive status, lethargy, and somnolence Signup and view all the answers

Which of the following symptoms is characteristic of thyroid storm?

Altered neurologic or mental state, such as delirium or psychosis Signup and view all the answers

Which factor is most commonly associated with precipitating a thyroid storm?

Withdrawal of antithyroid medications Signup and view all the answers

What is NOT a treatment option for managing thyroid storm?

Increasing thyroid hormone production Signup and view all the answers

Which of the following is a symptom of myxedema coma?

Hypoventilation Signup and view all the answers

Which medication can impede the formation of thyroid hormone in thyroid storm?

Propylthiouracil (PTU) Signup and view all the answers

What is a common effect of hypoventilation in myxedema coma?

Carbon dioxide retention Signup and view all the answers

Which symptom would indicate a life-threatening thyroid storm?

Extreme tachycardia and high fever Signup and view all the answers

What is a classic symptom of rheumatoid arthritis?

Symmetric joint pain with swelling and warmth Signup and view all the answers

Which statement correctly describes the initial symptoms of malignant hyperthermia?

Tachycardia may occur, with a heart rate exceeding 150 bpm. Signup and view all the answers

What should patients with systemic lupus erythematosus do to manage their skin lesions during exacerbations?

Use sunscreen and wear protective clothing Signup and view all the answers

What complication can be prevented by early ambulation postoperatively?

Deep vein thrombosis Signup and view all the answers

Which joint condition is characterized by hot, swollen, and painful joints that limit movement?

Rheumatoid arthritis Signup and view all the answers

What laboratory test is routinely used to detect infection prior to surgery?

White blood count (WBC) Signup and view all the answers

What is a possible manifestation of systemic lupus erythematosus during exacerbations?

Splinter hemorrhages Signup and view all the answers

What joint involvement pattern is typically observed in rheumatoid arthritis?

Begins in the small joints of hands, wrists, and feet Signup and view all the answers

What is one of the earliest signs of abnormal calcium transport?

Generalized muscle rigidity Signup and view all the answers

What can cause a rise in core body temperature during abnormal calcium transport?

Late response of abnormal transport Signup and view all the answers

If a patient has not had a bowel movement by the second postoperative day, what action should be taken?

Notify the primary provider for possible intervention Signup and view all the answers

Which condition is characterized by the disruption of a surgical incision?

Dehiscence Signup and view all the answers

What is a common symptom of diverticulitis?

Acute onset of mild to severe pain in the left lower quadrant Signup and view all the answers

Which factors can increase the risk of wound dehiscence and evisceration?

Increasing age and diabetes Signup and view all the answers

What common adverse effect is associated with Galantamine hydrobromide?

Tremor Signup and view all the answers

What is the primary treatment for pernicious anemia related to intrinsic factor deficiency?

Monthly intramuscular injections of vitamin B12 Signup and view all the answers

Galantamine hydrobromide is indicated for the treatment of what condition?

Mild to moderate dementia Signup and view all the answers

Which of the following is a sign of a hemolytic blood transfusion reaction?

Fever with chills Signup and view all the answers

Which drug is similar in action to Galantamine hydrobromide?

Donepezil Signup and view all the answers

Which condition can cause urinary retention and is associated with benign prostatic hyperplasia (BPH)?

Urinary tract infection (UTI) Signup and view all the answers

What is one of the primary pathological factors contributing to BPH?

Dihydrotestosterone sensitivity Signup and view all the answers

Which sign or symptom is not typically associated with pernicious anemia?

Loss of appetite Signup and view all the answers

What is the first nursing action to take when initiating a blood transfusion?

Confirm the order and signed documents Signup and view all the answers

Which of the following is a characteristic finding in patients with BPH?

Frequent urination at night Signup and view all the answers

Study Notes

Preoperative Assessment Checklist

Consent is obtained, understanding confirmed by surgeon
Patient history, allergies, effects of prior surgeries, and medications
Expectations of pre- and post-operative procedures, testing, and confirmed medications
Post-operative vital signs and drug use monitoring
Baseline vital signs for assessment of post-operative decline
Pain control, assessment of surgical site and drainage tubes, monitoring of IV fluids and access, and sensation/circulation assessment
Signs of infection or decline in baseline vitals
Ensure patient is monitored for post-operative infection or complications
Monitor for signs of bleeding or aspiration

Pain Scale and Medication Selection

Preventive approach to pain relief prioritized over "as needed" approach
Commonly prescribed opioid analgesic agents for immediate postoperative restlessness
Patient-controlled analgesia (PCA) allows patients to self-administer pain medication as needed
Epidural infusions and intrapleural anesthesia improve coughing and deep breathing during procedures like cholecystectomy, renal surgery, and rib fractures
Catheter delivers a continuous amount of local anesthetic at a prescribed amount determined by the primary provider

Malignant Hyperthermia

Risk of severe muscle rigidity and spasms, rapid shallow breathing, and low oxygen/high carbon dioxide levels postoperatively

Pain Outcomes

Nurse assesses patient's pain level using a verbal or visual analog scale.
Goal is pain prevention rather than sporadic relief
Patients recover more quickly with adequate pain relief
PCA allows patients to self-administer pain medication

Shock-Hypovolemic

Monitor fluid and electrolyte imbalance
Patient is NPO after surgery

Pneumonia

Prevention through vaccination
Occurs in people not hospitalized or in a long-term facility within 14 days
Treatable at home or in hospital

COPD

Patient oxygen level (baseline 88%) monitored
Pulse oximetry assessed to determine oxygen need
Supplemental oxygen administered as needed
Pulmonary vascular changes can result in hypertension
Chronic hypoxemia can result in pulmonary hypertension

COPD Infections

Monitor for any signs of infection
Changes in sputum color, consistency, or amount are indications
Fever and worsening symptoms (tightness, dyspnea, fatigue) are indications

Crohn's Disease

Chronic inflammation through all layers of the GI tract
Bowel wall thickens and becomes fibrotic
Leads to intestinal lumen narrowing
Common symptoms: diarrhea, crampy abdominal pain (especially after meals), malnutrition, and anemia.

Other Medical Conditions

Bariatric surgery (post-op) Watch
for dumping syndrome and vitamin/mineral imbalances
Watch for ulcer development
High levels of TSH and decreased T4 levels are assessed
Hypothyroidism treated with synthetic levothyroxine
Diabetic patients risk for complications need to be managed actively
Cardiovascular, respiratory, and abnormal musculoskeletal activity monitor for these in emergencies
Hypothyroid patients may experience myxedema (rare, severe hypothyroidism)
Patient can also experience thyrotoxicosis such as hyperthyroidism in emergencies

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Description

This quiz covers essential aspects of preoperative assessments and postoperative pain management strategies. It includes topics such as consent, patient monitoring, vital signs, and medication management. Test your knowledge on how to effectively prepare patients for surgery and ensure their comfort during recovery.