Surgical Nursing Exam Revision
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Questions and Answers

What is the role of cytokines in terminating the immune response during inflammation?

Cytokines provide anti-inflammatory signals that terminate the immune response.

Which of the following statements about fever is true?

  • Fever inhibits the production of immune cells.
  • Fever stimulates the growth of pathogens.
  • Fever can enhance the body's immune response. (correct)
  • Fever decreases the metabolic rate.

    • During the Coagulation Phase of haemostasis, _______ is converted to thrombin, which then converts fibrinogen to fibrin.

    prothrombin

    The Coroners Court is responsible for determining the cause of death only in cases of natural causes.

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

    What are venous thrombi primarily composed of?

    <p>fibrin and red blood cells</p> Signup and view all the answers

    What conditions can be commonly caused by low-flow, low-pressure venous circulation? Select all that apply.

    <p>Deep vein thrombosis</p> Signup and view all the answers

    Heparin enhances the activity of antithrombin III, which inhibits thrombin and factor Xa, preventing the formation of _________ clots.

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

    Aspirin inhibits the platelet enzyme COX-1, reducing platelet aggregation.

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

    Match the drug with its function:

    <p>Aspirin (acetylsalicylic acid) = Inhibition of the platelet enzyme COX-1 Heparin = Enhances the activity of antithrombin III, preventing blood clots Warfarin = Inhibits vitamin K epoxide reductase, reducing clotting factor synthesis Enoxaparin = Inhibits factor Xa and to a lesser extent, factor IIa, preventing clot formation</p> Signup and view all the answers

    Define surgical nursing?

    <p>Surgical nursing is an invasive medical procedure performed to diagnose or treat illness, injury, or deformity.</p> Signup and view all the answers

    How many phases is the perioperative journey divided into?

    <p>3</p> Signup and view all the answers

    What are some items documented on a preoperative checklist?

    <p>Pt id, consent, allergies, fasting time, diagnostic test results, history and physical exam, vital signs</p> Signup and view all the answers

    The nurse's responsibility is to ensure that the patient has legal consent before surgery.

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

    Match the following roles in perioperative nursing with their responsibilities:

    <p>Aesthetic Nurse = Greet Pt, verify id, check allergies, monitor vital signs Scout (Circulating Nurse) = Manage OR, maintain sterile environment Scrub (Instrument Nurse) = Set up sterile tables, prepare instruments, assist surgeon Recovery/ PACU Nurse = Monitor patients, provide postoperative care</p> Signup and view all the answers

    What is the study of how drugs interact with biological systems known as?

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

    What does pharmacodynamics study?

    <p>Pharmacodynamics studies how drugs interact with and exert their effects on the body.</p> Signup and view all the answers

    Higher affinity between a drug and its target receptor leads to a weaker binding.

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

    What is the difference between Antagonist and Agonist drugs?

    <p>Agonist causes a response, while Antagonist binds to receptor without eliciting a response.</p> Signup and view all the answers

    What is the role of Depolarizing Anaesthetic Agents?

    <p>Depolarizing anaesthetic agents stimulate muscle contraction by mimicking acetylcholine, causing sustained depolarization.</p> Signup and view all the answers

    What is the purpose of Analgesics in healthcare?

    <p>To relieve pain without affecting consciousness</p> Signup and view all the answers

    Define antiemetics?

    <p>Antiemetics are medications used to prevent or alleviate nausea and vomiting by targeting various pathways in the body.</p> Signup and view all the answers

    Vomiting can be triggered by sensory impulses like taste and smell.

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

    Study Notes

    Surgical Nursing

    • Definition: Surgery is an invasive medical procedure performed to diagnose or treat illness, injury, or deformity.

    Perioperative Journey

    • Consists of 3 phases:

      Preoperative

      • Discussion between healthcare team and patient about benefits, risks, and alternatives to surgery
      • Instructions on how to prepare for surgery
      • Physical, mental, and social assessments conducted prior to surgery

      Intraoperative

      • Patient transported to operating room
      • Surgical team prepares for operation
      • Anesthesia used to sedate or control unconsciousness
      • Surgical procedure performed
      • Nurses' role: monitoring patient's vital signs throughout the operation

      Postoperative

      • Patient moved to Post Anesthesia Recovery Unit (PACU) room until stable
      • Transferred to regular nursing unit for recovery
      • Nursing care: managing pain, monitoring vital signs, and preventing infections and complications

    Preparing a Patient for Surgery

    • Preoperative checklist:
      • Patient identification
      • Consent
      • Allergies
      • Fasting time
      • Diagnostic test results
      • History and physical exam
      • Vital signs
    • Patient preparation:
      • Hospital gown
      • Dentures and glasses removed
      • Jewelry locked
    • Ensuring patient has been legally prepared and consent is gained and documented
    • Patient and family members clearly understand what is happening
    • Complete medical records
    • Advance care or goals discussed

    Roles of Perioperative Nursing

    • Aesthetic Nurse:

      • Greets patient and ensures preparation
      • Verifies patient ID and consent
      • Checks allergies and fasting status
      • Monitors vital signs
      • Assists anaesthetist during induction, maintenance, and reversal of anesthesia

    • Scout (Circulating Nurse):

      • Manages Operating Room (OR) and monitors activities of the surgical team
      • Maintains OR environment and documentation
      • Ensures sterile environment maintained

    • Scrub (Instrument Nurse):

      • Sets up sterile tables and equipment
      • Prepares instruments and sutures
      • Assists surgeon by passing instruments and setting up drains
      • Accounts for all items during surgery

    • Recovery/PACU Nurse:

      • Monitors patients' ABCs
      • Conducts assessments relevant to patient (neurological, neurovascular, etc.)
      • Provides care postoperative care until patient recovers from anesthesia

    Pharmacology

    • Definition: Study of how drugs interact with biological systems

    • Pharmacodynamics: Study of how drugs interact with and exert their effects on the body

      Affinity

      • Refers to the strength of the binding between a drug and its target receptor
      • Higher affinity indicates a stronger and more specific binding leading to a greater pharmacological effect

      Antagonist vs Agonist Drugs

      • Antagonist: Drug binds to receptor without eliciting a response or blocks the activation of the receptor
      • Agonist: Drug binds to a receptor and causes a response

    Anaesthetics

    Depolarising vs Non-Depolarizing Anaesthetic Agents

    • Depolarizing: Anaesthetic agents, like succinylcholine, briefly stimulate muscle contraction by mimicking acetylcholine at neuromuscular junctions
    • Non-Depolarizing: Anaesthetic agents, like rocuronium, block acetylcholine from binding to neuromuscular receptors, leading to muscle paralysis

    Antipyretics and Analgesics

    • Analgesics: Medications used to relieve pain by acting on the CNS or peripheral pain pathways
    • 3 types:
      • Non-Opioids: Paracetamol, aspirin, ibuprofen
      • Opioids: Morphine, oxycodone
      • Adjuvant analgesics: Medication used to enhance the effects of analgesics

    Antiemetics

    • Definition: Medications used to prevent or alleviate nausea and vomiting
    • Work by targeting various pathways in the body involved in the sensation of nausea and the reflexes that lead to vomiting
    • Examples: Ondansetron, promethazine, metoclopramide, and dimenhydrinate

    Body System Responses

    • Immune Response:

      • Innate/Non-Specific Immune Response:
        • First line of defence: surface barriers (skin, mucous, tears, gastric acid)
        • Second line of defence: nonspecific natural killer cells (phagocytes, dendritic cells, NK cells, macrophages)
      • Adaptive Immune Response:
        • Humoral Immunity: involves the production of antibodies by B cells
        • Cellular Immunity: involves the direct action of immune cells to recognize and destroy infected or abnormal cells

    • Inflammation:

      • Definition: Nonspecific defence mechanism, involving a complex series of events to eliminate the cause of cell injury, clear out damaged cells and tissues, and initiate tissue repair
      • Acute inflammation: Rapid and short-term response to injury or infection
      • Chronic inflammation: Prolonged and persistent state that can lead to tissue damage

    • Fever:

      • Definition: Temporary increase in body temperature, usually in response to an infection or illness
      • Helps to inhibit pathogen growth, enhance immune response, mobilize immune response, and increase metabolic rate

    Principles of Fluids and Electrolyte

    • Compartments:

      • Intracellular Fluid (ICF): 80% of fluid in the body, inside cells
      • Extracellular Fluid (ECF): 1/3 of fluid weight in the body, outside cells
        • Plasma
        • Lymph
        • Transcellular fluid (e.g., cerebrospinal fluid, GIT secretion, synovial fluid)

    • Transport mechanisms:

      • Active Transport: net movement from low concentration gradient to high concentration gradient, requires energy
      • Passive Transport: net movement of molecules from high concentration gradient to low concentration gradient, no energy required
      • Osmosis: movement of water solvent
      • Diffusion: movement of molecules down concentration gradient
      • Facilitated Diffusion: uses protein carrier, glucose transport
      • Filtration: movement of water and solutes through a membrane

    Nutrition and Metabolism

    • Definition:

      • Macronutrients: carbohydrates, fats, proteins
      • Micronutrients: vitamins, minerals
      • Water: essential for bodily functions

    • Assessing for Malnutrition:

      • Insufficient energy intake
      • Weight and muscle mass loss
      • Loss of subcutaneous fat### Sudden or Unexplained Deaths

    • Deaths that occur suddenly or unexpectedly, with unclear or unknown causes, may require investigation by the coroner.

    • Examples include:

      • Violent or suspicious deaths (e.g., homicide, suicide, accidents)
      • Deaths in custody (e.g., prison, police cell, detention facility)
      • Industrial or occupational deaths (e.g., workplace accidents)
      • Deaths resulting from medical procedures (e.g., medical malpractice, negligence)
      • Deaths due to notifiable diseases (e.g., infectious diseases)
      • Deaths due to environmental factors (e.g., exposure to extreme temperatures, chemicals)
      • Deaths of unknown identity

    Phases of Haemostasis

    • Haemostasis is the process of stopping blood loss from damaged vessels.
    • The four phases of haemostasis are:
      • Vascular phase: vasoconstriction of blood vessels to reduce blood flow
      • Platelet phase: platelets stick to the injured blood vessel wall, aggregating and plugging the hole
      • Coagulation phase: chemical reactions lead to the production of a thrombus (blood clot)
      • Fibrinolysis phase: the breakdown of the thrombus by plasmin

    Blood Transfusion

    • Blood must be matched with the patient before administration.
    • Main blood groups are:
      • ABO (A, B, AB, O)
      • Rhesus (Rh-positive, Rh-negative)
    • Important blood types:
      • O negative: universal donor
      • AB negative: universal recipient

    Transfusion Reactions

    • Types of transfusion reactions include:
      • Febrile reactions: fever, chills, and malaise in response to a rise in temperature
      • Allergic reactions: immune response to a substance, leading to symptoms such as rash, itching, or difficulty breathing
      • Haemolytic reactions: life-threatening destruction of red blood cells, often due to incompatible blood transfusions or autoimmune conditions

    Venous Thrombosis Embolism (VTE)

    • Arterial thrombi: composed of rich platelets and fibrin, forming rapidly in high-flow, high-pressure arterial circulation, often leading to ischemic events like heart attacks or strokes
    • Venous thrombi: composed primarily of fibrin and red blood cells, forming more slowly in low-flow, low-pressure venous circulation, commonly causing conditions such as deep vein thrombosis or pulmonary embolism
    • Virchow's Triad: indicates the development of DVT, with factors including:
      • Stasis (blood stasis)
      • Hypercoagulability (excessive blood clotting)
      • Endothelial damage (damage to blood vessel walls)

    Anticoagulants and Fibrinolytic Drugs

    • Antiplatelet drugs: used to treat white thrombi (arterial thrombi), examples include:
      • Aspirin: inhibits platelet enzyme COX-1, reducing platelet aggregation
      • Risks: bleeding, Ryes syndrome, chronic overdose, acute salicylate poisoning, and interaction with warfarin
    • Anticoagulants: used to treat red thrombi (deep vein thrombi), examples include:
      • Heparin: enhances antithrombin III activity, inhibiting thrombin and factor Xa, preventing blood clot formation
      • Warfarin: inhibits vitamin K epoxide reductase, reducing synthesis of vitamin K-dependent clotting factors
      • Enoxaparin: inhibits factor Xa and, to a lesser extent, factor IIa, preventing clot formation

    Integumentary System

    • Functions of the integumentary system include:
      • Protection: forming a barrier against physical, chemical, and microbial damage
      • Temperature regulation: controlling heat loss through sweating and heat retention through vasoconstriction or vasodilation
      • Sensation: perceiving tactile sensations, temperature changes, and pain
      • Excretion: eliminating waste products through sweat secretion
      • Immune function: detecting and responding to pathogens, allergens, and other foreign substances
      • Synthesis of vitamin D: essential for calcium absorption and bone health
      • Water regulation: maintaining proper hydration levels
      • Blood reservoir: serving as a reservoir for circulating blood volume

    Wound Healing

    • The four stages of wound healing are:
      • Haemostasis: blood vessels constrict, and clotting begins to stop bleeding
      • Inflammation: white blood cells move to the wound to fight infection and clear debris
      • Proliferation: new tissue forms as cells multiply, filling the wound and creating new blood vessels and collagen
      • Maturation/Remodelling: the wound contracts and strengthens as collagen is remodelled, and new tissue gains strength and flexibility

    Types of Wound Healing

    • Primary intention: wound edges are brought together (e.g., with sutures, staples), healing occurs quickly with minimal scarring
    • Secondary intention: wound is left open and heals naturally from the bottom up, resulting in more scar tissue and a longer healing process
    • Tertiary intention: wound is initially left open to allow for debridement or infection control, then closed surgically, combining features of both primary and secondary healing

    Antibiotics and Infections

    • Antibiotics target specific sites in bacterial cells, including:
      • Cell wall
      • Inhibiting bacterial enzymes
      • Disrupting bacterial protein synthesis
      • Inhibiting bacterial DNA or RNA synthesis
    • Types of antibiotics include:
      • Penicillins: inhibit bacterial cell wall formation
      • Cephalosporins: work similarly to penicillins, inhibiting bacterial cell wall synthesis
      • Macrolides: inhibit bacterial protein synthesis
      • Tetracyclines: interfere with bacterial protein synthesis
      • Fluoroquinolones: inhibit bacterial DNA replication
    • Antibiotic resistance occurs when bacteria change in response to the use of antibiotics, rendering the drugs ineffective against them.

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    Test your knowledge on surgical nursing, including the definition and perioperative journey. Learn about the surgical process from decision to postoperative recovery.

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