MCA I Exam 1 Review Session PDF

Review Session MCA I Exam 1 By Harjot & Kelli 01 Preoperative Care social ppfffalffmidespsn.co postwound separates dehistineeviscerate  neath Preoperative Assessment VITAL SIGNS...

Review Session MCA I Exam 1 By Harjot & Kelli 01 Preoperative Care social ppfffalffmidespsn.co postwound separates dehistineeviscerate  neath Preoperative Assessment VITAL SIGNS consistant Surgery Q's Physicans PSYCHOLOGICAL STATE job monitoring for Monitor before and afterNO significantchanges Use therapeutic techniques to help administering medications reduce anxiety tff f RISK FACTORS Predisposition for Malignant RECENT LABS Assess values for signs of enjoin Hypothermia dehydration or infection RN Before any 88b gain NRCBC.HN Yhfihfim ResponsibilityCONSENT reggaeton levels ALLERGIES Consent must be signed prior to needsÑod low blood 488 Confirm all allergies with chart and administering pain medications patient Acuratelog of consented shellfish iodine info in pts chart Avocadobananastomatoes  late allergie Patient Preparation ☁ Prior to administering pain medication and/or sedatives: Review meds discharge ○ Ensure consent forms have been signed Minorserparent Emancipated minors can provide informed consent to.my t ○ e Confirm y.gg and discharge Review post-op e understandingseen ftp.fhfm tms instructions with the patient and leave time to address questions hept9confirmpt Assist patient to the bathroom for final void ○ understanding ○ was Beforemedications Discuss spiritual/cultural considerations that pertain to care After medication BEDPAN Patient presentation: If ☁ ○ IiE owngar Remove cosmetics, nail polish, dentures, contacts, and non-spiritual jewelry Ensure ID and allergy band have been placed W Pt Alert orientated ○ ○ Confirm area of surgical site is clearly identified DR label surgicalsite  Cultural Implications ☁ Native American Patients ○ Native American patients may deny feeling any pain, regardless of if they do or do not ○ Ask for pain level and note any facial expressions or body language ☁ Jehovah’s Witness Patients ○ Against patient's religious beliefs to accept blood products ○ It is essential to consult the patient before the procedure and clarify what they want in case they need blood ☁ Cultural Jewelry ○ Ask to remove, but if they refuse → tape it down 02 Intraoperative Care  Anesthesia Local Anesthesia ☁ Loss of sensation, but NO loss of consciousness Numbing a small, specific area of the body will talk Leastinvasive ☁ ☁ as_ Minor procedures → suturing a cut, dental work Regional Anesthesia ☁ Loss of sensation, but NO loss of consciousness will talk Alwaysinjected ☁ Numbs a larger region of the body by blocking nerve impulses f → epidural or spinal anesthesia, regional nerve blocks ☁ ALWAYS injected ☁ Surgeries involving larger areas, pregnancy General Anesthesia ☁ Patient is unconscious (need airway support) ☁ Given by ACP at t.EE taking Moderate Sedation red ☁ ☁ IV drugs + inhaled anesthetics Conscious sedation faiiiiouex.jointpoppedbackintoplace ☁ Used for procedures outside of the OR Benzodiaphines ☁ No ACP needed foranxiety ☁ Patient is conscious, but does not feel pain (reduces anxiety) t.ee k nutveryrelaxed Color = no feeling Color = feeling  Safety BEFORE ANESTHESIA BEFORE SKIN INCISION BEFORE LEAVING OR Patient has All team members What goes in comes confirmed identity, have name & role out procedure, site Surgical time out: Key concerns for Consent signed right patient, site, & recovery counts Checked for allergies Vitals monitoring on Teryone procedure Any anesthesia is going concerns whatgoes intothe patient 02 Sterility to saytheir bo Site marked confirmation Emergency Imaging displayed role equipment  Hypermetabolic Malignant Hyperthermia state Genetic condition triggered by inhaled anesthetics Given PRIOR to surgery Muscle rigidity ☁ Hypermetabolism of skeletal muscle results in altered control of intracellular calcium ☁ Succinylcholine is primary trigger Faintinghistory Tachycardia ☁ Treatment: prompt administration of Dantrolene ○ Helps to slow metabolism and reduce muscle contraction Pyrexia ☁ Preventative measures: ○ Thorough pre-op assessment (including careful bodytemp family history) Tachypnea ○ Genetic testing 03 Postoperative Care  Priority Postoperative Considerations Airway Circulation ☁ Ensure airway remains patent ☁ Hypotension → fluid or blood loss, ○ Monitor for airway obstruction or dehydration risk of aspiration ☁ Hypertension → unmanaged pain, ○ Utilize proper positioning anxiety, respiratory distress II Breathing ☁ Risk of hypoventilation ○ Anesthesia/opioids can cause respiratory depression Atelectasis is most common cause of hypoxia after surgery ffqgggq.si ☁ earliest ○ Encourage cough and deep breathing, incentive spirometer  D8 responsibility placing drains RN job Squeezbulb Drains cap use as suction loginput output ☁ Jackson Pratt (closed) clean wipe down to preventinfection ○ Bulb-like pump too ○ Must drain, measure much drainage, anddrainage report to DV squeeze the bulb before capping to retain suction ☁ Hemovac (closed) ○ Disk-like cylinder container ○ Must drain, measure drainage, and squeeze the cylinder before capping to retain suction ☁ Penrose Drain (open, passive) ○ Soft water hose like tube that EXTERNALLY sticks out of the patient’s body to drain oneend is entered into Ptwound sutured Bowel sounds wont be heard right after Arrestesia Cathsinserted BEFOREsurgery RNjob preventinfection cant control bladder bowels CAUTI Cath for retention try to ☁ Insert catheters when completely findprobleminjury necessary (patient should urinate 1 2 day within 6 hours) Try to remove I 8 is in (aim for ☁ Limit time that catheter 24 hours) fEan ☁ Hand hygiene & aseptic technique ☁ Keep bag below level of bladder Clean peri-area & tubing cleaning tubing out ☁ from perineal ☁ Ensure there are no dependent loops to urine bag 04 Venous Thromboembolism Put PE'S  blood clot air fat Gifford's DVT vs PE Venous Thromboembolism preakoff unilateral Deep Vein Pulmonary dislogged Thrombosis Embolism clot moves Blood clot that generally Blood clot originating from arises in the calf veins of DVT that has dislodged and the lower extremities traveled to the lungs or pulmonary arteries Redness, tenderness, swelling, warmth Dyspnea, impending doom, tachypnea, tachycardia, anxiety affiant  1mm Family NormalYQYfe.IS like Virchow’s Triad ‘SHE’ ☁ 3 factors that increase risk of thrombus formation she so stasis hypercoagulability endothelial damage Stasis Hypercoagulability Endothelial Damage nimy Slow or stagnant blood flow Blood is thickened Physical damage to vessels slowsblood can844 Immobility Hereditary: genetically 5 Endothelial dysfunction: Quadriplegicparalysis increased to clot Smoking, HTN Polycythemia Acquired: cancer, chemo, Endothelial damage: OCR/HRT, pregnancy, Surgery, catheter, PICC, too manyredbloodcells obesity, HIT trauma Addsmore intoblood makesbloodmove cause alot inflammation.gg slower fstroynaifef.pk Adverse dhikr ffto  I P induced thrombocytopenia s more Diagnostic Tests ☁ CXR → visualize the PE ☁ ABG, electrolytes, CBC, coagulation studies → changes due to hyperventilation, RBCs/platelets, PT/INR Testing for Drt mismatch therapurtocrangeaort ☁ Hypoxemia a platelets V/Q scan → Measures airflow & blood flow in the lungs chest X ray ftp.ffff Eventalationpertusionscan ☁ ECG → dysrhythmias VQ scan PE tachycardia spirant w contrast ☁ Spiral CT w/contrast → more detailed version of CT continuous movement pulmonary D-dimer → protein fragment that's a by-product of the body ☁ Angiography breaking down clots Found in everyonesblood notsuist people but putPEHave than normal value Put→ visualization ☁ Pulmonary angiography PE using fluoroscopy using due to visualize vessels in lungs for dots  Interventions Pt can't be on Anticoagulants Non-Massive Cases Massive Cases Anticoagulants: O2 Semi-Fowlers thrombolytic Eliquis, IV Intubation Coumadin, Catheter Thrombolytic therapy Heparin, Sedative Labs therapy: tPA, at the Lovenox Bedrest ‘plase/kinase’ Vasopressors same time to increase set it BP Embolectomy Up rightaway to breathe better InferVena cava recieres blood from vowerexrem pts w Anticoagulants long term getweaned off Prevention No PA to be on toumadin home cant gohome w iv heparin ☁ Sequential compression devices, compression socks ☁ Avoid sitting for long periods of time ☁ Exercise After THT☁ Inferior vena cava filter → for recurrent PEs ☁ Quadripletic pts Anticoagulants ☁ forWarfarin aPTT → Heparin) Lab work (INR → ☁ Freauently Avoid razors 2 3 therapeuticnormalrange use soft bristle brushes don'tFloss ☁ Report changes in calf pain & appearance 05 Practice Questions The nurse is admitting a patient to the clinical unit from surgery. Being alert to potential fluid volume alterations, what assessment data will be important for the nurse to monitor to identify early changes in the patient’s postoperative fluid volume? Select all that apply A. Intake and output B. Skin turgor 0 C. D. E. Lung sounds Respiratory rate Level of consciousness The nurse is admitting a patient to the clinical unit from surgery. Being alert to potential fluid volume alterations, what assessment data will be important for the nurse to monitor to identify early changes in the patient’s postoperative fluid volume? Select all that apply A. Intake and output B. Skin turgor C. Lung sounds D. Respiratory rate E. Level of consciousness Your patient is recovering from anesthesia, but is displaying signs of increasing agitation and confusion. What is your priority action at this time? A. Perform a focused neurological assessment B. Notify the health care provider immediately C. Provide reassurance because this patient is displaying signs of delirium D. Assess the patient’s vital signs 0 Your patient is recovering from anesthesia, but is displaying signs of increasing agitation and confusion. What is your priority action at this time? A. Perform a focused neurological assessment B. Notify the health care provider immediately C. Provide reassurance because this patient is displaying signs of delirium D. Assess the patient’s vital signs A patient scheduled for hip surgery has a history of DVT. What is the most important nursing intervention to minimize risk of venous thromboembolism in this patient? A. Encourage the patient to remain in bed postoperatively to avoid potential dislodgement 0C.B. Educate the patient about early ambulation and leg exercises Limit the patient’s fluid intake to prevent swelling D. Request a prescription for Coumadin and postpone the surgery A patient scheduled for hip surgery has a history of DVT. What is the most important nursing intervention to minimize risk of venous thromboembolism in this patient? A. Encourage the patient to remain in bed postoperatively to avoid potential dislodgement B. Educate the patient about early ambulation and leg exercises C. Limit the patient’s fluid intake to prevent swelling D. Request a prescription for Coumadin and postpone the surgery You are working on a surgical unit and have the following four postoperative patients. Considering the symptoms and condition of each patient, rank them in order of priority assessment. A. Postoperative day 1 after cholecystectomy. The patient reports abdominal pain 7/10, is 3 diaphoretic, and has a temperature of 100.6 B. Postoperative day 2 after knee arthroplasty. The patient reports severe shortness of breath and chest pain the worsens with deep breathing. Oxygen saturation is at 90% on room air. I C. Postoperative day 3 after abdominal surgery. The patient reports swelling and tenderness in the right calf which is warm to the touch. The patient reports an increased pain level of 5/10 2 and that they have been feeling more fatigued than usual. D. Postoperative day 3 after a laparoscopic appendectomy. The patient has complains of nausea and vomiting, but has been able to tolerate clear liquids. The patients lips appear chapped 4 and appears notably lethargic. You are working on a surgical unit and have the following four postoperative patients. Considering the symptoms and condition of each patient, rank them in order of priority assessment. 1. B. 2. C. 3. A 4. D A patient recovering in the PACU begins to complain of severe nausea. As his nurse, what is your priority action? A. Retrieve an emesis bag from the supply room B. Respect the patient’s preference for privacy and assist them to the bathroom C. Help the patient lay down and turn them to their side D. Administer the PRN antiemetic to reduce risk of aspiration A patient recovering in the PACU begins to complain of severe nausea. As his nurse, what is your priority action? A. Retrieve an emesis bag from the supply room B. Respect the patient’s preference for privacy and assist them to the bathroom C. Help the patient lay down and turn them to their side D. Administer the PRN antiemetic to reduce risk of aspiration A few minutes after receiving a premedication before surgery, the patient asks to get up to go to the bathroom. What next step should the nurse take? a. Ask a UAP to assist the patient to the bathroom so they do not fall b. Tell the patient you can bring them a bedpan o c. Let the patient go to the bathroom because the medication has not kicked in yet d. Tell the patient they will insert a catheter before the surgery starts A few minutes after receiving a premedication before surgery, the patient asks to get up to go to the bathroom. What next step should the nurse take? a. Ask a UAP to assist the patient to the bathroom so they do not fall b. Tell the patient you can bring them a bedpan c. Let the patient go to the bathroom because the medication has not kicked in yet d. Tell the patient they will insert a catheter before the surgery starts A patient who takes Lasix and a medication to control blood pressure is scheduled for a hernia repair surgery. Which patient information is most important to relay to the health care provider before surgery? potassium levels a) Hemoglobin 14.0 3.5 5.5 b) Blood pressure 140/86 c) Potassium of 3.1 d) Pulse 56 A patient who takes Lasix and a medication to control blood pressure is scheduled for a hernia repair surgery. Which patient information is most important to relay to the health care provider before surgery? a) Hemoglobin 14.0 b) Blood pressure 140/86 c) Potassium of 3.1 d) Pulse 56 On the day of surgery, which of the following can be assigned to a UAP? Select all that apply. a) Teaching how to use an incentive spirometer b) Explaining what will happen in the PACU c) Obtaining vital signs before surgery d) Removing jewelry e) Helping the patient transfer to the bathroom f) Explaining what medications the patient will receive On the day of surgery, which of the following can be assigned to a UAP? Select all that apply. a) Teaching how to use an incentive spirometer b) Explaining what will happen in the PACU c) Obtaining vital signs before surgery d) Removing jewelry e) Helping the patient transfer to the bathroom f) Explaining what medications the patient will receive A female patient in the hospital is complaining of cramping and tenderness in her right calf. The nurse believes the patient has a DVT since she has been immobile after surgery. What steps should the nurse take next? Select all that apply. a) Quickly get a pair of SCDs to apply to the patient’s legs b) Get the assistance of a UAP to help walk the patient around the unit c) Explain to the patient they will need to be on bedrest E d) e) Administer thrombolytics to break up the clot Insert a urinary catheter A female patient in the hospital is complaining of cramping and tenderness in her right calf. The nurse believes the patient has a DVT since she has been immobile after surgery. What steps should the nurse take next? Select all that apply. a) Quickly get a pair of SCDs to apply to the patient’s legs b) Get the assistance of a UAP to help walk the patient around the unit c) Explain to the patient they will need to be on bedrest d) Administer thrombolytics to break up the clot e) Insert a urinary catheter Which of the following information is most important to give to a patient receiving abdominal surgery? a) Early ambulation after surgery is vital to prevent DVT b) They need to void prior to receiving their premedication c) They should splint their abdomen when coughing d) They should void right after surgery Which of the following information is most important to give to a patient receiving abdominal surgery? a) Early ambulation after surgery is vital to prevent DVT b) They need to void prior to receiving their premedication c) They should splint their abdomen when coughing d) They should void right after surgery