NUR 425 - Exam 1
Malignant hyperthermia - answer- genetically linked
- adverse reaction to anesthesia with succinylcholine
- very rapid increase in temp, tachycardia, hypotension, muscle rigidity
- cyanosis
- antidote = dantrolene (muscle relaxer) with 60mL sterile water
- administer cold fluids
- anything to reduce temp
pre-op instructions / information - answer- NPO
- chlorhexidine bath
- Meds: none except thyroid, insulin, beta blocker
- Allergies: latex, iodine (allergy pt goes first)
- Family Hx: malignant hyperthermia
- No jewelry or underwear
pre-op at hospital - answer- informed consent: given by surgeon, nurse as witness
- site marking: done by surgeon, verified by nurse
- start IV: for meds and fluids
- check labs
- vital signs: baseline, must be fever free, diabetes increase risk for infection,
obese/asthma Increased risk for resp depression
- pt. education: before sedatives
meds and fluids through IV - answer- sedative: benzo (midazolam)
- beta blocker
- PPI: atropine
- antiemetic: ondansetron
- pain meds
- insulin
- abx
intraop: before pt. enters surg suite - answer- surgical safety checklist: ensuring
everything needed is there
- safety: surgical site infection, position related injury, retained items (increased risk for
adhesions), fire (gas / electricity)
intraop: pt enters - answeranestesia
- induction: putting pt under
- intubation: placing et tube
- maintenance: keeping them under
- emergency: removing tube
, - recovery: post op
Time-out:
- right before first cut
- verify pt, side, procedure, needed equipment
- every person must say "I agree"
sterile field - answer- chest down to sterile table
- 2 in. above elbows down to finger tips
- within box in front of you
post-op - answermost important: ABC's
- Airway: pt. might need to be re-intubated
- Breathing: turning, coughing, deep breathing, IS (10x per hr q hr while awake),
prevention of aspiration pneumonia
- Circulation: monitor bp and hr
PACU - Aldrete score: - answerAldrete score: determines post surgery status compared
to pre-op and if they can be d/c'd
- must have pre-op vitals before performing score
- higher the score, closer to d/c (out of 10)
- Activity, breathing, consciousness, circulation, SpO2
PACU - Pain control - answerMeds:
- PCA
- meds before PT
- don't wait too long to give
Non-pharm:
- splinting incision: places pressure on incision when coughing
- prevents dehiscence in abdominal incisions
incision dehiscence - answer- medical emergency: infection can occur
Interventions:
- don't leave pt, call for help
- tell them not to move, touch, and remain calm
- cover with sterile towels soaked in sterile saline
- call physician
PACU - monitoring for DVT's - answer- risk factor: surgery
- preventions: tedhoes, SCDs, avoid pressure behind knees, admin anticoags, early
ambulation
- S/S: swelling, pain, redness, heat typically in calf
- can lead to a pulmonary embolism
Interventions for DVT - answer- venous duplex to confirm
- rest: don't get up, legs should be higher than heart, dont massage, remove teds or
SCDs from only affected leg, blood thinner will hopefully dissolve clot
Malignant hyperthermia - answer- genetically linked
- adverse reaction to anesthesia with succinylcholine
- very rapid increase in temp, tachycardia, hypotension, muscle rigidity
- cyanosis
- antidote = dantrolene (muscle relaxer) with 60mL sterile water
- administer cold fluids
- anything to reduce temp
pre-op instructions / information - answer- NPO
- chlorhexidine bath
- Meds: none except thyroid, insulin, beta blocker
- Allergies: latex, iodine (allergy pt goes first)
- Family Hx: malignant hyperthermia
- No jewelry or underwear
pre-op at hospital - answer- informed consent: given by surgeon, nurse as witness
- site marking: done by surgeon, verified by nurse
- start IV: for meds and fluids
- check labs
- vital signs: baseline, must be fever free, diabetes increase risk for infection,
obese/asthma Increased risk for resp depression
- pt. education: before sedatives
meds and fluids through IV - answer- sedative: benzo (midazolam)
- beta blocker
- PPI: atropine
- antiemetic: ondansetron
- pain meds
- insulin
- abx
intraop: before pt. enters surg suite - answer- surgical safety checklist: ensuring
everything needed is there
- safety: surgical site infection, position related injury, retained items (increased risk for
adhesions), fire (gas / electricity)
intraop: pt enters - answeranestesia
- induction: putting pt under
- intubation: placing et tube
- maintenance: keeping them under
- emergency: removing tube
, - recovery: post op
Time-out:
- right before first cut
- verify pt, side, procedure, needed equipment
- every person must say "I agree"
sterile field - answer- chest down to sterile table
- 2 in. above elbows down to finger tips
- within box in front of you
post-op - answermost important: ABC's
- Airway: pt. might need to be re-intubated
- Breathing: turning, coughing, deep breathing, IS (10x per hr q hr while awake),
prevention of aspiration pneumonia
- Circulation: monitor bp and hr
PACU - Aldrete score: - answerAldrete score: determines post surgery status compared
to pre-op and if they can be d/c'd
- must have pre-op vitals before performing score
- higher the score, closer to d/c (out of 10)
- Activity, breathing, consciousness, circulation, SpO2
PACU - Pain control - answerMeds:
- PCA
- meds before PT
- don't wait too long to give
Non-pharm:
- splinting incision: places pressure on incision when coughing
- prevents dehiscence in abdominal incisions
incision dehiscence - answer- medical emergency: infection can occur
Interventions:
- don't leave pt, call for help
- tell them not to move, touch, and remain calm
- cover with sterile towels soaked in sterile saline
- call physician
PACU - monitoring for DVT's - answer- risk factor: surgery
- preventions: tedhoes, SCDs, avoid pressure behind knees, admin anticoags, early
ambulation
- S/S: swelling, pain, redness, heat typically in calf
- can lead to a pulmonary embolism
Interventions for DVT - answer- venous duplex to confirm
- rest: don't get up, legs should be higher than heart, dont massage, remove teds or
SCDs from only affected leg, blood thinner will hopefully dissolve clot
