Med Admin
Do we give IM injections in the dorsogluteal site?
NO! There is evidenced based practice showing that there has been risk of injury to nerves/vessels in that location.
What phase of surgery is the phase where the decision to have surgery begins until just before patient heads back into the OR.
Pre-Op Phase
If a patient has concerns about the surgery and she has not signed the consent, what do we do as the nurse?
Contact the physician prior to surgery so the surgeon can talk to the patient and get the consent form signed. We cannot begin surgery until a consent has been signed.
What aldrete score is appropriate for discharge from the PACU (post-anesthesia care unit) to the unit accepting the patient?
8-10 is adequate for discharge. 10 is the highest you can score on the Aldrete score.
What are your triggers for Malignant Hyperthermia?
Inhaled volatile liquids:
Enflurane (Ethrane)
Halothane (Fluothane)
Desflurane (Suprane)
Sevoflurane (Ultrane)
Succinylcholine
An insulin syringe can be used for other subcutaneous injections other than insulin? True or false?
FALSE! Insulin syringes are ONLY to be used to inject insulin due to the nature of the medication (units). Remember, no math with insulin due to UNITS.
Why are orders given to patient's preoperatively to hold medications as well as become NPO at least 8 hours prior to surgery? Explain.
Risk for aspiration if they vomit during the procedure could cause an asthma-like attack. Also, depending on the patient medications such as insulin, if the patient is not eating and they give insulin as normally prescribed, they could drop their blood sugar.
What are some interventions we teach our patients about post-op and things to help them improve their outcomes following surgery? With each intervention, why do we teach them these things? What are we trying to avoid?
Cough and Deep Breath (teaching them how to splint), use of incentive spirometer, leg exercises, ambulation, EPC cuffs/ted hose.
What intervention should the nurse ensure is done prior to ambulating a patient?
Medicate! The first few times a patient gets up to ambulate is hard. Ensure they are medicated appropriately for pain control.
What medication do we have in the OR to treat malignant hyperthermia?
Dantrium (dantrolene sodium)
You are the nurse caring for a client who requires an IM injection of penicillin. The ordered dose is 10mg IM qday. The label reads 5mg/2mL. You have chosen to inject into the ventral gluteal muscle. The nurse aspirates and has blood in the syringe. What are the next steps?
We should stop medication administration by withdrawing the needle, safety locking our needle, wasting the medication drawn up, and disposing of all other supplies. We must start over at this point.
What type of adjunct medication are used preoperatively to reduce salivation and excessive secretions in the respiratory and GI tracts?
Anticholinergics
We are doing an abdominal surgery on a patient. What position in the OR would you expect your patient to be in?
laparotomy positioning is best for abdominal surgery
You are caring for a postoperative patient who is attempting to ambulate for the first time since surgery. What steps should the nurse take to minimize risks for injury while getting the patient up?
First, dangle the patient at the bedside. Give them a few minutes to adjust to sitting at the bedside. Then have them stand with you at the bedside for a few minutes. We must ensure they are not dizzy or lightheaded before walking them around the patient room.
Name this type of anesthesia:
•reduces anxiety and sensitivity to pain
•combination of IV benzo's and opiates
•Preserves the patient’s ability to maintain own airway and to respond to verbal commands
•Used for diagnostic procedures and minor surgical procedures that do not require deep anesthesia
•Topical anesthetic may be applied also
•Rapid recovery time and greater safety profile than general anesthesia
conscious sedation (moderate sedation)
What are your teaching points for use with an inhaler?
rinse mouth out after use
what are signs of hypovolemic shock?
pallor; cool, moist skin; rapid breathing; cyanosis of the lips, gums, and tongue; rapid weak, thready pulse; narrowing pulse pressure; low blood pressure; and concentrated urine
What stage of anesthesia is this?
•Reached by continued administration of the anesthetic vapor or gas
•Pt is unconscious and is quiet
•Pupils are small but contract if exposed to light
•Respirations and pulse are regular, skin is pink or slightly flushed
•This stage may be maintained for hours in one of the four planes – ranging from light (1) to deep(4) depending upon on the depth of anesthesia needed
Second Stage
What is our priority assessment on a post-op patient?
Immediate postop primary objective is to maintain ventilation and prevent hypoxemia (reduced oxygen in the blood) and hypercapnia (excess carbon dioxide in the blood).
What do NMBD's do?
A high alert medication!!
These drugs paralyze the respiratory muscles and incorrect administration without sufficient ventilator support has resulted in patient deaths.
You are the nurse caring for a client who has a PO medication ordered. You have done your 5 rights of medication administration twice. You are now doing your final medication check with the patient. The patient states, "This medication is not correct, I do not take this. I don't even know what that is." What does the nurse do?
If the patient does not know what the medication is or has not been talked about the medication previously by a physician, they have the right to refuse. We can hold the medication and call the physician.
Sterile to sterile is sterile
Sterile to unsterile is.....
UNSTERILE.
You are the nurse taking care of a client who is having a total hip replacement and is currently in surgery. The anesthesiologist takes vital signs frequently and the last vital sign check was 15 minutes ago.
Temp was 99.4f, 78 HR, 14 resp, Bp 105/78.
Vital signs now are 103.8f, 152 HR, 22 resp, BP 138/82.
Explain the vital sign changes.
Malignant Hyperthermia is a rare inherited muscle disorder that is chemically induced by anesthetic agents - begins with skeletal muscle exposure to specific agents
Triggers: Potent inhalation anesthetic agents (halothane, enflurane) and muscle relaxants (succinylcholine) may trigger the symptoms
People who are at risk: those with strong and bulky muscles, history of muscle cramps or muscle weakness and unexplained temperature elevation, and an unexplained death of a family member during surgery that was accompanied by a febrile response
You are the nurse caring for a postoperative client. You have been doing q15 minute blood pressure checks on your client and have noticed the systolic blood pressure is declining at every check. What would you do?
Notify the physician and anesthesiologist. They need to be aware as there may be a complication with the surgery.
What are the different types of local anesthetics? Please explain them.
Epidural
Intrathecal
Infiltration
Nerve Block
Topical