Skin
A flat, non-palpable change in skin color usually less than 1 cm.
What is a macule.
When should the surgery nurse apply SCDs or TED hose? What are they used for?
What is prior to surgery- in pre-op holding area. To prevent thrombophlebitis or blood clots from immobility during surgery.
What does it mean to split the incision and when should it be done?
Splitting the incision means to apply pressure to it to avoid strain from coughing, sneezing, etc. You should teach a patient to apply pressure over the abdominal incision with a pillow when coughing or activity that increase intrabdominal pressure. Not only is it for comfort but to avoid dehiscence or evisceration.
Name the 4 different types of shock.
What is hypovolemic, cardiogenic, obstructive, distributive
What medication is used for post-op shivering?
What is demerol.
How long can wet dressings be applied to client?
What is no more than 72 hours.
What is the LPN's role with the surgical consent form?
What is make sure the patient is informed and doesn't have further questions, signs the form voluntarily, and is not under the influence of any medications that could alter their cognitive abilities.
What is a JP drain and how does it work?
A JP drain is a drain that is inserted near a surgical site when drainage is anticipated. It is a bulb-like suction device that must be compressed to create suction to help pull out the drainage. It has a valve at the bottom to drain the fluid. If there is an excessive amount of drainage the physician should be contacted.
What is the first symptom of hypovolemic shock?
What is tachycardia.
What class of medications decreases pre-op anxiety and induces amnesia?
What is benzos like versed (midazolam), valium (diazepam), and ativan (lorazepam).
Upon admission a patient had a sore on their sacrum that has exposed bone and muscle. What is the best way for the nurse to thoroughly document this pressure ulcer? What stage is this pressure ulcer?
What is take a picture of the wound. Stage 4.
How do you use an incentive spirometer? Why do surgical patients need to use an IS?
What is
IS (incentative spirometer)- Does it provide O2? What does it do? Opens alveoli.
-HOB at 45 degrees or greater
-take 2 normal breaths and exhale
-seal lips around the mouth piece
-inhale deeply and hold breath for 3-5 seconds
-exhale completely
-Use at least 10 times/hr while awake
A patient is 36 hours post-op and still hasn't had a bowel movement. What interventions can be done to help this poor backed up fella?
Your patient admitted with pneumonia has had decreased urinary output the last 8 hours and she has become tachycardic with a temperature of 96.2. You've noticed she's been slightly confused and requiring a bit more oxygen. Her blood pressure has been running lower than normal for her. What do you suspect?
What is septic shock. What should you do? Call the physician and anticipate collecting blood cultures, administering broad spectrum antibiotic, administering fluid to maintain blood pressure and if fluid is not enough, starting a vasopressor to keep circulatory status maintained. Monitor airway, if patient comes too unresponsive may need to intubate to protect the airway.
Please provide an example of an opioid antagonist
What is NARCAN. What will happen to the patient's pain when NARCAN is administered?
A patient has a healing wound on her abdomen. Wound care is not available when she is admitted and you must dress the wound. What type of dressing should you apply if the wound bed is red, grainy and moist?
What is a non-adherent dressing that will keep the wound bed moist like hydrocolloid, alginates, vaseline gauze or hydrogel.
When asking a patient if they or their family have had problems with anesthesia, what complication are we screening for? What are symptoms of that complication and what medication will treat it?
What is malignant hyperthermia. Muscle rigidity, fever, tachycardia, arrhythmias. Treat with STOP THE ANESTHETIC AGENT and administer dantrolene.
A post-op patient develops altered mental status, tachycardia and oliguria. What should the nurse do?
What is check the incision site to make sure there are no signs of bleeding. It does not have to be external bleeding. If you patient had an abdominal surgery and has a distended abdomen all of a sudden, there may be internal bleeding and the physician should be called immediately.
What is cardiogenic shock from MI.
What class of medications help to decrease gastric acid and may be administered prior to surgery? Give one example of a medication in that class.
What is H2 receptor antagonist. What is Pepcid (famotidine), Tagamet (cimetidine), and Zantac (ranitidine).
What is overexposure to UV rays (especially between 10-4), being fair skinned and blue eyed, history of radiation exposure or x-ray therapy, burns, chronic osteomyelitis, and immunosuppressive therapy.
The physician ordered the following pre-op labs prior to a cholecystectomy: CBC, CMP, PT/INR. WBC=11, K+=2.6, Creat=0.8, BUN= 22, and INR=1. What should you do?
What is alert the physician or anesthesia provider of the abnormal K+ level because it can cause arrhythmia during the surgery. Patient needs K+ replacement prior to the procedure.
A patient with congestive heart failure is 1 day post-op and receiving continuous IV fluids. You notice the patient has crackles in their lungs and shortness of breath. What nursing diagnosis is most important?
What is fluid volume overload. Do not administer fluids to this patient for tachycardia.
What is of MOST importance to maintain in anaphylactic shock? What is angioedema? Why does epinephrine help in anaphylactic shock?
AIRWAY. You can have angioedema& laryngeal edema with anaphylactic shock. It is important to establish an airway before the swelling becomes too severe that you can no longer intubate. Epinephrine activate the alpha 1 receptors causing vasoconstriction and the beta 1 and 2 receptors causing increased heart rate, contractility and bronchodilation.
A patient is hypotensive and short of breath. What position should this patient be in? Should a patient that is hypotensive be placed in trendeleburg position?
What is with the HOB elevated as much as the blood pressure will tolerate. No, it is old practice to place a hypotensive patient in trendeleburg position. It is not helpful and has been found to have negative effects.