Pre/Post Op
How often are vitals and CSM checks for a fresh post-op?
CSM - q1hr x 6
Vitals - q1hr x 2, then q4hr x 48 hours, then q12hr
DOUBLE POINTS !!!!
No, not unless the patient is symptomatic. Normal range is 135 - 145.
What is lansoprazole?
Medication that reduces stomach acid. It is prescribed to patients with peptic ulcer disease and GERD.
Your patient expresses to you that they live home alone and have concerns about being able to take care of themselves properly upon discharge. Who do you want to consult?
Social Work
How many doses of cefazolin does a post op patient get?
3
Your patient has a K+ of 2.9. What is your response? What do you expect the treatment to be?
Assess patient, notify the team, expect to replace K+, recheck blood work post replacement
The order reads "administer 0.25mg hydromorphone subcutaneous q3h as needed for pain". The ampule reads hydromorphone 2mg/mL. How many mL are you going to administer the patient?
0.125mL
Your patient tells you that they are experiencing chest pain. What do you do?
Assessment, let the team know, expect ECG, blood work, chest xray, document
TRIPLE POINTS !!!!!!
What are 5 topics to discuss during discharge?
Dressing, constipation, DVT, infection, prescriptions, follow up appointments, who to call if they have questions
What is considered a therapeutic INR for a patient on warfarin?
2 - 3
What medications do we avoid post op day 0?
Blood pressure meds, sedatives, anticoagulants
Your patients hemoglobin is 68 and the team has ordered 1 unit of PRBC to be infused over 2 hours. What are the steps you are going to take prior to administration?
Group and screen, consent, order, set up tubing, make patient aware, check with another nurse
List 5 potential post op complications
Infection, PE, DVT, bleeding, urinary retention, delirium
Your patient's hemoglobin yesterday was 145. Today is it 104. This patient had surgery 4 days ago and there are no obvious signs of bleeding. Does this require any intervention?
Yes. This is a large hemoglobin drop and the team needs to be made aware because the patient could be bleeding internally.
A patient is on call for the OR. What medications are you going to hold?
Ramipril, metformin, calcium carbonate, dalteparin, lasix, amlodipine
Your patient calls you into the room and says "I can't breathe." You check their SpO2 and it is 74%. What do you do?
Call for help, put O2 in patient, make sure the patient is sitting up in bed, encourage deep breathing, if O2 not successful call CCOT, let the team know, document
How many doses of an antibiotic do patient's who have had a revision get?
Until cultures back
Your patient was experiencing chest pain and had a troponin drawn at 1100h. When will you draw the next troponin? How many times do you want to reassess a patient's troponin post chest pain?
1900h. Every 8 hours until the troponin peaks.
Your patients creatinine is 386. What medications do you want to hold?
Dalteparin, naproxen, ferrous gluconate, cefazolin, ibuprofen, acetaminophen, bisoprolol
Your patients IV pump beeps "downstream occlusion." How are you going to fix this?
Make sure the IV line below the pump is not kinked or clamped off anywhere.