Preop
What documentation needs to be provided in a patient's chart prior to surgery?
H&P, Informed consent
Describe the difference in role between a scrub nurse and a circulating nurse.
Scrub nurse:
sterile, lay out surgical field, prepare instruments, hand instruments during surgery, also help others don surgical PPPE.
Circulating nurse:
documentation, phone calls, and moving non-sterile equipment
Explain the parameters of administering PRBC's, how long can they infuse and why? Once thawed how long do I have to use them?
Administration must occur over 2-4 hours to prevent infection.
Once blood is thawed you have 24hrs to use it.
What are the bleeding precautions (RANDI)
R- razor-electric
A- Aspirin, NO!!
N- Needles, small gauge
D- Decrease needle sticks
I- Injury, protect from
what are some indications for enteral feeding.
Anorexia, Oral/facial fractures, head/neck cancer, neurological/psychiatric disorders, critically ill, better than parenteral nutrition (less expensive)
Explain why a nursing assessment is important..
Identify risk factors, form a plan of care to ensure patient safety!
What is the purpose of a surgical timeout?
check pt identifier, verify surgery being performed and surgical site.
What is the indication for giving platelets and what action is required before running the platelets.
Platelets are used to treat thrombocytopenia and platelet dysfunction.
Since platelets are sticky, you have to agitate the bag to prevent them from adhering to the plastic.
Explain the BUN and creatinine relationship.....
(When BUN is high, but Creatinine is normal and when both are high. What does this mean?)
BUN is high and Creatinine is normal it is a sign of dehydration.
BUN and creatinine are both high it can be an indication of kidney failure.
What is refeeding syndrome?
Occurs when a malnourished patient is started on aggressive nutritional support and is characterized by fluid retention and electrolyte imbalances (especially hypophosphatemia)
Your pre-op patient states that are " feeling anxious and don't understand how the procedure is going to work" what is the nurses best action
Notify the surgeon to clarify any questions the patient may have.
Emergence Delerium S/S and potential causative agents.
Restlessness, agitation, disorientation, thrashing, shouting.
Causes: anesthesia, hypoxia, bladder distention pain, electrolyte abnormalities, or anxiety.
When would a nurse give fresh frozen plasma (FFP), and what are the components of FFP.
FFP is rich in clotting factors but contains NO platelets.
Indicated for blood loss caused by deficiency in clotting factors or a drug impacting clotting factors (warfarin)
Explain what it means to have a high neutrophil count? High lymphocytes?
Both indicate an infection but different kinds:
Neutrophils: acute bacterial (strep), trauma, or inflammatory response
Lymphocytes: Chronic bacterial infections and acute viral infections.
What are some complications of parenteral nutrition?
Infection, metabolic problems (hyperglycemia and hypoglycemia)
Catheter-related complications:
Air embolism, pneumothorax, hemothorax, dislodgement, thrombosis of vein, phlebitis.
What could be three potential red flags in patients' history that may suggest a latex allergy?
Health care worker, history of hay fever, history of asthma, food allergies (banana, eggs, avocados, chestnuts, potatoes, peaches).
What are signs and symptoms of a postoperative infection?
fever, PERT (wound), purulent drainage from wound, low urinary output (Uti), altered mental status, diaphoresis
What should the nurse do if there is a transfusion reaction?
Stop the transfusion!!!!!
run normal saline with new tubing and monitor VS every 5 minutes
What increases hemoglobin, hematocrit and RBCs? decreases?
Increases: dehydration, burns, smokers
decreases: fluid volume excess, anemia, hemorrhage.
What is dumping syndrome, what are some manifestations, and what are some nursing interventions that can help prevent it?
Dumping syndrome: when the contents of the stomach empty into the small intestine too quickly.
D/t excess fluid drawn into the small intestine from partially digested food a patient may experience nausea, cramping, diarrhea, sweating, faintness, and palpitations.
Prevention: 5-6 smaller meals, reduce intake of simple sugars, increase protein and healthy fats, avoid drinking fluids during meals, lay down after eating.
What three aspects must be included in informed consent, and who is responsible for obtaining it?
The surgeon is responsible for obtaining it.
1.Adequate disclosure: Diagnosis, purpose of procedure, risks and consequences of tx, probability of success, alternative treatments, prognosis without treatment.
2. Understanding and comprehension
Voluntarily given consent.
What are the clinical manifestations of malignant hyperthermia?
Tachycardia, Tachypnea, hypercarbia, ventricular dysrhythmias, muscle rigidity, extremely elevated temperature.
How much should one unit of packed red blood cells (PRBCs) raise your hemoglobin and hematocrit?
Hemoglobin: 1g/dL
Hematocrit: 2%-3%
Which lab value goes with heparin? Warfarin?
What is the antidote for heparin? Warfarin?
PT/INR: Warfarin
APTT: Heparin
Heparin - Protamine Sulfate
Warfarin - Vitamin K
What is the nursing management for a patient receiving enteral feedings?
HOB at least 30 degrees, flush the tube Q4 for continuous feeds, verifying proper placement of tube, keep insertion site clean and dry, if liquid meds are unavailable make sure to crush well and dilute in sterile water.