Pain
TRUE or FALSE. pain is what the patient states it is and where the patient states it is.
true
Who is responsible for marking the surgical site during the time-out?
the surgeon. should use their initials to mark the operation site as close to the actual site as possible and this should be done RIGHT before the procedure
what is important to assess for when asking the patient about family history?
malignant hyperthermia
what is the most common anemia worldwide?
iron deficiency
what is the most common s/s associated with an acute vaso-occlusive event in sickle cell disease?
pain!
TRUE or FALSE. Once we use one distinct pain scale to assess pain, we should not change the pain scale used (unless there is a change in patient condition warranting change).
true
what are some key teaching to be done during the pre-operative phase?
leg exercises, breathing exercises, expected pain management, drain management, wound management, nutrition therapy, rehabilitation/recovery course, early mobility
what labs does the RN need to report if they are abnormal before surgery?
electrolytes (potassium), HgB&HcT, pregnancy, WBC, bleeding/coag studies, UA
*make sure there is a type & screen active
what s/s does someone with iron deficiency anemia present with?
pallor, fatigue, exercise intolerance, dyspnea, fissures at the corner of the mouth, cold extremities, brittle nails, tachycardia
how can we prevent a sickling crisis?
hydration, avoid strenuous exercise, infection prevention, room temperature at least 72F, avoid high altitudes, avoid alcohol & smoking, chronic pain management
When assessing patients, what are some impacts the RN should consider and/or ask the patient about?
ADL impact, QOL impact, financial impact
who is responsible for doing the informed consent and what is the role of the RN?
the surgeon; the RN is there to witness and to clarify facts presented by the surgeon and to dispel myths that surround surgery
what s/s would suggest the surgical site is infected? think about what is normal suture/staple sites
redness, swelling, pain, odor, purulent discharge, fever/malaise, beginning stages of separation of the wound site
what is the most common cause of folic acid deficiency anemia and vitamin B12 deficiency anemia?
diet (vegan & vegetarian)
describe treatment for iron deficiency anemia.
PO supplements & increase dietary intake of iron-rich sources. IV preparations should only be used for severe symptomatic cases and/or refractory anemia
Name some non-pharmacological ways to manage pain.
massage, distraction, PT & OT, TENS units, relaxation techniques, CBT/psychological therapies, acupuncture
what s/s does the RN need to monitor for in the patient receiving general anesthesia, conscious sedation, or any opiate during the peri-operative period?
respiratory depression/respiratory failure, over-sedation, confusion & dizziness (orthostatic changes), low O2 sats, respiratory changes
what is the proper approach to managing medication orders on the day of surgery?
clarify which medications should be given with the surgeon and/or anesthesia
what is the name for the beefy red tongue associated with vitamin B12 anemia?
glossitis
vitamin b12 deficiency anemia can be due to an autoimmune disease which causes an inherit lack of intrinsic factor-what is the name for this anemia?
BONUS: what is treatment?
pernicious; weekly b12 injections and then monthly for life (OR if they have decent b12 absorption high dose PO b12 can be substituted for maintenance)
what are some SEs to using opiates and spinal/epidural analgesia that we need to monitor for and/or report to the PCP?
opiates: respiratory depression/respiratory failure, over-sedation (difficulty arousing patient), undertreatment of pain
spinal/epidurals: hypotension, spinal headache, worsening paralysis and/or sudden acute muscle numbness/loss of sensation, s/s of site infection, respiratory muscle paralysis
name the 2 medical emergencies that can happen post-operatively to the surgical site. these are more common in people with abdominal incisions, infected incisions, obesity, etc.
dehiscence and evisceration
Discuss special considerations/populations that you may encounter while getting informed consent.
blind pts: can sign their own consent form which needs to be witnessed by 2 people.
foreign language & hearing impaired: need a qualified translator & second witness
unable to write: can sign with an X which is witnessed by 2 people (one can be the RN)
Unable to consent: contact medical POA and get verbal consent
unable to consent & no medical POA: court appointed legal guardian
life-threatening, cannot get medical POA, cannot consent: 2 HCPs not associated with the case
what differentiates vitamin B12 from folic acid deficiency in terms of s/s?
vitamin b12 will have paresthesias/numbness and will have cognitive changes (personality changes, dementia/memory issues, agitation)
describe how we treat an acute sickling crisis.
pain control! oxygenation. hydration. stable room temperature at or above 72F. do not bend the knees or raise HOB too high (risk of avascular necrosis). remove restrictive clothing. avoid BP's with an external/standard cuff. may consider PRBC transfusion. medications (hydroxyurea).