Neurosurgery
What device helps prevent DVTs and should be worn at all times unless ambulating?
Sequential compression devices (SCDs)
If a patient had a sentinel lymph node biopsy, what is a key piece of education to let the patient know that is expected?
Blue urine, this will return to normal over the course of a couple days.
What is the expectation from the GU team in terms of activity orders for most GU observation patients?
Out of bed (OOB) and ambulating POD 0.
*GU team likes for their patients to be OOB for meals, and up to the chair when they round in the morning.
When should the RN be concerned with vaginal bleeding post-hysterectomy?
If the patient is saturating more than 1 menstrual pad an hour.
What lab level are we concerned with being low?
Calcium
What is a requirement patients must do before discharge, and how can nursing staff help them to achieve this goal?
Return of bowel function. Give scheduled and PRN stool softeners/laxatives and ambulate patients.
What is the purpose of a tissue expander?
A tissue expander is used to stretch skin and tissue for a permanent implant gradually.
How often should urine output be documented in the chart?
If the patient is voiding, it should be charted in real time, but at a minimum, output should be documented every 4 hours.
What is the difference between a total hysterectomy and a radical hysterectomy?
In a total hysterectomy, the uterus and cervix are removed, whereas in a radical hysterectomy, the uterus, cervix, and parametrium (the tissue that holds the uterus) are removed.
Why are patients who have had a total thyroidectomy at risk for hypocalcemia?
If a JP drain output suddenly changes to clear fluid, what might you suspect?
What are the signs and symptoms to report to the provider for breast and reconstructive surgery? Name 3.
Redness/bruising, Swelling, Fever, Hypotension, Tachycardia, Drain output changes (increase in output, suspension of output, backwards color changes e.g., serosanguinous to sanguinous), Excessive pain at the incision site unrelieved by pain.
Where do you look to assess the color of a patient's urine with a 3-way catheter and continuous bladder irrigation(CBI) ordered?
The catheter tubing. The collection bag is concentrated, so the color in the bag may look bloodier than it actually is.
What is a bilateral salpingo-oophorectomy?
What are signs and symptoms to assess for possible hypocalcemia?
perioral and distal extremity paresthesias
As calcium levels continue to decline, patients may experience tetany, bronchospasm, AMS, seizures, laryngospasm, cardiac arrhythmias
How do you instruct patients to use an incentive spirometer?
Suck in to make the plate rise, and encourage use 10 times an hour.
What consult is placed prior to discharge that ensures patients receive education on lymphedema?
Physical therapy will be consulted and will teach the patient exercises they can do to help prevent lymphedema before discharge.
For prostatectomy patients, patients come up with a JP drain. What is the purpose of this drain, and what are the indications for removal?
The JP drain evaluates for the presence of a urine leak and is checked for a JP creatinine level, prior to removal, if output from 11 p.m.- 7 a.m. was less than 75mL.
How long should you instruct a patient to have pelvic rest following a hysterectomy?
For 6 weeks, this includes sexual intercourse, douching, or using tampons.
How should Synthroid be given?
Administer at 0600 on an empty stomach, at least 30-60 minutes before food
Wait 4 hours to administer calcium, antacids, vitamins, iron, fiber as these can decrease absorption
What is an early postoperative assessment finding that may indicate a spinal hematoma?
A sudden change in neurological status (new weakness, numbness, or paralysis) or visual assessment changes (swelling, discoloration, drainage output changes)
If a patient has complaints of increased pain at the surgical site, redness and swelling, and their JP drain has increased bright red or dark merlot colored drainage, what is suspected?
A hematoma. Always assess the site throughout the shift to ensure there are no changes to the surgical site, especially if the patient has new pain unrelieved by their meds.
What are the signs and symptoms to report to the provider for all genitourinary surgeries? Name 5.
Low urine output, bright blood or clots in the urine, change in JP output amount and/or drainage color/character, difficulty urinating, pressure/severe pain in the abdomen, patient feels that he or she is unable to empty the bladder, flank pain, chills, tachycardia, tachypnea, flushing, fever
Because patients with pelvic surgery have an increased risk of developing blood clots, what are the symptoms you would notify the provider about?
Shortness of breath or swelling in one or both legs
What are signs and symptoms of a laryngeal nerve injury?
Hoarse or breathy voice, dysphagia, aspiration