Show:
Opiates
Postoperative Complications
Nursing
Assessment
Medications
Preoperative Care
100
Receptive neurons for painful sensations.
What are nocioceptors. Nocioceptive pain arises from damage to or inflammation of tissue other than that of PNS (peripheral nervous system) and CNS. Usually responds to opiodes and nonopiods. Types of nocioceptive pain include somatic, visceral and cutaneous.
100
What postoperative complication may a client have developed if she reports nausea and vomiting after advancing her diet as the MD has ordered?
What is paralytic ileus. Listen to bowel sounds 1st if client develops these symptoms after advancing her diet. The provider will need to know if the client has any bowel sounds -- and if so what type of sounds and where they are located (Right or left/upper or lower) -- in order to make any further recommendations and give further orders. Nursing interventions include monitoring bowel sounds, encouraging ambulation, advancing diet as tolerated and administering prokinetic agents (such as metoclopromide aka Reglan), if ordered.
100
The intensity level or duration of pain the client is able or willing to endure.
What is pain tolerance.
100
Very common and expected side effect of use of opioids. Clients with this side effect can be given docusate sodium as soon as they are taking fluids orally. Alternately, they could use glycerin or bisacodyl (Dulcolax) PR.
What is constipation. Other common side effects include pruritis and nausea. The incidence of these side effects varies from drug to drug and person to person. The serious side effect/adverse effect of opioids which could be life threatening is respiratory depression.
100
Surgical care performed under general, regional or local anesthesia involving less than 24 hours of hospitalization.
What is ambulatory surgery. Other names for ambulatory surgery include same-day, one-day, outpatient, in and out or short-stay surgery. Advantages of ambulatory surgery include decreased cost to the client, institution, insurance carriers and governmental agencies. Nosocomial infection risk is decreased. Client experiences less disruption to personal life and less anxiety about a lengthy hospitalization. the Aldrete Score has been modified for used with client having anesthesia on an ambulatory basis. The additional criteria for discharge help to establish that the client can care for themselves at home and accomplish ADLs independently and safely. They are discharged when their total score is 18 or higher.
200
Endogenous opiate-like substances.
What are endorphins.
200
Clients who have had a spinal or epidural block are more likely to have this complication of anesthesia if their block was administered higher in the spinal column.
What is orthostatic hypotension.
200
What does PQRST stand for (Please be exact and comprehensive).
What is PROVOKES the pain and PALLIATIVE measures (aggravating and alleviating factors), QUALITY of pain (gnawing, pounding, burning, stabbing, pinching, aching, throbbing and crushing), REGION (location) and RADIATION to other body sites, SEVERITY (quantity of pain on 0-10 scale) and SETTING, and TIMING (onset, duration, frequency).
200
Nonsalicylate similar to aspirin in its analgesic action but has no anti-inflammatory effect.
What is acetaminophen (aka Tylenol). Acetaminophen's mechanism of action for pain relief is not known.
200
Giving these two drugs or drug types prior to surgery is likely to result in a dangerously low blood sugar level, especially when a client is NPO.
What are insulin and oral antihyperglycemic drugs. There will be specific orders for insulin for diabetes patients undergoing surgery. Specific and individualized orders from the primary care provider, surgeon or anesthesiologist need to be reviewed and followed precisely. Orders for insulin may be manipulated and dosages increased interoperatively and postoperatively. Blood sugar monitoring will be strictly implemented. Surgery is stressful and will likely raise a diabetic client's blood sugar level.
300
Sense of detachment and well-being that occurs with opiates -- and is more pronounced in the short acting versus long acting opiates.
What is euphoria. Short acting opiates are more likely to be abused than long acting opiates because euphoria is more likely to occur. Methadone HCl (Dolophine HCl) is commonly used for treatment of opioid addiction because of its extended duration of action in suppressing withdrawal symptoms in opioid dependent persons. It is twice as potent when given parentally than orally. From Broyles: Pharmacological Aspects of Nursing Care, 7th Edition. Section 3. Chapter 10.
300
These two serious postoperative complications are more likely to occur 7-10 days after surgery and are preceded by a sudden spillage of serosanguinous drainage.
What are dehiscence and evisceration. These complications are more likely to occur in the very elderly client, the malnourished client, the client with an infection or the client with abdominal distention who is straining severely. Sudden spillage of serosanguinous drainage is an unexpected finding 7 days after surgery and needs to be reported to the charge nurse. If wound dehiscence or evisceration occurs, call for help, stay with the client, cover the wound with a sterile towel or dressing that is moistened with sterile saline, do not attempt to reinsert organs, position the client supine with hips and knees bent, monitor the client for shock and notify the provider immediately.
300
Signs of this postoperative complication include choking, noisy or irregular respirations, decreased O2 sat and cyanosis.
What is airway obstruction. If a patient begins to exhibit these symptoms in the PACU, check the airway immediately. If client has an artificial airway still in place, perform all appropriate and applicable nursing interventions to ensure patency and functionality.
300
Drugs used to enhance the analgesic efficacy of opioids, to treat concurrent symptoms that exacerbate pain and to provide independent analgesia for specific types of pain.
What are adjuvant medications.
300
Method of monitoring pulmonary ventilation.
What is capnography. Capnography measures a client's CO2 concentration when under the effects of drugs that sedate or cause CNS depression.
400
PCA pumps require that this person administer pain medication via an IV site using a PCA pump system.
Who is the client (self administer). Requirements for using PCA are the cognitive ability to understand how to use the pump and the physical ability to push the button. The nurse teaches the client and family about the pump and pain meds, how to activate the pump and that the client is the only one to press the button to deliver a dose of pain medication. Tell client to push the button when pain medication is needed. The client should not wait until the pain is uncontrolled. The major advantage of using PCA IV delivery system is that the patient can self medicate prior to pain becoming severe or overwhelming.
400
An emergency situation and a life threatening condition. Unexpected fever occurring while the client is anesthetized, or occurring even hours after surgery. Can recur up to three days after the initial episode.
What is malignant hyperthermia. When succinylcholine or anesthetic agents are administered, the susceptible client rapidly develops muscle rigidity, tachycardia and elevated temp (105 degrees F or higher). Skin is warm, mottled and respiratory and metabolic acidosis develops. If not treated promptly, the client may develop cardiac arrhythmias and vascular collapse and may die. The condition is apparently caused by a defect in the membrane of skeletal muscles. A sudden release of calcium by the sarcoplasmic reticulum into contractile muscles causes a high level of intracellular calcium. This, in turn, increases the metabolic rate of muscle cells, increases O2 consumption, and releases heat. Immediate measures are taken to lower the body temperature and to correct the metabolic imbalance. The anesthetic is discontinued. Dantrolene (Dantrium) is a muscle relaxant. It is given IV to the patient with malignant hyperthermia to block the release of calcium from the sarcoplasmic reticulum and relax the muscles. Other nursing interventions include use of a hypothermia blanket, ice packs, chilled IV fluids and a cold sponge bath. A foley catheter is usually inserted. From Broyles: Pharmacological Aspects of Nursing Care 7th edition, Section 3 Chapter 11.
400
What assessment factor, accompanied by hypotension, may indicate loss of blood or internal bleeding in the postoperative period?
What is tachycardia (rapid pulse rate).
400
Alternate opioid analgesic preferred over morphine in cases of biliary colic.
What is Meperidine HCl (Demerol). In cases of cholecystitis and cholelithiasis, Demerol is given as an alternative to morphine. Morphine is thought to potentially increase the occurrence of biliary spasm.
400
The ultimate responsibility for obtaining the informed consent lies with this member of the health care team.
What is the physician. The nurse often obtains and witnesses the client's signature and ensures that the client signs the consent form voluntarily and is alert and comprehending the action. The RN -- not the LVN -- should witness the signing of the consent form. The RN is ultimately responsible as the coordinator of care.
500
These 2 types of clients have an exacerbated risk for side effects and adverse effects of opioid pain medications.
What are the older adult client and the opioid-naive client. Keep in mind that overly sedating drugs will more than likely be avoided in patients with neurologic or CNS problems. Oral drugs may be preferable to IV opioids in patients with CNS problems. Giving IV opioids to neuro patients mask the signs and symptoms of neurological compromise and make it difficult for a nurse to assess levels of consciousness. LOC (level of consciousness) is the FIRST assessment a nurse with do to evaluate whether a patient's neurological status is deteriorating.
500
When these reflexes return postoperatively, the airway may be removed.
What is the swallowing/gag reflexes.
500
A diet high in these three elements should be encouraged to promote healthy wound healing postoperatively.
What are calories, protein and vitamin C. When assessing wound healing, draining should progress from sanguineous to serosanguineous to serous. Splinting should be encouraged with position changes and with coughing to allow a strong cough with reduced pain. Expected findings at the wound site include pink wound edges,slight swelling under sutures/staples, and slight crusting of drainage. Signs and symptoms of infection include redness, excessive tenderness and purulent drainage.
500
What symptom always precedes the side effect/adverse effect of respiratory depression? A nurse may observe this in patients receiving opioid analgesics.
What is sedation. Sedation, respiratory depression and coma can occur as a result of overdosing on opioids. Carefully titrate doses while closely monitoring respiratory status. Notify the charge nurse to administer Narcan (naloxone) if the client's respirations are less than 8/min and shallow, or if the client is difficult to arouse. Always check for arousability if a client appears sedated, whether in the PACU, med surg floor or any care area where a client is receiving doses of opioids. It is also very important to monitor for arousability when client is using PCA.
500
If any marked (substantial) differences from THIS TYPE of previously collected data are assessed by the nurse in the preop area while he or she is performing her preop assessment and checklist, the surgeon should be notified.
What is the BASELINE data. A large amount of baseline data is collected when a patient undergoes all preop testing and assessing -- often days before surgery. Lab tests, head to toe assessment from their primary care provider, ECG, imaging studies, etc., are often completed to establish a plan for the patients perioperative course.