POLICY
For patients with a foley catheter in post-operative--when would you remove the catheter?
What is Post-operative Day 2 at 6 am?
Your patient today is post op day 4 with a CVAD (central line) located in the neck. Their dressing was changed 2 days ago as per the MAR. A gauze is present underneath the When is the dressing due to be changed?
What is today? Gauze dressings are changed q 2 days and transparent q 7 days.
what is Empty into a container opening top. When drained completed, activate suction by squeezing drain bottle and reapplying cover.
Your patient has had an open hernia repair and you are doing the dressing on day 2 post op. As the nurse, how can you ensure all staff are carrying out the same care of the incisional wound.
What is use the wound care plan and wound care sheet?
Patient is post op and develops sudden onset of SOB and tachycardia. What is the possible complication?
What is a PE?
What antibiotic is given most often as a prophyalctic preopertively?
What is Cefazolin 2g?
How many mls of normal saline should be used when flushing CVADs?
What is 10-20mls using turbulent flush?
Your patient has a chest tube set to suction. Describe the steps of completing an assessment of a patient with a chest tube.
What is turn off the suction and assess the respiratory system--auscultate lungs, assess the drainage system for tidaling/bubbling, check the water seal level is at 2 cm. Assess amount, color, and consistency of fluid in drainage chamber and mark level of drainage on chest drainage system chamber, as appropriate. Check dressing. Ensure emergency equipment is available.
A patient has had a dehiscence of a midline incision. A wound vac has been ordered. The physicans asks do you have everything for your orders. What do you need from a physicans orders for wound VAC.
Refer to Wound VAC PPO. Would include pressure and intensity, type of foam, periwound care---any labs, frequency of dressing change. You as nurse will also complete treatment and wound care plan and a documentation form.
A post op hip patient develops pain in the right leg and it is warm to touch. You also note swelling ---the patient had a left hip replacement What is the possible complication?
What is DVT?
Who is responsible for completing the surgical safety checklist?
Who are the OR staff (nurses, surgeons, anesthesiologist)?
Your patient has a triple lumen central line. You are doing a routine flush and check this am. One lumen is occluded and maneuvering the patient provides no relief? You are able to flush but blood return is not acheiveable in the distal lumen. What is the appropriate management?
What is use alteplace? Ensure an order ( care directive is to come). The line and all other lumens should not be used until the occlusion is resolved. Consideration should be taken when patient is on TPN.
Your patient has a penrose drain. Your post-op orders include strict ins/outs. Describe how you will monitor and measure the drainage from this type of drain.
A patient is being discharge home. The wound has steristrips only now and open to the air. The patient asks you what to do with the steri strips.
What is leave in place until they come off on their own?
Your patient is 4 hours post op from a an open bowel surgery that resulted in a colostomy. You are into assess your patient. You find him to be confused, SOB, he is tachycardic at 167, and pale. Cap refill is > 3 secs. You assess his abdomen and it is rigid and hard. What do you think is going on?
What is hypovolemic shock related to possible internal bleeding?
Acceptable antiseptic agents include 2% chlorhexidine gluconate (recommended) and iodophors (povidone iodine) with 70% alcohol solution. Name two contraindications to using this skin prep.
Emergent cases: when there is not enough time to allow alcohol to completely dry before incision then a nonalcoholic solution should be used to decrease risk of fire. Procedures involving the: o ear, eye, mouth, mucous membranes, neural tissue, non-intact skin or open wounds Infants less than 2 months old Allergy to an alcohol based skin preparation
Prior to drawing blood from a CVAD, infusions should be stopped for how long?
What is one minute? Exception would be critical infusions. Also blood should not be drawn from a lumen that is infusing parental nutrition.
Do not draw blood sample from:
• Access port on administration set (to avoid cross-contamination)
• Lumen with continuous infusion that cannot be interrupted (ie. Critical medication).
• A lumen used for parenteral nutrition (if possible), due to the increased risk of catheter related infection and inaccurate or erroneous results
Your patient has an NG tube set to low intermittent suction. The order reads replace NG losses for greater than 600mls over 12 hrs. The order is to replace 1:1 over 8 hrs. At the end of your shift your patient has a loss of 1200ml. At what rate will you replace the fluids?
150 mls per hour.
What is typically 7 days?
Your patient is one day post operative from an appendectomy. On your assessment you find him to be diaphoretic, tachycardic and tachypneic. You take his temperature and he has a temp of 38.8. What is possibly going on with your patient?
What is septic shock?
What is the optimal level of glucose control for diabetic patients going to the OR?
Optimal target glucose control in the perioperative period depends on the clinical situation; however, it is reasonable to target glycemic levels between 5.0 and 10.0 mmol/L for patients with known diabetes undergoing minor and moderate surgeries.
Perioperative diabetes management protocols (e.g., Order Sets) and frequent blood glucose monitoring should be used to reduce the risk of hypo- and hyperglycemia.
You have a patient that is now 7 days post-op and he presents with a fever. The site of his femoral line is reddened. Blood cultures are ordered. How is a blood culture drawn from the line?
What is after confirming blood return/flush--draw back the amount required for cultures ( 20 ml--no discard---10 ml for the anerobic/anaerobic). Use a transfer device to place blood in culture bottles. Lab will need to draw from another site. If line infection is suspected, discuss removal of line---possible culture of site and sending tip. Need alternate access.
Describe the removal of a JP.
What is take off suction, cut the suture, and have the patient take a deep breath and pull---if any resistance stop!
A patient asks you as they are getting ready for discharge what they can do to ensure their wound heals well.
What are keep wound clean and dry. Good glucose control, smoking cessation--well balanced diet--ensure protein.
Your patient is a 89 year old female who is one day post op from a laproscopic hernia repair. She has had little for pain and has been mobilizing. She is on an IV at 150mls/hr. You note when she is up walking she is SOB and you can hear her wheezing. Her medications at home include a betablocker and an ace inhibiter. Her fluid balance from the last 24hrs is +2.5 L. What is the possible complication?
What is Congestive Heart Failure/Fluid Overload?