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Care of the surgical patient

In English

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Melissa Gatton

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when is an inventive spirometer contraindicated

in cranial and spin- related surgeries

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Care of the surgical patient - Details



75 questions
Why is it important to ventilate the lungs post op
To prevent or treat atelectasis, improve lung expansion and improve o2 and prevent post op pneumonia
H2 receptor antagonists
Famotidin ( pepcid) ranitdine ( zantac) not on market as of now reduce gastric acid volume and concentration monitor for confusion and dizziness in older adults
Opioid anglgesics
Morphine fentanyl citrate ( sublimaze) decrease anxiety and allow decreased anesthetics monitor for resp depression, n/v hypotension and pruritus
Midazolam diazepam (Valium) lorazepam ( Ativan) decrease anxiety and produce sedation. monitor for resp depression, hypotension, drowsiness and lack of coordination
Why should the pt not massage the legs after a surgery?
Because of the risk of dislodging a thrombus
When is an inventive spirometer contraindicated
In cranial and spin- related surgeries
What are to two types of incentive spirometer
Flow-oriented incentive spirometer volume-oriented spirometer
Metoclopramide ( reglan) droperidol ( inapsine) ondansetron HCI ( 5-HT3 receptor antagonist) Zofran enhance gastric emptying , tranquilizing effect , prevent postop n/v monitor for sedation and involuntary movement have pt report any problem breathing
What might the OR surgeon order for a pt with latex allergy?
Prophylactic treatment with glucocorticoid steroids and antihistamines
What are the ways latex allergy occur
1. as irritant contact dermatitis 2. as a type IV allergic reactions 3. as a type I allergic reaction
What are some laboratory tests commonly reviewed before surgery?
Urinalysis CBC Blood chemistery profile to assess endocrine, hepatic and renal and cardiovascular functions. serum electolytes chest x-ray electrocardiogram BUN
What should the nurse explain to the family regarding what to expect right after surgery to the pt family?
That V/S, dressings, and tubes are assessed every 10 to 15 min until the pt is awake and stable
What are some pre op considerations for Valerian root
Should not be used with sedative or anxiolytice
May prolong bleeding and hamper healing time. and may hamper body abilty to deal with stress of surgery
What is the greatest risk from general anesthesia?
Cardiovascular depression of irritability, respiratory depression and liver and kidney damage
What is done to establish and airway
Intubation with and endotracheal tube or use of a laryngeal mask airway
What do some common anesthetic agents include?
Propofol ( a nonbarbiturate IV anesthetic) nitrouse oxide gas and desflurane and sevoflurance vapors, muscle relaxants
Inhibit platelet function and may prolong bleeding leading the possible hemorrhage
Pt with DM may need a decrease need for insulin after surgery bc nutritional intake is decreased and stress
Herbal therapies
Affect clotting times, ginseng may increase hypoglycemia with insulin therapy
Can cause hypotension after surgery and decreased serum potassium levels
What are some per op considerations for St. John's wort
Should not be used with other psychoactive drugs, momoamine oxidase inhibitors or serotonin reuptake inhibitors this needs to be discontinue before surgery bc of possible drug interactions
Antiseizure drugs
Can interact with anesthetic agents
Can cause hypotension when combined with anesthetic agents and narcotics
Are stopped several days before surgery, can cause prolonged clotting times which can lead to hemrrhage
Medications for the perioperative anticoagulants
Enoxaparin sodium ( Lovenox) heparin sodium ( Heparin) warfarin sodium (coumadin) prevent new clot formation of secondary embolic complications dont not give IM but subQ and tell the pt not to take OTC drugs like aspirin
Nonsteroidal Antiinflammatory drugs NSAID
Ketorolac reduces intensity of pain and inflammations assess pt for pain onset location and have they respond to the drug.
Adrenocortical steroid
Methylperdisolone ( depo- medrol, solu- medrol ) decreases inflammation determin if pt had DM and anticipate and increase in antidiabetic drug regimen bc of raised blood glucose levels
Cefazolin sodium (ancef) cefotaxime sodium (claforan) ceftriaxone bactericidal minimizes risk of wound and infections monitor of s/s of abd pain, diarrhea severe anal or genital pruritus and severe mouth soreness
Atropine sulfate glycopyrrolate (robinul) reduce oral and resp secretion to decrease risk of aspiration decrease n/v monitor for confusion, restlessness and tachycardia pt my have dry mouth
Opening made to allow the passage of drainage ( ileostomy, formation of an opening of the ileum onto the surface of the abdomen for passage of feces)
List a few risks the older adults have when undergoing surgery.
Aspiration, atelectasis ( collapsed lung) pneumonia, thrombus formation, infection, altered tissue perfusion.
What are some of the major problems younger and older patients have during surgical procedures.
Temperature variations, cardiovascular shifts, respiratory needs, and renal functions.
What are some common fears associated with surgery?
Fear of loss of control associated with anesthesia. fear of the unknown. fear of waking up during the operation. fear of pain. fear of death fear of change in body image fear of detection of cancer
Surgery for relief or reduction of intensity of disease of symptoms, not cure
Excision or removal of diseased body part. ( amputation or removal of something
What can the nurse have the UAP do during patient preparation for surgery?
Administer an enema or douche, obtain v/s , apply antiembolic stockings, and assist pt in removing clothing, jewelry and prostheses
Plastic surgery
Fixation of ( cecopexy, fixation or suspension of the cecum to correct its excessive mobility)
Opening into ( thoracotomy, surgical opening into the thoracic cavity)
List what the perioperative nursing includes
Preoperative phase , intraoperative and postoperative phase.
Direct visualization with a scope ( cystoscopy, direct visualization of the bladder and urethra by means of a cystoscope)
Surgical repair ( herniorrhaphy, repair of a hernia)
Destruction or dissolution of ( lysis of adhesions, removal of adhesions)
Surgical removal of ( cholecystectomy, removal of gallbladder)
Surgical joining of two ducts or blood vessels to allow flow from one to another. to bypass an area ( Billroth I, joins stomach and duodenum.)
What are some common surgical settings?
Inpatient one day outpatient short stay surgical center short stay unit mobile surgery unit
Surgery is performed for various purposes, what are they?
Diagnostic ablative palliative reconstructive curative preventive transplant constructive and cosmetic
What are some per op considerations for Kava
May increase effects of certin muscle relaxants
What are per op considerations for Gaurana
May reduce the efficacy of Warfarin
Per op considerations for Ginseng
May increase anesthetic agent requirments and potential for hypoglycemia in pt with DM
What are per op considerations for Garlic and Ginger and Ginkgo biloba
Increased bleeding and prolonged clotting times
Per op considerations for feverfew
Has anticogulation factors can increase bleeding
What are some per op considerations for Ephedra sinica
Increased risk of cardiac dysrhythmias
What are some per op considerations for Echinacea
Neg impact on liver, can interference with hepatic metabolism of anesthesia meds
What are the classes of surgery?
Elective, urgent or emergent
Why do you need to ask about herbal remedies as alternative or complementary therapy.
Most people do not think of them as medications and they may interact with or potentiate other medications and interfere with surgical procedures.
What are some of the perioperative meds and agents used?
Anesthethetives, antimicrobials, anticoagulants , hemostatic agents, steroids , diagnostic imaging dyes, diuretics, central nervous system agents, emergency protocol medications.
What are a few common fears associated with surgery?
Loss of control fear of the unknown fear of the unknown fear of pain fear of death fear of separation ( kids are a big one for this) fear of disruption of life patterns fear of change in body image fear of detection of cancer
What does the ABCDEF mnemonic device to ascertain serious illness of trauma in the preoperative pt stand for?
A: allergy to medications, chemicals, and other including latex. B: bleeding tendencies of use of meds like aspirin, heparin, or warfarin sodium C: cortisone or steroid use D: diabetes mellitus E: embili any past hx. F: fighting ability any pt with immune system problems
If the pt is showing signs of malnutrition what should you as then nurse do?
Tube feeding , IV therapy of total parenteral nutrition can be initiated,