HESI Review PDF

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PERIOPERATIVE CARE 1) What is the role of the nurse in the perioperative phase?  Assessing & teaching the pt.  Interpreting data 2) What should you teach your patient in the preoperative phase?  

Provide surgery-specific information (may have post-op pain) Inform there may be tubes, drains, dressings, monitoring devices, special equipment during post-op  Teach deep breathing, coughing, complications, & early ambulation is important as appropriate  Basic information before arrival  Time & place  Fluid & food restrictions  Need for enema  Need for shower 3) What do you assess for in the preoperative assessment?  

Risk factors Allergies  Specific allergies to assess for is latex & iodine o Latex food allergy – chestnuts, eggs, avocado, bananas, kiwi o Iodine food allergy – shellfish  Medications (OTC, herbal prescriptions, recreational drugs, alcohol, tobacco, dietary supplements)  Patient’s baseline (VS, BS, lung sounds)  Past Medical History  Health problems  Any issues with prior surgeries  Personal or family issues with anesthesia 4) Risk factors (Explain why they are risk factors) 

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Diabetes  Increased risk for infection, delayed wound healing, higher BS levels b/c stress on body  poor perfusion HTN  Increased risk for stroke, MI, DVT b/c puts extra work on heart  If too high surgery won’t be done Obesity  Body has a hard time clearing out anesthesia, delaying recovery  Harder to intubate  High risk dehiscence, infection, and incisional hernia Smoking

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Lungs damaged – lungs won’t expand fully causing retaining of secretions which can lead to lung infections (pneumonia, URI) Need to quit 6 weeks before

CKD     Anxiety   

Not able to filter out anesthesia Fluid overload due to isotonic solutions Increased risk for infection Altered response to drugs & elimination Death, pain Control it by asking why they’re anxious Fear of death = no surgery

5) What are some important labs to look at in the preoperative phase? What does each lab assess for?  

WBC (4-10)  infection Hgb (13-17) & Hct (40-52% M or 36-47% F)  assesses volume (dehydration, hemorrhage)  PLTs (150-400)  how well can clot, will assess bleeding risk  BUN (8-21) & Creatinine (0.8-1.3)  kidney function  ALT/AST (5-30) & Bilirubin (T 2-20 / D 0-6)  liver function  K+ (3.5-5)  assess the beating of the heart  Na+ (135-145)  Specific Gravity (1.010-1.020) INFORMED CONSENT 6) Who is responsible for explaining the procedure, complications, and teaching risks & benefits? 

surgeon

7) Who is responsible for obtaining a signature? 

nurse

8) What is in the preoperative checklist?        

Teaching complete Consent forms signed NPO Status In gown Allergy & ID bands on No jewelry Voiding prior to transfer Pre-op meds given

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Blood type & crossmatch Valuables in a good place for patient Vitals within 4 hrs. of surgery Abnormal lab values identified Skin prepped

9) What is the role of the nurse in the intraoperative phase? 

Patient safety  Positioning, alignment, strapped up, VS stable, time out  Comfort of patient  Adequate support & padding, provide modesty 10) What do you need to check during a time out?  Right patient (name & DOB)  Right procedure  Right site marked  Consent forms signed  Allergies addressed  Make sure everything is correct 11) Intraoperative complications (explain each…like S/S & interventions) 

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Hypothermia: temperature below normal  S/S – temperature goes down  Interventions – cover with warm blankets, give warm IV fluids Anaphylaxis: allergic reaction  S/S – SOB, tachypnea, tachycardia, bronchospasms, wheezing, hypotension, low SpO2, pulmonary edema (crackles, gurgling sounds)  Interventions: give epi, steroids, Benadryl, diuretics Aspiration: choking and can’t breathe  S/S – wheezing, coughing, cyanosis, chest pain  Interventions: proper positioning (turn on side), suction, manage N/V (meds) F&E imbalances  S/S – low I&O, hypernatremia, agitation, thirst, restlessness, dry MM, edema, confusion, seizures, coma  Interventions – get fluids, assess I&O, assess for fluid volume overload, assess for renal failure/heart failure Malignant Hyperthermia: temperature rises above normal; skeletal muscle become rigid b/c can’t regulate calcium  S/S – tachycardia (>150), tachypnea, increased temperature (>100.4)  Interventions – stop surgery, stop responsible agent (usually succinylcholine), give 100% O2, get ice under armpits, put on cooling blankets, give antidote dantrolene sodium Environmental complications

 Fire b/c of volatile gases in OR  Fluid Pouring 12) What is the role of the nurse in the postoperative phase? 

Prevent complications (maintaining airway & stable VS are priority)

13) Postoperative complications (Explain each) 

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Bleeding (0-24hrs)  S/S – pain, soaked dressing, pallor, cold extremities, high pulse, low BP, SOB, low H&H, hypovolemia  Intervention – give fluids, give blood, Trendelenburg position Atelectasis (24hrs)  S/S – dyspnea, tachypnea, decreased breath sounds, restlessness, crackles  Prevention  deep breathing, IS, TCDB, ambulation, ROM, huff cough  Intervention  give O2, high fowler’s, pulse ox DVT (day 2)  S/S – swollen, pulses missing, edema, heat at site  Prevention  get them moving, use SCD’s, lovenox  Intervention  blood thinners, bed rest Infection (Day 3)  S/S – REDA, tachycardia, increased WBC, may be different at location of infection  Prevention: good hygiene, antibiotics, wound care, dressing changes, aseptic techniques  Interventions  give antibiotics Pulmonary embolism  S/S – chest pain, dyspnea, tachycardia, tachypnea, increased anxiety, diaphoresis, decreased orientation, decreased BP, blood gas changes  Interventions high fowler’s, O2, bed rest, call MD, blood thinners, heparin Hypovolemic Shock  S/S – decreased urine, decreased BP, weak pulse, cold & clammy, restless, increased bleeding, increased thirst, decreased CVP  Interventions  pressure to wound, Trendelenburg position, administer fluid or blood, notify MD Dehiscence & Evisceration  Dehiscence: wound open  Evisceration: organs protrude  Interventions  cover with moist dressing, low fowlers with knees bent, call doc Urinary retention  S/S – palpable bladder, unable to void 8-10hrs post op, pain in suprapubic area, frequent & small amount voids

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Interventions  pelvic muscle exercises, bladder training, regular timed voiding Pneumonia  S/S – tachypnea, shallow respirations, fever, wet breath sounds, asymmetrical chest movements, productive cough, hypoxia, tachycardia, increased WBC  Interventions antibiotics, TDBC, huff cough, IS DIABETES MELLITUS

14) What does insulin do?  

Insulin carries glucose out of vascular space into cell Insulin breaks down glucose, so when glucose can’t be broken down it causes increased glucose levels 15) Pathophysiology for type I & type II diabetes? 

Type I Diabetes  Autoimmune  Beta cell destruction  Pancreas makes NO insulin  Type II Diabetes  SOME insulin is made by pancreas but not enough  Insulin resistance 16) Assessment findings for type I & type II diabetes? 

Type I Diabetes  3 P’s  polyuria, polyphagia, polydipsia  Weight loss  Weakness  Fatigue  Ketoacidosis  Type II Diabetes  2 P’s  polyuria, polyphagia  Prolonged wound healing  Recurrent infections (yeast/UTI’s)  Weight gain/weight loss 17) What are the diagnostic tests for diabetes?    

Fasting Blood Sugar (FBS)  usually the first test Casual Blood sugar  fingerstick Glucose Tolerance test  Give patient glucose drink, wait 2 hours & then test BS HgbA1C (glycosylated Hgb)  1st time diabetic will be high  Long time diabetic  high result = poor control

 Goal is 6% 18) What is the ONLY treatment for type I diabetes? 

Insulin

19) What are the treatments for type II diabetes?  Insulin  Oral antidiabetics  Diet  exercise 20) Education 

Sick Days  BS rises when sick  monitor closely  May need more insulin  Maintain diet (if eating less, supplement with CHO fluids)  Unable to eat/drink call MD  Foot care  Diabetic shoes  Daily inspection  Nail trimming done by pediatrist only  Avoid being barefoot  Rule of 15’s  For hypoglycemia  15g of carb (fruit juice), recheck BS in 15 min, if BS 250)  S/S – ketosis, N/V, kussmaul’s respirations, acetone odor to breath, dehydration, acidosis, lethargic, polyuria, hyperkalemia  Interventions o >250  fluids (isotonic NS), oxygen, insulin (regular IV) o 249-100  insulin (regular IV), D5 ½ NS o 160 HDL...