Test 3
Nursing 300 with Kirkland at Tennessee Wesleyan College
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preoperative
prior to start of surgical procedure; includes "holding room"
intraoperative
during procedure in controlled germfree environment
postoperative
after surgery
Types of surgery
urgent
emergency
elective
optional
urgent
emergency
elective
optional
u: needs to occur in 1-2 days; ie appendix/gallbladder
em: needs to occur immediately
elective: dont have to have done but helps well being
o: preferred by client
em: needs to occur immediately
elective: dont have to have done but helps well being
o: preferred by client
degree of risk seriousness
major and minor
major and minor
major: involves extensive reconstruction or alternation in body organs or systems; ie CABG, lung or colon resection, transplant
Minor: minimal alteration to body parts; ie breast biopsy, plastic surgery, catarct, joint scopes, appendectomy
Minor: minimal alteration to body parts; ie breast biopsy, plastic surgery, catarct, joint scopes, appendectomy
clean procedure
no bacteria; ie vascular surgery, mastectomy
clean/contaminated procedure
bacteria, but no inflammation or infection; ie bowel resection, abdominal hysterectomy
contaminated procedure
acute bacterial inflammation or infection; ie rectal/vaginal surgery, perforation, abcessess
ALREADY CONTAMINATED
ALREADY CONTAMINATED
purposes of surgery(7)
diagnostic/exploratory
curative/ablative
palliative: explore but dont remove, make person more comfortable w/o correcting disease
reconstructive-breast reduction, etc.
constructive: genetic abnormalities
cosmetic
procurement for transplant
curative/ablative
palliative: explore but dont remove, make person more comfortable w/o correcting disease
reconstructive-breast reduction, etc.
constructive: genetic abnormalities
cosmetic
procurement for transplant
general anesthesia
loss of all sensation and consciousness; IV medications, volatile gases
Regional anesthesia
loss of sensation in one area of the body and pt remains conscious; spinal, nerve block, epidural
local anesthesia
loss of sensation to small area of tissue; teeth
conscious sedation
depressed LOC; colonoscopy; mandatory anesthesiology standby
surgery as stressor - stress causes stimulation of
ANS
ALDO - aldosterone causes sodium retention and excrete potassium
ADH - retaining fluid
glucosteriod - increased blood sugar
ALDO - aldosterone causes sodium retention and excrete potassium
ADH - retaining fluid
glucosteriod - increased blood sugar
preoperative diagnostic lab screening
CBC
PT/INR
type & crossmatch
chem
urinalysis
chest xray
EKG
PT/INR
type & crossmatch
chem
urinalysis
chest xray
EKG
preoperative prep
informed consent
pt teaching - TCDB
pt teaching - TCDB
malignant hyperthermia
s/s
s/s
hypermetabolic crisis(abnormal muscle metabolism)
s/s: tachycardia, dysrhythmia, tachypnea, cyanosis, muscle rigidity, skin mottling, profuse sweating, rapid rise in body temp
s/s: tachycardia, dysrhythmia, tachypnea, cyanosis, muscle rigidity, skin mottling, profuse sweating, rapid rise in body temp
postop resp complications
atelectasis - collapsed lung
PNA
hypoxia
pulmonary embolus
PNA
hypoxia
pulmonary embolus
postop circulatory complications
hemorrhage
hypovolemia- decreased blood volume
thrombophlebitis - blood clot
hypovolemia- decreased blood volume
thrombophlebitis - blood clot
postop GI complications
abd distention
constipation
n/v
paralytic ileus
constipation
n/v
paralytic ileus
postop urinary complications
urinary retention
UTI
UTI
postop wound complications
infection
dehiscence
evisceration
dehiscence
evisceration
comfort and pain are
subjective
pain is no longer considered a symptom of an illness but a
disease
4 processes of nociceptive (normal) pain
transduction
transmission
perception
modulation
transmission
perception
modulation
transduction
process of converting thermal, chemical, or mech energy to electrical energy
transmission
excitory neurotransmitters surround pain fibers causing inflammatory response --> substance P released in dorsal horn causing synapse from afferent/sensory peripheral nerves to spinal
2 types of peripheral nerve fibers that conduct painful stimuli
1. A fibers - fast, myelinated that send distinct sensations
2. C fibers - slow, unmyelinated that send poorly localized, burning sensation
2. C fibers - slow, unmyelinated that send poorly localized, burning sensation
perception
somatosensory cortex
association cortex
somatosensory cortex
association cortex
person is aware of pain
sc: id location and intensity of pain
ac: det how we feel about the pain
sc: id location and intensity of pain
ac: det how we feel about the pain
modulation
inhibition of pain impulse
protective reflex
bypasses the brain
gate control theory of pain
gated mechanisms in CNS
pain threshold (pt at which person feels pain) higher with exercis, stress, release of endorphins, massage, etc.
pain threshold (pt at which person feels pain) higher with exercis, stress, release of endorphins, massage, etc.
client physiological response - sympathetic
pain of low to moderate intensity and superficial pain elicit fight or flight
client physiological response - parasympathetic
when pain is continuous, severe, or deep - involving visceral organs
T or F: client in pain will always have change in vital signs
False
client may not report pain if...
pain might inconvenience someone else
loss of self control/pride
loss of self control/pride
durations of pain
acute, chronic, cancer
acute, chronic, cancer
a: identifiable cause, short time, autonomic activity
C: no id cause, > 3 months, may not respond to treatment well or need round the clock; fatige/depression
CANCER: acute or chronic; nociceptive or neuropathic; may be "referred to another site
C: no id cause, > 3 months, may not respond to treatment well or need round the clock; fatige/depression
CANCER: acute or chronic; nociceptive or neuropathic; may be "referred to another site
normal pain (2 types)
somatic - muscoloskeletal; localized aching/throbbing
visceral - internal organs; poorly localized, aching/cramping
visceral - internal organs; poorly localized, aching/cramping
neuropathic pain
from abnormal or damaged nerve; sharp
idiopathic pain
unknown cause or excessive for pathological condition
single most reliable indicator of existence/intensity of pain is....
pt self report of pain
verbal analog scale
verbal descriptor scale
verbal descriptor scale
no distress ---> unbearable
no pain, mild, moderate, severe
no pain, mild, moderate, severe
ABCs of pain management
A=ask
B=believe
C=choose (pain control app for pt)
D=deliver
E=empower
B=believe
C=choose (pain control app for pt)
D=deliver
E=empower
ultimate goal is for client to....
function to the best possible extent
..........increases the perception of painful stimuli
fear
holistic care looks at....
emotional meaning of health and sig of problem in light of their purpose in life
pharm pain relief
NSAIDS and nonopioids
opioids
adjuvants
NSAIDS and nonopioids
opioids
adjuvants
NSAIDS: mild to moderate intermittent pain - H/A pain 4-7
O: moderate to severe acute pain - cancer/postop pain 8-10
adjuvants: analgesic properties but not made for pain control (antidepressants, anticonulsants, corticosteroids)
O: moderate to severe acute pain - cancer/postop pain 8-10
adjuvants: analgesic properties but not made for pain control (antidepressants, anticonulsants, corticosteroids)
local analgesic infusion pump
directly into site
surgical interventions
dorsal rhizotomy
dorsal rhizotomy
cutting dorsal nerve roots as they enter spinal cord - relieves localized acute pain in specific nerve area
chordotomy
extensive, involves resection of spinothalmic tract; for treating unrelieved pain; risk for paralysis
pseudoaddiction
drug seeking
pseudotolerance
need to increase dose for reason other than tolerance
unique to each person, depends on culture,life exp, and beliefs
spirituality
relationship with higher power, incorporates reasoning and trust
faith
outward expressions of spirituality
religion
actual loss
can no longer be felt, heard, known, or exp
percieved loss
uniquely defined by person, often overlooked by others
maturational loss
changes expected in the developmental process
situational loss
sudden, unpredictable external even, usually multiple lossess
outward social expression of loss
mourning
inner feelings and outward reactions of the survivor
berievement
about 3 months
about 3 months
Kubler ross's stages of dying (5)
denial
anger
bargaining
depression
acceptance
anger
bargaining
depression
acceptance
therapeutic communication
be present and ask open ended questions
palliative care goals
symptom control
maintaining dignity and self esteem
preventing abondonment and isolation
providing peaceful and comfortable environment
maintaining dignity and self esteem
preventing abondonment and isolation
providing peaceful and comfortable environment
usual state of skeletal muscle is slight contraction called
tonus
contraction and relaxation of muscle groups called
exercise
isotonic exercise
muscle shortening and active movement
isometric
muscle contraction w/o shortening
isokinetic
muscle contractions with resistance
two most common diadnoses r/t mobility problems
impaired physical mobility
risk for disuse syndrome
risk for disuse syndrome
ankylosis
joint consolidation and immobilization
orthostatic hypotension parameters
systolic drop 20-25
diastolic 10
diastolic 10
learning objectives
describes what the learner will be able to do after successful instructions
percieved need for info; establishing learning objectives by teacher
referent
teacher who performs activity to help other person
sender
content or info taught
message
methods used to present content
channels
learner
receiver
determination of whether learning objectives were acheived
feedback
mild anxiety vs high anxiety
mild promotes learning; high prevents
T or F: it is ok to erase documentation
False
how do you correct an error?
one line through it
SOAP/SOAPIE
subjective
objective
assessment
plan
intervention
evaluation
objective
assessment
plan
intervention
evaluation
PIE
problem, intervention, evaluation
DAR
data, action, response
methods of reporting
-source records
-charting by exception(CBE)
-case management plan and critical pathways
-source records
-charting by exception(CBE)
-case management plan and critical pathways
sr: a seperate section for each discipline
CBE: focuses on documenting deviations
C:incorporates a multidisciplinary approach to care
CBE: focuses on documenting deviations
C:incorporates a multidisciplinary approach to care
About this deck
About StudyBlue
STUDYBLUE makes things that make you better at school.
Things like online flashcards with photos and audio.
Things like personalized quizzes and friendly reminders about when (and what) to study next.
Think of it as a digital backpack™: access to all of your study materials online and on your phone.
STUDYBLUE exists to make studying efficient and effective for every student, for free. Join us.
“I have been getting MUCH better grades on all my tests for school. Flash cards, notes, and quizzes are great on here. Thanks!”
Kathy
Kathy