questions
1. Pre-Op Why is liver health a pertinent assessment before surgery
a. Clotting factors are made in liver
b. Baseline assessment for labs
c. What drugs to use during the procedure
2. What do you do when the pt develops malignant hyperthermia
a. Stop anesthesia/ surgery
b. Admin muscle relaxant
c. Start cooling them down
d. Stabilize pt
3. List 3 primary interventions of post-op care
a. Pain management
a.i. Relieve pain
b. Wound care
b.i. Dressing and drains
b.ii. Amount and kind
c. DVT
d. Ambulate
e. Prevent skin beak
f. Preventing respiratory complications
f.i. Right after keep airway open head back and on side
f.ii. Later S/I
g. Compartment syndrome
h. Monitor Bowel sounds
h.i. Flatus/BM
i. Pt education
i.i. Ambulating safely
j. VS
k. Fluid retention right after
k.i. Urine output reduced initially
4. Who is responsible for obtaining operative informed consent? Nurses role n obtaining informed
consent
a. Nurse
b. Role - witness
c. Pt role
d. Importance to protect the pt and the hospital
5. What are the symptoms, treatment and causes of malignant hyperthermia
a. Extremely high body temperature
b. Tachycardia
c. Muscle rigidity
d. Treatment stop anesthetic, ice
e. Cause reaction to anesthetic, usually genetic
6. How many hours postop should you give around the clock pain
a. 24 hours need to ambulate!
a.i. Inflammatory response for first 48 hours
Orthopedic
1. 1 day postop Knee replacement. 2 things should do to protect knee and 2 interventions to prevent
complications
a. Knee extended
b. Do not dangle, no pillows behind knee
c. Immobilizer
d. Anti-coagulant
2.
3.
4.
5.
6.
7.
e. Teds/SCD
f. Pain management/
3 day postop. Yelling of pain and claiming burning
a. Head-to-toe
b. VS
c. Neurovascular
d. Pain control
e. Call doctor
Fractured right arm. Long arm cast. Potential complications the nurse should monitor. Common
s/sx
a. Pressure ulcers of boney prominences
b. Compartment syndrome
c. Restlessness
d. Rash of upper chest and neck
e. Disuse syndrome
f. Avascular my
Which of the following methods of fracture management is performed by manual manipulation
and may be followed by applying a cast
a. Closed reduction
Highest risk of fat emboli long bone fracture
Osteomyelitis
a. Pain and tenderness of bone
a.i. WBC will be increased
Postop
a. Respiratory S/I, monitor rate, sounds, coughing and deep breathing, ambulation
b. Pain
c. I/O initial, fluid retention into interstitial spaces, decreased urine output fluid shift
from blood vessels to tissues
d. Blood loss
e. Compartment syndrome distal to surgical site, burning pain with passive movement
Neuro
1. Pt is exhibiting slow, cautious behavior and communication problems after stroke, which side of
the brain is affected?
a. Left language center and cautious Right-sided behavior
b. paralysis, parasthesia
2. Right sided
a. Left sided paralysis, parathesia
b. Special perception deficits
3. Both
a. Slurred speak
b. Aphasia
4. Eye fluttering and prolonged stare w/o responding to you. Resumes activities but does not
a. Absent seizure
a.i. Document before, during and after
a.ii. Medication
5. Numbness and tingling in feet, difficulty speaking and headache. Extremely irritable and losses
consciousness for brief period
a. Transient ischemic attack TIA
b. Asprin
c. Antihypertensive meds
d. Lifestyle changes
e. Pt education on stroke signs
6. What is cerebral perfusion pressure? And what should it be kept above
a. Amount of blood flow to brain, enough perfusion 70 ml Hg
7. What is the appropriate nursing care during a stroke
a. Pillow at head of bed
b. Suction privacy, and reassure family
c. documentation
8. What are the pharmological therapies for ICP
a. O admin prevent hypoxia
b. Mannitol admin or lasix
c. Dobutamine prevent
d. Phentobarbital ?
e. IV fluids
f. Prevent coughing and bearing down
Wound
1. What are the three phases of surgical wound healing and what are their mechanisms
pg 473
a. First intention primary union, scar formation minimal
b. Second intention
c. Third intention 2. What are risk factors for impaired wound healing?
a. Diabetes impairs WBC function
b. Malnutrition albumin!
c. Decreased O
d. Decreased profusion
e. Age
f. Necrotic tissue
3. Why is it important to dress a wound
a. Prevent infection
b. Keeps it moist prevent crusts
c. Get rid of waste
4. Describe Levines technique and explain why it is the preferred technique for specimen sampling
a. Clean wound with normal saline
b. Swab
c. Getting sample from wound itself
5. Would a wound heal faster if it were exposed to air or covered with dressing
a. Dressing
b. Promotes growth factor
6. ID explain the three phases of full thickness wound healing
a. Inflammation
a.i. 1st response
a.ii. Infection will prolong this phase
b. Proliferation
b.i. Granulation
b.ii. New capillary formation
c. Remodeling up to two years
c.i. Collagen matrix broken down. New collagen laid down
Burn
1. Steps to take to help prevent infection in a severely burned pt
a. Monitor visitors, staff and equipment that goes into room
a.i. No fruit or flowers
2. Goals of debridement and what are the 3 different types
a. To remove necrotic tissue
b. Mechanical wet to dry, painful, scissors
c. Natural let the body do its thing enzymes, can give chemicals to make more enzymes
d. Surgical shaving off dead skin, until they see blood
3. Potential complications associated with burn victims?
a. Infection
b. Fluid loss
c. Pain
d. Drug toxicity
e. Pressure ulcer
f. Hyperthermia
g. Severe edema
h. Heart failure
i. Sepsis
j. Necrosis of visceral organs