Medical Surgical Nursing Questions and Answers

Subject Name : Nursing

Medical Surgical Nursing
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Medical Surgical Nursing Answers and Questions
The registered nurse has 4 legal responsibilities when working with therapeutic substances such as medications. Safe administration is one of these responsibilities. Which are the other three responsibilities
Answer
Safe handling and dosage
Safe disposal
Verify the order
Explain why clinical reasoning is an important part of nursing.(2 marks)
Answer
Clinical reasoning is the process by which nurses consider the pt, collect cues, process the information, identify the problem, establish goals implement actions/ interventions, evaluate outcomes amp reflect on amp learn from the process
Clinical reasoningis often considered the mostimportant aspectof a clinicians skill set because it has the power to determine the outcome of patient care. Poor clinical reasoningskills often result in a failure to deliver accurate or satisfactory health care
State in full(ie, the number and descriptor,no abbreviations) the normal adult range/values for
Answer
TemperatureT-36-37.5Heart rate-HR-60-100Respiratory rate-RR-12-20Blood pressure-BP-140-100 systolic amp 60-100 diastolicOxygen saturation-O2-95-100 (2.5 marks)
Define the following terms. Where appropriate, state the numerical value descriptor
Answer
Dysphagia- difficulty or discomfort in swallowing, as a symptom of disease
Peristalsis- successive waves of involuntary contraction passing along the walls of a hollow muscular structure (such as the esophagus or intestine) and forcing the contents onward
Melaena- is the presence of digested blood in the stool
Steatorrhoea- is the presence of excess fat in faeces
Tachypnoea- is the medical term for rapid and shallow breathing
Haemoptysis- the expectoration of blood that originates from the lower respiratory trac
Tachycardia- is a common type of heart rhythm disorder (arrhythmia) in which the heart beats faster than normal while at rest
Bradycardia- is a slower than normal heart rate which is usually lower than 60 beats per minute
Asystole- the cardiac rhythm that is caused by the lack of electrical activity within the heart because the heart is no longer beating
Ischaemia- a restriction in blood supply to tissues, causing a shortage of oxygen that is needed to the tissues alive
Erythema- is redness of the skin or mucous membranes, caused by increased blood flow in superficial capillaries due to an inflammation or skin injury
Eccymosis- an initially bluish-black mark on the skin, resulting from the release of blood into the tissues either through injury or through the spontaneous leaking of blood from the vessels
Atrophy- is the wasting away or reduction in size of some part of the body
Exudate- A fluid rich in protein and cellular elements that oozes out of blood vessels due to inflammation and is deposited in nearby tissues
Paraesthesia- as an abnormal sensation of the body, such asnumbness,tingling, or burning
Abduction- The movement of a limb away from the midline of the body
Adduction- is the movement of a body part toward the bodys midline
Flexion- abendingmovement around a joint in a limb (as the knee or elbow) that decreases the angle between the bones of the limb at the joint
Extension- -lengthening or stretching (10 marks)
Identify 5 pre-operative risk factors(2.5 marks)
Answer
Obesity
Cardiovascular problems
Peripheral vascular disease
Liver disease
Malnutrition
Dehydration
Explain why early mobilisation of people after surgery prevents the development of post-operative respiratory complications (1 marks)
Answer
Early mobilizationimproves cognitive andrespiratoryfunction
Identify 4 complications of surgery that the nurse should monitor for(2 marks)
Answer
Haemorrhage
Wound infection
Reaction to anesthesia
Shock
Pulmonary embolism
Lung complications
A persons response to pain and their pain tolerance is affected by multiple factors. Identify three factors that may impact on someones pain perception and response to pain (1.5 marks)
Answer
Age
Medical condition
Gender
Genes
You are administering an opioid analgesia. Identify 5 nursing responsibilities the nurse has when administering this medication (5 marks)
Answer
Label the distal ends of all access lines to distinguish I.V. from epidural lines.
Require independent double-checks of the patient and medication order and the appropriateness of the drug, dose, pump settings, and line placement for opioid infusions.
Establish guidelines for appropriate patient monitoring, including frequently assessing respirationquality(not just rate) and looking for specific signs of oversedation. Adequate personnel and equipment must be available to monitor patients per the established guidelines, and standardized formats should be used to document pain control and monitoring values.
Dont rely on pulse oximetry readings alone to detect opioid toxicity. Use capnography to detect respiratory changes, especially for patients at high risk, such as those with sleep apnea or obesity.
Make sure that oxygen and naloxone are available where opioids are administered
You are assessing a person recently admitted to your ward with a history of hypertension. You recognise that hypertension is a risk factor for coronary artery disease. Identify four other risk factors for coronary artery disease. (2 marks)
Answer
Age
Sex
Smoking
High blood pressure
Diabetes
The wrist is the commonly site to assess a persons pulse. Identify two other sites where you can assess a persons pulse (1mark)
Answer
Neck
Chest
Identify 3 features of angina pain (3 marks)
Answer
-chest pain radiating to the neck. Shoulders or jaw-tight squeezing constriction or heavy sensation-Pallor amp diaphoresis
You are caring for a person with cardiac arrest problems who is to be discharged tomorrow. They have a number of new or changed prescription medications, including a diuretic.
Identify 3 points you will make sure the person knows and understands about taking a diuretic medication before they are discharged home.(3 marks)
Answer
While taking a diuretic the patient should limit their water intake so as to limit urination
The patient should take the diuretic in the morning
In case the patient should experience some side effects such as dizziness, loss of appetite among others they should consult their doctor
People diagnosed with heart failure are often prescribed one or more antihypertensive medications. One of the nurses responsibilities is to monitor for adverse effects. Identify adverse effects you will monitor for.(2.5 marks)
Answer
Dizziness
Diarrhea or constipation
Coughing
Cardiac failure impacts on all body systems. Identify 5 home activity guidelines you will give to a person with cardiac failure who is preparing to go home.(2.5 marks)
Answer
Start slowly and gradually increase your walking pace overthree minutes until the activity feels moderate (slightly increased breathing, but should still be able to talk with someone). If you feel too short of breath, slow down your walking pace.
Walk at a moderate pace for about five-ten minutes the first time and each day try to add one or two minutes as you are able. You may tolerate shorter bursts of activity spread throughout the day. Aim for a goal of walking 30-45 minutes per day with rest intervals as needed on most days of the week.
Remember to cool down at the end of your exercise by gradually walking slower for the lastthree minute of your exercise.
Rest when you need to, but try not to lie down after exercise, as it reduces exercise tolerance.
If walking outside, walk with someone or in short distances close to home so you do not get too far away and have a hard time walking home
An important nursing goal when caring for a person with heart failure is to reduce cardiac workload and myocardial demand. Explain why this is an important goal when caring for these people (1 mark)
Answer
Reduce the possiblity of experiencing another MIOxygen relieves ischemia allowing for tissue perfusion. Working within the patients activity tolerance so as not to overwork the heartRegular monitoring and recording of vital signs indicates changes in these parameters
You are caring for Ralph who has been admitted with pneumonia. He has a history of asthma and is currently requiring oxygen therapy via nasal prongs to maintain adequate oxygenation.
Identify 3 nursing assessments you will do to assess Ralphs oxygenation status today (3 marks)
Answer
Physical- level of consciousness, vital signs, temperature, skin colourRespiratory- respiratory exersion, use of accessory muscles, lung soundseducation- alternative breathing techniques, Proper use of ihaler medications ie preventer, acute onset medication
Explain how the nursing assessments you identify above will help you identify that Ralph is adequately oxygenated (3 marks)
Answer
Physical- level of consciousness, vital signs, temperature and skin colourRespiratory- respiratory exertion, use of accessory muscles check lung soundsEducate Ralph on alternate breathing patterns and techniques, reassure
c) Ralph is at risk for complications related to his current respiratory problems. Identify two potential complications you will monitor over the remainder of your shift
Answer
Ineffective airway clearance which can result in pneumoniaPoor tissue perfusion through reduced oxygen intake
Explain why a person with chronic airways problem requires a high energy, high protein diet.
Answer
Breathing requires energy. Food and oxygen are changed into energy and carbon dioxide. Pulmonary disorders during an acute episode require more energy. Good nutrition assists the body with fighting infection.
You are caring for a person with altered gastro-intestinal function. Identify 5 different nursing assessments you will do to monitor their gastro-intestinal function
Answer
Health history Abdominal assessment Observation assessment Stool assessment Nutritional assessment
Explain what the 5 nursing assessments you identified in 21 above are and what will they tell you about the persons gastrointestinal function
Answer
health history - current symptoms and their duration, relieving and aggravating factors, ingestion historyabdominal assessment - appearance, bowel sounds tenderness and palpationobservation assessment - blood pressure temperature peripheral pulses oxygen saturations respiratory ratestool assessment - type of stool, frequency of stool, presence of occult blood in stoolimbalanced nutritional assessment - anorexia, malnutrition, poor food intake, check mouth and gums
Identify the four different assessment techniques a nurse uses when assessing the patient and what you would assess using each technique Identify the four different assessment techniques a nurse uses when assessing the patient and what you would assess using each technique
Answer
Physical-level of consciousness, appearance palpation - examining the body through touch auscultation- listen to sounds usually to the heart using a stethoscope precussion-tapping body surfaces to learn about the condition below
When nurses assess and care for people in medical-surgical settings, they collect a considerable amount of information from people. Explain the ethical and legal responsibilities of the nurse when gathering information from people in their care
Answer
Confidentiality is a legal and ethical aspect when nursing patients. There information is to be kept private and only discussed with other health care workers in line with their treatment
Morris is someone you are caring for today. He is recently returned from the operating theatre after a surgical procedure. After assessing him, you identify that acute pain is a key nursing problem and you recognise that keeping Morris as pain free as possible today is a priority goal of care. Identify four different nursing actions or interventions you will do to achieve this goal of care
Answer
Use prescribed analgesia to maintain pain levels below 2/10attend patient regularly to improve well-being doing observations amp report severe pain immediatelyHot/cold therapy to site of painEncourage rest periods to promote relief sleep and relaxation
For each of the nursing actions or interventions you have identified in question 25 above, explain how the identified action will help you achieve your goal
Answer
Anticipating signs and symptoms related to painWhether Morris has explored the option of mild analgesia coupled with heat/cold pack therapy. Heat relieves pain amp encourages blood flow amp cold decreases inflammation amp decreases pain impulses. It is also used as a distraction to relieve his painAssess cultural, environmental interpersonal factors which may inhibit Morris from expressing pain and what it does to the bodyRest periods promotes res sleep amp relaxation avoi8ding body exhaustion amp hypersensitivity
Identify two indicators that will tell you that the nursing interventions you have implemented in question 26 above to relieve Morriss pain are effective
Answer
Morris states that he is pain-freeRelaxation therapies have succeeded
Identify two errors in technique that can affect blood pressure assessments
Answer
Blood pressure cuff is the incorrect size and may give a falsely low readingPerforming blood pressure over clothing may result in a false reading
Identify two potential complications of acute coronary syndrome
Answer
Conduction disturbances resulting in bradycardia and atrioventricular nodal blockhemodynamic disturbances resulting from dysfunction of both the left amp right ventricles
You are caring for a person with cardiac problems. One of the medications they are prescribed is a diuretic. When assessing the person before administering the next dose, you note a low urine output and suspect he may be hypovolaemic. Identify three other clinical manifestations you might find on closer inspection
Answer
Confusionrapid heart rateshallow rapid breathing
Max has been admitted to your ward with increasing abdominal pain, nausea and abdominal fullness. His abdominal x-ray showed distended intestinal loops and a possible fluid level. Since admission, his vital signs have been slightly elevated. His pain score is 2-3 but he is still feeling full and bloated. The doctor has prescribed several broad spectrum antibiotics including metronidazole, an anti-emetic and prn pain analgesia. What conclusion would you make from these signs and symptoms
Answer
Bowel obstruction
You recognise you need to assess Maxs abdomen and gastro-intestinal function. Identify five nursing assessments you will do as part of this assessment, why you are doing them, what they tell you about Maxs abdomen and gastro-intestinal function
Answer
Physical assessment-inspecting contours symmetry and abdominal distention to look for obesity ascites or obstructionAuscultation- listening to bowel sound with a stethoscope. Listening to all quadrants listening for bruitsPercussion-listening to the dullness which indicates fluid, where tympani indicates air raising from the abdominal cavityHealth history- indicators from the patients history that can indicate issues such as gingivitis, bleeding of the gums abscesses or ill-fitting denturesPain - Where is it painful, have you had this pain before, do you get pain before meals after meals or during meals, heartburn, or problems with tongue or mouth that prevent mastication of food
You are asked to insert a nasogastric tube as part of Maxs treatment. Identify why Max needs a naso-gastric tube and how you will confirm that the tube is in the correct place
Answer
Max needs a nasogastric tube inserted as due to his abdomen distension, nausea vomiting he is unable to partake in hydration or nutrition that the body requires. To check the tube is in the correct place is through a litmus paper pH test less than 5 or can be verified through an x-ray of the area
Once the naso-gastric tube has been inserted and the position confirmed you aspirate 25mls of light, yellow brownish fluid with some tinges of green. You are directed to place the nasogastric on continuous drainage. Is this aspiration what you would normally expect when aspirating a naso-gastric tube Explain your response
Answer
Yes the colour is normal, and content has only diluted
What parameters need to be monitored closely when a naso-gastric tube is on free drainage and why
Answer
maintaining patency of the tube avoiding clogging in the tube,Fluid balance chart to monitor input and body outputBlood test to indicate homeostasis of electrolyte imbalanceDaily skin check to nasal area for trauma or irritation amp allergies to nose- tube pulling or constant contact with skin. Allergies from tapes supporting nasogastric tube
There is evidence that people requiring longer term hospitalisation or those with health problems affecting their ability to eat independantly can develop malnutrition. Ensuring an adequate dietary intake is a key nursing role. Identify three nursing actions you will do to ensure that people you are caring for today have adequate dietary intake
Answer
Prioritise your patients assisting them with meals when needed correct positioning for food amp fluid consumption amp decreases likelihood of aspirationMaintain and monitor a food and fluid chart so there is an accurate record of consumptionIdentify when nutritional status declines/signs of dehydrationtypes of foods being consumed. Diet appropriate to ability
Identify 5 steps in the clinical reasoning cycle
Answer
AssessmentDiagnosisPlanInterventionEvaluate
Identify 5 social determinants of health that may impact on the health and well being of people in your care
Answer
behavioural, biological, environmental, socioeconomic
Explain when it is appropriate for a nurse to perform a focussed assessment
Answer
In reference to a specific body part. More in-depth information required
Frank who has a history of coronary artery disease rings the bell for attention. When you come to his bedside he looks worried and tells you he doesnt feel very well. You recognise that it is possible that he is experiencing angina and that the appropriate nursing action is to use the PQRST pneumonic to assess his pain. What are the 5 items you assess using the PQRSTpneumonic
Answer
Provocation-what was Frank doing directly before the onset of this painQuality- what type of pain are you experiencing Frank- dull sharp or shooting painRadiation- where is the pain extending toSeverity- if 1 represents no pain amp 10 represents the most pain you have ever experienced. What number between 1-10 would you Frank rate this painTime- how long has Frank been experiencing this pain
You are assisting Robyn who has a respiratory problem to have a shower. Robyn becomes breathless her face becomes pale and her lips turn from dusky pink. Identify 3 priority nursing actions you will implement at this point
Answer
Sit her down immediatelyApply oxygenPhysical examination to assess skin colour, accessory muscle use
What are 4 early signs and symptoms of respiratory failure and inability to maintain ventilator effort
Answer
Wheezingrapid breathingfatigueconfusion
Identify the terms that applies to the following descriptionsMaterial coughed up from the lungs_____________The subjective sensation of a patient reporting loss of endurance________________________Build-up of fluid in the space between the lung and the chest wall_________________Bacteria in the bloodstream of through the body_________
Answer
-mucous-fatigue-pleural effusion-septisemia
42. Mary is admitted from CCU post an MI. During your shift, you are called to Marys room. She is grey amp gasping for breath. She manages to tell you shes never had pain like this before and never in this spot, has It felt like there is a cement slab sitting on her chestWhat would you do first and why
Answer
Reassure Mary, so as not to alarm her , place her in a comfortable position and apply oxygen
What is your next priority to Mary and why
Answer
Call for assistance to stabilise her condition and to reassure Mary
Identify 5 other nursing interventions you would put in place once Marys condition has stabilised
Answer
Monitor Marys blood pressure for alterations in her conditionAsk her to take regular rest periods so as to allow the heart breaks from activityMaintain regular pain medication to monitor painMaintain adequate oxygen levelsGood nutrition
What does the perioperative period include
Preoperative phaseBegins with decision to have surgery, last until patient is transferred to operating room
Intraoperative phaseExtends from admission to surgical department to transfer to recovery room
Postoperative phaseLast from admission to recovery room to complete recovery from surgery
What do you include in the health history
Looking for information specific to surgical experience1. Developmental infants/elderly greater risk of having complications more fragile. Infants less blood volume, difficulty keeping warm, renal/hepatic systems not fully developed...decreased metabolism and excretion of drugs. Elderly on the other end of spectrum, may not have as good renal/hepatic function, may have other chronic diseases or comorbidities that can complicate surgery. Slower reflexes, Risk for atelectasis, pneumonia, post op confusion2. Medical History medications, previous surgeries, allergies, skin status, CV/pulmonary /renal/hepatic/endocrine/neurological systems or problemsa) CV history of MI, cardiac surgery, dysrhythmias, hypertension, heart failure, dvt... Elderly decreased elasticity of Blood vessels, decrease cardiac output, decreased circulation - potential shock, thrombosis, would healingb) Respiratory copd, asthma, sleep apnea, lung surgeryc) Kidney/liver ESRD/ESLD pt will not metabolize or excrete drugs very well. Fluid status, IV access...could be problems, electrolyte imbalance., bleeding - Over hydration with IVF - hyperkalemia, UTI, Urinary retention- intestinal decreased mobility - fetal impaction - Fewer T cells - wound infections wound dehiscence or evisceration.d) Endocrine DM hyper/hypoglycaemia, impaired healing, hyperthyroidism - thyroid storm heart rate and blood pressure become dangerously highe) Skin want to know if they have any areas at risk for decubiti...or have any already - Aging - skin becomes thin.
HerbsDan shen - antibacterial may cause bleeding- Echinacea Tx cold may interferes with immunosuppressant and impair wound healing - Ephedra wt loss - causes sinus congestion may cause cardiovascular problems - Ginko may cause bleedingETOH, smokers, illicit drugs may require more anesthesia, smokers are at greater risk for pulmonary problems after surgery, it compromises wound healing...impairs blood flow to tissues. Pts on pain meds (narcotics) may need much larger doses postop.Nutrition malnourished pts at risk for poor wound healing, may be at risk for fluid/lyte imbal. Obese pts greater risk for reflux (gerd), obstructive sleep apnea, CV risk. Delayed wound healing in fatty tissue-poor blood supply.Exercise tolerance can you climb a flight of stairs, exercise tolerance tests- cardiology consult before surgeryFamily History problems with anesthesia (malignant hyperthermia), allergies Malignant hyperthermia hereditary autosomal dominant disease marked by skeletal muscle dysfunction after exposure to some anesthestics...body temp rises quickly over 105, if not treated immediately...can be fatal...usually occurs intraoperative...EMERGENCYCoping patterns/support/cultural variations surgery can be very anxiety producing. Need to know family structure available, spiritual beliefs, relaxation techniques, language barriers Knowledge of surgical procedure
What is the importance of pro-operative teaching
Answer
1. Patient education and emotional support have a positive effect on patient outcomes physically and psychologically2. Surgical patients receiving preoperative education and/or supportive intervention resulted in - decreased pain and anxiety- experienced fewer complications- were discharged sooner- returned to normal activities sooner- were more satisfied with their care
A nurse is reviewing results of preoperative screening test and notes the patients PT (prothrombin time) is very elevated. What should the nurse do next
Nothing an elevated PT is not going to affect the surgical outcome.
Document the data and notify the physician who will do the surgery
Review the patients medications and note he is on Coumadin, so it is ok to proceed.
Document the data and report it to the intraoperative nurse.
Answer
B. Document the data and notify the physician who will do the surgery
What is informed consent
It is a process of communication between a patient and physician that results in the patients authorization or agreement to undergo a specific medical intervention.
What is included in an informed consent
Answer
Description of procedure and alternative therapiesUnderlying disease process and its natural coursesNames and qualification of person performing procedureExplanation of the risks/benefits and how often they occurExplanation that patient has the right to refuse treatment or withdraw consentPatient should have an opportunity to ask questions to elicit a better understanding
What is the nursing role for the day of surgery
Answer
1. Review health hx.2. Go over preop checklist NPO, no dentures, hearing aids, voided, IV access, allergies (meds/latex), current VS/BS, autologous blood available.4. Medications in pre-op area ex Versed (midazolam), Pepcid (famotidine), Zofran (ondansatron)5. Prepare the patient for what to expect during each stage of surgery6. Questions for anesthesiologist7. What to expect when entering OR/anesthesia8. Mark the surgical site on the patient, ID pt.
What are some sociocultural factors of surgery
Answer
Perception/reaction to the surgical experience influenced by cultural/ethnic background, family beliefs
Reaction to pain varies by culture
Language barriers may influence experience
Family dynamics may influence experience
Cultural variations regarding treatment of illness may influence care
A 40 year old female is having a right mastectomy. She is currently taking 1 baby Aspirin a day for prophylactic reasons and is allergic to latex otherwise she is healthy. You observe her fidgeting with her admission papers and is expressing anxiety regarding the surgery. In planning her care which intervention should be used
A) Avoid using medication from glass ampules.
B) Avoid using IV tubing that is made of polyvinyl chloride.
C) Make all OR personnel aware of latex allergy and check all package labels for latex
D) Place a rubber urinary catheter
Answer
C) Make all OR personnel aware of latex allergy and check all package labels for latex
What is the intraoperative nurses role
Answer
Meet/assess pt. just prior to surgery review pre-op data, consent, npo status, ID pt, type of surgery, check if pt. marked, answer questions, provide reassurance, info for familyIntraoperatively positioning to prevent skin and neuromuscular injuries (done to ensure comfort, pad areas that may be at risk for breakdown...during surgery if a patient is left un padded in one position..can develop skin breakdown easily in a couple of hours. During surgery pts lose reflexes, may be cool, and decreased perfusion...all leading to skin breakdown) , sterile draping/maintaining surgical asepsis (done to create/maintain a sterile field around the operative site...only the incision site is exposed), skin prep, foley insertion, performing at time-out assisting surgeon-instruments, documentation (periop. nurse documents throughout the procedure...positioning, dressings, drains, procedure, specimens, intake/output, count of instruments/sponges, all present in room), sponge count, transfer to PACU
What are the Joint Commission 2011 National Patient Safety Goals
Answer
Improving patient identification two identifiers for each pt.Preventing surgical site infectionsPerforming time-out before any procedure or surgeryMarking surgical site right procedure, right pt. right site
What is the role of postoperative nursing care in the PACU
Answer
Immediate postoperative care think ABCsEmphasis on continuous assessment and prevention of complications-Status of the respiratory system-Status of the cardiovascular system-Status of CNS-Status of bodily fluids-Pain management-Injury management-The overall condition
What is the post-operative assessment
Answer
Vital signs, temp (may need warming), BP, pulses, capillary refill compare to baseline
Effort of breathing, adventitious breath sounds
Color of skin, lips, mucous membranes, O2 Sat
Fluid status EBL, UOP, I/O during surgery, bowel prep before surgery, length of NPO
Assess wound, drains, tubes, skin status
Focused assessment depending on surgery
Pain management early administration of opioids, NSAIDS, assessment of blocks, epidurals, spinals
Positioning, use of heat/ice, massage
PCA IV and epidural
Pain team consultation
Assess use of prior pain meds, chronic pain
Why is it so important to manage post-op pain
Answer
Controlled painReduces recuperation timeProvides for faster mobilizationAssists in returning to full activities and workIncreases patient satisfaction
Uncontrolled painPsychological and physiological consequences impaired healing, impaired pulmonary effort and increased pulmonary complications, muscle/skin breakdown, immobility, anxiety, depression, decreased patient satisfaction, weakness.....and more
What can you do to promote health and normalcy after surgery
Answer
Meet comfort and rest needsMeet fluid and nutritional needsMeet elimination needsAssist in copingInvolve family participation as much as possible as the patient wishesPrepare the patient for discharge
An operating room nurse is making preparations for a surgical operation for a child. His perioperative care is centred on what physiologic aspect that puts children at higher risk from operation than adultsA) Higher vascular inelasticityB) A reduced expansion of the chestC) Lower blood volumeD) Reduced circulation in the peripherals
Answer
C) Lower blood volume
Mrs. Vell, 74 is booked for an all out hip substitution as a result of osteoarthritis. She has found in the preadmission testing division multi week before medical procedure. What is the reason for seeing Mrs. Vell in the preadmission testing
Answer
For interview purposes, indicative testing, anesthesia meet, and preoperative instructing to guarantee that the patient is in the most ideal condition for the surgical procedure.
What kind of preadmission testing should be conducted
Answer
Laboratory tests blood glucose, bleeding time, blood glucose, CBC, BUN, PT, creatine, electrolytes, PTT, type and screen, and UA are the most common tests. Other tests include Saturation of oxygen, Chest X-rays, and electrocardiogram.
What interventions will help in reducing the risk factors for surgery in preoperative patients
Answer
- Playing relaxing music chosen by the patient
- Strengthening pain control techniques
- Showing the patient how to use the incentive spirometer
- Observing blood glucose levels for diabetic patients
- Training patients to conduct leg exercises every hour during wake times.
When training elderly preoperative patients, what is the most appropriate strategy that will improve their learning
Answer
- utilize large printed materials that are black and white in color
What methods of intervention would help avert atelectasis in postoperative patients
Answer
- Encourage coughing and as well as taking deep breaths
- Controlling the pain of the patient
- Ambulation
A patient has the accompanying preoperative prescription directive morphine 10 mg with atropine 0.4 mg IM. The medical attendant should notify the patient that the injections will help to
A. reduce vomiting and nausea while in surgery and after the operation.
B. reduce respiratory and oral secretions that cause drying of the mouth.
C. reduce anxiety and create amnesia of the preoperative period.
D. prompt the patient to sleep to make the unaware that they are being moved to the operating room.
Answer
B. reduce respiratory and oral secretions,that cause drying of the mouth.
Rationale
Atropine, an anticholinergic medicine, is as often utilized preoperatively to reduce oral and respiratory emissions amid the surgical procedure, and addition of morphine helps in relieving pain and discomfort amid the preoperative techniques. Antiemetics reduce vomiting and nausea during and after the surgical procedure, and scopolamine and a few benzodiazepines activates amnesia. A genuine sleep state is not often started by preoperative drugs except if a pain-relieving agent is administered before transportation to the operating room.
Among the following interventions, which are best suited to patients of spinal anesthesia
Elevation of the patients feet to increase their blood pressure
Elevation of the patients head to reduce nausea
Administration of oxygen to decrease hypoxia resulting from spinal anesthesia
Encouraging the patient to remain flat on the bed for 6 hours
Answer
D) Encouraging the patient to remain flat on the bed for 6 hours
Rationale
Alongside intervention methods that replace body fluids and indirectly replace spinal fluids that are lost after the spinal anesthesia procedure, the patient should be instructed to remain flat on the bed for 6 to 8 hour. Elevation of the bed after the procedure can lead to precipitation of spinal headache or nausea that relates to loss of cerebrospinal fluids or changes in ICP. Keeping the patients feet elevated and administration of oxygen are not essential interventions not unless the patient is hypoxic or hypotensive
References
Academy of Medical-Surgical Nurses. (2018).Scope and Standards of Medical-Surgical Nursing Practice(6th ed.). Pitman, NJ. Retrieved fromhttps//www.amsn.org/practice-resources/scope-and-standards(link is external)Craven, H. (Ed.). (2016).Core Curriculum for Medical-Surgical Nursing. (5th ed.). Pitman, NJ Academy of Medical-Surgical Nurses.
Hinkle, J.L. amp Cheever, K.H. (2018).Brunner amp Suddarths Textbook of Medical-Surgical Nursing(14th ed.). Philadelphia Wolters Kluwer.
Ignatavicius, D.D., Workman, M.L., amp Rebar, C.R. (2018).Medical-Surgical Nursing Concepts for Interprofessional Collaborative Care(9th ed.). St. Louis Elsevier.
LeMone, P., Burke, K.M., Bauldoff, G., amp Gubrud, P. (2015).Medical-Surgical Nursing Critical Reasoning in Patient Care(6th ed.). Upper Saddle River, NJ Pearson/Prentice Hall.
Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L., amp Harding, M.M. (2017).Medical-Surgical Nursing Assessment and Management of Clinical Problems(10th ed.). St. Louis Elsevier.
Potter, P.A., Perry, A.G., Stockert, P.A., amp Hall, A.M. (2017).Fundamentals of Nursing(9th ed.). St. Louis Elsevier/Mosby.
Potter, P.A., Perry, A.G., Stockert, P.A., amp Hall, A.M. (2019).Essentials for Nursing Practice(9th ed.). St. Louis Elsevier.
Roberts, D. (Ed.). (2014).MedicalSurgical Nursing Review Questions(3rd ed.). Pitman, NJ Academy of Medical-Surgical Nurses
Wilkinson, J.M., Treas, L.S., Barnett, K.L., amp Smith, M.H. (2016).Fundamentals of Nursing Volume 1- Theory, Concepts, and Applications Volume 2- Thinking, Doing, and Caring. (3rd ed.). Philadelphia F.A. Davis Co