NSE 22A/B- Final Exam Guide - Comprehensive Notes for the exam ( 25 pages long!)

322 views25 pages
29 Mar 2018
Department
Course
Professor

For unlimited access to Study Guides, a Grade+ subscription is required.

Ryerson
NSE 22A/B
Final EXAM
STUDY GUIDE
Unlock document

This preview shows pages 1-3 of the document.
Unlock all 25 pages and 3 million more documents.

Already have an account? Log in
Unlock document

This preview shows pages 1-3 of the document.
Unlock all 25 pages and 3 million more documents.

Already have an account? Log in
1. Discuss the purpose and aspects to include in the preoperative, intraoperative, and
postoperative assessment of a surgical client (including lab values and diagnostic
tests)
All three is known as perioperative nursing care. Important to practice surgical
asepsis, thoroughly document and emphasize patient safety in all phases of care.
Use nursing process as the basis of care, ensuring patient centred care. By using
nursing process you can help anticipate needs and minimize complications.
Preoperative(before):
Purpose: done to establish pt baseline to assist in preventing and recognizing possible
postop complications.
most assessments begin in preadmission clinic before admission for surgery to
prep patient physically and mentally for surgery
doctor comes in and does his thing and preop nurse comes in and does a
“double check” to make sure nothing was overlooked.
Aspects to include in assessment
Establish rapport and maintain professional rel. must be done quickly but with
compassion and effectively.
Assess patient’s physical, emotional and spiritual well being and cultural
heritage, recognize degree of surgical risk, coordinate diagnostic tests, identify
nursing diagnoses and nursing interventions, establish outcome is collab with pt
and his/her fam
Med history: include past illness along with primary reason for seeking care (pt
current and past med records are excellent sources). Any preexisting
illnesses?these influence choice of anesthestic agent used and to determine if pt
is fit enough to have surgery. Same day surgery pts must be carefully screened
for med conditions that may increase complication risks during or after surgery.
Risk factors: any risk factors? Like bleeding disorders (increase risk of
hemorrhaging during/after surgery)Knowing this helps you to plan a better plan
of care.
- diabetes: increase risk of infection affect wound healing due to altered
glucose metabolism and asoc circulatory impairment. Stress increase blood
sugar levels
- heart disease/ recent myocardial infarction: anxiety increase demands on
heart to maintain cardiac output and anesthetic depress heart function
- sleep apnea: opioids incr risk of airway obstruction postop
- upper resp infection: incr risk of resp compl during anesthesia
- liver disease: alters metabolism and elimination of drug used during surgery,
delay wound heaing and clotting time due to changes in protein metab
- fever: predispose pt to fluid and electrolyte imbalances and may indicate
underlying infection
- chronic resp disease(emphysema, asthma etc): reduce pt means to
compensate for acid-base alterations, anesthetic agents reduce resp function
incr risk of severe hypoventilation.
- Immunological disorders: increase risk of infection and delay wound healing
postop.
find more resources at oneclass.com
find more resources at oneclass.com
Unlock document

This preview shows pages 1-3 of the document.
Unlock all 25 pages and 3 million more documents.

Already have an account? Log in
- Drug abuse: they may have underlying disease eg hiv, hepatitis which can
affect anesthesia response, surgery and ability to heal
- Chronic pain: reg use of pain meds may result in higher tolerance. And so
they may require higher doses of analgesics to achieve pain relief.\
- Obesity; reduce resp and cardiac function. Hypertension, coronary artery
disease, diabetes and heart failure are prominent in bariatric pts. Increase ris
of pulmonary embolus and atelectasis, pneumonia postop. Risk of dcreased
mobility increases postop. Susceptible to poor wound healing as fatty tissue
has poor blood supply slowing nutrient delivery. Difficult to close surgery
wound due to thick fat layer. At risk of “dehiscence” i.e suture line opening
Age:
- young pts: 1. have immature physiological status. Nurses etc are particulary
concerned with maintenance of body temp as their shrivling reflex is
undeveloped and so their temp tends to fluctuate. Anesthesia is risky as it
cause vasodilation and thus heat loss. 2. Have difficulty maintaining
circulatory blood volume. Any blood loss can be serious. They have less
blood and affects ability to respond to incr. o2 demand. 3. At high risk of
dehydration but can easily be overhydrated. 4. Other concerns include
airway management, seizure treatment, identification and treatment of
emergene delirium, pain treatment
- elderly: physical ability to adapt to surgery stress is hampered due to decline
in renal and liver functions. Host of problems:
Prone to pressure ulcers due to fragility of skin and the fact that they have
less fatty tissue,
heart muscle and valves change and so they have reduced cardiac reserve,
blood vessels are stiff, and sympathetic/parasym stimulation reduced
making them prone to high bp and postop bleeding.
they have more ca2= and cholesterol in small arteries predisposing them
to clot formation in lower extremities.
Rib cage stiffening and size reduction reduces vital capacity, reduced
range of diaphragm movement reduces residual capaciet i.e amt of air left
in lung after breath( make pt ambulate/sit in chair frequently)
Reduced bladder capacity and so they pee more and larger amt of urine
stays in bladder postvoid
Reduced glomerular filtration and so ability to eliminate drugs/toxic
substances decrease
Nutrition: Important in preop to identify if pt is malnourished in case of elective
surgery. If surgery is of emergency nature interventions to restore nutrients will
occur post op. important for normal tissue repair and resistance to infection.
Increased vit a and c, protein and zinc facilitate wound healing. Malnourished pt
are prone to poor anesthesia tolerance, negative nitrogen balance, delayed blood
clotting, infection and poor wound healing.
Fluid and electrolyte imbalances: sodium and h20 retained and k+ loss withing
first 2-5 days postop. Severity of stress response influences how bad the
imbalance is i.e more extensive surgery = gr8r stress response. Hypovolemic pts
find more resources at oneclass.com
find more resources at oneclass.com
Unlock document

This preview shows pages 1-3 of the document.
Unlock all 25 pages and 3 million more documents.

Already have an account? Log in

Get access

Grade+
$10 USD/m
Billed $120 USD annually
Homework Help
Class Notes
Textbook Notes
40 Verified Answers
Study Guides
1 Booster Class