Final Review Med Surg 2
1. Know what to check for before patient received MRI
Pg. 1296 Before: Oral and/or IV contrast injection may be used. Check for pregnancy,
allergies, and renal function. Have patient remove all metal objects. Ask about any
history of surgical insertion of staples, plates, dental bridges, or other metal appliances.
Remove metallic foil patches. Patient may need to be fasting. Assess for claustrophobia
and the need for antianxiety medication.
During: Patient must lie completely still.
2. Know contraindications to CT contrast
60 yo or older, shellfish or previous contrast allergy, CKD, Metformin use, Diabetes,
current use of nephrotoxic drugs (Chemo, chronic NSAID use)
3. Prioritize patient manifestations and findings. What takes priority?
Often these questions will ask, “Which patient is a priority?” Patients with problems
regarding airway, breathing and circulation should always be the priority, and it should
always be in that order. First priority is the airway, next is breathing, then circulation.
4. Delegation to LPN/LVN
Pg. 9 & 10 As a registered nurse (RN), you will delegate nursing care and supervise
those who are qualified to deliver care. Delegation allows a care provider to perform a
specific nursing activity, skill, or procedure that is beyond their usual role.20 Delegating
and assigning nursing activities is a process that, when used appropriately, results in
safe, effective, and efficient patient care. Delegating can allow you more time to focus on
complex patient care needs. Delegating care and supervising others will be one of your
essential roles as a professional nurse. Delegation usually involves tasks and procedures
that licensed practical/vocational nurses (LPN/VNs) and unlicensed assistive personnel
(UAP) perform. Nursing interventions that require independent nursing knowledge, skill,
or judgment (e.g., initial assessment, patient teaching, evaluating care) are your
responsibility and cannot be delegated. State nurse practice acts and agency policies
identify activities that you can delegate to LPN/VNs and UAP. You will use professional
judgment to select which activities to delegate. Your decision will be based on the
patient’s needs, the LPN/VN’s and UAP’s education and training, and the amount of
supervision needed. The most common delegated nursing actions occur during the
implementation phase of the nursing process. For example, you can delegate measuring
oral intake and urine output to UAP, but you use your nursing judgment to decide if the
intake and output are adequate. The general guideline for LPN/VN practice is that they
can function independently in a stable, routine situation. However, they must work
under the direct supervision of a professional nurse in acute, unstable situations in
which a patient’s condition can rapidly change. In most states, LPN/VNs may give
medications, perform sterile procedures, and perform a wide variety of interventions
planned by the RN. The procedure itself is not the issue when an RN is determining what
to delegate. Rather, the stability of the patient determines whether it is appropriate for
an RN to delegate a procedure to an LPN/VN. For example, the LPN/VN can change a
dressing on an abdominal surgical wound, but the RN should do the first dressing change
and wound assessment.
5. Know treatment for oral candidiasis
Pg. 893 Miconazole Oral tabs (Oravig)
Nystatin or amphotericin B as oral suspension or buccal tabs
Good oral hygiene
6. Know prevention methods for respiratory disease
Pg. 503 Wash hands often to prevent and avoid spreading infections
Avoid cigarette smoking and exposure to environmental smoke
Get pneumococcal vaccine and yearly flu vaccine as directed by HCP
Avoid exposure to allergens, indoor pollutants, and ambient air pollutants
Wear PPE when working in occupation with prolonged exposure to dust, fumes, and
gases.
7. Paradoxical chest movement. What is it?
Pg. 524 Flail chest results from the fracture of 3 or more consecutive ribs, in 2 or more
separate places, causing an unstable segment (Fig. 27.5). It also can be caused by
fracture of the sternum and several consecutive ribs. The resulting instability of the
chest wall causes paradoxical movement during breathing. The affected (flail) area
moves in the opposite direction with respect to the intact part of the chest. During
inspiration, the affected part is sucked in, and during expiration, it bulges out. This
paradoxical chest movement prevents adequate ventilation and increases the work of
breathing. The underlying injured lung may be contused, aggravating hypoxemia.
Video: https://youtu.be/UWuzaIBKapY?si=ES9MUvIQ-kEIESoO
8. Manifestations and interventions for pneumothorax
Pg. 524-525 A pneumothorax is caused by air entering the pleural cavity. Normally,
negative (subatmospheric) pressure exists between the visceral pleura (surrounding the
lung) and parietal pleura (lining the chest cavity), known as the pleural space. The
pleural space has a few milliliters of lubricating fluid to reduce friction when the tissues
move. When air enters this space, the change to positive pressure causes a partial or
complete lung collapse (Fig. 27.6). As the volume of air in the pleural space increases,
lung volume decreases. Pneumothorax can be classified as open (air entering through an
opening in the chest wall) or closed (no external wound). Penetrating trauma allows air
to enter the pleural space through an opening in the chest wall (Fig. 27.6). A penetrating
chest wound may be referred to as a sucking chest wound, since air enters the pleural
space through the chest wall during inspiration. A pneumothorax should be suspected
after any trauma to the chest wall.If a pneumothorax is small, mild tachycardia and
dyspnea may be the only manifestations. If the pneumothorax occupies a large area,
respiratory distress may be present, including short, shallow, rapid respirations; dyspnea;
air hunger; and O2 desaturation. On auscultation, breath sounds are absent over the
affected area. Time permitting, a chest x-ray will show air or fluid in the pleural space
and reduction in lung volume.
Treatment of a pneumothorax depends on its severity, underlying cause, and
hemodynamic stability of the patient. If the patient is stable and has minimal air and/or
fluid accumulated in the intrapleural space, no treatment may be needed since the
condition may resolve spontaneously. Emergency treatment consists of covering the
wound with an occlusive dressing that is secured on 3 sides (vent dressing). During
inspiration, as negative pressure is created in the chest, the dressing pulls against the
wound, preventing air from entering the pleural space. During expiration, as the
pressure rises in the pleural space, the dressing is pushed out and air escapes through
the wound and from under the dressing. If the object that caused the open chest wound
is still in place, do not remove it. Stabilize the impaled object with a bulky dressing. Wait
until an HCP is present or arrange transport to the nearest medical facility. The most
definitive and common treatment of pneumothorax and hemothorax is to insert a chest
tube and connect it to water-seal drainage. Repeated spontaneous pneumothorax may
need surgical treatment with a partial pleurectomy, stapling, or pleurodesis to promote
adherence of the pleurae to one another. Tension pneumothorax is a medical
emergency, requiring urgent needle decompression followed by chest tube insertion to
water-seal drainage.
9. Know good O2 sat for COPD
Page 566. Goal is to keep O2 >90% during rest, sleep and exertion
10. Treatment for pt with COPD
Pg. 573 People with COPD should avoid others who are sick, practice good hand-washing
techniques, take drugs as prescribed, exercise regularly, and maintain a healthy weight.
Avoiding or controlling exposure to occupational and environmental pollutants and
irritants is another preventive measure to maintain healthy lungs. Patients with COPD
should have influenza and pneumococcal pneumonia vaccines
11. Interventions for COPD
Smoking Cessation
12. Potential Complications following surgical procedures
I did not find anything definitive in the book, the following is from John’s Hopkins
Medical Center: Sometimes, complications can occur after surgery. These are the most
common complications.
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Complications may include:
Shock. Shock is a severe drop in blood pressure that causes a dangerous reduction of
blood flow throughout the body. Shock may be caused by blood loss, infection, brain
injury, or metabolic problems. Treatment may include any or all of the following:
o Stopping any blood loss
o Helping with breathing (with mechanical ventilation if needed)
o Reducing heat loss
o Giving intravenous (IV) fluids or blood
o Providing oxygen
o Prescribing medicines, for example, to raise blood pressure
Hemorrhage. Hemorrhage means bleeding. Rapid blood loss from the site of surgery, for
example, can lead to shock. Treatment of rapid blood loss may include:
o IV fluids or blood plasma
o Blood transfusion
o More surgery to control the bleeding
Wound infection. When bacteria enter the site of surgery, an infection can result.
Infections can delay healing. Wound infections can spread to nearby organs or tissue, or
to distant areas through the blood stream. Treatment of wound infections may include:
o Antibiotics
o Surgery or procedure to clean or drain the infected area
Deep vein thrombosis (DVT) and pulmonary embolism (PE). Together, these conditions
are referred to as venous thromboembolism (VTE). This term is used because the
conditions are very closely related. And, because their prevention and treatment is also
closely related. A deep vein thrombosis is a blood clot in a large vein deep inside a leg,
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arm, or other parts of the body. Symptoms are pain, swelling, and redness in a leg, arm,
or other area. If you have these symptoms, call your healthcare provider.
Pulmonary embolism. The clot can separate from the vein and travel to the lungs. This
forms a pulmonary embolism. In the lungs, the clot can cut off the flow of blood. This is
a medical emergency and may cause death. If you have the following symptoms, call
911 or get emergency help. Symptoms are chest pain, trouble breathing, coughing (may
cough up blood), sweating, fast heartbeat, and fainting. Treatment depends on the
location and size of the blood clot. It may include:
o Anticoagulant medicines (blood thinners to prevent further clotting)
o Thrombolytic medicines (to dissolve clots)
o Surgery or other procedures
Lung (pulmonary) complications. Sometimes, pulmonary complications arise due to lack
of deep breathing and coughing exercises within 48 hours of surgery. They may also
result from pneumonia or from inhaling food, water, or blood, into the
airways. Symptoms may include wheezing, chest pain, fever, and cough (among others).
Urinary retention. Temporary urine retention, or the inability to empty the bladder, may
occur after surgery. Caused by the anesthetic, urinary retention is usually treated by the
insertion of a catheter to drain the bladder until the patient regains bladder control.
Sometimes medicines to stimulate the bladder may be given.
Reaction to anesthesia. Although rare, allergies to anesthetics do occur. Symptoms can
range from mild to severe. Treatment of allergic reactions includes stopping specific
medicines that may be causing allergic reactions. Also, administering other medicines to
treat the allergy.
13. Recognize what is normal and abnormal during liver assessment
Pg. 594 The liver and spleen are normally not detectable by palpating the abdomen. An
enlarged liver or spleen may be detectable by percussion or palpation. Measure the
degree of liver enlargement by the number of fingerbreadths it extends below the rib
border. The spleen may be harder to detect because of its deep location in the left
abdomen.
Pg. 839 To palpate the liver, place your left hand behind the patient to support the right
eleventh and twelfth ribs (Fig. 38.8). The patient may relax on your hand. Press the left
hand forward and place the right hand on the patient’s right abdomen lateral to the
rectus muscle. The fingertips should be below the lower border of liver dullness and
pointed toward the right costal margin. Gently press in and up. The patient should take a
deep breath with the abdomen so that the liver drops and is in a better position for
palpation. Try to feel the liver edge as it comes down to the fingertips. During
inspiration, the liver edge should feel firm, sharp, and smooth. Describe the surface and
contour and any tenderness. If the patient has chronic obstructive pulmonary disease,
large lungs, or a low diaphragm, the liver may be palpated 0.4 to 0.8 in (1 to 2 cm) below
the right costal margin.
14. ERCP
Pg. 842 Fiberoptic endoscope (using fluoroscopy) is orally inserted into descending
duodenum. Then common bile and pancreatic ducts are cannulated. Contrast medium is
injected into ducts to allow for direct visualization of structures. Can be used to retrieve
a gallstone from distal common bile duct, dilate strictures, biopsy, and diagnose
pseudocysts.
15. Abdominal Quads, what is in each and how to assess Pg 838
16. Daily recommended protein intake
Pg. 850 Proteins are an essential part of a well-balanced diet. They are needed for tissue
growth, repair, and maintenance; body regulatory functions; and energy production.
Ideally, 10% to 35% of daily caloric needs should come from protein.3 The
recommended daily protein intake is 0.8 to 1 g/kg of body weight. For the normal
healthy person of average body size, this equals about 45 to 65 g of protein daily. One
gram of protein yields 4 calories.
17. Electrolyte abnormalities, which is highest priority
Pg. 290 Box 16.17 Assessment abnormalities fluid and electrolyte imbalances
18. Delegate LPN/LVN-Nutrition Pg. 862
19. When TPN is empty and no new bag is available, what to do?
ATI/Quizlet: Infuse D10W until next TPN is available
20. Diet consult w/ nutrition
Pg 1560 Patients unlikely to be able to eat independently for 3 to 5 days should have a
nutritional assessment and EN started within 24 to 48 hours of admission.9 EN is the
preferred method to meet caloric needs of mechanically ventilated patients (see Chapter
39 for discussion of EN). Consult the dietitian to determine the caloric and nutrient
needs of these patients.
21. Education for GERD
Pg. 897 TABLE 41.9 Patient & Caregiver Teaching GERD Include the following
instructions when teaching the patient and caregiver about managing GERD:
1. Explain the reason for a low-fat diet.
2. Have the patient to eat small, frequent meals to prevent gastric distention.
3. Explain the reason for avoiding alcohol, smoking (causes an almost immediate,
marked decrease in lower esophageal sphincter pressure), and beverages that contain
caffeine.
4. Tell the patient to not lie down for 2–3 hr after eating, wear tight clothing around the
waist, or bend over (especially after eating).
5. Have the patient avoid eating within 3 hr of bedtime.
6. Have the patient to sleep with head of bed elevated on 4- to 6-in blocks (gravity
fosters esophageal emptying).
7. Provide information about drugs, including reason for their use and common side
effects.
8. Discuss strategies for weight reduction if appropriate.9. Encourage patient and
caregiver to share concerns about lifestyle changes and living with a chronic problem.
22. Risk factor for gastritis
Pg. 916
23. Medication regimen for peptic ulcer disease from H. Pylori
Pg. 899
24. Indication and MOA for Zantac
Pg. 899 Block the action of histamine on the H2 receptors to ↓ HCl acid secretion↓
Conversion of pepsinogen to pepsin↓ Irritation of the esophageal and gastric mucosa
25. Pt education for Ulcerative Colitis
Pg. 944 Teaching includes (1) the importance of rest and diet management, (2) perianal
care, (3) drug action and side effects, (4) symptoms of recurrence of disease, (5) when to
seek medical care, and (6) ways to reduce stress. Excellent teaching resources, written in
easily comprehensible language are available from the Crohn’s and Colitis Foundation of
America
26. Manual Physical exams for men >45yo
Pg 1178 Testosterone levels decline in men as they age. Manifestations of this decline
are more gradual in men and can be physical, psychologic, or sexual. Changes include an
increase in prostate size and a decrease in testosterone level, sperm production, muscle
tone of the scrotum, and size and firmness of the testicles. Erectile dysfunction (ED) and
sexual dysfunction occur in some men because of these changes.
27. Education for Celiac-diet education
28. Steps for clean catch urine
Pg 1018
Pg. 961
29. Abnormal values in UA, which value is reportable
Pg 1018 Urinalysis is one of the first studies done to evaluate disorders of the urinary
tract (Table 44.8). Results from the urinalysis may show abnormalities, suggest the need
for further studies, or show progression in a previously diagnosed disorder.Although a
specimen may be collected at any time of the day for a routine urinalysis, it is best to
obtain the first specimen urinated in the morning. This concentrated specimen is more
likely to contain abnormal constituents if they are present in the urine. The specimen
should be examined within 1 hour of urinating. Otherwise, bacteria multiply rapidly,
RBCs hemolyze, casts (molds of renal tubules) disintegrate, and the urine becomes
alkaline because of urea-splitting bacteria. If it is not possible to send the specimen to
the laboratory immediately, refrigerate it. However, for the best results, coordinate
specimen collection with routine laboratory hours.Creatinine ClearanceA common test
used to analyze urinary system disorders is creatinine clearance. Creatinine is a waste
product made by muscle breakdown. Urinary excretion of creatinine is a measure of the
amount of active muscle tissue in the body, not of body weight. Therefore people with
larger muscle mass have higher values. Because almost all creatinine in the blood is
normally excreted by the kidneys, creatinine clearance is the most accurate indicator of
renal function. The result of a creatinine clearance test closely approximates that of the
GFR. A blood specimen to measure serum creatinine should be obtained during the
period of urine collection. Creatinine levels stay remarkably constant for each person
because they are not significantly affected by protein ingestion, muscular exercise, water
intake, or rate of urine production. Normal creatinine clearance values range from 87 to
139 mL/min (Table 44.10). After age 40, the creatinine clearance rate decreases at a rate
of about 1 mL/min/yr.
30. Interventions for urinary incontinence, types of urinary incontinence
Pg. 1016
31. Pt education for self-intermittent catheterization
Pg 1051 Patients with chronic urinary retention may be managed by behavioral
methods, indwelling or intermittent catheterization, surgery, or drugs. Scheduled
toileting and double voiding are the primary behavioral interventions used for chronic
retention. Scheduled toileting can reduce, rather than expand, bladder capacity. In this
case, have the patient void every 3 to 4 hours regardless of the desire to void. This is
particularly useful in the patient with chronic overdistention, diabetes, or chronic
alcoholism with a large bladder capacity and diminished or delayed sensations of
bladder filling and urgency.
32. Prioritization
Sickest patients always take priority, follow ABC’s
33. Know when to give a phosphate binder
Pg. 283 Managing hyperphosphatemia (>4.5) involves identifying and treating the
underlying cause. Restrict the intake of foods and fluids high in phosphorus (e.g., dairy
products). Oral phosphate-binding agents (e.g., calcium carbonate) limit intestinal
phosphate absorption and increase phosphate secretion in the intestine. With severe
hyperphosphatemia, hemodialysis may be used to rapidly decrease levels. Volume
expansion and forced diuresis with a loop diuretic may increase phosphate excretion. If
hypocalcemia is present, institute measures to correct calcium levels.
Pg 1068 CKD mineral and bone disorder (CKD-MBD) develops as a systemic disorder of
mineral and bone metabolism caused by progressive deterioration in kidney function
(Fig. 46.3). Activated vitamin D is necessary to optimize absorption of calcium from the
GI tract. As kidney function deteriorates, less vitamin D is converted to its active form,
resulting in decreased serum levels. Low levels of active vitamin D result in decreased
serum calcium levels. Serum calcium levels are regulated primarily by PTH. When
hypocalcemia occurs, the parathyroid gland secretes PTH, which stimulates bone
demineralization, releasing calcium from the bones. Phosphate is also released, leading
to high serum phosphate levels. Hyperphosphatemia results from decreased phosphate
excretion by the kidneys. It decreases serum calcium levels and further reduces the
kidneys’ ability to activate vitamin D.
34. Which patient takes priority-Safety and acuity
Follow ABC’s
35. Side effects of tobacco, marijuana, heroin, and cocaine
Pg. 143
Tobacco: Nicotine is a central nervous system stimulant. Within seconds of entering the
body, nicotine reaches the brain, causing the release of adrenaline and creating feelings
of a “high” or a “buzz.” The effects last about 1 to 2 hours before withdrawal symptoms
occur, leaving the person feeling tired, irritable, and anxious. The need to have the
“high” or “buzz” feelings again makes the person crave more nicotine, leading to
addiction.
Marijuana: bronchitis, chronic cough, depression, anxiety, schizophrenia, memory
impairment
Heroin: sexual dysfunction, gastric ulcers, Glomerulonephritis
Cocaine: Cardiac Dysrhythmia, myocardial ischemia, infarction, seizure, stroke, psychosis
36. How to assess for pancreatitis
Pg 995
37. How to care for stage 2 pressure injuries
Woundsource.com Treatment of Stage 2 Pressure Ulcers
The goal of care for stage 2 pressure ulcers is to cover, protect, and clean the area. As
always, decreasing pressure on the area is key to wound healing. With quick attention, a
stage 2 pressure ulcer can heal very rapidly. Emphasis should be placed on proper
nutrition and hydration to support wound healing. Generally, pressure ulcers that
develop beyond stage 2 are considered to be a result of lack of aggressive intervention.
The following precautions can help minimize the risk of developing pressure ulcers injuries
in at-risk patients and to minimize complications in patients already exhibiting symptoms:
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Patient should be repositioned with consideration to the individual’s level of
activity, mobility and ability to independently reposition. Q2 hour turning is the
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standard in many facilities, but some patients may require more or less frequent
repositioning, depending on the previous list.
Keep the skin clean and dry.
Avoid massaging bony prominences.
Provide adequate intake of protein and calories.
Maintain current levels of activity, mobility and range of motion.
Use positioning devices to prevent prolonged pressure bony prominences.
Keep the head of the bed as low as possible to reduce risk of shearing.
Keep sheets dry and wrinkle free.
38. Nursing interventions for Rheumatoid Arthritis
Pg. 1511
39. Treatment for gout
Pg. 1514
40. Treatment for SLE, precautions and vaccines
Pg 1522 NSAIDs continue to be an important intervention, especially for patients with
mild joint pain. Monitor the patient on long-term NSAID therapy for GI and renal effects.
Antimalarial agents, such as hydroxychloroquine and chloroquine, are often used to
treat fatigue and skin and joint problems. They repress the immune system but do not
cause immunosuppression. These drugs may reduce occurrence of flares. Patients taking
hydroxychloroquine should have eye examinations by an ophthalmologist every 6 to 12
months. Retinopathy can develop with high doses of these drugs. It generally reverses
when they are stopped. If the patient cannot tolerate an antimalarial agent, an
antileprosy drug, such as dapsone, may be used. Use of corticosteroids should be limited
to the lowest dose for the shortest possible time. For example, steroids can be used for a
few weeks until a slower acting medication becomes effective. Taper the patient’s dose
of steroid slowly rather than stopping the medication abruptly. High doses of
corticosteroids may be especially appropriate for the patient with severe cutaneous SLE.
During a disease flare, the patient may quickly become very ill. Assess fever pattern,
joint inflammation, limitation of motion, location and degree of discomfort, and fatigue.
Monitor the patient’s weight and fluid intake and output. This is especially important if
corticosteroids are prescribed because of related fluid retention and possible renal
failure. Collect 24-hour urine samples for protein and creatinine clearance as ordered.
Observe for signs of bleeding due to drug therapy (e.g., pallor, skin bruising, petechiae,
tarry stools).Carefully assess neurologic function. Observe for vision problems,
headaches, personality changes, seizures, and memory loss. Psychosis may result from
CNS disease or be an effect of corticosteroid therapy. Nerve irritation of the extremities
(peripheral neuropathy) may cause numbness, tingling, and weakness of the hands and
feet. Explain the nature of the disease, treatments, and all diagnostic procedures. When
teaching patients about their prescribed drugs, include indications for use, proper
administration, and side effects. Help patients understand that abruptly stopping a
medication may worsen disease activity. Provide emotional support for the patient and
caregiver, especially during a disease flare. Emphasize the importance of patient
involvement for successful home management. Help the patient understand that even
strong adherence to the treatment plan is no guarantee against flares in this
unpredictable disease. Several factors may increase disease activity, such as fatigue, sun
exposure, emotional stress, infection, drugs, and surgery. Help the patient and caregiver
eliminate or reduce exposure to such factors
41. What is angioma and causes
Pg. 597 Benign tumor. Consists consisting of blood or lymph vessels
Most are congenital. May disappear spontaneously
42. Adverse effects of high potency topical corticosteroids
Pg. 1167
43. Infection prevention and wound care for Staph A
MN DOH: Hand Hygiene and:
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If you get a cut or scrape on your skin, clean it with soap and water and then cover it
with a bandage.
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Do not touch sores; if you do touch a sore, clean your hands right away.

Keep the infected area covered with clean, dry bandages.
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Cover any infected sores with a bandage and clean your hands right away after putting
on the bandage.
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Wear clothes that cover your bandages and sores, if possible.
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Throw used dressings away promptly.
44. Side effect of Isotretinoin/Accutane
Pg. 420
45. What is crepitus, torticollis, subluxation and epicondylitis
Pg. 1439
Crepitus: Frequent, audible crackling sound with palpable grating that accompanies
movement.
Torticollis: Neck is rotated and laterally bent in unusual position to one side.
Subluxation: Partial dislocation of joint.
Epicondylitis: Dull ache along outer aspect of elbow, worsens with twisting and grasping
motions.
46. Nursing Intervention for ORIF
Pg. 1452 Open reduction is the correction of bone alignment through a surgical incision.
It usually includes internal fixation of the fracture with wires, screws, pins, plates,
intramedullary rods, or nails. The type and location of the fracture, patient age, and
concurrent disease influence the decision to use open reduction. The main risks of open
reduction are infection, complications associated with anesthesia, and effects of
preexisting medical conditions (e.g., diabetes). However, open reduction internal fixation
(ORIF) facilitates early ambulation, thus decreasing the risk for complications related to
prolonged immobility.
47. Treatment for common L arm FX and long arm cast
Pg. 1453 Leave a fresh plaster cast uncovered to allow air circulation. Covering the cast
allows heat to build up in the cast. This may cause a burn and delay drying. Avoid direct
pressure on the cast during the drying period. Handle the cast gently with an open palm
to avoid denting the cast. Once the cast is thoroughly dry, the rough edges may be
petaled to minimize skin irritation. Petaling also prevents plaster of Paris debris from
falling into the cast and causing irritation or pressure necrosis. Place several strips
(petals) of tape over the rough areas to ensure a smooth cast edge. The long arm cast is
often used for stable forearm or elbow fractures and unstable wrist fractures. It is similar
to the short arm cast but extends to the proximal humerus, restricting motion at the
wrist and elbow. Support the extremity and reduce edema by elevating the extremity
with a sling. However, when a hanging arm cast is used for a proximal humerus fracture,
avoid elevation or use of a supportive sling. The hanging provides traction and maintains
fracture alignment.
48. ORIF pt from OR-infection
49. Shift change reportfemur fx with swelling
50. Education osteoporosis-post menopausal female
Pg 1494 However, supplemental vitamin D (800 IU) is recommended for
postmenopausal women, older men, persons who are homebound or in long-term care
settings, and those in northern climates due to decreased sun exposure.
51. Nursing intervention for Osteocalcin
Google: Osteocalcin, also known as bone gamma-carboxyglutamic acid-containing
protein, is a small noncollagenous protein hormone found in bone and dentin, first
identified as a calcium-binding protein. Because osteocalcin has gla domains, its
synthesis is vitamin K dependent
52. Which assessment firstNo void in 8 hours
53. Fall risks-what meds increase risk Blood pressure and pain meds are the main ones
54. Know normal CBC value and ranges:
55. RN delegate to UAP in Preop
I can’t find this in the book: Vital signs, transferring of patient, nothing with any
assessments, nothing with education, assist dressing/undressing patient, belongings list.
56. Prioritization malignant hyperthermia
Pg. 325 Malignant hyperthermia (MH) is a rare disorder characterized by hyperthermia
with skeletal muscle rigidity. It can result in death. MH occurs in susceptible people
when they are exposed to certain anesthetic agents. Succinylcholine (Anectine),
especially when given with volatile inhalation agents, is the primary trigger of MH. Other
factors include stress, trauma, and heat. When MH does occur, it is usually during
general anesthesia. It may occur in the recovery period, too. MH is an autosomal
dominant trait. It is variable in its genetic manifestation, so predictions based on family
history are important but not reliable. The fundamental defect is hypermetabolism of
skeletal muscle resulting from altered control of intracellular calcium. This leads to
muscle contracture, hyperthermia, hypoxemia, lactic acidosis, and hemodynamic and
cardiac problems. Tachycardia, tachypnea, hypercarbia, and ventricular dysrhythmias
may occur but are nonspecific to MH.MH is diagnosed after ruling out other causes of
the hypermetabolism. The rise in body temperature is not an early sign of MH. Unless
promptly detected and treated, MH can result in cardiac arrest and death. The definitive
treatment of MH is prompt administration of dantrolene (Dantrium, Ryanodex).
Dantrolene slows metabolism, reduces muscle contraction, and mediates the catabolic
processes associated with MH. To prevent MH, take a careful family history and be alert
to the development of MH perioperatively. The patient known or suspected to be at risk
for this disorder can receive anesthesia with minimal risks if proper precautions are
taken. Patients with MH need to be aware of the condition so that family members may
be genetically tested.
57. Delegate to surgical tech
Pg 315
Depending on the state’s nurse practice act, an LPN/VN or a surgical technologist may fill
the role of the circulating or scrub nurse. Surgical technologists attend an associate
degree program or a vocational, hospital, or military training program. The Association
of Surgical Technologists sets the standards for education, provides continuing education
opportunities, and offers certification for surgical technologists.6If the circulating nurse
is not an RN, the LPN/VN or surgical technologist must always have access to an RN. As
an OR RN, you take on responsibility for supervising an LPN/VN or surgical technologist
performing delegated nursing tasks.
58. What does peri-operative mean?
Around the time of surgery
59. What is included in surgical time out
Pg 319 Time Out and Surgical Checklist. The National Patient Safety Goals (NPSGs)
require a preprocedure verification process. This includes verification of relevant
documentation (e.g., history and physical examination, signed consent forms, nursing
and preanesthetic assessment) and the results of any diagnostic studies (e.g., x-rays,
biopsy reports). Any needed blood products, implants, devices, and special equipment
must be available. The Universal Protocol, one of the NPSGs, is followed to prevent
wrong site, wrong procedure, and wrong surgery. Wrong surgical procedure and surgery
on the wrong body part or wrong patient are sentinel events (never events) or SREs
(described in Chapter 1). The AORN has a position statement about correct site surgery
and guidelines for implementing the Universal Protocol.15 The surgeon marks the
procedure site. If possible, the marking is done with the patient’s involvement.3A
patient safety checklist for ORs is the cornerstone of a major focus to make surgery safer.
Using the World Health Organization (WHO) Surgical Safety Checklist has improved
compliance with standards and decreased complications from surgery (Fig. 18.5). In
addition, OR staff complete a fire risk assessment to identify and reduce the potential for
a fire.
60. No ambulating often, what is priority?
Oak Bend Medical Center:
Benefits of early ambulation after surgery:
• Walking promotes blood flow of oxygen throughout the body while maintaining
normal breathing functions.
• Ambulation stimulates circulation which can help stop the development of strokecausing blood clots.
• Walking improves blood flow which aids in quicker wound healing.
• The gastrointestinal, genitourinary, pulmonary and urinary tract functions are all
improved by walking.
• Walking increases muscle tone and strength, especially those of the abdomen and
ankles.
• Ambulation helps seniors with coordination, posture and balance. It also aids in joint
flexibility, particularly in the knees, hips and ankles.
• Early ambulation can help increase seniors’ appetites after surgery.
• Walking improves the patient’s feelings of independence, their mood and their selfesteem.
• Patients that practice ambulation are usually discharged sooner.
Problems that can occur when there is no ambulation
• Pressure ulcers (bed sores) are much more common when patients are stationary for
long periods of time.
• Patients who do not walk after surgery are more susceptible to urinary incontinence
and infection. Patients who can get up and go to the bathroom are less likely to
experience incontinence.
• When a person’s bones do not bear weight, they lose minerals which can lead to
osteoporosis.
• Patients who do not walk around experience more stress than those who start early
ambulation.
• Non-walking patients are more likely to develop venous stasis and deep venous
thrombosis which is a risk factor for forming blood clots caused my immobility.
• Walking post-surgery decreases constipation and gas pain.
• Choosing not to walk after surgery can lead to a higher risk of lung problems and
pneumonia for seniors. It also decreases their ability to fight off other infections.
Elderly patients in the hospital need to keep moving. It may seem like a simple thing, but
a quick walk every hour or two can help prevent many serious problems. Not all medical
centers and hospitals make an effort to get older patients up and moving after surgeries
or illnesses. Even with the growing evidence and research that shows staying in bed can
be harmful for seniors and lead to complications, many hospitals don’t put a high
priority on making them walk.
61. Treat hypothermia post-op
Pg. 339 Passive warming measures include the use of warmed cotton blankets, socks,
and reflective blankets and limiting skin exposure. Active warming measures involve the
application of external warming devices, including forced air warmers; heated water
mattresses; radiant warmers; heated, humidified O2; and warmed IV fluids. When using
any external warming device, record body temperature and the patient’s comfort level
at 15-minute intervals. In addition, take care to prevent skin injuries. Apply O2 therapy
via nasal cannula or mask to treat the increased demand for O2 caused by shivering.
Shivering can be treated with opioids (e.g., meperidine). Keep the supplies readily
available to manage MH. Treatment for MH includes the administration of dantrolene
(Dantrium), measures to cool the patient (e.g., ice packs), and correcting acid-base
imbalances. Use meticulous asepsis with wound and IV site care. Encourage airway
clearance with deep breathing, coughing, and use of the incentive spirometer. If fever
develops, chest x-rays may be taken, and antipyretic drugs given. Depending on the
suspected cause of the fever, obtain cultures of the wound, sputum, urine, or blood. If a
bacterial infection is the source of the fever, start antibiotics as soon as you obtain
cultures. If the fever rises above 103°F (39.4°C), you may use body-cooling measures.
Essay: Describe etiology, patho, manifestations, diagnostics and treatment for:
Rheumatoid Arthritis Pg. 1505
Osteomyelitis Pg. 1478