2 Nursing Practice Questions from a new RN

leslie :-D · Jun 20, 2008

when i started out as a new nurse, i wondered about postop n/v as well.

through some research, i learned that amount of nausea is r/t the type of surgery-abd/pelvic surgery causes most n/v.

also hx and type of anesthetic are also considerations.

however, in spite of preop fasting, our bodies respond to the real risk of aspiration during surgery.

during surgery, tissues are not getting their usual amt of o2, r/t cutting and displacement of organs, to facilitate the surgery.

these tissues seem to react to the inadequate o2 by releasing neurotransmitters and other powerful chemicals that ultimately produce the n/v.

it's thought (although, not in stone) to be a reaction that has evolved to rid the body of potential life threatenting noxious food.

granted, i haven't done any recent research but do remember that 12 yrs ago, no one really knew the reasons for n/v.

they knew only that gen'l anesthesia resulted in it, but little else.

does any of that make sense to you?

leslie

leslie :-D · Jun 20, 2008

1) I had a patient who had a Rt hip fracture. They did a pinning. Since it was not a total hip arthroplasty, she doesn't have to follow the same guidelines (once she is healed) as a THA, for example, never cross her legs or bend over 90 degrees.

sorry kristin, forgot about this question.

the surgery required for a hip fx, is much less complicated than a thr.

with a fx, the surgeon is placing a pin through the fx (on femoral neck) into the femoral head.

with thr, (depending on what type), usually a prosthesis is used in place of the degenerated acetabulum/femoral head.

total hip precautions are always instituted to prevent dislocation.

dislocation is not the concern when repairing a fx.

yes, we know that our elderly often do not fare well s/p hip fx repair, but dislocation is not the concern here.

leslie

Pipsqueak, ADN · Jun 21, 2008

sorry kristin, forgot about this question.
the surgery required for a hip fx, is much less complicated than a thr.
with a fx, the surgeon is placing a pin through the fx (on femoral neck) into the femoral head.
with thr, (depending on what type), usually a prosthesis is used in place of the degenerated acetabulum/femoral head.
total hip precautions are always instituted to prevent dislocation.
dislocation is not the concern when repairing a fx.
yes, we know that our elderly often do not fare well s/p hip fx repair, but dislocation is not the concern here.
leslie

This was a question I had while still in nursing school and I never did get a straight answer on it.......Are total hip precautions in place for the rest of the pts life, or just during the healing phase? It's for the rest of their life, right? No bending greater than 90 degrees or crossing legs, anything else? How do they tie their shoes if they can't bend greater than 90 degrees?

leslie :-D · Jun 21, 2008

This was a question I had while still in nursing school and I never did get a straight answer on it.......Are total hip precautions in place for the rest of the pts life, or just during the healing phase? It's for the rest of their life, right? No bending greater than 90 degrees or crossing legs, anything else? How do they tie their shoes if they can't bend greater than 90 degrees?

oh no.

hip precautions are in place during the healing phase only...

which will vary from surgeon to surgeon, but it's sev'l wks anyways.

the physical therapist will answer all questions about strategic, effective substitues in adl's.

leslie

NeoNurseTX, RN · Jun 23, 2008

2) What is it about anesthesia that makes most of my patients have nausea and vomiting when they come back to the floor?

Anesthesia is well known for doing that. I filled out a questionnaire before I got it and marked that I get motion sickness easily..they said they'd put something in my IV afterwards to help prevent it.. I'm guessing either Zofran or Phenergan. Whatever it was, it worked!!