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Test 1 🏁 > Perioperative Nursing > Flashcards

Perioperative Nursing Flashcards

1
Q

Perioperative Nursing

A
  • Preoperative begins when patient is scheduled for surgery ; ends at time of transfer to bed of surgical suite
  • Nurse functions as educator, advocate, promoter of health and safety
  • Patient is prepared for surgery
    — Identification
    — Assessment
    — Consent
    — Teaching
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2
Q

Reasons for Surgery

A

Diagnostic
- Determine origin and cause of disorder
Curative
- Resolves health problems by repairing/removing cause
Restorative
- Improves patient’s functional ability
Palliative
- Relieve symptoms of disease process, but not a cure
Cosmetic
- Alters/enhances personal appearance

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3
Q

Preoperative Role of Nurse

A

Assessment:
- History (previous surgery & anesthesia)
- Systems
- Labs, Dx. Tests
Psychosocial
- Informed consent:
- Surgeon obtains signed consent before sedation and/or surgery
- Nurse clarifies facts and dispels myths about surgery
- Nurse not responsible for providing detailed info about procedure!
- Patient may sign with an X
Teaching
- Environment
- Equipment

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4
Q

Consent

A
  • Must Be Voluntary
  • NO PAIN MEDS PRIOR TO SIGNING CONSENT!
  • In writing
  • Contain the following:
    — Explanation of procedure and its risks
    — Description of benefits and alternatives
    — An offer to answer questions about procedure
    — Instructions that the patient may withdraw consent
    — A statement informing the patient if the protocol differs from customary procedure
  • Patients must be able to understand, whether it be an issue of language, hearing impaired or cognitively impaired.
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5
Q

Pre Op Nurse Responsibility
Preparation for Surgery

A
  • History of Medications
  • Allergies
  • Consent Is it signed
  • Advanced Directive
  • Preoperative Medication
  • Pre op Blood
  • NPO 6-8 hours pre surgery
  • Surgical checklist
  • Preoperative Unit
    — Review of chart
    — Education of patient
    — Right site
    — Meeting team (surgeon, anesthesiologist, circulating nurse)
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6
Q

Collaborative Management

A
  • Assessment
  • Medical record review
  • Allergies and previous reactions to anesthesia or transfusions
  • Autologous blood transfusion
  • Laboratory and diagnostic test results
  • Medical history and physical examination findings
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7
Q

Older Adults: Considerations for Preop Care

A
  • Chronic illness
  • Malnutrition
  • Impaired self-care ability
  • Inadequate support systems
  • Stress from surgery/anesthesia
  • Cardiopulmonary complications after surgery
  • Mental status changes
  • Risk for falls
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8
Q
  • Gerontologic Considerations
A
  • *Older adult patients are at higher risk for complications from anesthesia and surgery compared to younger adult patients due to several factors:
    — *Age-related cardiovascular and pulmonary changes
    — *Decreased tissue elasticity (lung and cardiovascular systems) and reduced lean tissue mass
    — *Decreases the rate at which the liver can inactivate many anesthetic agents
    — *Decreased kidney function slows the elimination of waste products and anesthetic agents
    — *Impaired ability to increase metabolic rate and impaired thermoregulatory mechanisms
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9
Q

Intraoperative

A
  • Intraoperative begins when the patient enters the surgical suite and ends at the time of transfer to the post anesthesia recovery area, same-day surgery unit, or the intensive care unit.
  • The main concerns of perioperative nurses are safety and patient advocacy by preventing, reducing, controlling, and managing many hazards.
  • Begins with the patient entering the surgical suite, ends with the transfer of the patient to the post anesthesia care unit
  • Nurse functions as circulating and scrub nurse; advocate, promoter of health and safety
  • Patient undergoes anesthesia, surgical procedure What risks does the patient have in the OR?
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10
Q

Members of the Surgical Team

A
  • Surgeon
  • Anesthesia providers (MD, CRNA)
  • Circulating nurse
  • Scrub nurse
  • Don’t Forget the patient!
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11
Q

Environment of the Operating Room

A
  • Preparation of surgical suite, team safety Protection of patient by team, team safety
  • Layout: Unrestricted zone, semirestricted zone & restricted zone
  • Health and hygiene of surgical team
  • Surgical attire and scrub
  • Remember:
    — People are source of bacteria in surgical setting!
    — Special health care standards, dress are needed
    — Watch for nosocomial infections, identify source of pathogens
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12
Q

Environment of the Operating Room

A
  • Preparation of surgical suite
  • team safety
  • Protection of patient by team
  • Health and hygiene of surgical team
  • Surgical attire and scrub
  • Layout –
    — Unrestricted zone- allows street clothes
    — Semi restricted zone- Scrub clothes and caps
    — restricted zone- scrubs, shoe covers, caps, masks
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13
Q

Surgical Scrubbing

A
  • Broad-spectrum, surgical antimicrobial solution
  • Vigorous rubbing that creates friction used from fingertips to elbow
  • Scrub continues for 3 to 5 min
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14
Q

Minimally Invasive and Robotic Surgery (MIS)

A
  • Now common practice
  • Preferred technique for many surgery types, including:
    — Cholecystectomy
    — Joint surgery
    — Cardiac surgery
    — Splenectomy
    — Spinal surgery
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15
Q

Surgical Risk Factors

A
  • Hemorrhage: 500mL or more
  • Infection
  • Ventilation
    — Exacerbation of copd
    — Aspiration
    — Atelectasis
  • Perfusion
    — DVT, PE, BP problems
  • Injury related to positioning during surgery
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16
Q

Health Hazards Associated With the Surgical Environment

A
  • Faulty Equipment or improper use of equipment
  • Exposure to toxic substances/infectious waste
  • Burns from electrical equipment
  • Retained object in surgical site.
  • AORN: Association of periOperative Registered Nurses
  • Recommended practices
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17
Q
  • Older Adults: Considerations
    Intraoperative Nursing Interventions
A
  • *Allow patients to retain eyeglasses, dentures, and hearing aids until anesthesia has begun.
  • Use a small pillow under the patient’s head if his or her head and neck are normally bent slightly forward.
  • Lift patients into position to prevent shearing forces on fragile skin.
  • Position arthritic and artificial joints carefully to prevent postoperative pain and discomfort from strain on those joints.
  • Pad bony prominences to prevent pressure sores.
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18
Q

Anesthesia not on test; know what to do when pts come back from surgery

A
19
Q

Anesthesia

A
  • Induced state of partial or total loss of sensation, occurring with or without loss of consciousness
  • Purpose to block nerve impulse transmission, suppress reflexes, promote muscle relaxation, achieve controlled level of unconsciousness (in some cases)
    — General
    — Inhalation, IV
    — Regional - epidural, spinal, and local conduction blocks
    — Moderate or Conscious Sedation -monitored
    — Local
20
Q

General Anesthesia

A
  • State of narcosis (severe central nervous system depression produced by pharmacologic agents), analgesia, relaxation, and reflex loss.
  • Involves single or combination of agents
  • Depresses CNS, resulting in analgesia, amnesia, and unconsciousness with loss of muscle tone and reflexes
  • Administered via:
    — Inhalation
    — IV injection
    — Balanced anesthesia
21
Q

Four stages of General Anesthesia

A
  • Stage 1: Beginning Anesthesia
    — Dizziness and detachment
  • Stage 2: Excitement
    — eg. struggling shouting, singing
  • Stage 3: Surgical Anesthesia
    — Patient unconscious
  • Stage 4: Medullary depression
    — Too much anesthesia. Without intervention death will follow.
22
Q

Balanced/Combination Anesthesia

A
  • Combination of IV drugs and inhalation agents used to obtain smooth transition from one stage to another.
  • Begin with inhalation then move to IV
  • Provide close observation of responses of
    — Pupils
    — B/P
    — HR
    — Resp Rate
  • Table 18-1 Inhalation Anesthetic Agents given with nitrous oxide and Oxygen
23
Q

Complications from General Anesthesia

A
  • Anesthesia Awareness
  • Nausea and Vomiting
  • Anaphylaxis
  • Hypoxia/Respiratory Complications
  • Hypothermia
  • Overdose
  • *Malignant hyperthermia
24
Q
  • Malignant Hyperthermia
A
  • An Acute, life-threatening complication
    — May be caused by genetics
    — Rare - It occurs in 1 in 50,000 to 100,000 adults.
    — Mortality as high as 70%
    — Begins with skeletal muscle exposed to specific agent (body builders)
    — Causes increased metabolism and calcium levels in muscle cells
    — Increases serum Ca and K:
    — Increased CO2 first sign
    — Hyperthermia (Late sign/ last)
    — Tachycardia
    — Myoglobinuria
  • Leads to acidosis, high temperatures, dysrhythmias
25
Q
  • Clinical Manifestations of Malignant Hyperthermia
A
  • Tachycardia (heart rate greater than 150 bpm)
  • Hypotension
  • Decreased Cardiac Output
  • Hypercapnia- increase in CO2 (early sign)
  • Rigidity of muscles
  • Elevated temperature (late sign)
26
Q

Treatment for Malignant Hyperthermia

A
  • Prompt recognition of symptoms
  • O2/Hyperventilation
  • Hydration/Normal saline
    • Med: Dantrolene
  • Body Cooling
  • Meds for acidosis, Hyperkalemia, and dysthymias.
    — give sodium bicarbonate
    — maybe IV insulin
    — cardiac meds
27
Q

Capnometry and Capnography

A
  • Methods that measure the amount of carbon dioxide present in exhaled air, which is an indirect measurement of arterial carbon dioxide levels.
  • Non Invasive
  • Capnometry is exhaled air tested with a sensor, changes color or number with analysis
  • Capnography is the wave form along with a number on a monitor that measures CO2 levels
  • Used on both intubated and those breathing on their own
  • Normal values of partial pressure of end tidal carbon dioxide (PETCO2) 20-40 mg Hg.
28
Q

Regional Anesthesia

A
  • Anesthetic agent injected around nerve to anesthetize the area.
  • Patient awake
  • Epidural – epidural space
  • Spinal – subarachnoid space
29
Q

Local Anesthesia

A
  • Briefly disrupts sensory nerve impulse transmission from specific body area/region
  • Delivered topically and by local infiltration
  • Patient remains conscious, able to follow instructions
30
Q

Complications of Local or Regional Anesthesia

A
  • Anaphylaxis
  • Incorrect delivery technique
  • Systemic absorption
  • Overdose
  • Local complications
31
Q

Moderate Sedation

A
  • Previously called Conscious Sedation
  • IV delivery of sedative, hypnotic, opioid drugs to reduce level of consciousness
  • Patient maintains patent airway, can respond to verbal commands
  • Amnesia action is short
  • Monitored Anesthesia Care – MAC
  • given by an anesthesiologist or CRNA who must be prepared and qualified to convert to general anesthesia if necessary
32
Q

Common Surgical Positions

A
33
Q

Potential for Injury

A

Interventions:
- Proper body position
- Prevent pressure ulcer formation
- Prevent obstruction of circulation, respiration, nerve conduction

34
Q

Postoperative

A
  • Postoperative period starts with completion of surgery and transfer of pt to specialized area for monitoring eg. post anesthesia care unit (PACU)
  • Patient recovers from anesthesia, monitored for complications of surgery
  • Can continue after discharge from the hospital until all activity restrictions have been lifted.
  • Divided into three phases based on the level of care needed
    — Phase 1 immediately after surgery
    — Phase 2 preparing patient for extended care
    — Phase 3 Hospital or home for pts requiring continuing care
35
Q

Post operative Nursing

A
  • Patient goes to post anesthesia unit with nurse and anesthesiologist
  • Report given to receiving nurse
  • Monitoring of:
    — anesthesia wearing off
    — Pain control
    — Surgical site
    — Drains
    — I&O
  • Vital signs and assessment
  • Every 15 minutes first hour, every 30 mins second hour, then every hour PRN
  • Equipment
    — EKG monitor- SpO2, BP, Temperature
  • Length of stay 1-3 hours
  • Remember the family: Did MD speak with family, Communication is important to family members
36
Q

Comfort Measures

A
  • Pt may feel the following up to 24 hours post op
    — Sore throat
    — Aching muscles
    — General malaise
    — Shivering – not uncommon
  • Provide if needed:
    — Warm cotton blankets applied as necessary
    — Warm air blanket may be utilized
    — Medication is used for extreme shivering
37
Q

Potential for Infection

A

Interventions:
— Plastic adhesive drape
— Skin closures, sutures and staples, nonabsorbable sutures, Insertion of drains
— Application of dressing
— Patient transfer from OR table to stretcher

38
Q

Common Skin Closures

A
39
Q

Question 1
The nurse is monitoring a patient who is receiving moderate sedation. An expected outcome for conscious sedation is:
- A. Blocked multiple peripheral nerves in a specific region
- B. Decreased motor function in the targeted limb
- C. Decreased level of consciousness, yet able to respond to verbal commands
- D. CNS depression, resulting in analgesia and amnesia, with loss of muscle tone and reflexes

A

C

40
Q

Question 2
During a surgical procedure, the nurse notices the sponge count is incorrect. One sponge is missing. What is the priority nursing intervention?
- A. Communicate the discrepancy to the surgical team immediately.
- B. Complete appropriate documentation concerning the error in sponge count.
- C. Examine the environmental distractions, refocus, and count the sponges again.
- D. Anticipate that the surgeon will order an x-ray to look for the sponge postoperatively.

A

C?

41
Q

Question 3
The nurse is aware that a patient having surgery is at risk for infection if which additional factor is present?
- A. Diabetes mellitus
- B. Age greater than 65
- C. Impaired liver function
- D. Insertion of a surgical drain

A
42
Q

Question 4
The nurse is monitoring a patient who has received conscious sedation (moderate sedation) What are the expected outcomes for this patient?
- A. Block specific peripheral nerves in a specific region
- B. Decrease LOC yet able to respond to verbal commands
- C. Decrease motor function in the target area
- D. CNS depressant, amnesic effect and loss of muscle tone

A

B?

43
Q

Question 5
While at the scrub sink, the scrub person informs the circulating nurse that she now wears artificial nails because her own nails break frequently posing a risk for a glove puncture. What is the nurse’s best response?
- A. Ask the scrub person to wear double-gloves to prevent puncture or contamination.
- B. Confirm with the scrub person that artificial nails are acceptable and do not affect hand hygiene.
- C. Support the scrub person’s rationale that broken nails are a serious source of cross-contamination.
- D. Remind the scrub person that artificial nails alter skin flora, impede hand hygiene, and are not permitted.

A

D?

44
Q

Question 6
Which change in the anesthetized client alerts the nurse to the possibility of malignant hyperthermia?
- a) Widening pulse pressure
- b) Increasing output of dilute urine
- c) Increasing end-tidal carbon dioxide level
- d) Ascending flaccid paralysis of skeletal muscles

A

C

Test 1 🏁 (11 decks)

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