exam 1 preop Flashcards
(63 cards)
1
Q
preoperative
A
schedule time to transfer to surgical suite. Emphasis is on assessment, patient teaching, and completion of preparations for surgery
2
Q
intraoperative
A
within the surgical suite. Concerns are for patient safety; examples-surgical asepsis, electrical safety, sponge counts, etc
3
Q
postoperative
A
transfer to the PACU and after, concerns focus on immediate recovery to discharge planning
4
Q
inpatient
A
the patient stays in the hospital
5
Q
outpatient
A
the patient can go home
6
Q
when and where of surgery
A
decisions for surgery, timing of surgery depends on severity, urgency, response to treatment
7
Q
diagnostic surgery
A
to confirm a diagnosis–biopsy
8
Q
ablative or curative
A
removes or repairs damaged and diseased tissue/organs
ex appendecotmy, hysterectomy, colectomy
9
Q
reconstructive (or restorative)
A
restore function or appearance due to diseased or traumatized tissue
ex breast reconstruction
10
Q
palliative
A
to relieve symptoms but not to cure
ex remove intestinal obstruction due to colon cancer
11
Q
cosmetic
A
to improve the appearance
ex skin grafts
12
Q
exploratory
A
to confirm diagnosis/ determine extent of disease/damage
ex figure out where bleeding is coming from in an exploratory laparotomy
13
Q
constructive
A
restore function due to an anomaly
ex repair of cleft palate
14
Q
transplant
A
replace malfunctioning organs
ex- kidneys, lung, heart, etc
15
Q
4 domains of nursing practice in the preoperative period
A
safety, physiologic response, behavioral response, health care systems
16
Q
patient safety through the preoperative period
A
- WHO, TJC, AORN (association of operating room nurses)
- implementation of the SCIP core measures is mandatory (surgical care improvement plans)
- actions to prevent complications
- preparation is crucial
17
Q
minor surgery
A
minimal physical assault: skin lesion removal, cataract extraction, D&C
18
Q
major surgery
A
extensive physical assault or serious risk: transplant, TJA, colostomy
19
Q
emergent surgery
A
maybe life threatening, without delay
ex- ob emergency, ruptered aneurysm
20
Q
urgent surgery
A
prompt attention, 1-2 days
ex heart bypass, amputation from gangrene
21
Q
required surgery
A
plan within a few weeks, months
ex rbph without bladder obstruction, cataracts
22
Q
elective surgery
A
decision usually to improve quality of life
ex total knee arthroplasty
23
Q
optional surgery
A
personal preference
ex cosmetic surgery
24
Q
simple surgery
A
only affected area
ex finger amputation
25
radical surgery
surgery beyond affected area
| ex radical hysterectomy
26
minimally invasive surgery
athroscopy, laparoscopy
| ex through an endoscope, arthroscopy, tubal ligation, lobectomy
27
types of surgery that increases risk
neck, oral, facial--airway
chest or high abdominal--pulmonary
abdominal--parylytic ileus, VTE
orthopedic and fat emboli
28
recognizing risk factors prior to surgery-nurse must access needs and factors that may increase surgical risk
overall physical/psychological health
cognitive status
financial concerns
spiritual needs
29
factors that increase surgical risk
age, chronic disease hx, malnutrition, obesity, poverty, multiple drug use, heart disease, bleeding disorders, respiratory orders, endocrine disorders, hepatic disorders, renal disease, immune disorders, dental disease, previous history of surgical or postop complications, addictions, altered coping
30
relation to dental disease and surgery
teeth can get knocked out during intubation and can cause occlusions
31
medications that can increase surgical risk
```
corticosteroids
immunosuppressants
diuretics
phenothiazines
tranquilizers
insulin
antibiotics
anticoagulants
anti-seizure medications
thyroid hormone
opioids
some OTC, herbals, and supplements
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32
importance of prep screening
- identifies risk factors through assessment
- reduces risk for potential complications
- intiates teaching needs
- verifies all preop diagnostics are complete
- discusses advanced directives (what to do when the patient codes)
- involves family in interview
- begins discharge planning-assesses need for post op care
33
common preop diagnostic tests
often done 1-2 weeks prior to surgery if elective, ordered by surgeon or primary care physician
cxr, ecg, urinanalysis, blood work (cbc, electrolytes/chem, coagulation studies (pt, inr, ptt, platelets), serum creatining, bun, and gfr, pregnancy test
34
preop assessment
nutritional, fluid status, dentition, drug or alcohol abuse, respiratory status, cardiovascular status, hepatic/renal function, endocrine function, immune function, previous medication use, psychosocial factors, spiritual/cultural needs
35
important CV assessment information to report
hypo/hypertension, brady or tachycardia, irregular heart rate, chest pain, SOB or dyspnea, tachypnea, O2 sat
36
important s/s of infection to report
fever, purulent sputum, dysuria or cloudy, foul smelling urine, red, swollen, draining IV or wound site, elevated WBCs
37
important preop assessment to report bleeding/etc
increased PT, INR, aPTT time, hypo or hyperkalemia, possible or validated pregnancy
38
preop assessment important to report clinicical conditions that need further evaluations
change in mental status, vomiting, rash, recent anticoagulant intake
vomiting increases risk for aspiration
rash is an adverse reaction to meds
39
importance of preop education
reduces length of stay
facilitates recovery
decreases frequency and severity of complications--pain and vomiting, and patient knows what to expect which reduces anxiety
40
preop teaching topics
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required by TJC
informed consent
dietary restrictions
specific preparations for surgery
exercises post surgery
plans for pain management
plan of care
fears and anxiety
surgical type description
diagnostic tests-reason and preparation
arrival time
surgery prep including what to do with valuables
sedatives/hypnotics
any meds to take prior to surgery
expected time table for surgery and recovery
method to inform family
transfer to surgery department
location of surgical waiting room
transfer to PACU
anticipated postop routine devices and equipment
plans for pain control
appropriate clothing needed for discharge
fasting orders--fasting does not ensure the stomach will be empty or contents less acidic
```
41
preop teaching about postop things
diaphragmatic breathing-with or without incentive spirometer
coughing and splinging
dorsiflexion and plantar flexion, ankle exercises, early ambulation
TED hose, SCDs
42
preop teaching for postop ADLs
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meals
toileting
transfers and turning
ambulation expectations
splinting
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43
legal preparations preop
informed consent
blood transfusions
advance directives
power of attorney
44
preop teaching documentation
must be documented and reported to postoperative nurses
- avoid duplication of information
- assess learning
45
nursing decisions postop
what route of medication is best to take when NPO
| best practice-consult with surgeon or anesthesiologist due to potential interactions
46
preop medications
necessary for the nurse to access medication action before administering preop medications for safety and consent concerns
- does the patient need to be alert to answer questions
- has the patient had all questions answered
- is the consent signed
- is it anticipated that the patient will need to get out of bed?
47
insulin considerations
may be held if NPO or dose ajusted
depends on time of surgery
EBP supports glycemia levels
48
day of surgery preparations
final preop teaching
assessment and report of pertinent findings
verify signed consent
labs
history and physical assessment
baseline vitals
consultation records
nurses notes
assist with gown, changing, bathing
ensure NPO status
remove nail polish, lipstick, makeup, assists with CV status assessment
ID, blood, allergy bands are secure
remove hairpins, jewelry, rings may be taped
complete bowel/skin prep if ordered
insert urinary catheter, IV, NG tube if ordered
remove dentures, artificial eyes, contact lenses, prosthetic limbs
49
preop preparation
Check policy about hearing aids—leave them in or take them out—and when
Verify consent has been signed
Document ht and wt or weigh and measure
Have pt. empty bladder, measure and document
Adm. Pre-operative meds if ordered***-see next slide
Obtain and record vitals
Document all pre operative care on proper forms
Verify pt identity and all prep with surgical personal
Assist with transfer from bed to stretcher
Provide ongoing support
Prepare room for post operative care-anticipated supplies
50
attend to family
explain length of surgery-holding and prep time included
| reassure that updates will be given and that the surgeon will talk with them after
51
preop checklist
to ensure all documentation, preop procedures, and orders are complete (npo, gown only, labs/diagnostic results,
52
informed consent for surgery
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should be in writing
patient should have understanding and comprehension of:
Need for procedure related to dx
Description and purpose
Risk vs benefit
Adequate disclosure of risk with/without surgery
Likelihood of successful outcome
Alternative to surgery
Straight forward advice
Right to refuse and ask questions
```
53
voluntary consent
for consent to be valid must be freely given without coercion, patients must be over 18 unless emancipated, must be obtained by a physician, signature must be witnessed by a professional staff member
54
incompetent for informed consent
not autonomous, cannot give or withhold consent-cognitively impaired, mentally ill, neurologically incapacitated
55
role of nurse for informed consent
Witness to signing of consent
Can broadly explain/translate
Determine understanding
Patient to feel comfortable with decision/can withdraw at anytime
If the patient has questions or concerns not discussed or made clear by the surgeon the surgeon is responsible for supplying further information
56
aspects of consent
medical emergency may override need for consent
| legally appointed representative of family may consent if patient is-child, unconscious, mentally incompetent
57
SCIP measures (surgical care improvement project)
based on ebp
perioperative nurses should support these measures
reduce surgical/medical complications
-infection prevention
-cardiac protection protocols
-VTE prevention
-ventilation acquired pneumonia prevention
58
*examples of SCIP measures*
no longer shave the skin
administer antibiotic 1/2 hour prior to incision
foley catheter removed 48 hours or less post insertion
time out
SCDs
59
*more SCIP measures *
SCIP Inf-1 Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision
SCIP Inf-2 Prophylactic Antibiotic Selection for Surgical Patients
SCIP Inf-3 Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time
SCIP Inf-4 Cardiac Surgery Patients With Controlled 6 A.M. Postoperative Blood Glucose
SCIP Inf-6 Surgery Patients with Appropriate Hair Removal
SCIP Inf-9 Urinary catheter removed on Postoperative Day 1 (POD 1) orPostoperative Day 2 (POD 2) with day of surgery being day zero@
SCIP Inf-10 Surgery Patients with Perioperative Temperature Management@
SCIP Card-2 Surgery Patients on Beta-Blocker Therapy Prior to Arrival Who Received a Beta-Blocker During the Perioperative Period
SCIP VTE-1 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered
SCIP VTE-2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery
60
medication reconciliation
vital at every stage of surgical/hospitalization
| all meds including OTC and supplements
61
medications in surgery
preop- 45-70 minutes prior--sedation, anxiety reducing, antibiotic
preop and interoperative-analgesics, gastric acidity and volume reducing agents, gastric emptying increasing agents, antiemetics, anticholinergics
62
what meds are gastric acidity and volume reducing agents
PPI, H2
| regalin empties stomach not used with nausea
63
discharge teaching
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Begins at time of entering into pre-op care
Teaching points:
Infection prevention
Care of the incision
Management of drains, catheters, etc
Nutrition
Pain management
Drug therapy and home meds
Activity progression
VTE prevention/recognition
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