January 7 - Perioperative Nursing Flashcards
Phases of Perioperative nursing 3
Preoperative -> Intraoperative -> Postoperative
Surgeries are classified by three things and each can be further classified specifically
Seriousness:
- major
- minor
Urgency
- Elective
- Urgent
- Emergency
Purpose
- Diagnostic
- Palliative (Relieving pain without dealing with the cause of the condition/end of life?)
- Ablative (removal)
- Reconstructive
- Constructive
- Procurement for transplant
- Cosmetic
Informed Consent
What is the primary responsibility of the nurse
o Knowing they understand their HIPA and rights
o Proper teaching
Advocacy and problem solving
Repeat what the doctor says but cant explain anything new
o Nurses cant get someone to sign but we can be a witness
Day of surgery routine
- Hygiene
- Hair and cosmetics
- Removal of prostheses
- Safeguarding valuables
- Bowel/bladder prep
- Vital signs
- Performing special procedures
- Preoperative medications
- Latex sensitivity/allergy
- Eliminating wrong site and wrong procedure surgery
Purpose of NPO
Recommended fasting times
o Risk of chocking
o Aspiration
o Nothing to eat or drink after midnight
o Before elective procedures its 8 hours after a heavy meal
o 6 hours after a light meal (toast and milk)
o 4 hours after breast milk no additives
o 2 hours after clear fluids
What does the circulating room nurse do
What do scrub nurses do
• Circulating room nurse
o Infection control
o Protocols
•
Scrub Nurses o Handing equipment and supplies
Types of anaesthesia
General
Regional
Local
Procedural sedation
- General: state of total unconsciousness
- Regional: loss of sensation in an area of the body; patient may be sedated (Spinal/ epidural)
- Local: loss of sensation at a specific site
- Procedural sedation: used for procedures that necessitate only a reduced level of consciousness, (e.g., colonoscopy, bronchoscopy)
Post Op Nursing care
• Review post-op orders • Check OR and PACU records • VS, ABCs, head to toe assessment • Positioning, warmth o Recovery position • Oxygen administration, monitoring • IV fluids: solution, rate • Pain assessment and management • Intake and output, introduction of diet • Management of tubes & drains • Wound assessment and care o Marking and keeping an eye on wounds o Hemorrhage • Hygiene, rest • Breathing/leg exercises, mobility • Med administration: analgesics, antiemetics, antibiotics, anticoagulants, home meds
Post op breathing Exercises
If surgical incision will be abdominal or thoracic, teach the patient to place one hand over the incisional area and the other hand on top of it. During breathing and coughing exercises, the patient presses gently against the incisional area to split or support it. A pillow over the incision is optional
Read more in textbook
Post op leg exercises
Hip and knee movements
foot circles (draw circle with toe)
Dehiscence
Evisceration
Hematoma
Ileus
splitting or bursting open of a pod or wound.
Organ peeking out
hematoma is the result of a traumatic injury to your skin or the tissues underneath your skin. … A hematoma forms as your blood clots, resulting in swelling and pain. Hematomas can occur anywhere in your body, including your leg
lack of movement somewhere in the intestines that leads to a buildup and potential blockage of food material.
Primary Intention
Secondary intention
Tertiary intention
Incision with blood clot/ edges approximated with suture/ fine scar
Irregular large wound with blood clot/ granulation tissue fills in wound/ large scar
Contaminated wound/ granulation tissue/ delayed closure with suture
Primary Intention Healing – This occurs where the tissue surfaces have been approximated (closed). This can be with stitches, or staples, or skin glue (like Derma bond), or even with tapes (like steri-strips). This kind of closure is used when there has been very little tissue loss. It is also called “primary union” or “first intention healing.” An example of wound healing by primary intention is a surgical incision.
Second Intention Healing – A wound that is extensive and involves considerable tissue loss, and in which the edges cannot be brought together heals in this manner. This is how pressure ulcers heal. Secondary intention healing differs from primary intention healing in three ways:
The repair time is longer.
The scarring is greater.
The chances of infection are far greater.
Tertiary Intention Healing – This type of wound healing is also known as “delayed” or “secondary closure” and is indicated where there is a reason to delay suturing or closing a wound some other way, for example when there is poor circulation to the injured area. These wounds are closed later.
Wounds that heal by tertiary intention require more connective tissue (scar tissue) than wounds that heal by secondary intention. An example of a wound healing by tertiary intention is an abdominal wound that is initially left open to allow for drainage but is later closed.
Types of wound drainage
Serous
Purulent
Serosanguineous
Sanguineous
Clear watery plasma
Thick yellow green tan or brown
Pale red watery mixture of clear and red fluid
Bright red indicating active bleeding
To do Dressing change
- Check physician order, gather supplies
- Pain management (anticipating pain)
- Positioning
- Create sterile field, follow principles of surgical asepsis
- Remove and assess old dressing
- Sterile gloves or sterile instruments
- Teaching
REEDA for simple wounds
- Redness
- Ecchymosis
- Edema
- Drainage
- Approximation
