Med Surg Perioperative Management Flashcards
(24 cards)
What are the 3 time periods of Perioperative management?
Preoperative
Intra operative
Postoperative
What is Perioperative management with a surgical patient?
Nursing care provided during the total surgical experience.
What is the postoperative setting?
PACU where you do a follow up evaluation
Nurse educates, advocates, arrange for rehab and promote health and safety
Monitor vitals, administer meds, psych help, complications and communication for all involved
Why would surgeons choose to do outpatient surgeries?
Less stress Lower cost Decrease chance of hospital acquired infections Less assessment time Preoperative teaching Less meds Decrease risk of complications Less complex surgeries
In perioperative management of the surgical client what are the reasons for urgency of surgery?
Elective: can be scheduled at the convenience of the patient. (Joint replacement, cataract)
Urgent: may be life-threatening if delayed more than 24 hours (fracture, kidney stones, bowel obstruction)
Emergent: is a life-threatening situation (gunshot wound, AAA, evicerated wounds, trauma)
In perioperative management of the surgical client what are the different reasons for surgery?
Diagnostic to determine the origin of cause
Curative to repair or remove cause
Restorative to improve functional ability
Palliative to Relieve symptoms but not cure
cosmetic to a alter or enhance appearance
In perioperative management of the surgical client what do you get when you do history and data collection?
Drugs and substance use (meds may need to be stopped)
medical history
previous surgical procedures and anesthesia
blood donations
allergies
laboratory and other test
discharge planning
During peri operative management of the surgical client what is a systems assessment?
Cardiovascular: edema, circulation, listen to heart sounds, 30% of surgical deaths.
Respiratory: smoking, chronic disease, rate, effort, sounds, chronic deoxy
Renal/urinary: affect fluid balance dialysis, drug excretion, nocturia, dysuria, incontinence and fluid intake
Neurologic: mental status, loss of conscious, teaching provided, pupils, fall risk, ambulation
Musculoskeletal: arthritis, neck and chest deformation, joint replacement
Nutritional status: malnutrition, obesity, wound healing delay
Psychological: anxiety, coping, support, fear
During perioperative management of the surgical client what are some surgical risk factors?
Obesity; it’s harder to ventilate, skin breakdown, increased drug use, increase infection, increased demand of the heart
For nutrition; decreases
Helium increases and function decreases omnium
Fluid and electrolyte imbalance; leads to shock and dehydration
Aging; increases injury potential, meds accumulate, respiratory depression, chronic disease, blood loss, increased patients miles, increased sleeping eating pattern
Cardio; impaired oxygen & CO, acute MI, cardiac arrest, thromboembolism, avoid fluid overload
Diabetes mellitus; hypoglycemia, ketoacidosis, Poor wound heeling, increase infection, control glucose
Alcoholism; acute withdraw within 72 hours
Pulmonary respiratory disease; hypoventilation, pneumonia, contraindicated with respiratory infections, sleep apnea treated before surgery if possible, cautious opioids, low flow O2
Concurrent or prior pharmacotherapies; all meds herbal and over-the-counter
Perioperative management of the surgical client what are substances that healthcare providers and anesthesia should be notified of the patients taking?
Antibiotics
antidepressants; because they decrease blood pressure during anesthesia
phenothiazines; because they potentiate anesthesia cause behavior problems
diuretics; because they washout potassium
steroids; it decreases the bodies ability to reduce stress may increase those after surgery
anticoagulants; they increased hemorrhage risk
Anticholinergic; may increase postop confusion
Anticonvulsants: they alter anesthesia metabolism
Antidysrhythmiac; they decreased cardiac contractibility
antihypertensive; they can cause bradycardia hypertonic and and impair circulation
Inslin; the dose increases or decreases related to stress and nutritional intake
In perioperative management of the client what are preoperative tests?
Urinalysis; to detect infection or UTI
blood typing crossmatch; for transfusion
complete blood count are H&H; for hematocrit and hemoglobin for oxygen
clotting studies; for bleeding
electrolyte level; to correct hypo or hyperkalemia before surgery
creatinine level or BUNs; for medicine clearance
pulse ox symmetry; O2 status
pregnancy
Chest x-ray
Electrocardiogram
In Perioperative management surgical client what is the pre-op preparation for the G.I. system?
NPO status; patient advised not to ingest anything by mouth for 6-8 hours before surgery.
- it decreases the risk of aspiration
- patient should be given written and oral directions
- surgery can be canceled if not followed
In perioperative management of the surgical client what is the pre-op preparation for the intestines?
Enema or laxative maybe ordered by physician
Bowel intestinal preparation performed to prevent injury to the colon and reduce number of intestinal bacteria
IV fluid administration
decrease intestinal bacteria, and maintains fluid balance
In perioperative management surgical client what is the pre-op preparation for the GU system
Have patient void before heading to the OR
If patient has a foley empty and record immediately before heading to the OR
avoid distention and incontinence
maintain I&O
In perioperative management of the surgical client what is the pre-op preparation for the skin?
Skin preparation is first step and preventing of surgical infection, a break in the skin causes increased risk for infection, patient should ask the shower using antiseptic solution, shaving is not routinely done
In perioperative management of the surgical client what are some psychological effects of surgery in patients?
Fear and anxiety about the unknown, and Anastgesia Or lost control of anesthesia, of an adequate anesthesia, of disability pain or death, of course prognosis, and body image alteration, they’re also afraid of the sensation of separation or lifestyle change
In perioperative management of the surgical client letter this physiological effects of surgery on patients
Stress response; the neuroendocrine response of fighter flight maintain blood pressure and CO2, glucose, slows the G.I. function and vasoconstriction
- epinephrine; increased glucose decreased immune response increase platelet activity, aldosterone; adrenal cortex, sodium and oxygen reabsorption, urine output
defense against infection Lowered
Vascular system is disruptive, Organ system disruption temporary or permanent
In perioperative management of the surgical client what is patient education regarding postop care?
Vital signs frequently sights and sounds exercise and procedures bandages, tubes and drains need to awakened for care pain management nutrition families coaches; teach them and involve them in care
In perioperative management of the surgical client how do you get informed consent
Surgeon is responsible for obtaining a signed consent before sedation or surgery,
nurses role is to clarify facts presented by the physician and dispel myths with the patient and family may have surgery
nurse witnesses signature of patient responsible individual
may need separate consent for blood or anesthesia
In perioperative management of the surgical client what does informed consent mean of what the patient understands
Nature and reason for surgery, who is performing the surgery, available options and risks of each one with the procedure and expected outcome,
risks of anesthesia,
DNR should be handled differently my facilities and should be upheld
In perioperative management of the surgical client how can one administer regularly scheduled medications
Steroids for stress
Drugs for Cardiac, respiratory, seizures, hypertension allowed sip of water before surgery
Medical physician and anesthesia provider should be consulted for instructions about taking prescriptions before surgery
In perioperative management of the surgical client what do preoperative drugs do
Reducing anxiety promote relaxation reduce nasal or oral secretions prevent laryngospasm reduce vagal induced bradycardia, inhibit gastric secretion, decreasing amount of anesthetic needed for induction and maintenance of anesthesia antibiotic and protection of the heart
In perioperative management of the surgical client what should Pre-Op chart review consist of
Ensure all documentation, preoperative procedures, and orders are complete
check the surgical consent form and others for completeness,
document allergies,
Document height & weight
current set of vital signs,
ensure results in a laboratory and diagnostic tests on the chart, document any abnormal results, report special needs or concerns
In perioperative management of the surgical client what is preoperative patient preparation
Patient remove clothing and where hospital gown,
valuables remain with the family or locked up,
tape rings in place if cannot be renewed,
removed all pierced jewelry,
patient wears an ID bracelet,
dentures prosthetics hearing aids contacts being a polish and artificial nails removed,
have patient Void or empty Foley
