Mod 8 Flashcards by kelsey Berglund

preoperative care takes place from…

the time clients are scheduled for surgery until care is transferred to the operating suite.

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preoperative care includes thorough data collection of the clients..

physical, emotional, and psychosocial status prior to surgery

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surgery may be performed for?

restorative, curative, palliative, or cosmetic purpose

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whose responsibility is it to obtain consent after discussing procedure risks and benefits?

Responsibility of the provider. The nurse IS NOT TO obtain the consent for the provider IN ANY circumstance

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can the nurse provide new information or additional information not previously given by the provider

no. They can claify and info that remains unclear after the explanation but nothing new that has not been covered by the provider first.

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palliative surgery

to relieve pain or complications Ex; to remove a metastatic rumor from the abdomen that is causing considerable pain

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curative surgery

alleviates (cures) a problem as when a gallbladder that is full of stones causing blockage or pain is removed

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who is at risk of higher complications of surgery and why

the infant and the elder because of either immature body systems or a decline in function of various body systems.

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light amplification by the stimulated emission of radiation

laser surgery

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what surgery is common and is often combined with microscopic, endoscopic, and robotic enhanced procedures.

laser surgery

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allows the use of endoscopes with high-resolution video cameras passed through a very small incision for an ever increasing variety of surgical procedures.

fiberoptic surgery

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this surgery is operated from a nearby comp, views magnified three dimensional images of surgical field on screen, magnification up to 12 times that of normal. remote controlled instruments are inserted through small incisions.

robotic surgery

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what are some advantages of robotic surgery

has rock-steady hands, providing precision that is beyond human dexterity. Only small incisions are needed, the pt has less pain postoperatively and requires less time to heal. less scaring and fewer infections

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what decreases complications?

a normal fluid and electrolyte balance

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how long should pts avoid smoking before surgery

24 hours before surgery or 3 to 4 weeks before

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what is the benefits of not smoking before surgery

increases the action of the lungs defense mechanisms and makes more hemoglobin available to carry oxygen during surgery and improves wound healing

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what may cause nutritional deficiencies and bleeding problems

long term alcohol use

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PAT

preadmission testing

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what is included in the PAT interview

health history, identification of risk factors, pt and family teaching, discharge planning, and necessary referrals to social work, support groups, and educational programs. Ask about previous problems with anesthesia or malignant hyperthermia

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how much water can the pt take with their medications the morning of surgery when they are to be NPO

1 ounce

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atelectasis

collapse of the lung caused by hop ventilation or mucous obstruction preventing some alveoli from opening and being fully ventilated

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what helps prevent atelectasis

deep breathing, by expanding and ventilating the lungs.

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arterial blood gases

obtain baseline levels and detect pH and oxygenation abnormalities

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bleeding time

detect prolonged bleeding problem

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blood urea nitrogen (BUN) or creatine

detect kidney problem

complete blood cell count (CBC)

detect anemia, infection, clotting problem

electrolytes

detect potassium, sodium, chloride imbalances

fasting blood glucose

detect abnormalities, monitor diabetes control

partial thromboplastin time

detect clotting problem

international normalized ratio (INR)

detect clotting problem, monitor warfarin therapy

type and cross match

identify blood type to match blood for possible transfusion

urinalysis

detect infection, abnormalities.

what are the main priorities of care postoperatively?

maintaining airway, latency and ventilation and monitoring circulatory status

most surgeons postpone surgery if the pts ? is to low

hemoglobin level

the dictated report must be in the record...

before the pt goes to surgery

stasis

stoppage of flow

thrombophlebitis

blood clot causing inflammation of a vessel

how long should deep breathing and coughing be performed after general anesthesia

every 2 hours for 72 hours

most preoperative medications are given ? in the surgical holding area

intravenously

what are the two purposes of a consent

1) protects the patient from unauthorized procedures 2) protects the physician, anesthesiologist, hospital, and hospital employees from claims of performance of unauthorized procedures.

the type of anesthesia and the anesthetic agents are ordered by the anesthesia prouder with input from?

the pt and the physician

what are the two types of anesthesia

general and local (regional)

this anesthesia causes the pt to lose sensation, consciousness, and reflexes. it acts directly on the nerve impulses along the nerve where it is injected, resulting in the loss of sensation to a region of the body without the loss of consciousness

General

general anesthesia is commonly given by ?

IV or inhalation

maintenance of anesthesia is accomplished by using ?

inhalation agents

rare hereditary muscular disease that can be triggered by some types of general anesthetic agents.

malignant hyperthermia

what is the most effective med for malignant hyperthermia?

Dantrolene sodium (dantrium) - muscle relaxant - must be kept readily available in the OR

achieved by injecting the medication into the tissue where the incision is to be made

local infiltration

done by injecting the local agent along a nerve that carries impulses in the region where anesthesia is desired

regional block

injection of a local agent into a nerve at a specific point

nerve block

done by placing a tourniquet on an extremity to remove the blood and then injecting the local agent into the extremity

Bier block

is a series of injections surrounding the surgical area

field block

is injection of a local agent into an area around the spinal nerves.

spinal or epidural block

used mainly for lower extremity and lower abdominal surgery. both motor and sensory function is blocked.

spinal and epidural blocks

what happens if the block travels too far upward?

respiratory depression

results from leakage of cerebrospinal fluid (CSF) from the needle puncture hole in the dura that does not close when the needle is withdrawn.

Postdural puncture headache(reduces pressure on the spinal cord and brain causing a headache)

purposeful minimal sedation that does not cause the complete loss of consciousness. pts still have control of their own airway. Medications such as sedatives, hypnotics and opiods are given to produce this sedation

conscious sedation

what are priority areas of pt assessment

ensuring a patent airway, preventing falls and injury from uncontrolled movements, respiratory status, vital signs including Sao2, level of consciousness and responsiveness, surgical site incision/dressing/drainage tubes, and pain level and pain management

begins when the pt is admitted to the PACU or a nursing unit and ends with the pts postoperative evaluation in the physicians office

postoperative phase

what medication is used to relieve shivering or shaking from anesthesia

Demerol (meperidine)

what med is used for nausea or vomiting

antiemetics

includes level of consciousness; orientation to person, place time and event; pupil size and reaction to light; and motor and sensory function

neurologic assessment

IV analgesics usually have a ? duration than IM analgesics

shorter

the edges of the wound are approximated with staples or sutures. scaring is minimal

first intention healing

wound is usually left open and allowed to heal by granulation. scaring is usually extensive with prolonged healing

second intention healing

an infected wound is left open until there is no evidence of infection and the wound is then surgically closed

third intention healing

wound problems can include

hematoma, infection, dehiscense, and evisceration

dehiscence

sudden bursting open of a wounds edges which may be preceded by and increase in serosanguineous drainage

eviscreation

is the viscera spilling out of the abdomen ( feels like something let loose or gave away)

what aids in healing dehisced surgical incisions that resist healing?

VAC - vacuum assisted closure

after abdominal surgery, GI assessment should include?

monitoring vital signs, the return of flatus, the return of appetite, first bowel movement, any nausea or vomiting, or signs of ileum, such as distention, bloating, and cramps.

after abdominal surgery, peristalsis, bowel sounds and flatus is usually stopped or absent for how many hours?

24 - 72 hours

pt will return to normal bowel elimination patterns and report freedom from gas pains and constipation within how many days

3 - 4 days post op

what is the primary purpose of most IV fluids?

to provide hydration ( most iv solutions do not provide enough nutrients or calories to prevent malnutrition)

discharge planning begins during the ? and continues...

preadmission testing; | after admission to ensure that the pt is ready for a timely discharge.

clinical discharge criteria include?

stable vital signs, no bleeding, no nausea or vomiting, and controlled pain that is not severe. Depending on the type of surgery the pt may be required to void before leaving.

list in order what is done in the intraoperative phase

1) pt transported to holding room where circulating nurse verifies pts ID and that all preoperative orders have been accomplished 2) anesthesiologist or nurse anesthetist start IV if not already in place 3) surgical consent for is checked to eunsure pt is being prepared for correct surgery 4) surgical site is verified and marked BEFORE medications are given 5) PREop meds are administered 6) when OR is ready pt is transferred

when is anesthesia begun?

as the pt is being draped. further skin preparation is done at this time also

warming the pt before an operation can reduce the risk of surgical wound infection by what percent

57%

vital signs are taken every ? - ? mins in the post anesthesia care unit (PACU)

5-15 mins until stable

anesthesia recovery period usually takes ? hours

2-6 hours

what form of scoring system may be used to determine readiness for transfer? activity, respiration, circulation, consciousness, and skin color are each given a score of 1-3. total score of 9-10 usually indicates the pt is ready for transfer.

form of the "Aldrete" scoring system.

when can the post anesthesia care same day surgery pt be discharged?

when vital signs are stable, the pt is allowed to sit up and then is ambulated. "when able to ambulate unassisted, the pt may be discharged if ital signs are stable"

how long is the usual recovery time in the same day surgery unit

1-4 hours

(post-op care) vital signs and careful assessment are performed every ? mins for the 1st hour, every ? mins for the next 2 hours, every ? mins for the next 4 hours, and then every ? hours until the pt is totally recovered from anesthesia and vital signs have returned to normal

15mins; 30mins; 60 mins(hour); 4

the pt must be positioned ? or ? to prevent aspiration, if not contraindicated, until fully recover, alert, and with the swallowing reflex intact

on the side; | with the head turned to the side

why is it important to encourage the pt to drink plenty of fluids even those containing caffeine?

the fluids and caffeine raise the vascular pressure at the spinal puncture site and help seal the hole

what is the expected amount of drainage postoperatively for : urine, gastric contents, wound drainage, and T-tube, bile

urine = 500-700mL for 1-2 days post-op, then 1500-2500mL thereafter depending of intake Gastric contents = up to 1500mL/day Wound drainage = variable with procedure and type of drain T-tube, bile = up to 500mL

atelectasis

collapse of alveoli in the lungs

what occurs when lack of movement or of position change causes stasis of secretions, which become a breeding ground for bacteria?

hyopstatic pneumonia

coughing may be contraindicated for pts that have had what kind of surgery?

hernia repair, eye, ear, or brain surgery

what can be especially helpful to prevent atelectasis and hypoventilation?

use of an incentive spirometer

report arterial oxygen saturation (Sao2) readings below ? to the physician

92%

when the procedure involved an extremity or the pelvic area, what pulse do you check for each full assessment?

check the distal or peripheral pulse.

swelling at the surgical site can...

compress vessels and decrease blood flow distal to the area.

what can an increase in pulse indicate

internal bleeding is occurring, but can also signify incomplete pain control

blood pressure falling below normal baseline level may indicate...

major bleeding

if the urine flow is less than ?mL/kg/hr report it to the charge nurse. If flow is less than ? mL over a 2-hour period, notify the surgeon.

5mL/kg/hr; | 60mL

no potassium additive should be given until the urine flow is at least...? why?

5 mL/kg/hr; | Potassium may cause hyperkalemia if kidney function is not adequate.