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NUR 118 Lecture > NUR 118 Lecture 5 - Perioperative Nursing > Flashcards

NUR 118 Lecture 5 - Perioperative Nursing Flashcards

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1
Q

3 Phases of Perioperative Nursing

A

Preoperative
- From the decision to have the surgery to OR
intraoperative
- When the patient enters the OR until the PACU
Postoperative
- From end of operation until healing

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2
Q

What are the 4 ways surgeries are classified?

A

By body system
By purpose
- Why?
By degree of urgency
- Ex: Aesthetic surgery vs. infection
By degree of risk

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3
Q

Define an Ablative surgery

A

Removal of diseased body part

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4
Q

Define diagnostic surgery

A

Confirm or R/O A DX
-Not curing anything
-See what’s going on
Ex: Liver biopsy, cardiac catheter

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5
Q

Define a Palliative surgery

A

Not curative, relieves symptoms/pain
Ex: Tumor debulking

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6
Q

Define a Reconstructive surgery

A

Restores function
Ex: Torn ligament

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7
Q

Define a Cosmetic surgery

A

Improves appearance
- Ex: Face lift

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8
Q

Define a Transplant surgery

A

Replace a failing body part or organ
- Ex: Kidney

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9
Q

Define a Procurement surgery

A

Organs and tissue harvested to transplant to another

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10
Q

List the Degrees of Surgery Urgencies

A

Elective - Recommended course of action but not time sensitive

Urgent - Must be done within 24-48 hours
Ex: Symptom relief - Body part repair (fractures)

Emergency - Surgery done as soon as possible, save a patient’s life or function
Ex: Trauma, open fractures, organ rupture

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11
Q

Degrees of Surgical Risk

A

Major surgery - High risk
Ex: cardiac bypass
Minor surgery - low risk
ex: outpatient, endoscopies

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12
Q

Factors contributing to surgical risk

A

Allergies - analgesics, latex, anesthesia, shellfish (iodine)

Type of wound - Pre-existing or post-op

Pre-existing conditions - Acute or chronic

Mental status - Confused/mentally ill

Age - Very old or very young

Medications - Prescribed/OTC/Herbal

Personal Habits - Smoking/illegal drugs/alcohol

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13
Q

Pre-Operative Nursing Responsibilities

A
  • History and physical:

History, what happened; physical, how are you now

  • lab and diagnostic tests
  • pre-op teaching
  • Informed consent
    -Prepare the client physically and mentally
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14
Q

What are the three systems where surgery is “clean-contaminated”

A
  • Gastro-Intestinal (GI)
  • GenitoUrinary (GU)
  • Respiratory system
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15
Q

PreOp Nursing Responsibilities:

List what to assess for History & Physical

A

History
- Health history
- Physical status
-Medications
-Allergies
-Mental status
Physical
- Respiratory system
- Vital Signs
- Risk for thrombophlebitis

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16
Q

List examples for Diagnostic Testing preop assessments

A
  • Complete Blood count
  • Urinalysis
  • Comprehensive metabolic panel
    Electrolytes, glucose, albumin
  • Fasting blood sugar
  • electrocardiogram
    -Chest x-ray
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17
Q

List examples for Pre-Op teaching

A
  • Pain management
  • Deep breathing/coughing & Incentive spirometer
  • Splinting
  • Leg Exercising
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18
Q

How is an incentive spirometer used?

A

Inhale 10 times, helps to prevent alveoli from collapsing in atelectasis

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19
Q

What does informed consent/surgical consent entail?

Study These Flashcards
A

Includes:
-Type of surgery
-Risks & benefits
- Statement that patient has right to refuse

Protects patient from surgery that’s unwanted or not understood
Protects agency and workers from later claims that patient did not consent

20
Q

Pre-Op Medications

Study These Flashcards
A

Opiod:
>Morphine - can cause respiratory depression

Anti-infective:
>Ampicillin -
>azithromycin

Anesthetic sedation:
>Midazolam
>Propofol

Anticholinergic:
>Atropine - Reduces secretions, prevents aspiration pneumonia

Antiemetic:
>ondansetron - Helps with nausea

21
Q

What is the universal protocol - Three step process?

Study These Flashcards
A

Preoperative
1. Pre-verification process
- Verify the correct procedure, for the correct patient, at the correct site
- When possible, involve the patient in verification process
2. Marking Site
Intraoperative
3. “Time out” - Initiated by nurse, when everything is ready right before operation

22
Q

List and describe the types of anesthesia

Study These Flashcards
A

Local:
Loss of pain at the desired site, injected or topical

Moderate Sedation:
CONSCIOUS (drowsy) sedation and analgesia, IV

Regional:
Patient awake/alert, numb @ surgical site

General:
Rapid unconsciousness + loss of sensation, may cause stroke, death, heart attack

23
Q

Intraoperative: Nursing Roles in OR for Circulating Nurse

Study These Flashcards
A
  • Part of “Clean Team”, works around sterile field
  • Client advocate
  • Monitors client and sterile field
  • Docuents
  • Handles specimens
24
Q

Intraoperative: Nursing Roles in OR for Scrub Nurse

Study These Flashcards
A
  • Part of “Sterile Team”
  • Set up and maintain sterile field
  • Prepares instruments
  • Passes instruments to surgeons
25
What are the two phases of postoperative care?
Phase 1 - Recvoery from anesthesia in the Post Anesthesia Care Unit (PACU) Phase 2 - Recovery from surgery (On the surgical unit, at home, in rehab)
26
What's a big concern regarding pain post-operatively?
- They probably won't do deep breathing which may lead to pneumonia or atelectasis
27
What are PACU responsibilities & assessments?
1. Airway - If unconscious, turn patient on side 2. Breathing - Respiratory rate, lung sounds, skin color - Pulse oxi 3. Circulation - Blood pressure, pulse rate 4. Nausea, pain
28
What are some perioperative nursing diagnoses?
Pre-Op: -Knowledge deficit - Anxiety -Pain Intra-Op: -Risk for injury Post-Op: -Acute pain -Risk for: (all complications)
28
How often to take vitals in PACU?
Every 15 minutes for 1 hour
29
Signs of anxiety in a Pre-Operative patient may manifest as:
Tachycardia Inability to concentrate Diaphoresis (sweating for no reason)
30
A Cardiac Catheterization is considered which "purpose" of surgery?
Diagnostic - Used to diagnose and treat heart problems
31
What degree of surgical urgency is a rotator cuff repair?
Elective Surgery
32
Which blood test evaluates renal function?
BUN and Creatinine
33
Which diagnostic test evaluates respiratory/pulmonary disease?
Chest X-Ray
34
Which blood test evaluates WBC, Hgb & Hct?
CBC (Complete Blood Count)
35
Which blood test is needed if a patient requires a blood transfusion?
Type and Screen/Cross Match
36
Which diagnostic test is used to identify infection, kidney function & pregnancy?
Urinalysis
37
A patient who vomits in the PACU post-operatively is at risk for what?
Aspiration
38
What class of medication can be administered to the pre or post operative patient to prevent nausea & vomiting?
Anti-Emetic
39
Physical preparation of the patient for surgery includes?
-Maintaining Normo-thermia​ -Ensuring NPO status​ -Skin prep​ -Bowel prep​ -Last void or catheterization​ -Pre-op meds​ -Status of routine medications -Removal of dentures, artificial limbs, contact lenses, wigs, jewelry. *eye glasses, *nail polish​ -Anti-embolism stockings or sequential compression devices
40
Preparing patient mentally for surgery?
Communicate what will happen before, during, and after surgery.​ Discuss how the patient or caregiver can participate in the care​ Encourage expression of feelings and concerns that patient may have about surgery.
41
A nurse is caring for a client with the following type of portable wound drainage device. Which should the nurse do when caring for a client with this type of drainage system?  Jackson-Pratt Drain
Empty container, compress collection container, close port and release hand compression Keep collection container below insertion site Empty collection container when HALF-full Attach tubing to clothing (prevents tension on cord)
42
The nurse is reviewing diagnostic screening tests. Which test evaluates renal function, fluid & electrolyte status, and serum electrolytes? ​
Comprehensive Metabolic Panel (CMP) NOT urinalysis. Urinalysis is for detecting UTIs and presence of glucose or protein in urine.
43
Purpose of Urinalysis?
Detect: UTIs, presence of glucose & proteins - Can also detect poorly managed diabetes, renal disease and pregnancy
44
What is the major purpose of withholding food and fluid before surgery?
It prevents aspiration and respiratory complications?
45
In which phase of perioperative care will the nurse ​prepare the client’s skin, encourage the client to void, ​and remove the client’s dentures?​ ​
PreOperative
46

NUR 118 Lecture (21 decks)

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