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Adult Health 1 > Perioperative basics > Flashcards

Perioperative basics Flashcards

1
Q

Ambulatory/ Outpatient/ Same Day

A

They go home right after surgery

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2
Q

Inpatient

A

They recover in the hospital after surgery

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3
Q

What are the surgical phases?

A

Preoperative - before surgery
Postoperative- after surgery recovery
Intraoperative- during the surgery

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4
Q

Elective surgeries

A
  • person is not going to die if they don’t have the surgery
  • does not mean they don’t have to have surgery
  • 90% of surgeries are elective
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5
Q

Urgent / Emergent

A
  • the person will die if they do not have this surgery right away
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6
Q

Minor vs. Major Risk surgery

A

Open versus laparoscopic

- Minor is more common due to newer techniques

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7
Q

Diagnostic Surgery

A

-Biopsy to figure if someone has a condition

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8
Q

Curative Surgery

A
  • getting rid of tumors to get rid of disease
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9
Q

restorative Surgery

A
  • restoring a patient back to original condition

- knee replacement

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10
Q

Palliative Surgery

A
  • Providing a patient with comfort and extension of time

- debalking a tumor

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11
Q

Cosmetic Surgery

A

-Allows one to change their appearance

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12
Q

Extent of surgery: Simple/Radical/ MIS

A

MIS- minimally invasive
Simple- removing someone’s toenail
Radical- Removing a foot, total hysterectomy

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13
Q

Pt Safety vs Cost?

A

Changes are constantly made in OR cause by pt. safety and cost
- Should be balanced

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14
Q

Preoperative Phase what happens?

A 
-The time the surgery is scheduled until patient goes into surgical suite.  
Nursing Priorities: 
- Preparing pt for surgery 
- patient education
- patient safety
- patient advocacy
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15
Q

Preoperative Assessment: What to consider with age

A
  • Elderly people have not the best outcomes due to impaired skin integrity, decreased immune response, risk of pressure ulcers
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16
Q

Preoperative Assessment: Knowing what type of surgery

A
  • all surgeries are different
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17
Q

Preoperative Assessment: Knowing pt. medications

A
  • pt may need to be of medications (anticoagulants)
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18
Q

Preoperative Assessment: Med history including allergies

A
  • allergies are always important
  • strawberry/ banana allergies lead to latex allergy
  • people who are allergic to propofol are allergic to nuts
  • beta iodine contains shellfish
  • shellfsih allergy can’t have IV contrast
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19
Q

Preoperative Assessment: Current use of complementary practices

A
  • are you taking any herbal remedies

- practices that may have interactions with surgery

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20
Q

Preoperative Assessment: Tobacco use, alcohol use, drug use

A

Tobacco: people who smoke are likely to develop atelectasis and pneumonia and pulmonary complications
Alcohol: likely to develop cardiovascular issues and issues with other organs. Chronic alcohol use can lead to withdrawal.
Drug: Leads to cardiovascular event during surgery. Also, can interact with anesthetics. Can increase tolerance to pain meds.

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21
Q

Preoperative Assessment: Family History/ Prior Surgeries/ Exp with Anesthesia

A
  • Watch for genetic links that may affect a persons reaction to anesthesia
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22
Q

Preoperative Assessment: Patient’s Support System

A
  • Do they have someone to take them home and help take care of them
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23
Q

Preoperative Assessment: Current understanding of surgery

A
  • check on patient’s level of understanding and process of surgery
  • If pt does not understand, surgeon needs to come back and explain surgery
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24
Q

Preoperative Assessment: Risk of need for blood products

A
  • decided by surgeon
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25
Q

Preoperative Assessment: Head to Toe assessment

Cardiovascular

A

Cardiovascular:

  • Hypertension- if over 180/100 is way too high and needs to controlled before operation
  • Pulses: checking for bounding, diminshed, and not hypotensive
  • Heart Rate: Increased HR if too high needs to be controlled before surgery
  • Edema: hx of hf?
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26
Q

Preoperative Assessment: Head to Toe assessment

Respiratory

A
  • Smoker: risks
  • COPD/asthma: increased risk of pulm isssues
  • Sleep apnea: bring CPAP for general anesthesia
  • Lung sounds: do they have crackles, are they adventious
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27
Q

Preoperative Assessment: Head to Toe assessment Renal Status

A
  • Tells us how a pt will excrete anestetics
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28
Q

Preoperative Assessment: Head to Toe assessment

Neurological Status

A

-Document baseline mentation

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29
Q

Preoperative Assessment: Head to Toe assessment

skin assessment

A
  • Make sure a person’s skin is intact
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30
Q

Preoperative Assessment: Head to Toe assessment

Mobility and musculoskeletal status

A
  • how does the person ambulate
  • do they use a cane or walker
  • do they position their leg a certain way
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31
Q

Preoperative Assessment: Head to Toe assessment

Nutrional status

A
  • Malnutrition- lead to complications during healing process.
  • obesity: extended healing times and higher risk for complications
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32
Q

Preoperative Assessment: Head to Toe assessment

Psychosocial assessment

A
  • Anxiety
  • Support
  • Coping
  • What’s the long-term plan
  • What do you need? What can I do for you?
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33
Q

Lab assessment

A
  • Urinalysis
  • Pregnancy Test
  • Blood work: CBC, BMP, Blood type and screen, Blood coagulation (PT, INR, aPTT). Depends on if person has been anticoagulated
34
Q

Imaging

A
  • Diagnostic
  • Establish baseline data
  • Chest XR
  • MRI
  • CT
  • ECG depends on patient and surgery
35
Q

Nursing Diagnosis relating surgeries

A
  • knowledge deficit related to surgical procedure as manifested by patient statement regarding after surgery care needs
  • Anxiety related to upcoming surgery as manifested by pt’s increased HR, diaphoresis, and statement of fear of death during surgery
  • Risk for self-care related to surgery as manifested by lack of support person.
36
Q

Interventions: Education/ Teaching

A
  • Specific to pt and family’s needs
  • should include any specific instructions for safe surgery
  • Bowel prep
  • skin prep
  • Preoperative routine
  • Postoperative expectations/activity/ instructions
37
Q

Surgery Education can come in many diff methods

A
  • verbal, written, video, class

- may occur in hospital, home, phone, provider’s office

38
Q

Informed Consent before a procedure

A

-Surgery requires informed consent (before surgery is performed or sedation is administered)

39
Q

Informed Consent what is it?

A

Patient is informed and involved in decisions affecting their health care and must include:

  • Nature of surgery and reason for surgery
  • Person performing the surgery
  • Who will be present during the surgery
  • Alternatives to this specific surgery
  • associated risks with this surgery and alternative options
  • Risks of anesthesia
  • Correct site verification
40
Q

Surgeon’s role in informed consent

A
  • the surgeon provides the informed consent
  • Surgeon is resonsible for providing detailed information about the surgery
  • must ensure that the consent form has been signed
  • May be a written order for nurse to have form signed (
41
Q

Nurse’s role in informed consent

A
  • To clarify facts presented by the surgeon during the informed consent process
  • Verify that the consent form is signed
  • Serve as a witness to the patinet’s/ HCPOA’s signature
42
Q

Special cases for informed consent

A
  • Blindness: they can sign for themselves
  • Non-English speaking pt: must have an interpreter present
  • Emergency/ pt unable to sign: s physician signs an emergency form
  • pt unable to sign but not an emergency: must go to next of kin or POA
  • Pts unable to write: they can sign an X
  • Pts who refuse a surgery: call surgeon and say they don’t want to go forward
  • Patient is unclear regarding surgery and has questions for the surgeon.
43
Q

Dietary Restrictions

A
  • NPO usually after midnight

- Pt’s surgery may be canceled due to high risk of aspirating and vomiting due to medications

44
Q

Are current practice and current evidence the same or not regarding time for being NPO?

A

Nope they are different

- Many anesthesiologists require patients to be NPO for 8 hours or more

45
Q

American society of anesthesiologist states

A
  • Patient should be NPO for 6 hours for solid food

- 2 hours for clear liquids

46
Q

What about medication administered before surgery

A
  • Decision should be made by surgeon or anesthesiologist

- Should not take blood thinners, beta blockers

47
Q

Tubes and drains

A
  • IV access everyone going to surgery
  • Large Bore (18-20g)
  • NG if ordered by surgery usually for major abdominal surgery
  • Not everyone gets a foley catheter
48
Q

Intraoperative Team

A
  • Surgeon
  • Surgeon Assistant: surgeon, resident, advanced NP,
    PA, RN first assist, surgical tech
  • Anesthesiologist
    -CRNA
    -Holding Area Nurse
    -Circulating Nurse
    -Scrub Nurse
    -Scrub Tech
49
Q

People who need to scrub up for surgery

A
  • Surgeon
  • Surgeon Assistant
  • Scrub Nurse
  • Scrub Tech
50
Q

What is a Time Out

A
  • Before incision, the entire surgical team must perform this
  • everyone present must be in agreement on key elements of time out
  • Correct placement, correct site, correct procedure, has antibiotic been given, is necessary imaging available (U/s before central line)
51
Q

What to wear in OR

A
  • Scrub attire
  • Clean not sterile
  • Hospital administered scrubs
  • Mask in OR/sterile field
  • Sterile attire worn by sterile team members
52
Q

people scrub up

A
  • after they put their mask on

- before they put their gloves and gown on

53
Q

What do they do before preform surgical scrub?

A
  • antimicrobial soap for hands
54
Q

Surgical Scrub

A
  • finger tips to elbows
  • 3-5 mins
  • sterile towel
55
Q

Anesthesia

A
  • Induced state of part or entire loss of sensory perception with or without loss of consciousness
  • Block nerve impulse transmission, suppress reflexes, induce muscle relaxation and to often induce loss of consciousness (controlled)
  • General Anesthesia (deep loss of conciousness)
  • Local Anesthesia
  • Regional Anesthesia
  • Twilight Anesthesia: sedated but can still talk
56
Q

Complications of General Anesthesia

A
  • Very from minor to death

- Minor: sore throat, N/v, peristalsis stops, small bowel blockage

57
Q

Malignant Hyperthermia

A

Inherited genetic disorder

  • don’t find out until under anesthesia
  • results increased Ca levels and increase muscle BMR
  • thermoregulation= high body temp 108 this happens late stage
  • First they will have decreased in O2 saturation/ increased end-tidal CO2
  • End Tital should 35-45
  • Tachycardia
  • Dysrthymias
  • muscle rigidity
  • Hypotension
  • Skin motting
  • Cola-colored urine due to muscle breakdown
58
Q

How to treat malignant hyperthermia

A
  • Stop anesthtics

- give dantrolene

59
Q

Malignant hyperthermia can happen….

A

from induction all the way up to recovery

60
Q

Nurse’s role in induction

A
  • positioning of patinet
  • assisting the anesthesia provider
  • observing for breaks in sterile technique
  • sooth patient
61
Q

Assessment before entering OR

A
  • confirm pt identification
  • confirm informed consent
  • confirm allergies
  • pre-surgery checklist
  • Dentures remove dental inserts
  • Attire - hospital gown
  • Jewelry needs to be removed
  • Contacts need to be taken out
  • hearing aids out
  • glasses out
62
Q

Interventions in the OR

A
  • Position
  • transferring
  • gel peds
  • comfort
  • warmth (blankets)
  • reducing interruptions
63
Q

Postoperative Phase 1

A
  • Immediately after surgery until hemodynamic stable
  • Most commonly taken to PACU
  • May go to ICU
  • Priority is airway management
  • Frequent vital signs (q15 for 1 hour) depends on pt state
  • Level of consciousness
64
Q

Postop phase 2

A
  • Begins at end of phase 1 and ends when patinet achieves pre-surgery level of alertness ( and hemodynamic stability)
  • Preparing pt for care in extended care environment: med surg unit, step-down unit, home, SNF
65
Q

Post-op care phase 3

A
  • Extended care environment

- Hospital or home

66
Q

PACU unit

A
  • ongoing eval and stabilization of patients in order to anticipate, prevent and manage complications after surgery
  • Often open area for optimal visualization and optimal access to emergency equipment
  • Verbal hand-off from/ btwn circulating Nurse and Anesthesia provider to/ with PACU nurse
67
Q

Post-op Assessment

A
  • LOC
  • VS
  • Surgical Site
  • ” Post Anesthesia Recovery Score”
  • Discharge when score 9-10
68
Q

Aldrete Scale

A

used to score recovery

- Respiration, O2 sat, consciousness, circulation, activity

69
Q

Assessment: Respiratory

A
  • ABC
  • Patent Airway Gas exchange
  • Snoring a simple maneuver
  • Stridor: upper airway closed emergency
  • Continuous pulse ox >95 for healthy
  • Resp rate & depth
  • Lung sounds
  • Work of breathing
70
Q

Assessment: Cardiovascular

A 
Vs (BP, HR) pain meds for high HR and BP 
- Heart sounds 
TElemtry 
- Pulses 
-Circulation, motion, sensation
71
Q

Assessment: Neuro

A

Know the baseline

  • LOC
  • Voice -> Touch -> and so on
  • Orientation
  • Motoe & sensory fxn
  • Pain Level
72
Q

Assessment: F&E

A
  • I&O/ hydration status
  • Urine, vomit, wound drainage, NG tube output, IV fluids
  • ABGs
  • Lab Values
73
Q

Assessment Kidneys & Urinary

A
  • Urinary retention
  • Bladder scanner
  • Bladder Distension
    Assess Urine :
    -color
    -amount
    -Clarity
    -Urinary output
74
Q

Asssessment GI

A
  • N&V : Ondansetron, Dimenhydrate, Scopolamine
  • Increases risk for aspiration
  • Increase intracranial & intraocular pressure
  • wash cloth on forehead and back of neck
  • Monitor bowel sounds & gas
  • NG tube output
  • Constipation: chewing gum
75
Q

Assessment wound

A
  • CLosure (staples, sutures)
  • Skin (color, swelling, temp, sensation)
  • Drainage (serous, serosanguinous) Purulent is bad!
  • Dehiscence is bad finidng
  • Evisceration contents of abdomen are poking out
  • sterile dressing with saline and put over organ
76
Q

Wound drains

A
  • jackson pratt
  • Hemovac
    Penrose
77
Q

Surgical Complications

A
  • pneumonia ( most common) getting people up and moving and pain managed well in order to take deep breaths
  • DVTs: coagulation issues, imobility
  • Bleeding
  • Anxiety
  • Paralytic ileus
  • Bowel obstruction
  • infection (happen within 30-90 days after surgery)
  • Shock (decreased bp and increased HR)
  • Delayed wound healing
78
Q

Interventions: Pain management

A
  • Multi modal management of pain: Opioids, acetaminophen, NSAIDs (after risk of bleeding)
  • people who have stomach ulcers or bleeding no nsaids
  • Know who can get meds by PO or IV. (abd surgery may need IV meds)
  • PCA is being used less
  • Epidural (nerve block) only good for couple days
  • Positioning: making a pt more comfortable
  • Healing touch
  • promote rest
  • Massage
  • Music
79
Q

Interventions: up & out

A
  • Mobility is so important
  • give pain meds to get them up
  • Discharge
80
Q

Incentive spirometer

A
  • 10x an hour
  • prevents atelectasis
  • SCDs provide pressure to calf and prevents clots
  • Prophylatic heparin and lovenox

Adult Health 1 (18 decks)

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