Overall goal: ensure pt is mentally & physically prepared for surgery discharge planning Home care

Perioperative Care Flashcards by Samantha Boyer

3 phases of periop period

preoperative

intraoperative

postoperative

How well did you know this?

Not at all

Perfectly

preop period begins and ends…

Begins with decision to have surgery
Ends with pt transferred to op table

How well did you know this?

Not at all

Perfectly

intraop begins and ends…

Begins with pt transferred to op table
Ends with pt admitted to PACU

How well did you know this?

Not at all

Perfectly

postop period begins and ends…

Begins with admission to PACU
Ends with healing completion

How well did you know this?

Not at all

Perfectly

5 purposes of surgery

Diagnostic
Palliative - relieving pain/sx - does not cure disease
Ablative - removal of diseased body part
Constructive - restores appearance that has been lost
Transplant - replaces malfunctioning structures

How well did you know this?

Not at all

Perfectly

2 degrees of surgical urgency

Emergency - performed immediately to save life
Elective - non-life-threatening situations

How well did you know this?

Not at all

Perfectly

what distinguishes major vs minor surgery?

examples?

Major - high blood loss, complications, vital organ removal
- ex heart surgery, hip surgery
Minor - less risk - less complications, can be performed outpatient
- ex tonsil removal, biopsy

How well did you know this?

Not at all

Perfectly

why does being >65yo increase risk in surgery

decreased immune system, decreased kidney function, response to anesthesia, chronic disease, obesity

How well did you know this?

Not at all

Perfectly

what should nurses be sure to assess for older surgical pts?

respiratory function

How well did you know this?

Not at all

Perfectly

resp condition that ↑ surgical risk

OSA

How well did you know this?

Not at all

Perfectly

questionnaire that assesses OSA

what does it ask about?

STOP-bang

snoring, tiredness after sleep, apnea, hypertension

How well did you know this?

Not at all

Perfectly

what should a nurse take note of for surgical pts with OSA?

BMI, age, neck circumference, sex

How well did you know this?

Not at all

Perfectly

micronutrients vital for surgical wound healing (7)

vit A, B, C, K; iron, zinc, copper

How well did you know this?

Not at all

Perfectly

meds that can interfere with anesthesia

anticoags

tranquilizers

steroids

diuretics

seizure meds

How well did you know this?

Not at all

Perfectly

stop taking anticoags ____ days before surgery

5-7

How well did you know this?

Not at all

Perfectly

steroids in surgical pts increase risk of…

inadequate wound healing

infection

How well did you know this?

Not at all

Perfectly

aspects of the preop phase (5)

informed consent

physical assessment

pt teaching

physical prep

safety protocols

How well did you know this?

Not at all

Perfectly

aspects of the preop assessment (8)

general health

resp & cardio

allergies (meds, tape, latex, iodine, soaps, foods, etc)

meds

screening tests

MMSE

smoking, alcohol

coping mechanisms, support

How well did you know this?

Not at all

Perfectly

preop screening tests (11)

CBC

blood grouping

electrolytes

glucose

BUN & creatinine

liver function

albumin/protein

urinalysis

chest x-ray

EKG on all pts >40 or with cardio conditons

pregnancy test

How well did you know this?

Not at all

Perfectly

preop planning

Overall goal: ensure pt is mentally & physically prepared for surgery
discharge planning
Home care

How well did you know this?

Not at all

Perfectly

components of preop teaching (5)

skills training (5)

Discuss pain scale
Explain what will happen and when
Dr will most likely order pain meds
Explain roles of pt and support people in preop prep, during surgical procedure, & during postop period
Skills training
- Moving
- Deep breathing
- Coughing
- Splinting incisions (pillow on incision during movement, coughing)
- Using incentive spirometer

How well did you know this?

Not at all

Perfectly

preop nutrition rules

NPO after midnight (usually)

light meal 6hrs before surgery

clear liquids 2hrs before surgery

How well did you know this?

Not at all

Perfectly

preop physical prep (7)

Study These Flashcards

Cleansing enema
Antiseptic soap night before & morning of
Nail polish, makeup removed
Preop meds
Prostheses removed
Ask if they have any loose teeth
Check orders for special requirements

preop meds that may be given and why

Study These Flashcards

Versed - anxiety

morphine - sedation

Zofran - n/v

3 preop safety protocols

* _Preop verifications_ - schedule, time of testing, time of admission * _Mark operative site_ c pt initials/Dr initials OR word “yes” * _Time out_ - final verification of correct pt, procedure, site

loss of sensation & consciousness; loss of protective reflexes; blocks awareness centers; IV or inhalation

general anesthesia

disadvantages of general anesthesia

depresses resp & circulatory systems protective reflexes/self-care abilities compromised

lidocaine or benzocaine

topical anesthetic

lidocaine 0.1% - injected - small procedures

infiltration anesthesia

nerve block example

facial surgery

low (saddle, caudal), mid, or high - lumbar puncture

spinal/subarachnoid block

low spinal block examples

surgery involving perineal or rectal areas

mid spinal block examples

hernia, appendectomy - below umbilicus

high spinal block examples

Caesarean births

anesthesia inside spinal column

epidural

**conscious sedation** drugs used advantages example

morphine, fentanyl, Valium minimal depression of LOC - allows pt to retain ability to maintain patent airway, respond to commands ex endoscopies

nurses' responsibilities in intraop period (8)

* **Position** pt * Preop **skin** prep * Assist in preparing/maintaining **sterile** field * Open & dispense sterile **supplies** * **Provide** meds & solutions * **Manage** caths, tubes, drains, specimens * Perform sponge, sharps, instrument **counts** * **Document** nursing care provided & pt response

circulating nurse role (4)

* Coordinates activities * Assess pt position * Monitors aseptic practice * Monitors temp, humidity, lighting in OR

scrub person role (2)

* Draping pt c sterile drapes * Handling sterile instruments & supplies

_RNFA_ - registered nurse first assistant role

* Assists surgeon by controlling bleeding & suturing

who is responsible for counting all sponges, needles, instruments used in surgery

scrub & circulating nurses

how to position pt as they're coming out of anesthesia

* Unconscious pt positioned on side c face slightly down * Elevate pt’s upper arm on pillow - maximum chest expansion

what indicates anesthesia ending?

return of reflexes coughing out airway (except endotrach)

PARS

post anesthesia recovery score

ALDRETE what is the score we want?

postop discharge rating 0-2 based on absent or present for each question 9-10 allows discharge from recovery room

when is pt discharged from recovery room? (8)

* **Conscious** & oriented * Clear **airway** & desirable O2 sat * Stable **VS** for 30 mins * **Reflexes** active * **I/O** adequate * **n/v** controlled * Temp between **96.8 to 100.4** * Dressings **dry** & intact without overt drainage

potential postop problems (resp, cardio, urinary, GI, wound, psych)

RESP — pneumonia; atelectasis; PE CARDIO — hypovolemia; hemorrhage; hypovolemic shock; thrombophlebitis; thrombus; embolus URINARY — retention; UTI GI — n/v; constipation; tympanites; postop ileus WOUND — infection; dehisence; evisceration PSYCH — depression

when should pain decrease postop?

2-3 days

spinal surgery pts must be positioned… for ____ hrs

flat/supine 8-12 hrs

unconscious pts postop must be positioned…

laterally

resp interventions postop

deep breathe & cough q2h spirometer splint incision

leg interventions postop

ambulate day after (usually) antiemboli stockings NO pillow under knees

measure I & O for ___ days postop until stable

2 days

urinary & GI function should return ___ hrs postop

6-8hr

assess bowel sounds q ___ hr postop

6-8 hr

when can surgical pts resume sex

2-4 weeks

Perioperative Care Flashcards

(56 cards)