Perioperative Care Flashcards by Rebecca Woods

Whats the peri-operative nursing?

Peri-operative Nursing is the care of an individual who is undergoing a surgical procedure. Care takes place from the time the decision is made to have surgery, through to recovery from the procedure.

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What is the preoperative phase nursing?

Commences with the patient’s decision to have surgery and ends at induction (of anaesthetic).

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What is the Intraoperative phase?

is the time from the patient’s induction of anaesthetic until extubation and/or transfer from the operating table

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What is the Post-operative phase?

Commences with the patient’s transfer from the operating room to the Post anaesthetic care unit and continues until discharge from hospital and/or health team care.

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What is the Pre-op Nurse roles?

DSU/ ward

Preadmission

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What is the Intra-op Nurse roles?

Scrub/ Instrument
Circulating
Anaesthetic

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What is the Post-op Nurse roles?

PACU nurse
DSU/ ward nurse
District nurse

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What does the INSTRUMENT (scrub) nurse do?

Assumes primary responsibility and
accountability for all items used during the surgical procedure
Sets up all sterile instruments and supplies

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What does the CIRCULATING (SCOUT) NURSE do?

 Documentation and management of all accountable items opened onto the sterile field

 Supports the instrument nurse

 Provision of equipment

 Being the communication link between theatre staff and those outside

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What are the other members of the peri-op team?

Surgeons
Anaesthetists
Anaesthetic Technicians
Residents/ Medical Students
CSSD Staff
TSAs
Parent Support
Medical device company representative

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What is Perioperative Nurses College (PNC)

PNC by NZNO

The professional organisation of perioperative nurses in New Zealand.
Promotes excellence in nursing practice in the pre-, intra- and postoperative care of patients.

Provides national and international representation of peri-op nurses

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What are surgery classifications?

According to risk:
◦ Major
◦ Minor

According to urgency:
◦ Emergency
◦ Elective

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What are the six PURPOSES of surgery?

Diagnostic

Ablative (the removal or destruction of a body part or tissue or its function)

Constructive (Treats innate defects)

Reconstructive (procedure that restores your body after an injury)

Cosmetic

Palliative (operations that aim to alleviate symptoms)

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What factors increase surgical risk?

Age
Obesity
Nutrition
Fluid and electrolyte balance

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What are pre operative preparations?

 Physical preparation
 Psychological preparation
 Admission
 Nursing risk assessments
 Informed consent
 Teaching activities
 Examination of the individual by the
anaesthetist and surgeon

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What are pts right in regards to infomred consent?

Right 7: Right to make an informed choice and give informed
consent
 Competence
 Advance directive
 Health care procedure- consent must be in writing (research, experimental, GA, significant risk of adverse effects)
 Right to refuse/ withdraw
 Right to choose the provider
 The right to make a decision about the return or disposal of any body parts or bodily substances

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What is involved in a Anaesthetic Assessment?

 Vital signs, height & weight, allergies
 Review of current medications
 Pre-medication (calm vs anxious patients)
 Anaesthetic technique
 Airway (apnoea, Mallampati score),
dentition

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What does ASA mean?

Classification system identifies your health status before a surgical procedure.

ASA I A normal healthy patient.

ASA II A patient with mild systemic
disease.

ASA III A patient with severe systemic
disease

ASA IV A patient with severe systemic
disease that is a constant threat
to life

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What is the surgical Attire Considerations

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The following recommendations are based on AORN’s 2019 guideline:
 Laundering (healthcare-accredited laundry facilities versus home)
 Arm coverings
 Footwear
 Head coverings
 Jewellery

What are principles of Sterile Technique?

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1) All objects used in a sterile field must be sterile.

2) A sterile object becomes non-sterile when touched by a non-sterile object.

3) Sterile items that are below the waist level, or items held below waist level, are considered to be non-sterile.

4) Sterile fields must always be kept in sight to be considered sterile.

5) When opening sterile equipment and adding supplies to a sterile field, take care to avoid contamination.

6) Any puncture, moisture, or tear that passes through a sterile barrier must be considered contaminated.

7) Once a sterile field is set up, the border of one inch at the edge of the sterile drape is considered non-sterile.

8) If there is any doubt about the sterility of an object, it is considered non-sterile.

9) Sterile persons or sterile objects may only contact sterile areas; non-sterile persons or items contact only
non-sterile areas.

10) Movement around and in the sterile field must not compromise or contaminate the sterile field.

What happens in the post opertaive phase?

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Anaesthetist hands the patient over to the PACU nurse.

Immediate general post-op care & assessment:
* ABC
* Vital Signs
* Wounds/ Drains
* IV
* Pain

What are some considerations with Older Adults and Surgery

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 Degenerative Changes
 Frailty
 Cognitive Impairment
 Discharge conditions

What are some considerations with children/ young people and surgery

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 Consent- “Gillick competence
 Weight-based treatment
 Speaking their language
 Safety (e.g., fasting, restraint)

What are potential post opertaive problems

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Nausea and/or vomiting
Abdominal distension
Paralytic ileus
Urinary retention
Constipation
Pain
Shock
Haemorrhage
Hypoxia
Pulmonary embolism
Wound infection
Wound dehiscence

Define pain

Pain is a complex, individual, multifactorial experience influenced by a person’s culture, previous pain experiences, beliefs, mood and coping ability. (Levett-Jones, 2018) Pain is whatever the patient says it is, existing whenever the patient says it does.- (McCaffery, Rolling Ferrel & Paseo, 2000) Pain is a lived experience, a product of the continuous conflict between the internal and external stimuli and the whole individual. (Brown et al 2020) Pain may indicate an injury, tissue damage, or an unidentifiable cause.

What are the types of pain Classifications

Nociceptive Neuropathic Psychogenic Phantom Referred

Whats Nociceptive pain?

Generated from damage of the tissues, skin, ligaments, and visceral organs; responds well to simple analgesics and opioids

Whats Neuropathic pain?

Pain generated from damage to nervous system; much more difficult to treat and often requires adjuvant medications

Whats Psychogenic pain?

Exists in the absence of known pathophysiology and it is associated with mental and emotional behaviours; complex

Whats Phantom pain?

Pain sensation resulting from body parts that have been surgically removed

What is Referred pain?

Pain which originates from visceral organs but is felt on cutaneous areas, suggesting some embryonic origin. A good example is cardiac pain which is also felt in the neck and shoulders

What are the two kinds of Pain Classifications (based on duration)

Acute Chronic

What is acute pain?

Has a recent onset and limited duration Examples: pre-&post-op pain, headache, burns, childbirth, etc.

What is chronic pain?

Pain that persists beyond the time of healing of the original injury Pain that has lasted for a period of 3 months or more in the past 6 months and is an ongoing experience that fails to resolve naturally or does not respond well to intervention. Chronic Malignant Pain- includes pain in individuals with cancer, HIV/AIDS, motor neurone disease (MND), multiple sclerosis, end-stage organ failure, advanced COPD, advanced CHF, parkinsonism, etc. Chronic non-malignant pain- Examples include spinal pain or low back pain, chronic degenerative arthritis, osteoarthritis, rheumatoid arthritis.

What is COLDSPA and what does it stand for?

The questions must be designed to enable the individual to describe the pain in their own words. In circumstances when individuals cannot describe their pain, appropriate assessment questions and tools should be used. CHARACTER ONSET LOCATION DURATION SEVERITY PATTERN ASSOCIATED FACTORS

What is the character part of COLDSPA?

Description

What is the onset part of COLDSPA?

When did it begin?

What is the location part of COLDSPA?

Where is it?

What is the duration part of COLDSPA?

How long does it last?

What is the severity part of COLDSPA?

How bad is it? (use pain scale)

What is the pattern part of COLDSPA?

What makes it better/ worse?

What is the associated factors part of COLDSPA

What other symptoms occur with it? (e.g., nausea)

What are some pain assessment tools?

The aim of these tools is to standardise and objectify assessment. These tools include: * Numerical rating scale * Categorical or verbal descriptor scale (VDS) * Visual analogue scale (VAS) * Faces scale

What are some barriers to effective pain management?

Age Gender Culture Emotional State Environment Self-image Time of Day Previous Experience

How to Tell if a Patient is Faking Pain?

 Being very specific about the drug or saying they are allergic to similar drugs  Asking for a brand-name drug  Starts to be angry or irritable as you drill down closely about their symptoms and concerns (because they start to anticipate you will refuse them)  Has taken more of the pain medication than ordered or used it for other purposes or in a different form (signs of misuse)  Calls the physician’s office often, including during off-hours, and show up without an appointment (opioid seeking patients)  Resists diagnostics or referrals to specialists

Perioperative Care Flashcards

(45 cards)