Flashcards in Perioperative Care Deck (112)
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1
What are the purposes for surgery?
Diagnosis
Cure
Palliation
Prevetion
Exploration
Cosmetic improvemnt
Transplant
2
What are the four distinct phases of surgery?
Pre- operative
Intra- operative
Post- anesthesia
Post- operative
3
What should be assess in pre- op?
Data collection
Medication review (prescribed med, OTC, illegal, herbal, vitamins)
Nutritional status
Pain
ROM limitations
Pre- op labs and diagnostic tests
Allergies
Baseline VS
4
What are some meds that would cause concern in pre- op assessment?
Anti- coagulant
- lovenox, heparin, warfarin, aspirin
Steroids
- prednisone
5
Why is height and weight important?
To make sure they get the required anesthesia
6
Why is ROM limitations important?
Positioning during surgery
7
What is involved in health history for coping/adaption?
Psychological
Developmental
Socio-cultural
Spiritual
8
Coping/adaption: Psychological
Stress and coping mechanisms
9
Coping/adaption: Developmental
Age and gender
10
Coping/adaption: Socio- cultural
Support system
Economics
Plans for convalescence
11
Coping/adaption: Spiritual
Consider influence of religious/philosophical beliefs on surgical risk
Non- judgemental
Pastoral care referral
12
What are some surgical risks?
Age
Nutritional
Smoking
ETOH/Drug use
Chronic steroid use
Pre-existing conditions
13
Why is age a surgical risk for the very young?
Poorly developed lungs: increases risk of pulmonary problems
Looses water quickly being dehydrated
14
Why is being obese a surgical risk?
Excess adipose tissue and poor blood supply
- Prolonged surgery
- Prolonged excretion of anesthetic agent
- Reduced ventilatory function
- Slower healing process
15
Why is being underweight a surgical risk?
May lack needed vitamins and proteins
- Risk for poor wound healing and infection
- May be at risk for skin impairment with significance of bony prominences
16
Why is smoking a surgical risk?
Decreases ciliary action
Nicotine constricts blood vessels
Decreased amount of functional hemoglobin
17
Why is excessive alcohol consumption a surgical risk?
Affects liver function
- Metabolism and detoxification of drugs may be delayed
- May have poor nutrition: delayed wound healing
At risk of alcohol withdrawal (DT)
18
What are some pre- existing conditions?
Bleeding disorders
Diabetes
Heart disease
Fever
Upper resp. infection
Chronic resp. disease
Liver disease
Immune disorders
Renal insufficiency
Chronic steroid use
19
If steroids are being used chronically and abruptly stopped what can happen to the patient?
Adrenal crisis
- Hypertensive
20
What does BUN assess?
Hydration
21
What does creatinine assess?
Kidney function
22
Guidelines and safe practice recommendations are published by who?
AORN (American operating room nurse association)
ASPAN (American society of perianesthesia nurses)
WHO (World health organization)
Joint Commission (SCIP)
23
According to the WHO, what are the ten essential objectives to for safe surgery?
- Operate on correct Pt on correct site
- Use methods known to prevent harm from
administration of anesthetics while protecting
Pt from pain
- Recognize & effectively prepare for life threatening
loss of airway or resp function
- Recognize & effectively prepare for risk of
high blood loss
- Avoid inducing an allergic or adverse drug
reaction
- Use methods known to minimize risk for
surgical site infections
- Prevent inadvertent retention of instruments
& sponges
- Secure & identify all surgical specimens
- Effectively communicate & exchange critical
information
- Establish routine surveillance of surgical
results
24
When should the pre- op antibiotic be given?
Within 1 hr before incision
25
When should antibiotics be discontinued?
With what exception?
Within 24hrs of anesthesia end time
48hrs for cardiac surgery
26
What antibiotics should they be given 2hrs before incision?
Vancomycin
Levaquin
27
What should be remembered about blood glucose and cardiac surgery patients?
Controlled 6am post-op serum glucose (less than 200 mg/dl post-op day 1 and 2)
28
Why is maintaining a normal blood glucose important post-op?
Risk of infections higher if blood glucose levels are elevated
29
What should be used for hair removal?
Clippers (preferable)
30
