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Perioperative Client Flashcards

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1
Q

Oscopy?

A

An action or activity involving the use of an instrument for viewing

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2
Q

Ostomy?

A

An artificial opening in an organ created during surgery

Ex. Colostomy, ileostomy

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3
Q

Otomy?

A

Means to cut into a part of the body

Ex. Gastronomy cuts into stomach but not remove

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4
Q

Plasty?

A

Molding or shaping of a defect to restore form and function to a body part

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5
Q

Anastomosis?

A

A connection made surgically between adjacent channels of the body
Ex. Blood vessels

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6
Q

Dermatome?

A

An area of the skin that is supplied with the nerve fibres of a single, posterior, spinal root

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7
Q

Preoperative phase?

A

The time period between the decision to have surgery until the patient enters operating room

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8
Q

Intraoperative phase?

A

Starts when patient enters operating room until the patient enters recovery/PACU
-includes anesthesia admin and surgical procedure

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9
Q

Postoperative phase?

A

Begins when patient enters recovery/PACU and continues until healing is complete
-includes follow up/rehab

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10
Q

Pneumatic compression device?

A

A device that prevents thrombosis in bedridden patients
-it uses an inflatable device that squeezes the calves to prevent pooling of blood from forming mimicking the effects of walking

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11
Q

Atelectasis?

A

Collapse of alveoli

-partial or complete

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12
Q

Thrombophlebitis?

A

Inflammation of the wall of a vein with associated thrombosis

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13
Q

Paralytic ileus?

A

Small bowel obstruction when peristalsis stops

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14
Q

Conscious sedation?

A

A combination of medications to help you relax and block pain

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15
Q

General anesthesia?

A

Anesthesia that affects the whole body and induces a loss of consciousness

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16
Q

Regional anesthesia?

A

Only numbs the area of the body that requires surgery

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17
Q

Spinal anesthesia?

A

A form of regional anaesthesia involving injection of local anaesthesia into the subarachnoid space
Loss of feeling below perineum

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18
Q

Epidural anaesthesia?

A

Injection of anaesthesia into the epidural space of the spine which eliminates sensation from the point of insertion and downward
Ex. C-section

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19
Q

Things that determine type of surgery?

A

Purpose

Degree of urgency

Level of invasiveness

Body part

Equipment used

Degree of risk

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20
Q

Purposes of surgery?

A

Diagnostic (exploratory): confirms or establishes

Palliative: relieves or reduces pain but does not cure

Ablative or curative: removes diseased body part

Constructive: restores function or appearance

Transplantation: replaces malfunctioning structures

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21
Q

Levels of invasiveness?

A

Invasive (open): involves large incisions made to visualize and provide direct access

Minimally invasive: involves small incisions through telescopic equipment to provide indirect visualization and manipulation

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22
Q

Degree of urgency?

A

Emergency: performed immediately to preserve function or life

Urgent: within 24-48hrs

Elective: treatment for something that is not life threatening or to improve clients own life

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23
Q

Degree of risk: major?

A

Involves a high degree of risk

  • complicated
  • large loss of blood may occur
  • vital organs involved
  • post op complications
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24
Q

Degree of risk: minor?

A

Involves little risk
Few complications
Often day surgery

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25
What may affect degree of risk?
Age: neonates/infants & older adults General health Nutritional status: malnutrition/obesity Medical hx: medications, surgeries Mental health status: ability to cope
26
What's covered in preoperative phase?
``` Consent Assessment Physical assessment Psychological assessment Planning -discharge ```
27
What are some things covered in informed consent?
``` Nature and reason Name and qualifications of surgeon Risks and potential outcomes Possible alternatives Right to refuse or withdrawal consent ```
28
Preoperative assessment?
``` Collecting and reviewing client data Nursing hx Allergies Previous surgeries Mental status Medications Current health status Understanding of procedure/anaesthesia Coping Cultural/spiritual considerations ```
29
Why is previous surgeries an important part of assessment?
How did they respond to their previous surgery Response to anaesthesia Any complications
30
What is the perioperative period?
Entire operative period Starting when doctor says you need surgery and includes rehab/restorative care at home/follow up
31
Why can the postoperative phase last a long time?
Because surgical wounds are primary intention healing which can take up to a year or longer
32
Why might someone need an urgent surgery?
Preserve clients life Preserve a body part Preserve function of the body
33
What are some physical assessments done in preoperative phase?
``` Head to toe -mini mental -resp assessment -cardiovascular assessment -other systems --> GI, GU Preop labs and diagnostics Vitals ```
34
Ectomy?
Surgical removal of a specified part of the body
35
What are some preoperative planning?
``` Teaching pre and post op Physical prep -NPO, enema, skin prep, meds Psychological prep -providing comfort, reducing fears Planning pick up/drive home Discharge planning -home care Continuum of care -coordination throughout transfers -care of patients belongings -contact with physician and fam ```
36
True or false. | It's the nurses role to gain informed consent?
False. It's the physicians responsibility to gain informed consent from patient Nurses can answer questions about procedure but cannot gain informed consent from patient Consent must be documented
37
Planning in intraoperative phase?
``` Maintain clients safety Maintain homeostasis Preserve patients life Maintaining sterile environment Promote psychological comfort Updating family Ensuring right patient, right procedure, right body part, etc. Managing tubes Documentation Advocating for clients dignity Sponge and instrument counts Assisting with positioning ```
38
Preoperative teaching topics?
``` Info. about what will happen to client -sensations/discomfort Providing accurate info that decrease fears/misbeliefs Skill training -coughing, splinting incisions Explaining need for preoperative tests Educate about anaesthesia ```
39
Medications given in preop period?
``` Antibiotic -prophylactic Analgesic -additive to anaesthetic, decrease post op discomfort Antiemetic -decrease post op discomfort Anticholinergic -decrease secretions Benzos -decrease anxiety, sedative effect, increase amnesia ```
40
Postoperative phase?
``` Promoting wellness/healing Multidisciplinary communication Preventing associated risks Head to toe assessments Assess drains/wounds Med admin Psychosocial support Documentation Continue discharge planning ```
41
Health problems that increase surgical risks/post op complications?
``` Malnutrition Obesity Cardiac conditions Blood coagulation disorders Resp tract infections Renal disease Diabetes Liver disease Uncontrolled neurological disease ```
42
Purpose of moving a client?
Promote venous return Mobilize secretions Stimulate GI mobility Facilitate early ambulation
43
Purpose of leg exercises?
Promote venous return | Prevent thrombophlebitis and thrombus formation
44
Purpose of deep breathing and coughing?
Enhance lung expansion Mobilize secretions Prevent atelectasis and pneumonia
45
Types of anaesthesia?
General Regional Local
46
Characteristics of general anaesthesia?
``` Loss of sensation and consciousness Loss of protective reflexes Ex. Cough and gag Blocks awareness centres in the brain -amnesia, analgesia effects ``` Given through IV or inhalation
47
Narcosis?
A state of severe CNS depression produced by pharmacological agents
48
Regional anaesthesia characteristics?
Temporary interruption of transmission of nerve impulses Loss of sensation in an area of the body Concurrent meds may be given for mild sedation or to relieve anxiety -less risky than general -not given by IV because you cannot target one area
49
Techniques to give regional anaesthesia?
Nerve block: injected into a nerve group IV block: tourniquet used to prevent absorption beyond extremity Spinal or subarachnoid block: numb below perineum Epidural Conscious sedation: depression on consciousness but patient retains control of airway
50
True or false. | LPNs can assess dermatome return?
False. RN job
51
Local anaesthesia?
``` Interrupts transmission of nerve impulses Used on specific small areas Used in minor procedures Clients remain conscious Ex. Dentist ``` Given by local infiltration (injected) or topical
52
Do LPNs care for patients in PACU?
No. PACU is a specialty to care for patients recovering from anaesthesia and surgery Once patients are stabilized they are returned to the surgical unit where RNs do assessment and depending on stability LPNs may care for them
53
Potential post op problems?
``` Pneumonia Atelectasis Pulmonary embolism Hypovolemia Hemorrhage Thrombophlebitis UTI Constipation Postoperative ileus Wound infection Depression ```
54
Postoperative assessment?
``` LOC Vitals Skin colony and temp Comfort Fluid balance Dressing abs bedding Drains and tubes ```
55
Epidural vs. Subarachnoid anaesthesia?
``` Different locations of the spinal cord Narcosis in different locations Used for different types of surgery Different risk factors Different assessments post op ```
56
What are some key assessments of a patient coming off anaesthesia?
``` ABCs Vitals Level of sedation Autonomic return Side effects -headache, nausea Assessing dressing for leaking or bleeding ```
57
Lifespan considerations for anaesthesia: young children?
At higher risk for complications due to immature physical status - need extra help maintain temp - dosing and oxygenation - more susceptible to dehydration - pain assessments - smaller equipment - safety
58
Lifespan considerations for anaesthesia: pregnant women?
2 physiological systems to consider - Influences mom and baby - monitoring vitals for both - hormone levels affect dosages - tetragenic effect to fetus - increase risk venous stasis/DVT - lab values and oxygenation might be different - anxiety - stimulation of premature labour
59
Lifespan considerations for anaesthesia: older adults?
``` Delayed healing/recovery from anaesthetic Rigidity of vascular system Decrease cardiac output Increase risk of skin breakdown Increase risk of clots/DVT Stiffening of alveoli, decreased gas exchange Increased risk of atelectasis Increased risk of shock ```
60
What type of data should you review on a patients chart prior to receiving patient on surgical unit?
``` OR report Preop checklist PACU charting Meds given Baseline assessment Orders for dressing changes and post surgical diagnostics Sedation scale Drains, catheter? Teaching that's been given Safety concerns ```
61
When a patient comes to the surgical unit what should you do?
Head to toe - all systems - vitals - IV - catheter - pain - safety - comfort - mood
62
Possible anaesthesia complications?
``` Spinal headache N/V High block DVT Hypovolemic bleeding ```
63
Importance of preop lab values/diagnostics?
Establishes baseline and potential for complications | -identifies high risk patients
64
Common labs/diagnostics?
``` CBC & diff Coagulation Serum Cr BUN LFT Blood glucose Electrolytes ```
65
Why do a CBC before surgery?
Establish baseline | Determine oxygenation status/carrying capacity (RBC)
66
Why check coagulation before surgery?
INR, PTT, PT -how much time it takes for clotting to occur -increased INR = blood taking longer to clot Warfarin= anticoagulant
67
What does serum Cr and BUN evaluate?
Kidney function Poor kidney function affects fluid balance (excrete and filter)
68
Post op head to toe?
``` Safety Neurological Mood/psychosocial Pain/sedation Respiratory Cardiovascular Nutrition/hydration Hygiene/oral care Incisions/drains Skin integrity GI/GU Mobility ```

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