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254 > Perioperative Client > Flashcards

Perioperative Client Flashcards

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
Q

What may affect degree of risk?

A

Age: neonates/infants & older adults

General health

Nutritional status: malnutrition/obesity

Medical hx: medications, surgeries

Mental health status: ability to cope

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26
Q

What’s covered in preoperative phase?

A 
Consent 
Assessment 
Physical assessment 
Psychological assessment 
Planning 
-discharge
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27
Q

What are some things covered in informed consent?

A 
Nature and reason 
Name and qualifications  of surgeon 
Risks and potential outcomes 
Possible alternatives 
Right to refuse or withdrawal consent
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28
Q

Preoperative assessment?

A 
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
Q

Why is previous surgeries an important part of assessment?

A

How did they respond to their previous surgery
Response to anaesthesia
Any complications

30
Q

What is the perioperative period?

A

Entire operative period

Starting when doctor says you need surgery and includes rehab/restorative care at home/follow up

31
Q

Why can the postoperative phase last a long time?

A

Because surgical wounds are primary intention healing which can take up to a year or longer

32
Q

Why might someone need an urgent surgery?

A

Preserve clients life
Preserve a body part
Preserve function of the body

33
Q

What are some physical assessments done in preoperative phase?

A 
Head to toe 
-mini mental
-resp assessment 
-cardiovascular assessment 
-other systems --> GI, GU
Preop labs and diagnostics
Vitals
34
Q

Ectomy?

A

Surgical removal of a specified part of the body

35
Q

What are some preoperative planning?

A 
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
Q

True or false.

It’s the nurses role to gain informed consent?

A

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
Q

Planning in intraoperative phase?

A 
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
Q

Preoperative teaching topics?

A 
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
Q

Medications given in preop period?

A 
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
Q

Postoperative phase?

A 
Promoting wellness/healing 
Multidisciplinary communication
Preventing associated risks 
Head to toe assessments 
Assess drains/wounds 
Med admin 
Psychosocial support 
Documentation 
Continue discharge planning
41
Q

Health problems that increase surgical risks/post op complications?

A 
Malnutrition 
Obesity 
Cardiac conditions 
Blood coagulation disorders 
Resp tract infections 
Renal disease 
Diabetes
Liver disease 
Uncontrolled neurological disease
42
Q

Purpose of moving a client?

A

Promote venous return
Mobilize secretions
Stimulate GI mobility
Facilitate early ambulation

43
Q

Purpose of leg exercises?

A

Promote venous return

Prevent thrombophlebitis and thrombus formation

44
Q

Purpose of deep breathing and coughing?

A

Enhance lung expansion
Mobilize secretions
Prevent atelectasis and pneumonia

45
Q

Types of anaesthesia?

A

General
Regional
Local

46
Q

Characteristics of general anaesthesia?

A 
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
Q

Narcosis?

A

A state of severe CNS depression produced by pharmacological agents

48
Q

Regional anaesthesia characteristics?

A

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
Q

Techniques to give regional anaesthesia?

A

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
Q

True or false.

LPNs can assess dermatome return?

A

False.

RN job

51
Q

Local anaesthesia?

A 
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
Q

Do LPNs care for patients in PACU?

A

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
Q

Potential post op problems?

A 
Pneumonia 
Atelectasis 
Pulmonary embolism
Hypovolemia 
Hemorrhage 
Thrombophlebitis 
UTI
Constipation
Postoperative ileus 
Wound infection 
Depression
54
Q

Postoperative assessment?

A 
LOC
Vitals 
Skin colony and temp 
Comfort
Fluid balance
Dressing abs bedding
Drains and tubes
55
Q

Epidural vs. Subarachnoid anaesthesia?

A 
Different locations of the spinal cord 
Narcosis in different locations 
Used for different types of surgery 
Different risk factors 
Different assessments post op
56
Q

What are some key assessments of a patient coming off anaesthesia?

A 
ABCs
Vitals 
Level of sedation 
Autonomic return 
Side effects 
-headache, nausea  
Assessing dressing for leaking or bleeding
57
Q

Lifespan considerations for anaesthesia: young children?

A

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
Q

Lifespan considerations for anaesthesia: pregnant women?

A

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
Q

Lifespan considerations for anaesthesia: older adults?

A 
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
Q

What type of data should you review on a patients chart prior to receiving patient on surgical unit?

A 
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
Q

When a patient comes to the surgical unit what should you do?

A

Head to toe

  • all systems
  • vitals
  • IV
  • catheter
  • pain
  • safety
  • comfort
  • mood
62
Q

Possible anaesthesia complications?

A 
Spinal headache 
N/V
High block 
DVT
Hypovolemic bleeding
63
Q

Importance of preop lab values/diagnostics?

A

Establishes baseline and potential for complications

-identifies high risk patients

64
Q

Common labs/diagnostics?

A 
CBC & diff
Coagulation
Serum Cr
BUN
LFT
Blood glucose 
Electrolytes
65
Q

Why do a CBC before surgery?

A

Establish baseline

Determine oxygenation status/carrying capacity (RBC)

66
Q

Why check coagulation before surgery?

A

INR, PTT, PT
-how much time it takes for clotting to occur

-increased INR = blood taking longer to clot

Warfarin= anticoagulant

67
Q

What does serum Cr and BUN evaluate?

A

Kidney function

Poor kidney function affects fluid balance (excrete and filter)

68
Q

Post op head to toe?

A 
Safety 
Neurological 
Mood/psychosocial 
Pain/sedation 
Respiratory 
Cardiovascular 
Nutrition/hydration 
Hygiene/oral care 
Incisions/drains 
Skin integrity 
GI/GU
Mobility

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