perioperative/intraoperative assessments, risks and IV therapy. Flashcards Preview

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Flashcards in perioperative/intraoperative assessments, risks and IV therapy. Deck (28)
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What is IV therapy and what are the two main types (also sites etc.)

IV can be administered continuously or intermittent (bag or burette directly into vascular access device)
Sites: commonly used with peripheral IV therapy in the hands and arms. Scalp veins are common for new-borns and infants •
Two categories: crystalloids and colloids
• Crystalloids are divided based on tonicity: hypertonic, isotonic, hypertonic
• Colloids are solutions that contain protein or starch. Particles remain intact in the solution and are unable to pass through the capillary membrane. They are used to re-establish circulating volume and oncotic pressure


describe the types of Crystalloids.

○ Solution same osmolarity as blood plasma
○ Expands the body's fluid volume without causing a fluid shift
○ Solution with exactly same water concentration as the cell
○ 0.9% sodium chloride (normal saline), glucose 5% in water, Hartmanns solution
○ Solution of lower osmolality pressure. Solution moves fluid into cells
○ Dilute solution with a higher water concentration than the cell
○ Cell will gain water through osmosis
○ 0.45% sodium chloride
○ A solution of higher osmotic pressure
○ Solution pulls fluid from cells
○ Cells will lose water by osmosis
○ Causes cells to shrink
○ 10% Dextrose in water , Glucose 5% in 0.9% sodium chloride


What is the flow rate formula?

Gravity flow:

volume to be infused/ time X drop rate/60min = drops per min

Macro- 20 drops per ml
Micro- 40 drops per ml

Infusion pump
total volume (ml) / time (hours) = rate (ml/hr)


What are some complications of IV therapy?

• Most common cause of infiltration is due to damage to the wall during insertion or angle of placement. It is the leaking into the surrounding tissues. When this occurs lift the arm up, take out cannula, and call doctor and document that it was ceased.
• Phlebitis/Thrombophlebitis- Chemical, Mechanical, Bacterial. Inflammation of the vein. Can be due to the drug, the cannula, bacteria getting into vein
• Cellulitis: inflammation of loose connective tissue around insertion site, caused by poor insertion, red swollen area spreads, treated with antibiotics,
• Septicaemia: severe infection that occurs to a system or body, most often caused by poor insertion technique or poor care. Discontinue device immediately, culture and treat.
• Pulmonary oedema- caused by rapid infusion (fluid volume excess)


Why do we do pre-operative assessments?

• Check patients physical and psychological status
• Identify potential problems
• Perform pre-operative preparation
• Identify the need for further investigations
• Plan care
• Develop a rapport with the patient


What are some potential risks to patients having surgery ?

Positioning injuries
Retained surgical items
Incorrect procedure
post operative infection


What is the ASA physical status classification assessment?

A tool to evaluate the patient's risk for anaesthesia.
ASA 1 to 6 classifications
1. healthy/normal patient
2. patient with mild systemic disease
3. patient with severe systemic
4. patient with severe systemic disease that is a constant threat to life
5. Moribund patient who is not expected to survive with surgery
6. a declared brain dead patient whose organs are being removed for donor purposes


What does an assessment of airway in pre-op prep consist of?

• Fasting - Nil by mouth
• Solids
• Fluids
• Feeds
• Medications
• What happens if do/don’t


What are some reasons for premedication that also help with pre-op anxiety ?

• Pre-emptive analgesia and/or nausea
• Reduce secretions to reduce risk of aspirating
• Reduce anxiety e.g. valium
• Induce amnesia
• Attenuate vagal reflexes
• Increase volume/decrease PH of gastric juices (more for pregnant women)
• Treat pre-existing conditions that may be present


What do we do and have to know in pre-operative preparations (summary)?

What surgery is the patient having?
How much prep is needed?
What is the significant prognosis? - informed consent e.g. pros and cons of surgery and alternative options
Previous experience e.g. previous surgical history that may be distressing
Level of Knowledge- if they understand consent, the procedure
What do the patients expect? - to reduce anxiety
Check allergies e.g latex, anaesthesia, iodine
Psychological prep


What anaesthetic process occurs when patients are being admitted to the operating theatre?

• Patients will be taken to the anaesthetic bay or waiting area
• Anaesthetic will be administered in the aesthetic bay OR the Anaesthetic Triad

Anaesthetic Triad:
• Three components: narcosis, analgesia, relaxation
• A general anaesthetic always involves an hypnotic agent, usually analgesic and may also include muscle relaxation


Why may patients be at risk of Venous thrombosis and what are ways to reduce the risk?

Why patients are at risk
• Immobility
• Positions needed to be put in for surgery or post op
• Positive pressure ventilation - (Positive-pressure ventilation means that airway pressure is applied at the patient's airway through an endotracheal or tracheostomy tube)

Ways to reduce risk
• Compression socks/stockings
• Calf compressions
• Heparin


Define time out.

suspension of activity immediately before commencing a procedure to undertake final verification
The Joint Commission defines as “an immediate pause by the entire surgical team to confirm the correct patient, procedure, and site."


Who is involved in time out?

Everyone in the surgical suite:
Clinicians, proceduralist, anaesthetist, radiologist, nursing staff, technicians


What is infection control in intraoperative settings? what does it involve?

Infection control is being constantly vigilant in an operative setting, meaning
:equipment sterilisation (e.g. use by date, packaging is intact) = aseptic technique. Even the most spacious theatre can become crowded one surgery commences


What is a surgical count? Why do we do it? and How do we do it? Who is responsible?

• Surgical Count: accountable items (what goes in must come out- except prosthesis). Document all instruments against the tray list.
○ Why do we do it? Infection control, legal requirements, duty of care, inventory control
○ How do we do it? With two people, document all on the operating room nurse report, instruments- document all instruments against the tray list
○ Who is responsible? Nurse and surgeon. If anything is missing search all cavities, surgical area and bins


What is a specimen and what are the types?

○ Everything is a specimen EXCEPT tonsils from children below 14, varicose veins, bone chips and skin trimmings
○ Types: microbiology, frozen , blood, tissue for disposal, histopathology


Describe patient positioning during operation.

○ Aims/what factors are considered for the type of positioning: surgical site, anaesthetic (airway, monitoring, arterial access), body systems ( prevent comprise to respiratory system, cardiac, nervous and integumentary)
○ Positioning: supine, prone, Lithotomy, lateral, jack knife, sitting, Trendelenburg
○ Need to consider: patients restrictions, type of surgery
○ Risks: over extension , pressure, impacting of nerves, skin


What are some potential risks in the operating room?

Volatile liquid and gases- anaesthetic gases need to be removed to prevent exposure of gas to staff
electricity and fire- volatile liquid and gases may link to equipment and result in fire
radiation- e.g. X rays, appropriate protection for patients, staff etc.
Laser- vigilant for volatile gases that may react with laser
Plume - diathermy machine used to seal off/cut blood vessels, plume (gas) from the machine needs to be removed.


What are some potential positioning risks?

over extension of joints
development of pressure injuries
impacting nerves
skin shearing


How can nurses provide a safe environment for patients about to go into the operating theatre/ in the OT?

• Time out procedure
• Constantly vigilant
• Understanding potential dangers and knowing how to reduce


What do we need to consider/know about the patient as perioperative nurses?

the gender of the patient
procedure that the patient is scheduled for
if it is an elective or emergency procedure
if it is in regular working hours or out of hours
the patients psychological needs, linguistic needs, cultural and physiological needs


List some different patient groups.

pregnant women
CALD: culturally and linguistically diverse
people with disabilities
Transplants (people who need, have or are donors)


Describe paediatric patients.

Neonates - under 6 months

They need to be cared for specifically
neonates: we ask parents if they want to carry or hold their babies anesthetize.
Teenagers: need to be respected as young adults


Describe the considerations when caring for a pregnant woman.

- research into anaesthetic and assessment of their risks/health
- they may need to laid on their side : so that their respiratory system is not compromised
- increased pH balance in gastric contents for pregnant women
- more women are obese - (batriatric patients) which needs to be considered for transfer and moving.


Describe considerations for elderly patients.

- skin conditions: any tears, cuts, pressure injuries
- mobility : moving and positioning
- hearing or visual disturbances: glasses and hearing aids are kept in until right before surgery so that patients feel safe and understand their surroundings.
- comorbidies


Describe considerations for culturally and linguistically diverse patients.

- the differing languages: if a translater is needed
-different cultural and religious beliefs
- different expectations
- speak slowly etc.


List some considerations for patients with disabilities.

- sensory, hearing, sight
- physical , movement and intellectual abilities