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Perioperative Nursing Flashcards

(38 cards)

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1
Q

Perioperative Goals

A

Providing safety and well-being of patient

Collaborative teamwork of perioperative personnel

Maintain surgical standards of care (AORN*)
* The Association of PeriOperative Registered Nurses

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2
Q

Perioperative Nursing

A

Knowledge of:
Surgical anatomy
Physiologic alterations and their consequences
Intraoperative risk factors
Potential for injury and the means of prevention
Psychosocial effects of surgery for the patient and their family

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3
Q

The Perioperative TEAM

A

Preoperative Nurse
Circulating Nurse
Scrub Tech or RN
Anesthesia Personnel
PACU Nurse

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4
Q

Preoperative Nurse

A

Begins the surgical experience with the patient and their family
Confirms all surgical orders
Verifies informed consents
Checks lab work and informs surgeon of any discrepancies
Starts IV
Does all prep work prior to surgery

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5
Q

Circulating Nurse

A

Patient assessment before and during procedure
Collaboration with surgeon, anesthesiology and other OR personnel /anticipate needs
Management of OR
OR conditions, asepsis, equipment, coordinating OR team, surgical count, positioning of patient
Verify consent completion, lab work, documentation
Review pre-op checklist
Initiate “Time Out”
Ensure patient safety and a caring environment

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6
Q

Surgical Tech or RN

A

Performs hand scrub, sterile gown and gloves
Sets up sterile field/table
Prepares supplies/equipment
Assists with draping the patient
Passes instrumentation to the surgeon and assists with procedure
Tracks instruments, sponges, sharps
Confirms specimens with circulating RN
Assists with tracking irrigation fluids and blood loss

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7
Q

Anesthesia Personnel

A

MD or CRNA (Certified Registered Nurse Anesthetist)
Assess medical readiness for surgery
Maintain patient’s airway
Monitor and control patient’s vital life functions (i.e. HR, BP, Temp, fluid balance)
Control patient’s pain and level of consciousness

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8
Q

PACU Nurse

A

Post Anesthesia Care Unit
Monitor patient airway and level of consciousness
Monitor pain level and administer pain meds to reach a comfortable goal for the patient
Monitor vital signs and watch for any immediate postoperative complications
Prepare patient for next stage of recovery

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9
Q

Patient Safety

A

Patient identification
Verification of correct informed consent completed
Verification of records of health history and physical
Results of diagnostic tests
Allergies (include latex allergy)
Assessing special needs of patient (mobility, hearing, language)
Monitoring and modifying the physical environment
Safety measures such as grounding of equipment, restraints, and not leaving a sedated patient
Verification and accessibility of blood
Signing of the surgical site

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10
Q

National Patient Safety Goals

A

A critical method by which The Joint Commission promotes and enforces major changes in patient safety (minimize mistakes)
2 patient identifiers (Do you have the correct patient?)
Mark the operative site (Is this the correct side?)
Universal Protocols
Label specimen container in presence of patient
Or 2 OR personnel if patient is sedated
“Time Out”

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11
Q

Time Out

A

Occurs immediately before starting the invasive procedure or making the incision.
Standardized
Involves the immediate members of procedure team: surgeon, anesthesia, other OR staff
Team members agree, at a minimum, on the following:
Patient identity, correct site & procedure

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12
Q

Patient SafetySCIP (Surgical Care Improvement Project)

A

Prevention of Surgical Site Infection
Prophylactic Antibiotic: received within one hour prior to surgical incision
Appropriate hair removal immediately prior to incision (clip/not shave)
Prevent hypothermia: Ideally 36C within 15 min of arrival to PACU
Blood Glucose: <200mg/dl on POD1 and POD2 cardiac patients
VTE prophylaxis (SCD’s, TED Hose, Heparin therapy)
Beta Blocker treatment

Foley Catheter use has been decreased in the surgical population-only used if necessary to monitor for urine output or based on type of anesthesia

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13
Q

Principles of Surgical Asepsis

A

Medical asepsis: Practices that reduce the number, growth, transfer and spread of pathogenic microorganisms. They include hand washing, bathing, cleaning environment, gloving, gowning, wearing mask, hair and shoe covers, disinfecting articles and use of antiseptics.
Surgical asepsis: Practices that keep an area or objects free from all microorganisms non pathogenic and pathogenic including spores and viruses.

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14
Q

Surgical SuiteRestricted Areas

A

can only be accessed through a semi-restricted area
traffic in the restricted area is limited
personnel are required to wear surgical attire and cover head and facial hair. Masks are required where open sterile supplies or scrubbed persons may be located.

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15
Q

Surgical SuiteSemi-restricted area

A

peripheral support areas surrounding the restricted area of a surgical suite
storage areas for clean and sterile supplies, sterile processing rooms, work areas for storage and processing of instruments, scrub sink areas, corridors leading to the restricted areas

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16
Q

Principles of Surgical Asepsis

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A

Sterile field
Opening sterile items
Sterile limits
Sterile tables
Sterile packages
Pouring fluids to the sterile field

17
Q

Principles of Surgical Asepsis Surgical Scrub

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A

Daily: 5-10 min scrub of hands and arms
Fluids flow in the direction of gravity
Hold hands above the elbows
Dry hands starting at the fingertips and progressing to the elbows

18
Q

Surgical Scrub

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A

Gel may be used after initial scrub
Start at hands and work to elbows
Antimicrobial effects for up to 24 hours

19
Q

Nursing Goals in the Perioperative Period

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A

Maintain patient privacy and dignity
Reduce anxiety
Patient remains free from injury (safety)
Avoid surgical complications

20
Q

Nursing GoalsPatient is free from injury

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A

Surgical count
RN + 1 other person performs count
Minimal count: Sponges and sharps
Instruments are counted when there is an open cavity
Final count when cavity is closed
X-ray if count is incorrect

21
Q

Nursing GoalsPatient is free from injury

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A

Chemical injury
Latex allergy (anaphylaxis)
Appropriate meds (overdose)

Electrical injury
Proper grounding
Prevent burns (Bair, Bovie, laser)
Prevent fires (prep dry time)

22
Q

Nursing GoalsGuidelines for Positioning

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A

Preserve patient’s dignity
Pad all bony prominences and restraints
Maintain adequate respiratory exchange
Maintain adequate circulation
Avoid hyperextension or strain on joints and muscles
Ensure perfusion to extremities
Do not allow extremities to dangle
Do not position patient on an extremity

23
Q

Surgical Complications

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A

Respiratory
Cardiac dysrhythmias
Nausea/Vomiting
Hemorrhage
Anaphylaxis
Hypothermia
Pain
Infection

24
Q

Nursing Actions

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A

Assess the patient
Anesthesia awareness
Warming devices and minimal exposure
Traffic control
Excellent aseptic techniques

BE A LEADER!

25
Types of Anesthesia
General Monitored Anesthesia Care (MAC) Conscious Sedation (IV) Regional Local
26
General Anesthesia
IV and/or Inhalation Places the body and brain in a state of unconsciousness (sleep) during which there is no awareness or memory of the procedure Patient is intubated to maintain a patent airway RN assists with induction and intubation Cricoid pressure, monitoring VS’s, masking Laryngeal Mask Airway (LMA) Endotracheal Tube
27
Monitored Anesthesia Care
Used in conjunction with local anesthesia Administered by Anesthesiologist or CRNA Involves a deeper sedation in which the airway can easily become compromised Most common drug is Propofol
28
Conscious (IV) Sedation
Can be administered by an RN under the supervision of MD Patient is awake and able to respond to verbal stimulation Protective reflexes are intact (cough and gag) Goal: calm, tranquil, amnesic, and relatively pain free
29
Regional Anesthesia
Reversible loss of sensation in a specific area or region of the body by injecting anesthesia around a nerve supply No loss of consciousness May be used with sedation Types: Spinal, Epidural, Bier, or Nerve block Spinal/Epidural anesthesia risk Hypotension Headache (Blood patch) Backache Infection, nerve damage, allergic reaction, seizures, cardiac arrest Bleeding and paralysis
30
Local Anesthesia
Injection of anesthetic agent into tissues at surgical site Most common: Lidocaine or Marcaine Economical and safe For short and minor surgical procedures Used for post op pain control
31
Common Perioperative Medications Benzodiazepines
Versed (Midazolam) Valium (Diazepam) Xanax (Alprazolam) Used as sedative and treatment of anxiety or muscle spasms Versed causes therapeutic amnesia Can cause respiratory depression Reverse OD with Flumazenil (Romazicon)
32
Common Perioperative Medications Narcotics
Fentanyl Morphine Dilaudid Used for sedation and pain control Can cause respiratory depression Reverse with Narcan (Naloxone)
33
Malignant Hyperthermia
Rare, life threatening complication that can be triggered by anesthesia drugs A hypermetabolic syndrome in which the patient becomes hyperthermic due to increased metabolic activity in the skeletal muscle Rapid intra and extra-cellular imbalance of calcium causes sustained muscle rigidity with increased O2 consumption and, consequently, increased levels of CO2 Inhalation anesthetic gases and Succinylcholine are most common triggering agents Symptoms: hypercarbia, tachypnea, tachycardia, hypoxia, metabolic/respiratory acidosis, cardiac dysrhythmia, and elevation of body temp If not recognized and treated quickly the patient has a greater risk of not recovering
34
Malignant Hyperthermia Treatment
Proper pre-operative screening of patients In an event: Discontinue all triggering agents Hyperventilate with 100% O2 Immediate infusion of Dantrium Cooling the patient (ice packs, cold IV solution, iced lavage) Treat other symptoms as necessary
35
Gerontology Considerations
Elderly patients are at increased risk for complications due to surgery and anesthesia because of: Increased likelihood of coexisting conditions. Aging heart and pulmonary systems. Decreased homeostatic mechanisms. Changes due to aging such as decreased renal function, and changes in body composition of fat and water.
36
Immediate Post-op Care
Client is moved from the OR table to a stretcher or bed and transported to PACU Client may be moved directly to the ICU Client may be moved directly to a general care room if surgery was performed using Regional Anesthesia
37
Post Anesthesia Care (PACU)
Airway/respiratory and breathing Circulation/Neurological function Level of Consciousness Surgical Incision Site Drains and Invasive Tubes Vital Signs Fluid/Electrolytes Comfort Level (Pain) Aldrete Score Aldrete Score includes: Patient consciousness, Activity, Respiration, Blood Pressure, and Oxygen Saturation Level: Max of 2 points a piece given. Min score of 8 needed to move to next level of care.
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Conclusion
Nurses in Periop use the same process inpatient nurses use when caring for patients They focus on safety, prevention of medical errors, and help coordinate the surgery team They possess knowledge of equipment and procedures necessary to care for patients Nurses in Periop are passionate and patient advocates

Med surg I (11 decks)

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