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Fundamentals of Nursing > Perioperative Nursing > Flashcards

Perioperative Nursing Flashcards

1
Q

3 phases

A

pre
intra
post

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2
Q

what phases are completed by the generalist nurse

A

pre and post

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3
Q

what phase does the OR nurse do

A

intra

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4
Q

pre

A

time patient decides to have surgery to OR table

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5
Q

intra

A

OR to PACU

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6
Q

PACU

A

post anesthetic care unit

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7
Q

Post

A

PACU to complete recovery

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8
Q

3 types of urgencies

A

elective, urgent, emergency

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9
Q

elective

A

scheduled, no urgency

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10
Q

urgent

A

perform soon

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11
Q

emergency

A

STAT

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12
Q

risk is minor or major, what contributes

A

hours under for surgery
under longer=greater risk

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13
Q

5 purposes

A

diagnostic
ablative
palliative
reconstructive
transplantation

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14
Q

what 2 are not curative

A

diagnostic and palliative

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15
Q

diagnostic

A

to diagnose

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16
Q

ablative

A

removed an organ

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17
Q

palliative

A

reduce intensity

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18
Q

reconstructive

A

restore function

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19
Q

transplantation

A

organs

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20
Q

what is breast biopsy

A

diagnostic

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21
Q

what is hip replacement

A

recontructive

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22
Q

what is debridement of pressure injury

A

palliative

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23
Q

what is hysterectomy

A

ablative

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24
Q

ambulatory surgery

A

stay at home night before and come in for same day surgery

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25
Q

why is ambulatory surgery good

A

reduces length of stay
reduces stress for patient

*since surgery is breaking integrity of the skin we limit stay at hospital so decreased chance of nosocomial infections

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26
Q

why might ambulatory surgery require additional teaching

A

because patient will be monitoring themself

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27
Q

who might not be a good candit for ambulatory surgery

A

elderly
unable to follow directions, no support, respond to anesthetics differently

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28
Q

for an ambulatory surgery we want to make sure we have the right

A

patient and type of surgery

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29
Q

what is the main priority for preop

A

SCREENING AND TEACHING

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30
Q

what is screening

A

identify all risks so they do not occur in OR

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31
Q

what are some examples of stuff we need to know during screening

A

risk factors
allergies (esp to anethtics)
lab results
abnormal results
consent is signed

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32
Q

why do nurses need to sign the consent

A

as a witness

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33
Q

who goes over the complications and procedures with the patient for consent form

A

surgeon and anesthisologist

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34
Q

if the patient signs the consent and then says they don’t understand what is your job

A

get the surgeon back down to explain it again

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35
Q

when is teaching performed

A

pre

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36
Q

when is teaching reinforced

A

post op

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37
Q

what do we want to teach

A

pain management
coughing and deep breahting
incentive spirometry
medications

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38
Q

what does coughing and deep breathing do

A

prevent pneumonia and atelectasis
how? anesthetics decrease cillary movement which cause secretions to sit and lead to pneumonia

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39
Q

what do we want to do for a patient who has a midline abdominal surgery

A

splint

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40
Q

SMILE

A

sustained maximum inspiratory lung expanded

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41
Q

where do we want the incentive spirometry at

A

bedside

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42
Q

what meds do we want to discontinue

A

blood thinner

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43
Q

what meds do we want to continue

A

blood pressure and beta blockers

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44
Q

what does a chest x ray tell us

A

infection, heart failure, lungs

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45
Q

what does a EKG tell us

A

arrthymias

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46
Q

what does a complete blood count tell us

A

WBC
HC
HB

*infection, anemia, platelets

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47
Q

electrolyte levels

A

NA, K, CA, CL

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48
Q

what does K tell us

A

heart

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49
Q

what does Na tell us

A

dehydrated

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50
Q

urinalysis is

A

gross/global/broad

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51
Q

previous surgery and how did you tolerate

A

possible allergies

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52
Q

nutrition such as

A

protein, vit c, a, d, zinc, copper, iron

*wound healing

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53
Q

who does poorly in nutrition category

A

obesity and thin

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54
Q

why are obesity poor wound healers

A

hypoventilators which leads to atelectasis and pneumonia and difficulty taking narcotics because of hypoventilator, increase subq which has no blood flow

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55
Q

why are thin poor wound healers

A

no protein

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56
Q

atelectasis turns into

A

pneumonia

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57
Q

what do we want to know about illicit drugs

A

what type and last use so no WITHDRAWL

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58
Q

what do we want to know about nicotine

A

pack year
(pack/day x years smoking)

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59
Q

what is included in informed consent

A
  • procedure
  • alternative therapies
  • name and qualifications performing procedures
  • risks and how often
  • expected outcomes
  • recovery
  • rehabilitation plan
  • refuse treatment
  • withdraw consent
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60
Q

what is an advance directive

A

legal document for patient specific instructors post op

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61
Q

AND

A

allow natural death

62
Q

what do sedatives do

A

relax patient

63
Q

what do anticholinergics and histamine receptor antihistamines do

A

decrease secretions and decrease aspiration

64
Q

when are antibiotics hung

A

1 hour prior to first cut

65
Q

what do we do for hygiene and skin prep

A

CHG baths

66
Q

what type of affect do CHG have

A

cumulative

67
Q

CHG decreases

A

bacterial load on skin

68
Q

why do we not shave the skin

A

can lead to micro cuts which breaks skin intergity

69
Q

since we don’t shave what do we do now

A

electric razor in OR

70
Q

clear liquids up to ___ hours before elective surgery

A

2

71
Q

light breakfast __ hours prior to surgery

A

6

72
Q

heavier meal allowed __ hours prior to surgery

A

8

73
Q

what is the main goal intraop

A

safety and monitoring

74
Q

increased hydration decreases

A

PONV

75
Q

what is PONV

A

postop nausea and vomiting

76
Q

what do we do before surgery

A

universal protocal

77
Q

what is a universal protocol

A

a timeout,
right patient, prodecure

78
Q

what does universal protocol decrease

A

senital events and adverse events

79
Q

what is included for safety

A

aspiration
positioning
body temp

80
Q

how do we prevent aspiration

A

fluids and positioning

81
Q

what is the time and pressure for capillary breakdown

A

30 mmHg for 2 hours

82
Q

we do not want hypothermia because what does that lead to

A

decrease blood flow which results in less o2 to site and less nutrients

83
Q

what vital signs show bleeding/shock

A

increase HR and decrease BP

84
Q

we want I&O

A

equal

85
Q

what do equipment counts limit

A

surgical souvenirs

86
Q

what does general anesthesia affect

A

LOC, analgesia, relaxation, loss of all reflexes, amnesia

87
Q

what is analgesia

A

pain relief

88
Q

what relaxes are included under loss of all relfexes

A

gag, airway, cough

89
Q

what does amnesia mean

A

don’t remember

90
Q

what does regional affect

A

analgesia, relaxation, and loss of all reflexes below sight of injection

91
Q

what does conscious sedation affect

A

analgesia, relaxation, amnesia

92
Q

what does topical/local anesthesia affecy

A

analgesia

93
Q

what is an example of regional

A

spinal block, epidural

94
Q

what is an example of conscious sedation

A

wisdom teeth

95
Q

what anesthesia has the greatest risk

A

general

96
Q

malignant hyperthermia inherited

A

autosomal dominat trait

97
Q

malignant hyperthermia is a reaction to

A

general anesthesia gases and neuromuscular blocking agents

98
Q

how will malignant hyperthermia react

A

increase in HR, RR, which leads to hyperthermia, disrhytmias and respiratory/metabolic acidosis

99
Q

what is the treatment for malignant hyperthermia

A

dantrolene

100
Q

what does malignant hyperthermia result in

A

death

101
Q

when should we pick up malignant hyperthermia

A

screening

102
Q

what is the main priority in PACU

A

assessment and prevention of complications

103
Q

how long do we normally stay in PACU

A

1 hour

104
Q

what do we want to see in vital signs

A

stable

105
Q

what do we want to see in LOC

A

waking up

106
Q

what is included in reversal of anesthesia

A

feeling back, gag and cough

107
Q

vital signs post op

A

Q15mins x4
Q30mins x4
Q1HR x4
Q4hrx4

108
Q

why do we check vital signs frequently on a post op patient

A

catch complication early
complications occur earlier

109
Q

what do we want to see in color and skin temp

A

warm so there is circulation and no hypothermia

110
Q

what reflexes do we want to see

A

cough and gag (protect the airway)

111
Q

how do we have the head of the bed on a patient with general anethstia

A

HOB up

112
Q

who do we want the HOB down and why

A

regional anesthetics, because if they are up they have a shift if cerebral spinal fluid which causes bad headaches so we want flat with head to side and suction in mouth

113
Q

what are some tubes and drains seen post op

A

JP/Hemovac/-Pressure/woundvac
penrose
trach
feeding (for decompress the stomach)
chest
ostomy
foley

114
Q

do we expect a patient with a ostomy to have output

A

no
- NPO and anesthetics

115
Q

how do we know if a patient has active drainage

A

draw a circle around the drainage on the dressing

116
Q

who removes the first dressing

A

surgeon

117
Q

what are some complications of the heart

A

hemorrhage and shock

118
Q

why will we see an increase HR

A

because CO=HRxSV and we cannot change stroke volume so we compensate by increasing HR

119
Q

what are some nursing interventions for hemorrhage and shock

A

monitor BP and HR
monitor I&O
assess dressing and drainage
monitor Hgb and Hct

120
Q

what are some complications with the lungs

A

thrombophlebitis
pulmonary embolus

121
Q

what are some nursing interventions for pulmonary embolism

A

SCD stockings and prophylactic low does heparin/lovenox
assess for sudden onset of chest pain, tachycardia, tachypnea, O2 and desat

122
Q

what is a saddle embolism

A

goes into both pulmonary arteries/veins

123
Q

what are some post op respiratory complications

A

atelectasis
aspiration
pnuemonia
respiratory arrest

124
Q

what are some interventions for respiratry complications

A

monitoring vital signs
implement coughing and deep breathing
SMILE
ambulating (expands chest and reserves anesthetics)
HOB 30 or higher
maintaining hydration (looses secretions)
avoid flat positioning that decreases ventilation
monitor response to narcotics (decreases reps)

125
Q

why would an obese person be high risk post op for respiratory

A

they are a hypo ventilator and they are receiving narcotics which slows resps

126
Q

lungs on an XRAY

A

costrophrenic angle

127
Q

black on XRAY

A

air

128
Q

what does early ambulation do

A

improve convalesce and decrease LOS, increase GI motility and decrease analgeisic use

129
Q

why is it important to get GI motility back

A

patient can drink and eat which leads to decrease PONV
decreases small bowel obstruction

130
Q

CABG

A

coronary artery bypass and graft

131
Q

early ambulation decreases

A

length of stay = decrease nosocomial ifection

132
Q

early ambulation

A

decreases NPO
low analgesic use
increase energy
decrease LOS
return to baseline function faster

133
Q

who’s going to have delayed wound healing

A

obesity
smoker
nutritionally deprived

134
Q

dehiscence and eviseration

A

splint

135
Q

monitor wounds by

A

drainage and WBC

136
Q

complications of PONV

A

pain and anxiety
delayed recovery
surgical site stress
dehydration
aspiration pnumonia
delayed resumption of eating
increase health care cost

137
Q

PONV risk

A

female
history of PONV
motion sickness
nonsmokers
post op use of opiods (prolong GI emptying)
surgery lasting longer than 60 min (more anesthetic)
obesity (longer time to remove anesthics, anesthetic love lipids)
pain

138
Q

prevention and treatment of PONV

A

asses for risk factors
500mL infused prior to OR
antiemetics given at first sign
cool cloth
GINGER ALE
change position slowly
deep slow breaths

139
Q

how do we remove sutures

A

cut on non knot side so not exposing outside thread to inside

140
Q

SCIP

A

surgical care intervention plan

141
Q

does aspirin only for DVT work

A

no

142
Q

does walking to bathroom work for DVT

A

no

143
Q

what surgery puts patients at greater risk for DVT

A

ortho

144
Q

how early do we hang antibiotic

A

1 hour before incision

145
Q

what is the exception to hanging antibiotics 1 hour before

A

vancomycin or clindamycin because they are aminoglycosides and they are nephroTOXIC

146
Q

when do we discontinue all antibiotics

A

within 24 hours after surgery
48 for cardiac patient

147
Q

when do beta blockers need to be taken

A

24 hour prior to surgery

148
Q

when do beta blockers start back up

A

post op day 1

149
Q

when does the foley get removed

A

on or before post op day 2

150
Q

what do we want glucose post op 18-24 hours after surgery

A

less than 180

151
Q

we need to document what

A

SCDS were placed during surgery for all procedures

152
Q

we ned to administer what before 24 hours of surgery end

A

DVT prophylaxis

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