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Adult Health Nursing I > Perioperative Nursing > Flashcards

Perioperative Nursing Flashcards

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1
Q

What are some reasons why surgery is performed?

A 
Diagnostics; 
Cure; 
Palliation; 
Prevention; 
Cosmetic; 
Exploration
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2
Q

Two times surgery is performed…

A

Elective;

Emergency

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3
Q

Diagnostic surgery

A

Determine the extent of a condition

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4
Q

Diagnostic Surgery

Example

A

Biopsy

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5
Q

Surgery for Palliation

A

Done to alleviate symptoms without curing the disease to increase the quality of life of a patient

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6
Q

Surgery for Prevention

A

To remove a growth before (or to prevent) malignancy

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7
Q

Surgery done in which the client has time to prepare and plan.

A

Elective Surgery

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8
Q

To have surgery quickly would be

A

Emergency Surgery

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9
Q

What determines whether or not a surgery will be inpatient or outpatient?

A

Complexity of Surgery;
Recovery;
Needed level of post op care

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10
Q

Benefits of Outpatient Surgery

A

Decreased Cost; Reduced HA-infections;
Less interruption in daily routine; less time missed at work;
Less physiologic stress to patient and family

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11
Q

3 Phases of Perioperative Care

A
  1. Preoperative
  2. Intraoperative
  3. Postoperative
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12
Q

When does pre-op begin?

A

Begins when decision is made to have surgery until transfer to the OR

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13
Q

When does intraoperative phase begin?

A

From Entry into the OR to Transfer to recovery

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14
Q

When does post-op phase begin?

A

From Admittance to recovery to complete recovery of the patient

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15
Q

Definition of Informed Consent

A

Active, shared decision-making process between the provider and the patient

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16
Q

3 Conditions of Informed Consent

A
  1. Adequate Disclosure
  2. Clear understanding of the information by the patient BEFORE the administration of sedating drugs.
  3. Patient must give voluntary consent
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17
Q

What does it mean to give Adequate Disclosure in Informed Consent?

A

The surgeon must discuss:

  1. Diagnosis. 2. Nature and purpose of treatment
  2. Probability of a successful outcome
  3. Availability, benefits, risks of alt treatment
  4. Prognosis if not implemented
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18
Q

Who must give the person Adequate Disclosure to meet the condition of Informed Consent?

A

The surgeon is responsible for adequate disclosure

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19
Q

What is the nurse’s role in obtaining informed consent?

A

Verify the identity of the patient;
Witness patient signature;
Make sure all the conditions are met

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20
Q

5 Steps in Preoperative Nursing Assessment

A
  1. Past Medical History
  2. Document Current Medications
  3. Allergies
  4. Diagnostic Studies
  5. Review of Systems
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21
Q

PreOp Nsg Assessment:

Parts of PMH

A

Medical History: Previous Surgeries & Complications

Family History

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22
Q

Medications that should be especially paid attention to for documentation during pre-op.

A 
Opioids,
Antihypertensives,
Diabetic Medications,
Antiplatelets,
Immunosuppressive,
Herbal Supplements
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23
Q

Diagnostic Studies to include in Pre-Op Assessment

A

CBC, Coag,
Electrolytes, Chest X-ray; EKG;
Liver and Kidney function`

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24
Q

Types of Medications given in PreOp setting:

A

Antibiotics; Anticholinergics; Antidiabetics;
Antiemetics; Benzodiazapines; beta blockers;
Histamine receptor antagonists;
Opioids

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25
Priority NANDA Diagnoses: | Preoperative
Fear Anxiety Knowledge Deficit
26
A controlled environment to minimize the spread of pathogens and allows for the smooth flow of patients, staff and equipment needed to provide safe patient care.
Surgical suite
27
3 Areas of a surgical suite
1. Unrestricted Area 2. Semi-Restricted Area 3. Restricted Area
28
What is the unrestricted area of the surgical suite?
People in street clothes can interact w/ those in surgical attire; Ex. Holding area where caregivers can wait with the patient
29
What is the semi-restricted area of the surgical suite?
Area outside of the OR for those in surgical attire w/ head and facial hair covered
30
What is the restricted area of the surgical suite?
Inside the OR; | Masks must also be worn in addition to the head and facial hair coverings
31
Members of the Perioperative team | 7 Members
1. Scrub Nurse 2. Circulating Nurse 3. Surgeon 4. Surgical Tech 5. Surgical Assistant 6. RN 1st Assistant 7. Anesthesiologist or CRNA
32
What is the role of the perioperative nurse?
RN who implements plan of care
33
What types of perioperative nurses are there?
Scrub Nurse | Circulating Nurse
34
Whit is the role of the scrub nurse?
Perform sterile procedures using sterile technique
35
What is the role of the circulating nurse?
Perform activities and documentation that require non-sterile technique.
36
What does Safety in the OR entail?
Prevention of wrong site surgery and retention of foreign objects; Accurate labeling and handling of specimens; Prevent thermal, electrical, and chemical burns; Safe blood, fluid, med admin.; Prevention of positioning injuries
37
What are some things that you should ensure when positioning a client after the administration of anesthesia?
Provide correct musculoskeletal alignment, Adequate thoracic excursion, and modesty of exposure. Prevent undue exposure on nerves, skin, bony prominences, earlobes and eyes; occlusion of arteries and veins. Recognize and respect individual needs such as previously assessed pain and physical deformities.
38
Why is it important to monitor the patient for hypothermia during surgery?
Patient is at increased risk of hypothermia because of altered temperature control of the body because of anesthesia and the cool temperature of the OR
39
Why is the OR kept cool?
Prevention of growth of microorganisms | Comfort of the surgical team who is dressed in layers of surgical attire
40
What has unintended hypothermia been linked to?
Impaired wound healing Adverse cardiac events Altered drug metabolism Altered blood clotting
41
How to clean incision site?
Scrub in circular motion, clean to dirty (or incision site and moving outward)
42
``` Anesthesia Techniques (5 types) ```
``` Moderate -> Deep Sedation Monitored Anesthesia Care General Anesthesia Local Anesthesia Regional Anesthesia ```
43
Who can perform moderate to deep sedation?
Trained RN can administer
44
Where is moderate to deep sedation usually done? What is an example?
Outside the OR | Ex. Colonoscopy
45
Where is monitored anesthesia care done? Who can administer and why?
In or outside the OR; | Administered by anesthesiologist or CRNA because of a possible conversion to general anesthesia.
46
What is general anesthesia?
Can be through IV or inhaled meds. Patient is intubated and airway is managed by the surgical team.
47
What is local anesthesia?
Interrupts nerve impulses by altering the flow of sodium into nerve cells; Does not require sedation or loss of consciousness
48
What are some ways local anesthetics can be administered?
Topical; ophthalmic; | nebulized or injected
49
What is a regional anesthetic? How is it administered? What is an example?
Regional anesthetic involves a central or group of nerves that supply an area remote to injection. Always Injected Ex. Epidural
50
Intraoperative surgical risks:
Thromboembolism and DVT —> PE; Anaphylactic reactions; Adverse cardiac reactions r/t ischemia; Malignant Hyperthermia
51
What are some NANDA diagnoses for intraoperative care?
Ones that focus on: Airway, breathing, circulation, temperature, pain; Risk for: imbalanced fluid volume, infection, injury, impaired skin integrity
52
Immediate actions during postoperative care?
Monitor vital signs and surgical site Assess: Airway, breathing, mental status, LOC, hydration status, pain level Provide emotional support
53
Respiratory Problems during Post-Op Care?
Airway obstruction Hypoxemia Hypoventilation
54
Cardiac Problems seen in PostOp care
Hypo/Hypertension; Dysrhythmias; Fluid Retention; Hypokalemia; DVT; Syncope
55
Neurological problems during PostOp recovery?
PostOperative cognitive dysfunction | Delirium
56
What is postoperative cognitive dysfunction?
When patient experiences memory problems after surgery; especially after multiple surgeries; related to anesthesia
57
What is the most important thing to teach about the PCA pump and something that the nurse should be checking on?
The PCA pump should be controlled by the patient and not the family. It would be easy to oversedate the patient and possibly lead to a negative outcome.
58
During the postoperative period immediately following surgery, how often should pain be assessed and medications be administered.
Around the clock; to achieve therapeutic pain management level.
59
Gastrointestinal problems related to surgery
Nausea & Vomiting Ileus Constipation Hiccups
60
What is the standard value for urinary output
0.5 ml/kg/hr
61
NANDA Diagnoses during PostOperative Phase
Risk for: Infection, Falls Pain Impaired skin integrity Knowledge Deficit
62
Surgical Risk and Safety Protocols
Surgical Care Improvement Project (SCIP); National Patient Safety Goals; Handoff (Handover); Medication Reconciliation
63
What is handoff/handover communication?
Documentation for each area; | Increases communication between all units and the providers
64
What is medication reconciliation?
Lets the providers/caregivers know what medications should be continued in each area

Adult Health Nursing I (3 decks)

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