perioperative nursing Flashcards by Chyanne Caniglia

what are the purposes of surgery

diagnosis
cure
palliation: alleviate symptoms
preventions
exploration
cosmetic

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why is it important to know the surgical patients prescribed and OTC meds

some vitamins/herbs can increase/decrease effectiveness of anesthetics
-allergies
ask about hay fever, asthma, allergy to bananas, kiwi, guava, avocados

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what are the preoperative interview purposes

patient health history
patient expectations
provide and clarify info
assess emotional state
verify that consent is signed

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Discuss effective preoperative teaching with an older adult that has difficulty seeing and hearing.

Allow additional time for teaching, ensure adequate lighting and quiet environment for teaching, ensure safety if patient experiences balance, thought or cognitive deficits

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Why is deep breathing/incentive spirometer and coughing important for surgical patients? What would be appropriate to do for an abdominal surgical patient prior to coughing and deep breathing?

Prevention of complications – pneumonia, atelectasis, pulmonary embolism. Pt with abd

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What would be an appropriate intervention when the surgical patient refuses to take off their wedding ring?

tape it to their finger

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Why is the bedpan the only option for patients that have received preoperative IV medications?

After preop meds are given pt is at a higher risk for falls. Safety first!

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Review principles of basic aseptic technique.

All materials entering sterile field must be sterile
• Front from chest to table level and the sleeves to 2 inches above the elbow are sterile
• If sterile item comes in contact with an unsterile item, it is contaminated
• Tables sterile on tabletop only
• Edges of sterile packages are not sterile
• Bacteria harbor on the skin
• Must maintain margin of safety between sterile and non-sterile (1 inch)
• Bacteria travels on airborne particles

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What is general anesthesia

General anesthesia- the loss of sensation, with loss of consciousness, skeletal muscle relaxation, analgesia, and elimination of the somatic, autonomic and endocrine responses, including coughing, gagging, vomiting, and sympathetic nervous system responsiveness.

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Two types of General Anesthetic Agents:

Intravenous induction agents- usually start with this IV induces pleasant sleep lasts a few mins. ET tube and inhalant started
2. Inhalation- Foundation of general anesthesia enters body through alveoli in lungs via mask or ET-Tube can irritating and produce laryngospasms
Patient risks- damage to teeth, irritation of vocal cords

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what are adjunct to general anestheia

are added to the anesthetic regimen to achieve unconsciousness, analgesia, amnesia, muscle relaxation, or autonomic nervous system control.

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what is dissociatvie anesthesia

interrupts associative brain pathways, pt appears catatonic is amnesic and experiences profound analgesia into post-op period. Ketamine used promotes bronchodilation (used for asthmatic patients), however can produce hallucinations

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what is local anesthesia

allows op procedure to be performed on a part of body without loss of consciousness or sedation. Topical, ophthalmic, nebulized, or injectable.

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what is topical anesthesia

Applied directly to skin (EMLA 30-60 minutes before procedure)

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what is local infiltration

inject into tissues through which incision will pass- lidocaine.

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what is regional

(peripheral) nerve block

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what are the types of regional

Spinal- injection of local anesthesia in CSF usually below L2. Mixes with CSF. Has faster onset, increased H/A with leakage @ injection site.
o Epidural- injection into epidural space. Does not enter CSF, binds to nerve roots entering and exiting spinal cord.

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Define malignant hyperthermia. What is the treatment?

A rare metabolic disease characterized by hyperthermia with rigidity of skeletal muscles that can result in death. Defect is hypermetabolism of skeletal muscle resulting from altered control of intracellular calcium. This causes muscle contractures, hyperthermia, hypoxemia, lactic acidosis, and hemodynamic and cardiac alterations. Can be prevented by obtaining a thorough family history and alert to MH s/s during the perioperative period.

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what is the definition of surgery

the art and science of treating disease injuries and deformities by operation and instrumentation

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what are the preoperative medications

antibiotics- precent postoperative infection
benzodiazepines- sedative and amnesic effect, decrease anxiety
anticholinergics- decrease oral and respiratory secretions
opiods- decrease pain
antimetics- increase gastic emptying, prevent nausea and vomiting

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what are the routes of Preop meds

oral- 60-90 mins before
IM,SC 30-60 mins before
IV admiinist in OR

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in the unrestricted surgical suite what is the attire

those in street cloths can interact with those in scrubs

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int he semi restricted area in the surgical suite whats the attire

peripheral support areas and corridors- only authorized and must wear scrubs

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in the restricted area in the surgical suite what is the attire

Study These Flashcards

must weak masks and scrub sink area

what does the circulating nurse do

Prepares room, ID pt, check chart, admits pt to OR, monitoring devices in place, monitors asepsis, labels monitors and measures blood and fluid loss, assists ACP,(Anesthesia care provider) records med used, counts sponges, coordinates activities (students), reports to PACU, goes with patient.

what does the scrub nurse do

Assists with prepping room, scrubs, gowns & gloves self and others, prepares instruments on table, counts sponges, and needles, assists with draping, keeps track of irrigation solution, reports amount of anesthesia used ACP. Keeps hands above operating table level.

what does the LPN or surgical tech do

scrub function, passes instruments, supervised by RN

what does the surgeon and assistant do

perform surgical procedure

what does the registered nurse first assist do

works collaboratively with surgeon, may provide/require formal education

what does the nurse anesthetist do

administers anesthesia, assess pt preop- P-rating scale, prescribe preop meds, monitors cardio and resp function, VS’s, fluid and blood.

what are the 4 levels of sedation

Mild- pt responds normal Moderate (conscious sedation) - airway and C-V function are maintained, maintains his/her own airway with emotional and physical acceptance of painful stimuli, used for diagnostic procedures, monitor closely Deep- pt not easily aroused Anesthesia- pt requires assisted ventilation

what are the phases of general anesthesia

Phases: o Preinduction-Pre-op meds to start of IV, monitors, etc.. o Induction- Start of med sequence rendering pt unconscious o Maintenance-During procedure, pt unconscious o Emergence- Surgery complete, pt prepared for return to consciousness, removal of airway

what are the patient risk with general anesthetic

damage to teeth | irritation of vocal cords

what are the two types of local anesthesia

topical | local infiltration

what are catastrophic events in the OR

anaphylactic reactions | malignant hyperthermia

what is an anaphylactic reaction

Most severe form of allergic reaction characterized by decreased BP, tachycardia, bronchospasm, pulmonary edema (ABX or latex?) Reaction may be masked by anesthesia

what is the treatment for malignant hyperthermia

Rapid administration of Dantrolene (slows metabolism) is a skeletal muscle relaxant along with cardiac support and iced saline lavage to body cavities

what is the primary trigger of a malignant hyperthermia

succinlycholine

hypventialtion is caused by

opioids

when should post op patent do deep breathing

10 times every hour while awake

when should you change patients position

every 1-2 hours

when should you notify the surgeon

``` systolic BP less than 90 or greater than 160 pulse less than 60 or greater than 120 pulse pressure narrows BP trends up or down Change in heart rhythm ```

deep breathing is encouraged to

aid in gas exchange

what are petition cardiovascular risk problems

hypotension hypertension dysrhymia

early ambulation associated with walking

increase muscle tone stimulate ciruclation increases vital capacity maintain normal respiratory function

what is DVT prevention

Administering LMWH (low molecular weight heparin) in combination with antiembolism stocking

how to prevent syncope

by making changes slowly in the patient’s position. Raise patient’s head of bed first and then assist patient to sit on the side of the bed. If faintness occurs the nurse can help the patient to a nearby chair or ease the patient to the floor

emergence delirium can include what behaviors

``` restlessness agitation disorientation thrashing shouting ```

what is delayed emergence

-the most common cause is prolonged drug action- particularly opioids, sedatives, and inhalation anesthetics

the most common cause of post op aviation is

hypoxemia

what is the most reliable indicator of pain

patients self report

during the first 48 hours of post op

opioid are used and then after that nonopioid are used

what are non pharmacologic approach of helping with acute pain

music imagery relaxation aromatherphy

when should you take the temperature

every 4 hours for the first 24 hours

what are hiccups in the GI problems

irritation by the phrenic nerve

what is low output caused by

increase aldosterone and ADH

what is wound dehiscence

separation and disruption of previously joined wound edges

what are gerontologic considers

Decreased respiratory function, Decreased ability to cough and Decreased thoracic compliance - increases work of breathing and decreases ability to eliminate drugs – need to monitor reaction to drugs. Pneumonia – common complication Altered vascular function due to atherosclerosis and decreased elasticity in blood vessels. Compromised cardia function – decreased circulating blood volume, HTN common. Drug toxicity due to decreased renal perfusion – decreased ability to excrete drugs. Changes in mental status due to age, history of alcohol abuse, poor baseline cognition, hypoxia, severe metabolic derangement, hypotension, polypharmacy. Pain control – do not want to ask for medications.

perioperative nursing Flashcards

(58 cards)