Perioperative Patients Flashcards
(43 cards)
When does the peroperative period begin? When does it end?
– begins when pt is scheduled for surgery
– ends at the time of transfer to surgical suite
What are the 5 reasons for surgery? Describe each.
- diagnostic: determining cause of disorder
- curative: resolving health issues
- restorative: improving functional ability
- palliative: relieving symptoms for pt comfort
- cosmetic: altering appearance
What are the 3 ways to describe surgery based on urgency?
- elective: planned
- urgent: requires prompt intervention
- emergent: requires immediate intervention
What are the 3 ways to describe surgery based on extent?
- simple: only most affected areas involved
-
radical: extensive surgery beyond area obviously involved
- attempts to find root causes
- minimally invasive: performed through an endoscope
What is the nurse’s role in preoperation?
- clarification of the facts presented by the physician/surgeon
- acting as a witness for signed consent
- SIGNED consent, not INFORMED consent
What are the dietary restrictions for preoperative pts? Why?
– NPO for 6 - 8 hours prior to surgery
– decreases risk for aspiration
- surgery will be cancelled if pt is noncompliant
- written and oral directions provided
Which medications are permitted with a sip of water prior to surgery? Outside of these medications, how should a pt’s regularly scheduled medications be handled?
– meds permitted with sip of water prior to surgery:
- cardiac
- respiratory
- seizure
- HTN
– physician and anesthesia providers should be consulted on how to handle regularly scheduled medications other than the above
How is the GI tract prepared for surgery? Why?
– enemas or laxatives may be ordered
– preparations prevent injury to colon and reduce number of intestinal bacteria
How is the skin prepped for surgery? Why?
– washed with antiseptic solution and hair may be removed using clippers (razors may nick the skin)
– a break in the skin increases the risk for infection
What are 4 interventions that are used post-operatively to prevent respiratory complications?
- breathing exercises
- incentive spirometry
- cough and deep breath
- splinting of incision
What are the 2 purposes of pre- and post-operative pt teaching?
- decrease anxiety
- increase compliance
What are 3 interventions that are used post-operatively to prevent circulatory complications?
- leg exercises and ROM
- early ambulation
- support stockings (TEDs) or sequential compression devices (SCDs)
What 4 things can be taught to pts pre- and post-operatively regarding pain management?
- pain scale
- requesting/taking pain meds PRN
- PCA
- other mechanisms of pain control
What are 5 pre-operative anxiety interventions?
- pre-operative teaching
- encouraging communication
- promoting rest
- using distraction
- teaching family members
What are the 7 items the nurse should review in the pt’s chart pre-operatively?
- ensure documentation, pre-operative procedures, and orders are completed
- check surgical consent form for completion
- document allergies
- document height and weight
- ensure results of all labs and diagnostic tests are in chart
- document and report any abnormal results
- report special needs and concerns
What are the 6 things that the nurse must do to prepare the pt for surgery?
- ensure pt has removed most clothing and is wearing a hospital gown
- valuables locked up or with family
- tape rings in place that cannot be removed
- remove all pierced jewelry
- ensure pt has an ID band
- remove dentures, prosthetics, hearing aids, contact lenses, nail polish, and artificial nails
What are the 7 functions of pre-operative drugs?
- reduce anxiety
- promote relaxation
- reduce nasal/oral secretions
- prevent laryngospasm
- reduce vagal-induced bradycardia
- inhibit gastric secretion
- decrease amount of anesthetic needed
What is the intra-operative period?
begins once the pt enters the surgical suite and ends when the pt enters the recovery room
What is the purpose of universal protocol? What are the 3 items that comprise universal protocol?
– purpose – the Joint Commission protocol for prevention of wrong site surgery
– 3 items:
- verify pt using 2 identifiers
- mark surgical site
- time-out – verify pt, procedure, and site
What is anesthesia? What is it used for?
– anesthesia: induced state of partial or total loss of sensation, with or without loss of consciousness
– used to block nerve impulses, suppress reflexes, relax muscles, and control level of unconsciousness
What regions of the body does general anesthesia affect? What is the effect of general anesthesia?
– regions:
- head
- neck
- upper torso
- abdominal procedures
– effect – reversible loss of consciousness by use of a single agent or a combination of agents
What are the 5 stages of general anesthesia?
-
stage 1 – analgesia, sedation, relaxation
- pt can hear everything
-
stage 2 – excitement, delirium
- involuntary movement of extremities
-
stage 3 – operative anesthesia, surgical anesthesia
- loss of reflexes, depression of vital functions, surgery is ready to move forward
-
stage 4 – danger
- more pronounced depression of vital functions
- if not addressed, can result in respiratory failure or cardiac arrest
-
emergence – recovery from anesthesia
- pts will sometimes get sick as they come back – N/V, restlessness, shivering, rigidity, cyanotic
What is balanced anesthesia?
combination of IV drugs and inhalation agents used to obtain specific effects
What are 5 possible complications of general anesthesia?
- malignant hyperthermia
- could result as a complication from certain agents
- causes electrolyte disturbance
- high calcium
- increased muscle metabolism
- acidosis
- high potassium
- can treat with dantrolene
- overdose
- especially of concern in the elderly and pts with comorbidities
- unrecognized hypoventilation
- hypoxia – need to check perfusion before and after procedure
- complications of specific anesthetic agents
- complications of intubation
