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Perioprerative Flashcards

1
Q

Reasons for surgical intervention

A

-Diagnostic
-Palliative
-Preventive
-Curative or repair
-Transplant
-Cosmetic
-Explorative

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2
Q

General Principles/Effects of Surgery

A

-Evokes a major stress reaction on the body
-Lowers body’s defenses
-Disrupts of vascular system
-Organ functions are disturbed
-body image can be disturbed
-Lifestyle may change

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3
Q

-Ectomy

A

Cutting into/incision of

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4
Q

-Oscopy

A

Repair or reconstruction of

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5
Q

-Ostomy

A

Opening into

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6
Q

-Otomy

A

Looking into

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7
Q

-Plasty

A

Remove

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8
Q

Classifications of surgery

A

-Emergency: immediately
-Urgent: 24-30 hours
-Required: need surgery in upcoming weeks
-Elective: should have
-Optional: not nessacary - a choice
-Inpatient
-Ambulatory (same day surgery)

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9
Q

Perioperative nursing period that constitutes the surgical experience includes three phases:

A

-Preoperative phase
-Intraoperative phase
-Postoperative phase

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10
Q

Preoperative phase

A

The period from the decision for surgery until the patient is transferred into the operating room

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11
Q

Intraoperative phase

A

The period from when the patient is transferred into the operating room to the admission to the PACU

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12
Q

Postoperative phase

A

The period that begins with admission to the PACU and ends with follow-up evaluation in the clinical setting or at home

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13
Q

Preoperative care

A

-Occurs in advance or on day of surgery
-Most often completed in the Preoperative admission clinic (PAC), or the hospital Preoperative area

Purpose:
-Obtain health information
-Determine expectations
-Assess emotional state and readiness
-Assess knowledge and understanding in preparation for discharge planning and postoperative teaching

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14
Q

Pourpouse of Preoperative nursing assessment

A

-Determine psychological status
-Determine physiological factors
-Identify cultural and ethnical factors that may affect the surgical experience
-Determine if the client has assaulted information to make and informed decision and ensure that the consent form is signed
-Establish baseline data
-Plan and institute post op care

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15
Q

Pre-op assessment

A

-Psychosocial
-Past and present health history
-Cardiovascular system
-Respiratory system
-Renal, hepatic, musculoskeletal, endocrine systems
-Nutritional status
-Medications (and also herbals), allergies

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16
Q

Pre-op teaching

A

-Client has right to know what to expect and how to participate
•reduces fear, anxiety, stress, pain, and vomiting
-Several days before surgery
•observe and listen to determine amount of teaching for each session
•anxiety and fear can hinder learning
•give priority to clients concerns

-Routines
-DB & C exercises
-PCA
-Surgery specific information
-Pre-op prep if required
-Bloodwork (see activity #2)

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17
Q

Legal preparation

A

All required forms are signed and in chart
•informed consent
•blood transfusions
•Advance directives
•Power of attorney

-Surgeon is responsible for obtaining consent
-Nurse may obtain and witness signature (not student)
-Document in client chart
-Verify client has understanding
-Clients permission may be withdrawn at anytime

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18
Q

Informed consent

A

Must be valid
-adequate disclosure, understanding and comprehension, operative consent signed prior to administration of pre-op medication, voluntary given

Surgeon is responsible for obtaining consent
-RN might witness signature
-Verify client has understanding
-Clients permission may be withdrawn at anytime

A legally appointed representative of family may consent if client is
-A minor
-Unconscious
-Mentally incompetent

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19
Q

Nursing responsibilities: pre-op

A

-Admission history/ physical exam on chart
-Consultation records
-Nurses notes
-Baseline V/S
-Weight
-Appropriate tests (CXR, EKG) completed
-Urinalysis completed
-Blood work (CBC, lytes, Xmatch,…) completed
-ID and allergy bands on wrists
-Valuables returned to family
-Other pre-op diagnostic tests

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20
Q

Nursing responsibilities: pre-op continued

A

-Health teaching
-Signed consent in chart
-Shave prep if required
-NPO
-Insert foley if ordered
-I&O
-IV
-Prosthesis out
-Clean hospital gown
-Rings off/ taped; jewlery; dentures, contacts, prostheses removed
-Nail polish/ makeup off
-avoid prior to going
-Pre-op meds if ordered (sedation, antibiotics)
-Safety issues (ie side rails, call bell near)
-Pre-op checklist… is charting up to date
-Room ready for return
-Instruct family on waiting area where they can be informed of progress

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21
Q

Age related considerations

A

Nurse must be particularly alert assessing and caring for older adult surgical clients
-An event that has little effect on a younger client may be overwhelming to the older client
-Greater risks associated with Anastesia, surgery
-Greater risk for post operative complications

Consider clients physiological condition, not just chronological age.

22
Q

Nursing interventions-Preoperative

A

-Physical preparation
-Nutrition
-Elimination
-Removal of items that may impede assessment or cause injury
-Identification and allergies verified
-Surgical site
-Voiding
-Pre-anesthetic medications
-Psychosocial preparation
-Anxiety
-Need for information
-Privacy
-Cultural care

23
Q

Nursing care: documentation

A

-Pre-op checklist
-Physical and diagnostic work-up complete
-Patient physically prepared
-Current condition
-Medication Reconciliation
-Current vital signs

24
Q

Day of surgery

A

-Consent and progress note in chart
-Pre-op checklist
-Pre-op meds (ie benzodiazepines, narcotics, H2 receptor antagonists, antacids, anti-emetics, anti-cholinergics)

25
Common pre-op medications: to decrease anxiety
-Versed -Valium -Ativan
26
Common pre-op medications: for sedation and analgesia
-Morphine -Demerol
27
Common pre-op medications: to increase gastric PH and decrease gastric volume
-Tagamet -Pepcid -Zantac
28
Common pre-op medications: nausea and vomiting
Antiemetics
29
Common pre-op medications: to decrease oral and gastric secretions
Anticholinergics (I.e atrophine)
30
Common pre-op medications: other meds you may see ordered pre-op
-Eyedrops -Heparin -Antibiotics
31
Informed consent
Consider the following questions -What is an informed consent? -What’s the RNs role? -What’s the students role? -What is not our role?
32
Types of anesthesia
-General -Dissociative (ie ketamine) -Local (ie spinal, epidural)
33
Intraoperative: Nursing Management
1. Pre-op med (ie. atrophine) 2. Iv induction (ie dipropvan) 3. Inhalation agent (ie. halothane) 4. Opiates + neuromuscular blocking agents
34
OR emergencies
-Hemorrhage -Cardiac arrest -Hemodynamics instability -Anaphylaxis -Malignant hyperthermia -Hypovolemic shock
35
Postop care: PACU, nursing responsibilities
-Receive verbal report from anesthetist (ie intra-op complications, EBL) -Airway management, oxygen therapy… watch for hypoxemia, ineffective respirations -Monitor VS, ECG (compare with baseline) -LOC, orientation of pt. (Watch for emergence delirium) -I & O -IV lines, drains, dressings (type and amt of drainage)
36
Complications: PACU
-Airway obstruction -Hypoxemia -Hemodynamic instability -Neurologic compromise -Hypothermia -Pain -N & V
37
Blood Transfusion
-General Principles -Types of blood products
38
Post-op care on the unit
-Assessment is critical -Watch for: respiratory difficulty, hemorrhage, hemodynamic instability, fluid and electrolyte balance -Ongoing… watch for return of bowel sounds, pain management, post op DB & C as well as leg exercises
39
Post op checks upon patients return from PACU to unit
-Surgical procedure preformed -Time of arrival -Check Drs orders with primary nurse (post op orders) -airway, breathing, circulation, Meier status (LOC) (Systems assessment) -Dressing and incision -VS •q 15 mins x 2 hrs •q 1/2hr x 2hrs •…refer to agency policy -IV -Catheter/drainage tubes
40
Post-op checks upon patient’s return to unit continued
-Breathing-position for airway maintenance, comfort & safety (lateral) -CV: circulation, colour, temp… -GI/GU -Surgical site -pain -Orient to room -Call bell within reach -Traction devices -Post op bath -Health checks -Emesis basin -Early ambulation (refer to agency guidelines re spesific procedures) -Emotional (family now back in room)
41
Assessment on the clinical unit: post-op
-Respiratory function -Cardiovascular, hematologic, and circulatory function -Temperature -Fluid and electrolyte balance -Neurological status -Pain and discomfort -Gastrointestinal function -Urinary function -Integumentary function and wound assessment -Nutritional status
42
Other potential post-op complications
-Atelectasis -Pulmonary embolus -Infection -Alterations in Temperature -Thrombophelebitis -Fluid and electrolyte Imbalances (e.g. hypovolemic shock) -Impaired surgical wound healing/infection -Delirium
43
Maintain Respiratory function
-Deep breathing and coughing -Incentive spirometer -Early ambulaiton -Turning side-to-side -O2 as ordered -Regular Respiratory assessment
44
Avoiding atelectasis
-Collapse of alveoli with retained mucous secretions due to decreased lung expansion -S&S increased respirations, dyspnea, crackles, cough
45
Avoiding pneumonia
-Inflammation of alveoli -S&S: fever, chills, productive cough, chest pain, purulent sputum
46
Prevent circulatory stasis
-Leg exercises q1 -Apply TEDS as ordered -Early ambulaiton -Avoid positioning that disrupts blood flow to the extremities -Anticoagulant drugs (heparin) -Adequate fluid intake -Regular C/V assessment-BP, HR, perfusion, hemorrhage
47
Prevent infection
-Aseptic technique -Assess surgical wound-change dressings as per orders/routines -Looking for: •wound infection (3-6 days post-op) (>37.7°) •Dehiscence •Evisceration
48
Promote comfort
-Assess pain frequently -Provide pain medications -Make sure they understand PCA machine-respirations A12 -Provide blankets -Good mouth care -Positioning comfort
49
Assess and promote fluid balance and urinary elimination
-Important to assess 1st void (colour, amount, at least 30ml… up to 200ml/hr) consistently, odour. -To bathroom ASAP - normal position -Inspect abdominal contour, palpate & percuss for distension; in some institutions, bladder detectors are used to detect bladder volumes. -Catheter may be ordered (if voiding has not occoured in 8-12 hours) -Accurate I&O -Check output from all drains, tubes, etc…
50
Nursing interventions: Post-op
-Integumentary function and wound assessment -Repositioning -Use of support surfaces and special beds -Dressing changes -Monitoring of and maintenance of drains -Psychological function -Provide emotion support to Patient and family/support network
51
Discharge preparation
-Meds -Appointments -Dressings -Complicaitons -Any specific discharge instructions (ie. mobility, cast care) -Provide written and verbal instructions. -Give prescriptions and phone numbers. -Discuss actions if complications occur. -Give instructions to patient and responsible adult who will accompany the patient. -patients are not to drive home or be discharged to home alone. Sedation and anesthesia may cloud memory and judgment and affect ability.

Health Challenges (13 decks)

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