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N230 exam 1 and 2 > Preop > Flashcards

Preop Flashcards

1
Q

Reasons for surgery

A

Diagnosis (biopsy)

Cure (removal of ruptured appendix)

Palliation (cutting a nerve root)
*doesn’t cure just enhances life

Cosmetic (burn repair, breast reconstruction)

May be emergency/urgent or elective

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2
Q

Settings for surgery

A

Ambulatory surgery

Impatient surgery

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3
Q

Ambulatory surgery

A

aka (same day/outpatient)

Stable

Pt evaluated in office prior to procedure, gets medical clearance from PCP as needed

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4
Q

Inpatient surgery

A

May be planned admission

May be emergent or based on something found during admission

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5
Q

Perioperative nursing care

A

Preop: decision to do surgery until OR

Intraop: OR until PACU

Postoperative: Pacu until meeting w/ provider (last visit)

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6
Q

Pre op assessment***

A

Identify risk

Establish baseline for comparison
Including:
Health history
ROS
Head to Toe Exam

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7
Q

Health History ***

A

-Allergies and intolerances

-Past surgeries

-Women: LMP

-FH: malignant hyperthermia, Heart disease, or with anesthesia

-Medication list : all perscription, OTC, and herbal meds
*HTN and DM meds can interfere with anesthesia

-Substance abuse
*smoking, ETOH

Dentition: dentures or dental abcess

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8
Q

Why should we repost sulfa allergies ASAP?***

A

Some local anesthetics contain preservatives with bisulfate

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9
Q

What meds should you look out for in surgery ***

A

HTN

DM meds

Long term anticoagulants (warfarin) needs to be held for a certain time before surgery depending on the type

Asprin

Herbal meds

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10
Q

What herb meds should you hold and why ***

A

Garlic, Vit E, Gingko, fish oil: increase risk of bleeding

Kava, valerian: increase risk of sedation

Astragalus, ginseng: increase BP

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11
Q

Problem with piercings in surgery

A

Can cause arch with a spark and cause a fire

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12
Q

What to look out for in arthritis pts

A

Position in OR

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13
Q

DM risk in surgery ***

A

Hypoglycemia:
-delayed wound healing
-infection

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14
Q

Physical exam ***

A

VS, Glucose, Ht/Wt

Head to toe

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15
Q

What are some things you would report to the HCP?

A

VS

Labs

Anticoagulant use

H/o Issues with anesthesia

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16
Q

Psychological assessment

A

Identify gaps of knowledge and fear

Record relevant cultural beliefs

Common fears

Support hope

17
Q

RBC

A

men: 4.3-5.7

Women: 3.8-5.1

18
Q

Hgb

A

Men: 13-18

Women: 12-16

19
Q

Hct

A

Men: 42-52%

Women: 37-47%

20
Q

WBC

A

4,000-11,000

21
Q

Platelets

A

150,000-400,000

22
Q

Albumin

A

3.5-5

23
Q

Sodium

A

135-145

24
Q

Potassium

A

3.5-5

25
Q

Glucose

A

70-110

26
Q

Calcium

A

8.5-10.5

27
Q

BUN

A

8-20

28
Q

Creatinine

A

0.6-1.2

29
Q

Preop testing/labs ***

A

CBC: wbc, hgb, hct, plt
Electrolytes, renal, liver function
HCG
UA
Type and cross match: for blood
Coags: PT/PTT, INR
EKG
CXR
PFT
ABG

30
Q

Informed consent ***

A

Must be signed and surgeon/anesthesiologist must discuss:
-procedure/risk
-benefits and alternative treatments

Must get consent voluntarily and pt should show clear understanding before any sedating meds

Nurse should advocate for pt

surgeons responsibility

31
Q

Situations where you can not get consent is***

A

Minor, mental incompetent, unconscious

Get emergency censent: document well the need for intervention (may have to fill out an incident report)

32
Q

Preop teaching ***

A

-abdominal splinting
-plan for main management/ report pain
-deep breathing/ coughing
-early ambulation
-ROM exercises
-no driving postop (ambulatory surgery)
-what youll see/hear/smell
-drains/equipment theyll see postop

33
Q

What complications are we trying to prevent with preop teaching ***

A

Bloodclots

Sepsis

Allergic reactions

Adverse reactions

Atelectasis

34
Q

Preop meds

Classes to know ***

A

Antibiotics: start one hour before incisions

Beta blockers: reduce postop cardiac dysrhythmias

Antidiabetics (insulin): for blood surgar

35
Q

Preop meds

Know drug names ***

A

Benzodiazapines: midazolam (relax them)

Opioids: fentanyl, morphine (relax them)

Anticholinergics: scopolamine (nausea)

Antiemetic: ondansetron (nausea)

36
Q

Preop checklist ***

A

Signed infromed consent
ID band on/allergy bands
Site marked: done by pt with physician
Skin prep/hair removal
NPO
Chart ready
Personal items removed/labeled
Preop med given at bedside as ordered

37
Q

Transport pt to OR

A

Chart with you, checklist complete

SBAR communicated to OR staff

Direct family to waiting room

38
Q

Considerations for older adults

A

Discuss advanced directives

Leave glasses/hearing aids in until pt is under anesthesia

May have fear/anxiety not making it home

Increased risk of anesthesia/surgery

Fluid balance

N230 exam 1 and 2 (11 decks)

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