Preop

Question 1

Reasons for surgery

Answer 1

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

Question 2

Settings for surgery

Answer 2

Ambulatory surgery

Impatient surgery

Question 3

Ambulatory surgery

Answer 3

aka (same day/outpatient)

Stable

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

Question 4

Inpatient surgery

Answer 4

May be planned admission

May be emergent or based on something found during admission

Question 5

Perioperative nursing care

Answer 5

Preop: decision to do surgery until OR

Intraop: OR until PACU

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

Question 6

Pre op assessment***

Answer 6

Identify risk

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

Question 7

Health History ***

Answer 7

-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

Question 8

Why should we repost sulfa allergies ASAP?***

Answer 8

Some local anesthetics contain preservatives with bisulfate

Question 9

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

Answer 9

HTN

DM meds

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

Asprin

Herbal meds

Question 10

What herb meds should you hold and why ***

Answer 10

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

Kava, valerian: increase risk of sedation

Astragalus, ginseng: increase BP

Question 11

Problem with piercings in surgery

Answer 11

Can cause arch with a spark and cause a fire

Question 12

What to look out for in arthritis pts

Answer 12

Position in OR

Question 13

DM risk in surgery ***

Answer 13

Hypoglycemia:
-delayed wound healing
-infection

Question 14

Physical exam ***

Answer 14

VS, Glucose, Ht/Wt

Head to toe

Question 15

What are some things you would report to the HCP?

Answer 15

VS

Labs

Anticoagulant use

H/o Issues with anesthesia

Question 16

Psychological assessment

Answer 16

Identify gaps of knowledge and fear

Record relevant cultural beliefs

Common fears

Support hope

Question 17

RBC

Answer 17

men: 4.3-5.7

Women: 3.8-5.1

Question 18

Hgb

Answer 18

Men: 13-18

Women: 12-16

Question 19

Hct

Answer 19

Men: 42-52%

Women: 37-47%

Question 20

WBC

Answer 20

4,000-11,000

Question 21

Platelets

Answer 21

150,000-400,000

Question 22

Albumin

Answer 22

3.5-5

Question 23

Sodium

Answer 23

135-145

Question 24

Potassium

Answer 24

3.5-5

Question 25

Glucose

Answer 25

70-110

Question 26

Calcium

Answer 26

8.5-10.5

Question 27

BUN

Answer 27

8-20

Question 28

Creatinine

Answer 28

0.6-1.2

Question 29

Preop testing/labs ***

Answer 29

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

Question 30

Informed consent ***

Answer 30

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

Question 31

Situations where you can not get consent is***

Answer 31

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

Question 32

Preop teaching ***

Answer 32

-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

Question 33

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

Answer 33

Bloodclots Sepsis Allergic reactions Adverse reactions Atelectasis

Question 34

Preop meds Classes to know ***

Answer 34

Antibiotics: start one hour before incisions Beta blockers: reduce postop cardiac dysrhythmias Antidiabetics (insulin): for blood surgar

Question 35

Preop meds Know drug names ***

Answer 35

Benzodiazapines: midazolam (relax them) Opioids: fentanyl, morphine (relax them) Anticholinergics: scopolamine (nausea) Antiemetic: ondansetron (nausea)

Question 36

Preop checklist ***

Answer 36

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

Question 37

Transport pt to OR

Answer 37

Chart with you, checklist complete SBAR communicated to OR staff Direct family to waiting room

Question 38

Considerations for older adults

Answer 38

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