Preoperative care Flashcards by Amanda S.

Preoperative Phase:

Assessment; Review of each system and potential complications; medication reconciliation; preoperative teaching; preoperative checklist/consenting (could be 10 min or 3-4 months)

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Intraoperative Phase: (nurse intra-operating room)

Intraoperative Phase: Role of the scrub nurse and circulating nurse; anesthetics

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Postoperative Phase: (what could go wrong?)

Postoperative Phase: Immediate postoperative assessment priorities; potential complications; interventions to prevent complications;discharge planning

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surgical setting

Ambulatory/Outpatient Surgery - just a few hours

Inpatient - hospitalized

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outpatient preferred bc

infection.

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23 hour hospital stay

must be discharged on 23rd hour to avoid charges

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Surgical procedures can be classified By (PUR said the procedure)

By purpose: e.g., palliation (to make comfortable)

By degree of urgency: e.g., elective vs. emergenic (life or limb)
By degree of risk (degree of risk assigned by anesthesialogist)

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John risk for surgery

high risk - smoking, etc.

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preop (teach, plan and prep in the preop)

teaching, planning, prepping for sugery

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preop assessment

Psychosocial - John has anxiety.

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assessment

Past Health History
Past diagnoses -
current medical problems -
John - smoking, CAD,

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preop assessment

Family health history

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nervous system - preop

stroke, cognitive decline - can he follow instructions, mobility, parkinson’s (med admin should be a consideration - do you hold, or not?) mobility - paralysis -

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cardiovascular - preop assessment

stents, coronary artery disease, what is his bp/HR. Could impact kidneys and stroke - at risk for clotting. Hes prob on anticoagulants

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pulmonary assessment

smoking history (try to get him on nicotine patches) COPD, would likely want a chest x-ray, check for signs of infection, check oxygenation, does he have a history of cough, SOB, lung sounds

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renal system

medications, diabetes, CAD, kidney function test, urinalysis, BUN/creatinine. Glucose in urine.

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hepatic system (liver - glucose, bleeding, alcohol)

maybe consider he could have liver problems that impact glucose, bleeding times, liver failure, alcohol history. if pt drinks, ask what kind and how does he measure the drinks.

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GI system

nothing by mouth, bowel prep, prob clear diet, (leak can cause peritonitis) worry about infection (diverticultis - looking for signs of acute infection, and potential for infection d/t diabetes)

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muscle-skeletal

mobility issues during post-operative, padded table

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nutrition

obesity (dehissence) and malnourishment (edema, skin breakdown)

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endocrine

diabetes (wound healing, insulin managed appropriately, A1C, glucose, monitor glucose)

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infection (CAP)

chronic infection, acute infection, and post op infection.

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medications

reconcile meds, ask John’s wife to bring all of his meds.

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Which meds are a problem?
Insulin 6 units Regular with 15unit NPH sub-cutaneous q am.
Aspirin 325mg PO q d.
Plavix 75 mg PO once daily
Ativan 0.5mg IVP on call to OR in AM.

get insulin order clarified, aspirin - bleeding, ativan - get consent before taking it, plavix - bleeding

we don’t use qd anymore***

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allergies (LISBA)

latex, iodine, shellfish, bannana, avacado (all from same tree family) antibiotics (and find out what the exact reaction is), tape allergies,

lab tests

CBC - Type & Cross - Urinalysis - Pulse Oximetry - ECG - Xrays - pregnancy

Client Fears and Anxiety

not waking up, infection, colostomy, be awake during surgery, complications, pain post-operatively (this is why teaching is important), teach about pain management. encourage family to stay with him as long as possible. you can have the anesthesiologist speak with the patient also.

Geriatric Considerations

cognitive decline so have family there, decreased kidney functions, confusion, not following direction

NPO status - what to know? (just how long)

time frame

prescreening (prescreen for a walker)

usually done in dr. office. may need walker, etc.

Postoperative medications/prescriptions

very little time so teach during every interaciton

Postoperative transportation

arrange transport

Preoperative Phase Teaching

coughing and splinting

preop if possible

contraindications to coughing (coughing in my skull, eye and spine)

intercranial pressure, eye, spinal surgery

turning

provide assistance

leg exercises

prevent DVT and promote venous return

pain management

what to expect, PCA (morphine pump)

skin prep

showering the day before with chlorahexadine, advise John not get chloro on face and not put on lotion.

shaving

don't shave on surgical site - microabrations

bowel prep

whatever comes out should be clear.

Informed Consent

Only surgeon can consent pt - all you do is witness. Physician ultimately responsible for obtaining consent Nurse may be responsible for obtaining & witnessing pt signature Nurse acts as pt advocate Must be signed before preop meds given! Emergencies? sometimes no time to consent - in this situation, it requires 2 surgeons signatures

preop checklist checked...(check my tests, meds, and VS)

twice, Form that lists requirements to be ascertained before patient goes to OR Documents diagnostic tests complete Documents pre-op medication given Documents VS

intraoperative phase

Aseptic Technique (Surgical Asepsis) Goal is to minimize contamination of wound and prevent post-op infection - NEED to review surgical technique in book

universal protocol

Conduct a pre-procedure verification process Mark the procedure site Perform a “Time Out”

operating room (intraoperative phase)

Role of Surgical Nurse Scrub Nurse/Techćician RN Circulator (problem-solver and advocate - make sure everything is ready, equipment) Patient Advocacy Nurse legally responsible for correct counts! (count - keep track of what is going to surgeon, ie sponges, to make sure that everything is accounted for)

general anesthesia

intravenous Agents Inhalation Agents Adjuncts to General Anesthesia

Postanesthetic Medications - used for what? (anxious after surgery)

Used to treat anxiety, pain, agitation Watch for resp depression Flumazenil used to reverse effects of benzodiazepines Narcan used to reverse effects of opioids

Surface or Topical

Examples include EMLA, Lidocaine

Local Infiltration (infiltrate the nerves)

Injection into tissues Regional Nerve Block Injection into or around specific nerve or nerve group to promote anesthesia Lymph node bx, cataract surgery

Spinal Anesthesia (short spine ed)

shorter duration Injection of local anesthetic into CSF found in subarachnoid space Anesthesia can extend from xiphoid process to feet Autonomic, sensory and motor block For procedures involving lower abd, groin, perineum, lower extremity

dont confuse a spinal headache with

a caffeine withdrawal headache

Epidural Anesthesia (preg in thoracic and lumbar)

Injection of anesthetic into epidural space Thoracic or Lumbar Sensory pathways blocked, motor intact, unless high doses Used intraop and postop continuous infusions Commonly used in L&D, hip replacements, knee replacements, lower abd surgery

Conscious Sedation (conscious of colonoscopy)

can respond and answer questions, but they are sedated. Pt. who had colonoscopy, ie morphine and versed. Indications? Nurses often responsible for administering meds & monitoring pt.

Begins with admission to recovery

Verbal report by anesthesia & RN Circulator General Information Patient History Intraoperative Management Intraoperative Course.

post op assessment (ABCs)

Adequacy of airway: Immediate priority assessment Vital Signs CV/peripheral perfusion Status: LOC

post operative -Presence of Protective Reflexes

Presence of Protective Reflexes: gag, cough Activity: Able to move extremities, sensation

Fluid Status: post op assessment

I&O IV infusion rate Patency of tubing Signs of dehydration/overload (catheter, fluid in lungs, edema, increase BP) defecit - decreases pulse, tenting, increased HR, decreased urine output

Condition of Operative Site - post op

Dressing drainage: Amt, color, type Mark Inform – do not change. May reinforce Patency & Character of drains Catheter, tubes, JP, hemovac etc… circle the stain and initial, see if it gets bigger over time.

we dont change the first dressing,

usually it's the surgeon.

Discomfort

Pain - anesthesia and then pain meds

Nausea and Vomiting

Nausea and Vomiting Notify anesthesia Position

safety post op

side rails up and call light near

Nursing Diagnoses post op

Nursing Diagnoses Ineffective Airway Clearance Ineffective Breathing Pattern Impaired Physical Mobility Acute Pain Impaired Tissue Integrity Deficient/Excess Fluid Volume Risk for Delayed Surgical Recovery

Evaluation Discharge Criteria: (report, VS, I&O)

Review Aldrete Score in Hinkle Figure 19-3 Report: Give report to floor Documentation - Usually flow sheet - Document assessment, communication, VS, I&O. Has pt. met discharge criteria?

Sequential Compression Device (SCDs)

to prevent DVTs

Implementation (con’t) NPO as ordered ice chips?

Ice - cold air, make sure it's minimal Monitor I&O Maintain patency of drains Up in chair as soon as possible Ambulate as soon as possible most significant measure to prevent post-op complications Advance diet as indicated

potential complications (I'm shocked during surgery by the thumb, emboly and pneumonia)

Shock: Inadequate tissue perfusion (First sign may be decreased urine output) Hemorrhage Thrombophlebitis Pulmonary Embolus Pneumonia

Geriatric Considerations

May have more difficult and longer post-op recovery Decreased resp function, cough: Risk of pneumonia Decreased renal perfusion: Can’t compensate for CV changes Under treatment of pain

discharge teaching

Appropriate Referrals: i.e. Home Health Nurse Follow-up appts Supplies Documentation

degree of risk assigned by...

anesthesialogist

preop checklist (VJ DICA on the checklist)

Documents safety data ID band in place; 2 identifiers Jewelry removed Last void Dentures removed Informed consent verified Patient Allergies

surgical asepsis

can't touch any object that isn't sterile

medical asepsis

contaminated if they are suspected to have pathogens - but can touch other objects

shellfish (red orange fish)

iodine

latex

avacado bannana

asprin

ibprofen

checklist checked twice

pre-op and intraop

if spinal headache,

lay patient down

who gives post op report?

anestheseologist bc they carried out all of the interventions. can be supplemented by nurse.

post op - looking for what?

quick check to see if pt is breathing, talking if possible. nail beds, vital signs, mucus membranes, loc,

post op spinal surgery - what do pt needs to do before discharge?

move extremities and sensation

dehydration and fluid overload are

a possibility during surgery.

Preoperative care Flashcards

(83 cards)