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nursing 20030 > preoperative nursing > Flashcards

preoperative nursing Flashcards

1
Q

describe whats include in the assessment portion of preoperative nursing phase

A

-history and physical (H&P)
-identification of risk factors and allergies
-medication and treatment assessment
-facilitating/reviewing diagnostic tests
-identification of teaching and psychosocial needs
-assessing for postsurgical support and referral needs

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2
Q

whats included in preoperative history assessment?

A

-developmental considerations
-medical history (comorbidities)
-surgical history
-allergies and meds (substance use such as ETOH, illicit drugs, nicotine)
-nutritional status
-ADLs and occupation
-sociocultural needs
-support system (learning and discharge needs)

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3
Q

history

what surgical history is important r/t surgery

A

-trach - may intubate different route
-malignant hyperthermia (also check fam history)

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4
Q

history

why are meds important to know preoperatively?

A

-some can interact with anesthesia
-ppl on blood thinners are gonna bleed out

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5
Q

history

what socialcultural needs are important to know preoperatively?

A

-will they receive blood products?
-who is the decision maker?

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6
Q

history

when should you have history and physical done before surgery?

A

30 days prior

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7
Q

physical exam

what are the compenents of the physical exam?

A

-general survey
-integumentary
-respiratory
-cardiovascular
-neurological
-GI/GU
-musculoskeletal

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8
Q

physical exam

describe general survey

A

-vital signs (want to figure out baseline bc anesthesia decreases bp)
-height and weight (most anesthesia is weight dosed)

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9
Q

physical exam

integumentary

A

look to make sure skin is intact

is there increased risk for skin infection?

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10
Q

physical exam

cardiovascular

A

-regular heartbeat?
-CHF?
-ejection fraction (how much blood is being pumped out? if its too low there is risk for volume overload)

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11
Q

physical exam

neurological

A

-establish A&O baseline
-crainial nerve function

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12
Q

physical exam

GI/GU

A

do they urinate and shit regularly? what are their normal patterns?

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13
Q

key considerations

comorbidities associated with CV system

A

HTN, MI, HF, arrythmias, CVA, thrombocytopenia, anemia

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14
Q

key considerations

comorbidities associated with respiratory system

A

COPD, asthma, pneumonia, bronchitis, URI

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15
Q

key considerations

comorbidities

A

-CV
-respiratory
-renal or heptic disease
-diabetes

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16
Q

meds

antibiotics in surgery

A

increase effect of anesthesia = more sleepy

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17
Q

meds

antiarrhythmics in surgery

A

decrease contractility

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18
Q

meds

anticonvulsants in surgery

A

effect metabolism of drugs

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19
Q

meds

antiHTN drugs in surgery

A

effect during anesthesia

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20
Q

meds

diruretics in surgery

A

-decrease BP and cause electrolyte shifts

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21
Q

meds

NSAIDS in surgery

A

increase bleeding risks

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22
Q

meds

ginsing in surgery

A

increase hypoglycemia

23
Q

what are some risk factors in surgery?

A

-age
-nutritional status (malnutrition and obesity)
-fluid and electrolyte imbalance
-pregnancy
-previous surgical or anesthesia complications

24
Q

what bloodwork is important for surgery?

A

-complete blood count (CBC)
-basic metabolic panel (BMP) or complete metabolic panel (CMP)
-coagulation studies
-blood type
-HCG

25
Q

bloodwork

describe CBC

A

-WBC, RBC, HBG, HCT, platelets
-increase in WBC = risk for infection
-increased platelets = clot
decreased platelets = continue to bleed and bleed

26
Q

bloodwork

what is included in BMP/CMP

A

-electrolytes
-BUN and creatinine
-glucose
-liver function

27
Q

bloodwork

what is included in coagulation studies

A

-PT/INR (tells if pt will continue to bleed)
-PTT

28
Q

bloodwork

what is HCG

A

prenancy test

29
Q

lab values

RBCs

A

-men: 4.6-6.2 million/mm3
-women: 4.2-5.4 million/mm3

30
Q

lab values

Hgb

A

-men: 13-18 g/dl
-women: 12-16 g/dl

31
Q

lab values

Hct

A

-men: 42-52%
-women: 35-47%

32
Q

lab values

WBCs

A

4500-11000/mm3

33
Q

lab values

platelets

A

150-450 x 10^9/L

34
Q

name some serum electrolytes

A

-Na+
-K+
-Cl-
-HCO3-
-glucose

35
Q

serum electrolyte values

Na+

A

135-145 mmol/L

36
Q

serum electrolyte values

K+

A

3.5-5.0 mmol/L

37
Q

serum electrolyte values

Cl-

A

95-105 mEq/L

38
Q

serum electrolyte values

HCO3-

bicarb

A

22-26 mEq/L

39
Q

serum electrolyte values

glucose

A

70-110 mg/dl

40
Q

renal function labs

creatinine

A

0.7-1.4 mg/dl

41
Q

renal function labs

BUN

A

10-20 mg/dl

42
Q

coagulation studies

prothrombin time (PT)

A

9.5-12 seconds

43
Q

coagulation studies

international normalized ratio (INR)

A

0.76-1.27 (when not anticoagulated)
2-3 (when anticoagulated)

44
Q

coagulation studies

activated partial thromboplastin time (aPTT)

A

20-39 seconds

45
Q

coagulation studies

anti-factor Xa Assay

A

0.3-0.7 units/ml (when anticoagulated)

46
Q

what imaging tests are used preoperatively

A

-CXR
-joint or bone Xrays
-CT
-MRI

47
Q

whats included in cardiac workup

A

-EKG
-cardiac stress test
-sleep study

48
Q

what are some preoperative nursing diagnoses

A

-knowledge deficit
-anxiety
-pain
-risk for infection
-impaired physical mobility
-disturbed body image
-disturbed sleep pattern

49
Q

describe planning

A

-setting goals with the pt that are realistic and will help lead to a successful and complication free surgical experience
-many preoperative nursing interventions involve setting expectations and providing information

50
Q

describe implementation

A

-teaching
-postoperative referrals

51
Q

describe teaching

A

-general info
-communicating expectations/protocols
-providing anticipatory guidance
-verifying informed consent

52
Q

describe postoperative referrals

A

-case management/social work
-DME (durable medical equipment)
-homecare, skilled nusing care
-prescriptions
-postoperative apppointments

53
Q

what are some day of surgery preparations?

A

-NPO status, IV
-bowel prep/ empty bowel and bladder
-preoperative meds
-hygiene and skin prep
-removal of dentures, jewelery, hearing aids
-documentation completion and review
-provide directions and emotional support for patient and significant others

54
Q

describe document review

A

-consent
-advanced directives
-preoperative checklist

nursing 20030 (31 decks)

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