Week 2: P and Z and the client undergoing surgical procedure Flashcards
(59 cards)
1
Q
What is preoperative?
A
Before surgical procedure
2
Q
Intraoperative
A
During surgical procedure
3
Q
Postoperative
A
After surgical procedure
4
Q
Disease vs Illness
A
Disease: viewed from medical POV (objective)
Illness: human experience (subjective)
5
Q
Multimorbidity
A
Simultaneous occuerence of several chronic medical conditions
6
Q
Top 3 leading causes of chronic illnesses
A
- Cardiovasc disease
- Cancer
- Resp disease
7
Q
What are the 3 models of disability?
A
Medical, social and biopsychosocial
8
Q
Informal Caregiver
A
Anyone who provides care without pay
9
Q
Caregiver burden
A
Overall physical, emotional and financial costs of caregiving
10
Q
What are factors that increase caregiver burden?
A
- caregiver has poorer sense of well-being
- higher frequency of client dysfunctional behavior
- higher demand for assistance
- caregiver dissatisfied with outside help
11
Q
Chronic: Illness Trajectories Phases
A
Crisis phase: period before and immediately after diagnosis, when learning to live with symptoms
Chronic phase: timespan between initial diagnosis and final time phase
Terminal phase: Marked by issues surrounding grief and death
12
Q
ectomy
A
remove
ex; appendectomy
13
Q
oscopy
A
look into
ex; endoscopy
14
Q
ostomy
A
opening into
ex; colostomy
15
Q
otomy
A
incision/ cutting into
ex; tracheotomy
16
Q
plasty
A
repair or reconstruct
ex; mammoplasty
17
Q
Purpose of preoperative nursing assessment
A
- determines worries/ concerns/ priorities
- physological factors
- identify cultural and ethnical factors
- establish baseline data
- post op teaching
18
Q
What should you include in subjective pre-op assessment?
A
Fears, anxiety, hope, past health history, medications, allergies, latex allergies
19
Q
What is important information to gather in pre-op for a neuro system?
A
- Vision and hearing
- Cognitive function
20
Q
What is important information to gather in pre-op for a cardio system?
A
- Baseline vitals
- Bleeding/clotting times
- Lab reports
21
Q
What is important information to gather in pre-op for a resp system?
A
- History of dyspnea, coughing, hemoptysis, COPD or Asmtha
- Smoking
- Airway infections
22
Q
What is important information to gather in pre-op for a urinary system?
A
- Hx of urinary or renal diseases
- Renal function tests
23
Q
What is important information to gather in pre-op for a hepatic system?
A
- Consider presence of liver disease if there is a history of jaundice, hepatitis, and alcohol abuse
24
Q
What is important information to gather in pre-op for a integumentary system?
A
- Hx of skin and musculoskeletal problems (pressure ulcers)
25
Why are clients with diabetes mellitus at greater risk for complications?
- hypo/hyerglycemia
- ketosis
- cardiovascular alterations
- delayed wound healing; infections
26
Common preop lab tests?
Urinalysis, chest x-ray, ECG, pulmonary function, CBC (hemoglobin/hematocrit, WBC, electrolytes, oximetry, ABG, INR, blood glucose, creatinine, Renal proBUN, liver function, type, screen&crossmatch, Prothrombin (INR)
27
Legal preparations: what are important forms to have signed pre-op?
- Informed consent, blood transfusions, advance directives, power of attorney
28
Who is responsible for obtaining consent?
Surgeon
- But RN might witness patient's signature, verify client has understanding and recognize client permission may be withdrawn any time
29
Describe techniques of medical asepsis
- hand hygiene 10-15 seconds lather
- hands are most contaminated
- keep hands and forearms lower than elbows
- dry with paper towel from fingers to wrists to forearms
30
Describe techniques of surgical asepsis
- surgical scrub
- 2-6min
- hands become cleanest
- wet hands and arms to 5cm above elbows
- keep elbows above elbows at all times
- dry with sterile towels
31
When can appointed family consent for client?
If they are a minor, unconscious or mentally incompetent
32
When is the only time that doctors may override need to obtain consent
In a true medical emergency
33
Nursing Preop Responsibilities
Admission history/physical exam on chart
Consultation records
Nurse’s notes
Baseline V/S
Weight
Appropriate tests (e.g. CXR, EKG) completed
Urinalysis completed
Blood Work (CBC, lytes, completed
ID and allergy bands on wrist
Valuables returned to family
Other pre op diagnostic tests
Health teaching
Signed consent in chart
Shave prep if req’d
NPO
Insert Foley if ordered
I&O
34
Pre-op nursing jobs day of the operation
IV
Prosthesis out
Clean hospital gown
Rings off/taped; jewelry; dentures, contacts, prostheses removed
Nail polish, makeup off
Void prior to going
Pre-op meds if ordered (sedation, antibiotics…)
Safety issues (i.e., side rails; call bell near)
Pre op check list ...is charting up to date??
Room ready for return
Instruct family on waiting area where they can be informed of progress
35
Diferentiate purpose of three different areas of surgiacal suite and appropriate attire for each
Unrestricted
Semi-restricted
Restricted
The semi-restricted area is where scrub attire and hair coverings are worn, the scrub sinks are located, and clean and sterile supplies are stored; it also includes some of the areas used to process surgical instruments. The restricted area includes operating rooms, procedure rooms, and clean-core areas. This is where full surgical attire and masks are worn. The work flow of people, supplies, and equipment needs to travel from dirty to clean areas in such a way that contaminated items are separated from clean and sterile items by space, time, and traffic patterns
36
General Anaesthesia
- IV inductionl; inhalation agents
- Adjuncts to general-opioids, bezodiazepines, muscle relaxants
37
Local anesthesia
- Topical (EMLA cream)
- Regional (peripheral) nerve block
- Spinal (into CSF below L2; autonomic, sensory and motor block)
- Epidural (above dura binds to nerve root as they enter-exit spinal cord)
38
Epidural vs Spinal
Epidural
- dose high
- onset slow
- doesnt cause much of neuromuscular blocl
- multiple dosing possible
- various points along backbone
Spinal
- dose is low
-onset is fast
- can cause neuromuscular blocl
- single dose only
- given only at specific point to avoid damage to spinal cord
39
Post Op Checks upon patient's return from PACU to Unit
- surgery done
- time of arrival
- dr. orders w primary nurse
- check ABC's
- dressing and incision
- VS
- IV
- Catheter/draining tubes
40
Post Op Checks upon patient's return from PACU to Unit
- surgery done
- time of arrival
- dr. orders w primary nurse
- check ABC's
- dressing and incision
- VS
- IV
- Catheter/draining tubes
41
Hypoxemia/ atlectasis
Low oxygen levels in blood relating to collapsed lung
42
Illeus
A temporary lack of the normal muscle contractions of the intestines.
43
Hypovelemic Shock
emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body
44
How to prevent complications in during Post Op
Deep breathing & coughing
Incentive spirometer
Early ambulation
Turning side to side
O2 as ordered
Regular respiratory assessment
45
How do you prevent circulatory stasis?
- Leg exercises, early ambulation, anticoagulants, adequate fluid intake, regular C/V assessment
46
What is PACU?
Post-anaesthesia care unit
47
Existentialism
Type of philosophy; find meaning and make responsible choices
48
Benign
Non cancerous
49
Malignant
Cancerous
50
Circulating Nurse
Going around in and out, updates to family, where she needs.
51
Scrub Nurse
Handing instruments, sterile
52
Describe the areas of the surgical suite
Unrestricted, semi-restricted and restricted
53
Unrestricted area
No clothing restrictions; patients, family members and others may enter these areas for temporary business in street clothes
54
Semi-restricted
Authorized personnel only. Surgical attire and covering of all head and facial is required. PPE is required
55
Restricted
OR and procedure rooms. To enter these you must cross the red line.
- Movement of personnel in and out of room is kept to minimum
- Surgical attire, covering of all head and facial hair and appropriate footwear are required for all
- masks required where sterile supplies are open
- PPE required
56
What do Registered Nurse First Assistants do? (RNFA)
Assists surgeon by monitoring patient's vital signs during surgical procedures. Helps with stabilizing patient
57
What do Registered Nurse Anaesthesia Assistants do?
Help monitor patient stability for anaesthesiologist. May administer meds to help keep pt. sedated.
58
Local vs regional vs general anesthesia
Local: temporarily stop pain in certain area of body. Can be given via injection ot site or absorbed into skin
Regional: numbs only portion of body that will undergo surgery. (Spinal and epidural anesthetic)
General: unconsciousness during surgery; either inhaled or given by IV
59
How to prevent post op atelectasis
Atelectasis can be prevented or treated by adequate analgesia, incentive spirometry (IS), deep breathing exercises, continuous positive airway pressure, mobilisation of secretions and early ambulation.
