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NRSG 302 > Week 2 - Perioperative > Flashcards

Week 2 - Perioperative Flashcards

1
Q

What are the 3 components to peri-operative?

A
  • preoperative
  • intraoperative
  • post operative
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2
Q

What are the different classifications of surgical procedures?

A
  • seriousness
  • urgency
  • purpose
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3
Q

in regards to the different classifications of surgical procedures describe major serious procedure?

A
  • involves extensive reconstruction or alteration in body parts
  • poses great risks to well-being
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4
Q

in regards to the different classifications of surgical procedures describe minor serious procedure?

A
  • involves minimal alteration in body parts
  • designed to correct deformities
  • involves minimal risks compared with major procedures
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5
Q

in regards to the different classifications of surgical procedures describe elective urgency procedure?

A
  • usually optional
  • may not be necessary for health
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6
Q

in regards to the different classifications of surgical procedures describe urgent urgency procedure?

A
  • necessary for pt health
  • may prevent additional problems from developing
  • not necessarily emergency
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7
Q

in regards to the different classifications of surgical procedures describe emergency urgency procedure?

A
  • must be done immediately to save life or preserve function of body part
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8
Q

in regards to the different classifications of surgical procedures describe a diagnostic purpose procedure?

A
  • surgical exploration that allows physician to confirm diagnosis
  • may involve removal of tissue for further diagnostic testing
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9
Q

in regards to the different classifications of surgical procedures describe a ablative purpose procedure?

A

excision or removal of diseased body part

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10
Q

in regards to the different classifications of surgical procedures describe a palliative purpose procedure?

A
  • relieves/ reduces intensity of disease symptoms
  • will not produce cure
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11
Q

in regards to the different classifications of surgical procedures describe a reconstructive/restorative purpose procedure?

A

restores function or appearance to traumatized/ malfunctioning tissues

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12
Q

in regards to the different classifications of surgical procedures describe a procurement for transplant purpose procedure?

A
  • removal of organ, tissues or both from person pronounced dead for purpose of transplantation into another person
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13
Q

in regards to the different classifications of surgical procedures describe a reconstructive purpose procedure?

A

restores function lost or reduced as result of congenital anomalies

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14
Q

in regards to the different classifications of surgical procedures describe a cosmetic purpose procedure?

A

performed to improve personal appearance

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15
Q

What is included in the nursing process for pre-operative?

A
  • assessment
  • nursing diagnosis
  • planning
  • implementation
  • evaluation
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16
Q

in regards to the nursing process for pre-operative what is included in the assessment?

A
  • psychological status
  • physiological factors
  • baseline data/ allergies
  • lab/ diagnostic tests completed
  • cultural and ethnic factors
  • info given to pt is adequate
  • pregnancy status
  • planned or emergency surgery
  • pre-op consults as ordered by surgeon
  • best possible medication history
  • NPO status
  • use of substances
  • provide/ clarify info about surgical experience
  • assess emotional state/ readiness
    psy
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16
Q

in regards to the nursing process for pre-operative what is included in the assessment?

A
  • psychological status
  • physiological factors
  • baseline data/ allergies
  • lab/ diagnostic tests completed
  • cultural and ethnic factors
  • info given to pt is adequate
  • pregnancy status
  • planned or emergency surgery
  • pre-op consults as ordered by surgeon
  • best possible medication history
  • NPO status
  • use of substances
  • provide/ clarify info about surgical experience
  • assess emotional state/ readiness
  • psychosocial needs of pt/ family
  • discharge planning/ post-op teaching
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17
Q

in regards to the nursing process for pre-operative assessment what is included in the lab tests?

A
  • PT
  • INR
  • iron
  • platelets
  • potassium
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18
Q

define informed consent

A
  • don’t need to explain surgery
  • need to confirm that pt doesn’t have anymore questions/ understand what surgeon explained to them
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19
Q

older adults are more likely to experience perioperative complications than younger adults, why?

A
  • more likely to have chronic illnesses
  • have lower % of body water
  • reduced kidney and liver function
  • may be poorly nourished
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20
Q

in regards to older adults how can having a lower % of body water increase their risk of experiencing perioperative complications ?

A

more likely to experience fluid and electrolyte
disturbances

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21
Q

in regards to older adults how can having a reduced liver and kidney function increase their risk of experiencing perioperative complications ?

A

metabolize and excrete drugs slower increasing risk of toxic effect

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22
Q

in regards to older adults how can being poorly nourish increase their risk of experiencing perioperative complications ?

A

impair wound healing

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23
Q

What herbs and supplements can cause complications?

A
  • echinacea
  • feverfew
  • garlic
  • ginger
  • ginko biloba
  • ginseng
  • goldenseal
  • licorice
  • saw palmetto
  • St. John’s wort
  • valerian
  • Vitamin E
  • Kava
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24
Q

what medications should be checked pre-op and the day of the procedure?

A
  • glucocorticoids
  • anti-diabetics
  • blood thinners
  • cardiac medications
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25
Q

why do you need to check for glucocorticoids pre-op and the day of the procedure?

A
  • suppress adrenal function
  • will either be on pre-printed orders to take or not to/ dose
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26
Q

what are glucocorticoids?

A

steroids

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27
Q

why do you need to check for anti-diabetics pre-op and the day of the procedure?

A
  • pt NPO
  • watch for hypoglycaemia
  • surgeon may have changed orders
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28
Q

why do you need to check for blood thinners pre-op and the day of the procedure?

A
  • need to be discontinued a certain amount of time prior to surgery
  • prevents blood from clotting so pt could bleed out during surgery
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29
Q

what are some examples of blood thinners?

A
  • heparin
  • warfarin
  • LMWH
  • ASA
  • plavix
  • NSAIDS
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30
Q

what are some examples of cardiac medications?

A
  • betablockers
  • ACE inhibitors
  • ARBs
  • diuretics
31
Q

are betablockers held pre-op?

A

typically given but check orders

32
Q

are Ace inhibitors and ARBs held during surgery? why?

A
  • yes
  • associated with hypotension during surgery
  • can impair renal function
33
Q

are diuretics help pre-op? why?

A
  • yes
  • lead to postoperative hypovolemia and hypotension
34
Q

what do you need to fill out on the best possible medication history form prior to surgery?

A
  • when last dose of each medication was taken
35
Q

what do you always need to check for medication orders prior to surgery?

A

surgical PPO and written pre-operative orders

36
Q

after your nursing assessment for pre-op surgery you may come to some nursing diagnoses relevant to surgical nursing. What are they?

A
  • deficient fluid volume
  • infection
  • perioperative positioning injury
  • deficient knowledge
  • impaired physically
  • acute pain
  • powerlessness
  • ineffective airway clearance
  • allergic reaction to latex
  • anxiety
  • disturbed body image
  • ineffective thermoregulation
  • ineffective breathing pattern
  • ineffective coping
  • fear
37
Q

what is the purpose of planning in regards to the nursing process for pre-op?

A
  • pt teaching
  • prepare pt for post- op
38
Q

what do you need to go over with the pt in the planning portion of the nursing process for pre-op?

A
  • review pain management
  • activity to prevent atelectasis
  • deep breathing/ coughing
  • post op diet
  • wound care
  • common complications to watch for
  • discharge plan/ if they need help
39
Q

what are the 3 key elements needed to have informed consent?

A
  • must be voluntary
  • must have mental capacity to consent
  • must be properly informed
40
Q

for informed consent what would be needed if the pt didn’t have the mental capacity to consent?

A

written permission by legally appointed representative is needed

41
Q

what are common pre-op medications the patient may receive the day of surgery?

A
  • sedatives
  • prophylactic antibiotics
  • pain medications
  • anti-emetics
  • bronchodilators
42
Q

what are examples of medications that reduce stomach acid?

A

H2 receptor blockers
- ranitidine

proton pump inhibitors
- pantoprazole

43
Q

what are examples of medications that reduce oral/ respiratory secretions and dilate bronchi?

A

anticholinergics
- atropine

44
Q

what are examples of sedative medications?

A

benzodiazepines
- lorazepam
- ativan

45
Q

what are examples of prophylactic antibiotic medications ?

A
  • cefazolin
46
Q

what pain medication would the pt get prior to going in for surgery?

A

tylenol

47
Q

what are examples of bronchodilators?

A

salbutamol

48
Q

what are examples of anti-emetics?

A
  • metoclopramide
  • dimenhydrinate
49
Q

once the pt has completed their surgery where do they go ?

A

PAR/ PACU

50
Q

when is the pt transferred out of the PAR/ PACU?

A
  • maintain airway
  • has stable vital signs
  • conscious/ oriented
  • pain/ nausea managed
  • pt stable
  • have a bed on different floor
51
Q

when the pt is in the process of being transferred from the PAR to a ward what will happen prior to the pt going to the ward?

A

the PACU/ PAR nurse will call and give report to primary RN

52
Q

what will the PACU/ PAR nurse include in her handover report to the primary RN prior to the pt arriving on the ward?

A
  • how they did in surgery
  • current status
  • important events/ interventions
  • recent meds
  • in/out from OR and PAR
  • review important dr orders
  • last analgesic/ antiemetic given
  • type of anaesthesia
53
Q

what must the ward nurse complete prior to the patient arriving on the ward?

A
  • have all safety equipment ready at bedside
  • check safety equipment is working
  • have bed at appropriate height
54
Q

once the pt arrives on the floor what assessments will the nurse complete?

A
  • across the room
  • visually assess pt
  • primary survey (ABC)
  • ABCDEFG
  • full head to toe assessment with vitals
  • pain
55
Q

what is included in the visual assessment of the patient?

A
  • able to answer questions
  • how is there breathing overall
  • any obvious concerns
  • visualize any tubes/ drains
56
Q

what does ABCDEFG stand for?

A

A - airway
B - breathing
C - circulation
D - disability (depth/ LOC), discomfort
E - environment/ everything for surgery
F - full set of vitals/ freedom from risk
G - gather information/ chart

57
Q

when assessing the A (airway) in the ABCDEFG assessment what are you looking for?

A
  • open/ patent airway
  • gag reflex
58
Q

when assessing the B (breathing) in the ABCDEFG assessment what are you looking for?

A
  • resp rate
  • use of accessory muscles
  • normal depth
  • able to speak full sentences
  • position
59
Q

in regards to B (breathing) in the ABCDEGF assessment, what questions are you going to ask the pt?

A
  • any SOB?
  • difficulty breathing?
60
Q

when assessing the C (circulation) in the ABCDEFG assessment what are you looking for?

A
  • pulse (radial and apical)
  • O2 sats
  • BP
  • check any bleeding is under control
  • check IV site is patent/ IV is infusing as ordered (rate/ solution)
  • ## ask pt if they have chest pain, palpitations
61
Q

when assessing the D (disability/ discomfort) in the ABCDEFG assessment what are you looking for?

A
  • alert
  • respond to verbal, painful stimuli or not at all
  • oriented X3
  • assess pt pain
62
Q

when assessing the E (everything from surgery) in the ABCDEFG assessment what are you looking for?

A
  • wound/ dressings dry/ intact
  • drains/ tubes are in situ/ functioning
  • braces/ splints in situ
  • other ordered treatments are taken care of
63
Q

when assessing the E (environment) in the ABCDEFG assessment what are you looking for?

A
  • safety equipment has been checked and is working correctly
  • bed brakes on
  • bed rails are up
  • bed is in lowest position
  • pt has the call bell/ knows how to use it
64
Q

when assessing the F (full set of vital signs/ freedom from risk) in the ABCDEFG assessment what are you looking for?

A
  • VS at timed increments
  • parameters to maintain
  • orders to implement interventions
65
Q

when assessing the G (gather information and chart) in the ABCDEFG assessment what are you looking for?

A

chart important information
- type of anesthesia used
- drugs received in PAR
- amount of blood/ fluid pt lost/ received
- pts vital signs in PAR/ PACU and interventions they perform

66
Q

what happens to all the doctors orders after the patient has bad surgery?

A
  • they are cancelled and need to be reordered
67
Q

if the pt has an epidural or PCA all supplemental sedatives, anticoagulants and pain medication must be okayed by who ?

A

anesthesia regardless if ordered by MRP post-op

68
Q

does a pt need to notify nurses when they have their first pee after surgery? Why?

A
  • yes
  • if pt doesn’t void need to bladder scan and look for urine retention/ distended bladder
  • needs to be addressed quickly
69
Q

when you are presented with multiple pt problems how do you prioritize them? (need to put in order that you would respond to them)

A
  • immediately life or limb threatening problems
  • serious but not immediately life-threatening problems
  • prevention of future complications or problems
  • routine, non-urgent care/tasks
70
Q

what are the different levels of Maslow’s hierarchy of needs starting from the bottom going to the top?

A
  • physiological
  • safety
  • love/ belonging
  • esteem
  • self-actualization
71
Q

in Maslow’s hierarchy of needs what is included in the physiological level?

A
  • breathing
  • food
  • water
  • sex
  • sleep
  • homeostasis
  • escertion
72
Q

in Maslow’s hierarchy of needs what is included in the safety level?

A

security of:
- body
- employment
- resources
- morality
- the family
- health
- property

73
Q

in Maslow’s hierarchy of needs what is included in the love/ belonging level?

A
  • frienship
  • family
  • sexual intimacy
74
Q

in Maslow’s hierarchy of needs what is included in the esteem level?

A
  • self-esteem
  • confidence
  • achievement
  • respect of others
  • respect by others
75
Q

in Maslow’s hierarchy of needs what is included in the self-actualizatoin level?

A
  • morality
  • creativity
  • spontaneity
  • problem solving
  • lack of prejudice
  • acceptance of facts

NRSG 302 (8 decks)

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