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ADN002 MED SURG > Week 2 Perioperative > Flashcards

Week 2 Perioperative Flashcards

1
Q

Preoperative Phase

A

Period of time from decision for surgery until the patient is transferred into operating room

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2
Q

Intraoperative Phase

A

Period of time from when the patient is transferred into operating room to admission to PACU

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3
Q

Post Operative

A

Period of time from when patient is admitted to PACU to follow up eval in clincal setting or at home

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4
Q

Surgical Classifications

A

Purpose
Cure
Repair
Reconstructive
Palliative
Rehabilitative
Degree of Surgery

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5
Q

Pre Admission Testing

A

Educating the PT and Family

Pre op assessment
intiates teaching
Verifies completion of pre op diagnostic testing
Verifies understanding of surgeon specific orders
Discuss and review advanced directive
Begins discharge instructions

Make family know what to expect and how to assist. Dangerous warning signs and symptoms and what to do when they occur.

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6
Q

Special Considerations During Pre Operative Period

A

Pt who are

Obsese
disabilities
Undergoing ambulatory surgery
emergency surgery

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7
Q

Gerontological Considerations

A

Cardiac and circulatory compromise
Respiratory Compromise
Renal Function
Confusion
Fluid and Electrolyte Imbalance
Skin
Comorbidities
Altered Sensory
Mobility Restrictions

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8
Q

Informed Consent

A

Should be in writing
Should contain:
Explanation of procedure, risks
Description of benefits, alternatives
Offer to answer questions about procedure
Instructions that patient may withdraw consent
Statement informing patient if protocol differs from customary procedures

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9
Q

Voluntary Consent

A

Valid consent must be freely given and without coercion

Patient must be at least 18 years of age unless emancipated minor
Consent obtained by physician
Patient signature must be witnessed by professional staff member

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10
Q

Incompetent Patient

A

Individual who is not autonomous

Cant give or withhold consent
Cognitively imparied- Dementia
Mentally Ill- Schizophrenic
Neurologically Incapacitated- coma

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11
Q

Nonautonomous

A

Not having the right of power or self government

not capable of functioning, existing, developing, or occurring independently

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12
Q

Cognitive Impairment

A

Person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life

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13
Q

Malignant Hyperthermia

A

Genetic Reaction to sedation

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14
Q

Preoperative Assessment

A

Nutrition and fluid status
Dentition
Drug or alcohol abuse
Respiratory status
Cardiovascular Status
Hepatic and Renal function
Anticoag use
Previous surgeries
Adverse Reaction to sedation in the past

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15
Q

Preoperative Assessment

A

Endocrine Function
Immune Function
Previous Medication use
Psychosocial Factors
Spiritual Beliefs

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16
Q

Corticosteroids

A

ant inflammatory
risk for infection and increase blood sugar

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17
Q

Diuretics

A

Removal excess fluid in the intravascular space

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18
Q

Phenothiazines

A

Used for nausea and vomiting and hiccups

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19
Q

Tranquilizers

A

Can all have synergistic affects of sedation and affect post op delay wearing of sedation

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20
Q

Anticoags and Herbal remedies

A

Can affect proper clotting and increase risk of bleeding

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21
Q

Insulin

A

Pt is NPO puts patient at risk for hypoglycemia

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22
Q

Hypothyroidism

A

Increased risk of CHF

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23
Q

General Pre Operative Nursing Interventions

A

Provides psychosocial interventions
Resp. complications
Mobility and movement
Pain and management
Maintaining patient safety
managing nutrition
Preparing bowel
Preparing skin

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24
Q

Immediate Preoperative Nursing Interventions

A

Administering preanesthetic medication
Maintaining preoperative record
Transporting pt to presurgical area
Attending family needs

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25
Q

Preoperative Instructions to prevent complications

A

Diaphragmatic breathing
Coughing and splinting
Leg exercises
turning to side
Getting out of bed

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26
Q

Protecting the Patient from Injury

A

Pt identification
Correct informed consent
time out
Verify records
Results of diagnostic tests
Allergies include latex
Monitoring and modifying physical environment
Safety measures
Verification of blood

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27
Q

The Patient

A

Cognition
Fears
Effect on meds
Risks
Loss of self protective mechanisms
Loss of Senses
Advocate
Cultural Diversity

Education is very important

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28
Q

Gerontological Considerations

A

Older Patients increased for risk for complications of surgery due to

Increased due to coexisting conditions
Aging, heart, pulmonary systems

Decreased homestatic mechanisms

Changes in responses to drugs, anesthetic agents due to aging changes

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29
Q

Members of the Surgical Team

A

Patient
Circulating Nurse- Does not scrub in
Scrub role- Assist the doctor
Surgeon
RFNA
Anesthsiologist, Anesthetist

30
Q

Prevention of Infection

A

Surgical environment
- Unrestricted zone
- Semi restricted zone
- Restricted Zone

Surgical Asepsis
Environmental Controls

31
Q

Unrestricted

A

Control flow of patients and staff

32
Q

Semi- Restricted

A

Peripheral support area, surgical sink, scrub in area, wearing surgical attire

33
Q

Restricted Area

A

Surgical room, only accessible through a semi- restricted area

34
Q

Surgical Asepsis

A

Absence of all microbes within any type of invasive procedure

35
Q

Sterile Techniques

A

Set of specific practices and procedures performed to make equipment and area free from all microbes and to maintain that sterility

36
Q

Basic Guidelines for Surgical Asepsis

A

All material in sterile field sterile

Gowns sterile in front from the chest to level of sterile field , sleeves from 2 inches above elbow to cuff

Only top of draped tables considered sterile

Items dispensed by methods to preserve sterility

Movements of surgical team are from sterile to sterile or from unsterile to unsterile only

37
Q

Guidelines for Surgical Asepsis

A

Movement at least 1 foot distance must be maintained

Sterile barrier breached- contaminated

Every sterile field is constantly maintained

Health Hazards
Laser risks
Exposure to blood and bodily fluids
Fume exposure

38
Q

Intraoperative Complications

A

Anesthesia Awareness
Nausea and Vomiting
Anaphylaxis
Hypoxia and Resp. complications
Hypothermia
Malignant Hyperthermia
DIC
Infection

39
Q

Malignant Hyperthermia

A

Fast rise in body temperature and severe muscle contractions

Treated with Dantrolene

40
Q

Dantrolene MOA

A

Inhibits muscle contractions by increasing the release of calcium from the sarcoplasmic reticulum.

41
Q

Dantrolene Used for

A

TX of chronic spasticity and prophylaxis against malignant hyperthermia

42
Q

DIC

A

Small blood clots from throughout the body, coags are set up , PT cant stop bleeding in other areas

43
Q

Early Signs of Malignant Hyperthermia

A

Increase of ETCO2
Cardiac arrythemias
Muscle rigidity
Hypoxia
Profuse Sweating
Masseter Muscle Rigidity
Metabolic
Resp. Acidosis
Mottling of Skin
Tachycardia
Unstable arterial pressure

44
Q

Late Signs of Malignant Hyperthermia

A

Acute Renal Failure
Circulatory Failure
Dark Colored Urine due to myglobinuria
DIC
Elevated CK
Elevated Myglobin
Hyperkalemia
Hyperthermia
Rhabdo
Severe Cardiac Arrythemias

45
Q

Malignant Hyperthermia

A

Abnormal Protein on surface
After exposure to anesthetic, abnormal amount of calcium accumulates in muscle cells, muscles stiffen and are consistently contracting and dramatic increase in body temperature

46
Q

Malignant Hyperthermia

A

Usually not diagnosed until after event occurs, always important to ask about reactions to anesthesia for self and family members present

47
Q

Elevated levels of CPK

A

Indicator of genetic abnormality

High risk population a family history, history of heat stroke, hyperthermia and hyperthermia after exercise

48
Q

Malignant Hyperthermia TX

A

Stop Contributing Medication
Mix and administer Dantrolene
Cool body Temperature
Administer O2
Control HR and BP
Correct abnormalities of electrolytes

49
Q

Adverse Effects of Surgery and Anesthesia

A

Allergic Reactions and Drug toxicity
Cardiac Dysrhythmias
CNS changes
Trauma
Hypotension
Thrombosis

50
Q

Positioning Factors to Consider

A

Comfortable as possible
Operative Field must be adequately exposed
Position must not obstruct or compress respirations, vascular supply, or nerves

Extra Safety precautions for older adults
Patients who are thin or obese

Light Restraint before induction in case of excitement - straps, cushions, wedges

51
Q

Nursing Management in PACU

A

Provide care for patient until patient has recovered from effects of anesthesia

Patient has resumption of motor and sensory function is oriented, has stable VS, shows no evidence of hemmorhageof other complications of surgery

Vital to perform assessment

52
Q

Responsibilities of PACU Nurse

A

Reveiw pertinent information, baseline assessment upon admission unit

Assess ABCs

Reassess VS, patient status every 15 min

Transfer report, to another unit or discharge pt to home

53
Q

Maintaining PT Airway

A

Primary Consideration, necessary to maintain ventilation, oxygenation

Provide Supplemental Oxygen

Assess Breathing by placing hand near face to feel movement of air

Keep of HOB elevated 15 to 30 degrees unless contraindicated

May require sunctioning

If vomiting occurs turn pt to side

54
Q

Use of Oral Airway

A

Do not remove oral airway until evidence of gag reflex returns

Oropharyngeal airway

55
Q

Maintaining Cardiovascular Stability

A

Monitor all indicators of CV

Assess all IV lines
Potential for hypotension
Potential for hemmorrhage
Potential for hypertension and dysrhythemias

56
Q

Indicators of Hypovolemic Shock

A

Pallor
Cool moist skin
Rapid RR
Cyanosis
Rapid and weak thready pulse
Decreasing pulse pressure
Low blood pressure
Concentrated Urine

57
Q

Controlling Nausea and Vomiting

A

Intervene of Nausea at first indication of nausea

Medications

Assessment of preoperative nausea, vomiting risk, prophylactic treatment

Zofran, Reglan, Promethazine, Phenergan

58
Q

Relieving Pain and Anxiety

A

Assess Patient comfort

Control environment ; quiet, low lights, noise level

Administer analgesics as indicated, usually short acting opiods IV

Family visit, dealing with family anxiety

59
Q

Gerontologic Considerations

A

Decreased physiological reserve
Monitor carefully frequently

Increased confusion
Dosage
Hydration

Increased likelihood of post operative confusion, delerium

hypoxia, hypotension, hypoglycemia

Reorient as needed

Pain

60
Q

Outpatient Surgery/ Direct Discharge

A

Discharge planning, discharge assessment

Provide written verbal instructions regarding follow up care, complications, wound care, activity, medications, diet

Give prescriptions, phone numbers

Discuss actions to take if complications occur

61
Q

Outpatient Surgery/ Direct Discharge

A

Give instructions to patient, responsible adult who will accompany patient

Patients are not to drive home or be discharge to home alone

Sedation, anesthesia, may cloud memory, judgement, effect ability

62
Q

Nursing Care for Post operative Pt

A

Receiving the patient from PACU
Nursing Management
1st 24 hrs
Focused Assessment
Pain Management
Respiratory
GI
GU
Mobility
DVT/PE
Infection
Anxiety

63
Q

Wound Healing

A

First Intention - Surgical incision

Second Intention - Edges of wound can’t be brought back together - union by adhesion of granulating surfaces

Third Intention -Union of a wound that is closed surgically several days after injury - the wound is left open until contamination has been markedly reduced and inflammation has subsided

Factors that affect wound healing

64
Q

Jackson Pratt Drain

A

Consists of perforated round or flat tube connected to negative pressure collection device

65
Q

Blake Drain

A

Round silicone tube with channels that carry fluid to a negative pressure collection device

66
Q

Penrose Drain

A

Soft rubber tube
Hemovac- accordion like negative pressure wound therapy

67
Q

Montgomary Straps

A

Adhesive that helps keep the wound closed

68
Q

Purpose of Postoperative Dressings

A

Provide Healing Treatment

Absorb Drainage

Splint immobilize
Protect

Promote homeostasis

Promote patient’s physical, mental comfort

69
Q

Change the Postoperative Dressing

A

Clean
Clean Contaminated
Contaminated
Dirty
First Dressing changed by surgeon

Types of dressing materials

Sterile technique
Assess wound

Applying Dressing, taping methods

PT response
PT teaching
Documentation

70
Q

Wound Dehiscence and Evisceration

A
71
Q

Nursing Diagnosis

A

Activity intolerance
Impaired skinintegrity
ineffective thermoregulation
Risk for imbalanced nutrition
Risk for constipation
Risk for urinary retention
Risk for injury
Anxiety
Risk for ineffective management or therapeutic regimen

ADN002 MED SURG (18 decks)

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