adult 1_ periop - Sheet1 Flashcards
What is the purpose of a preoperative assessment?
To identify risk factors and devise a plan that ensures patient safety.
What subjective information is gathered during a preoperative assessment?
Anxiety and fears, hope for positive results, health history (hospitalizations, surgeries, medical issues, menstrual/obstetric history), social history (smoking, alcohol, drug use), current medications (including OTC and herbal), allergies and reactions, family health history (heart/endocrine diseases, adverse reactions), and review of systems (ROS) for comorbidities.
What objective information is collected during a preoperative assessment?
Physical examination and diagnostic studies (CBC, CMP, EKG, urinalysis, etc.).
What are important nursing interventions before surgery?
Teach deep breathing, coughing, and ambulation; explain lines, drains, and equipment; instruct NPO after midnight; witness consent signing; ensure pre-op orders are completed; admit the patient; prepare paperwork (lab results, signed consent, H&P, baseline vitals); prepare the patient (bathing, shaving, ID bands); encourage voiding; administer pre-op medications; transport patient with chart to OR; provide handoff report.
What are key cultural considerations for preoperative care?
Pain tolerance, expectations, and beliefs about surgery.
What are important gerontologic considerations for preoperative care?
Sensory limitations, transportation needs, and mobility concerns.
What are the three main components of preoperative education?
Sensory (OR temperature, lighting, monitor machines, drugs/antiseptic solutions), Process (flow of procedure from admission to recovery), Procedural (arrival time, food/fluid restrictions, bathing/shaving, vital signs, IV insertion, anesthesia administration).
What are the fluid and food restrictions before surgery?
NPO (nothing by mouth) after midnight or 12 hours before surgery.
Why is it important for a patient to void before surgery?
To prevent bladder distension and reduce complications during surgery.
What documents must be prepared before surgery?
Lab results, signed consent, history & physical (H&P), and baseline vital signs.
What is the nurse’s role in patient consent?
Witness the patient signing consent for the procedure, blood products, pelvic exams, etc.
What is included in a preoperative handoff report?
Patient condition, completed paperwork, pre-op medications given, and any special considerations for the receiving nurse.
What are the primary roles of the RN in the OR?
Maintain patient safety, dignity, and confidentiality; communicate with the patient, surgical team, and other departments; provide quality nursing care.
What is the role of the scrub nurse?
Follow surgical antisepsis with sterile precautions; prepare and manage the sterile field and instruments.
What is the role of the circulating nurse?
Maintain an unsterile role; facilitate the progress of the procedure; keep documentation.
What are key nursing interventions during surgery?
Prepare the OR using sterile procedures, obtain proper equipment, maintain privacy during transfers, apply vital sign monitors and safety straps, assist anesthesia administration, position the patient safely, change patient position if needed, and cleanse the surgical site with antimicrobial agents.
How should a nurse maintain safety when electrosurgical equipment is used?
Ground the patient properly.
What is a surgical “time-out”?
A safety check before surgery to verify documentation, diagnostics, blood products, proper surgical site, and other critical information.
What is the purpose of maintaining aseptic technique in the OR?
To prevent surgical site infections and maintain sterility.
How can bony prominences be protected during surgery?
By using padding and proper positioning techniques.
What is local anesthesia?
Loss of sensation to a specific part of the body without loss of consciousness.
What is regional anesthesia?
Loss of sensation to a region of the body without loss of consciousness.
What is moderate anesthesia (conscious sedation)?
A sedative state where the patient is responsive and breathes without assistance.
What is general anesthesia?
Loss of sensation and loss of consciousness; requires airway management.
What is malignant hyperthermia?
A genetic condition causing a rapid rise in core body temperature and severe muscle rigidity due to calcium overload and muscle breakdown.
What are nursing interventions for malignant hyperthermia?
Stop the anesthetic agent, administer dantrolene to relax muscles, give 100% oxygen, and cool the patient with ice packs at the groin, head, and armpits.
How can malignant hyperthermia be prevented?
Proper health history intake and avoiding medication triggers.
What general information is included in a postoperative transfer report?
Patient name and age, surgeon and ACP, surgical procedure, tubes/lines/catheters/drains, type of anesthesia, use of reversal agents, airway status, pain management interventions, NPO status, and other post-op orders.
What patient history should be included in a postoperative report?
Surgical indications, medical history, medications/allergies, pre-op labs/vitals, LOC, specific patient characteristics (hearing, vision, immobility, etc.), cultural preferences, and emotional status on arrival.
What intraoperative management details should be reported postoperatively?
Anesthetic drugs, other pre-op/intra-op drugs, last dose of opioid administration, pain management plan, total fluid replacement/loss, and urine output.
What intraoperative events should be communicated in a postoperative report?
Unexpected anesthetic events/reactions, unexpected surgical events, most recent vital signs and trends, and lab/x-ray results.
What are the first nursing interventions after receiving a postoperative handoff report?
Assess airway, breathing, circulation; monitor vital signs (EKG, BP, SpO2); complete a focused neurological assessment (LOC, AxO, motor, sensory, etc.); assess urinary output and fluid balance; note all lines and drains; assess surgical site and dressings.
Why should the head of the bed be elevated postoperatively?
To encourage deep breathing, prevent aspiration, and promote lung expansion to prevent atelectasis.
How can atelectasis be prevented postoperatively?
Encourage deep breathing and incentive spirometry use.
What intervention helps prevent wound dehiscence when coughing?
Splinting an abdominal incision with a pillow.
What should be done for postoperative hypotension?
Administer fluid boluses to maintain blood pressure.
What should be done for postoperative hypertension?
Identify and remove the stimulus (pain, respirations, voiding, etc.).
Why is early ambulation important postoperatively?
It stimulates circulation, increases muscle tone, and promotes overall well-being.
What can help reorient a postoperative patient?
Providing assistive devices like a clock or calendar.
What should be included in patient pain education postoperatively?
How to report pain and how it will be managed (oral, IV, PCA pump, etc.).
What safety measures should be followed when using warming devices postoperatively?
Monitor temperature to prevent burns or overheating.
How can infections be prevented with postoperative lines and drains?
Practicing aseptic technique during care and dressing changes.
How is fluid and electrolyte balance maintained in NPO patients postoperatively?
Administering IV fluids.
What should be done if a postoperative patient vomits or is at risk of aspiration?
Lay patient in the left lateral position and have suction at bedside.
How can postoperative constipation be managed?
Offering a stool softener and encouraging mobility and hydration.
What interventions help promote postoperative voiding?
Encouraging natural voiding or using intermittent catheterization if necessary.
When should the first postoperative dressing change occur?
It should be done by the surgeon unless the dressing becomes too saturated.
What are the three PACU phases?
Phase I: Immediate post-anesthesia care; goal is transfer to Phase II, inpatient unit, or ICU. Phase II:Ambulatory surgical patients; goal is preparing for discharge or extended care. Extended Observation:Goal is preparing for self-care.
