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Ambulatory Flashcards

1
Q

Admission criteria for ambulatory surgery services?

A
  1. Must be in compliance with state licensure laws
  2. The center for medicaid and medicare regulations
  3. Accreditation guideline for accreditation entity that is used
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2
Q

Who is the admission criteria, supporting policies, and procedure developed by?

A

Medical staff committee

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3
Q

Who can perform a focused assessment?

A
  1. Licensed vocational nurse (LVN)

2. Licensed practical nurse (LPN)

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4
Q

What is a focused assessement?

A

An appraisal of an individual health status as a nursing assessment performed by an LPN/LVN

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5
Q

What is a comprehensive nursing assessment?

A

involves extensive data collection( initial and ongoing) for individuals, families, groups, and communities.

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6
Q

A pt should discuss any risk and benefits regarding surgery to who?

A

The surgeon

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7
Q

Surgical risk is established by a number of risk factors including?

A
  1. Scheduled surgical procedure
  2. Type of anesthesia
  3. Pt comorbidities
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8
Q

Equipment used in asc preoperative care?

A
  1. Cardiac monitors
  2. pulse oximeters
  3. temperature
  4. suction equipment
  5. IV pumps
  6. Compression devices
  7. emergency equipment
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9
Q

Supplies that are available in asc preoperative care?

A
  1. Medication
  2. IV supplies
  3. O2 masks and ambu bags
  4. PPE
  5. Anti-embolism stockings
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10
Q

One strategy for risk reduction in ambulatory surgery centers for obesity is to establish?

A

body mass index criteria for admission

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11
Q

a thrombus that travels to the lungs?

A

Pulmonary embolism

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12
Q

What are risk reduction strategies for prevention of VTE?

A
  1. Develop a VTE assessment tool to classify pt risk level

2. Establish protocol orders for VTE/PE prevention

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13
Q

Risk factors for obstructive sleep apnea?

A
  1. Loud snoring
  2. significant daytime sleeping
  3. obesity
  4. hypertension
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14
Q

Symptoms of sleep apnea?

A
  1. fall asleep easily
  2. awake frequently at night
  3. feeling tired or groggy after sleeping
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15
Q

What is the treatment for sleep apnea?

A

CPAP(continuous positive airway pressure)
a treatment that uses air to keep airways open
* pt should bring cpap machine with them the day of the surgery

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16
Q

Cardiac clearance is needed when?

A
  1. a pt is under care of a cardiologist

2. a pt has been cleared for surgery by a cardiologist according to pre-assessment findings

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17
Q

Pediatric considerations for ambulatory surgery?

A
  1. establishing cognitive developmental level of child
  2. determining the presence of chronic conditions such as asthma and diabetes
  3. Assessing a child’s anxiety level
  4. Assessing for upper respiratory infections
  5. check for presence of fever
  6. verify recent immunizations
  7. Assess nutritional status
  8. screen for signs of abuse
  9. Assess for risk of hypothermia
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18
Q

Geriatric considerations for ambulatory surgery?

A
  1. cognitive impairment
  2. skin turgor/integrity
  3. type of surgical procedure
  4. duration of surgical procedure
  5. effects of general anesthesia
  6. cardiovascular changes
  7. impaired mobility/risk for falling
  8. risk for hypothermia
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19
Q

medication assessment for asc?

A
  1. prescription medication
  2. otc
  3. herbal
  4. dietary
  5. medication dosage
  6. times and last doses
  7. street drugs
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20
Q

Criteria for a pre-anesthesia evaluation for admission includes?

A
  1. past and present medical and medication history
  2. previous anesthesia experience
  3. ASA physical status assessment
  4. Result of relevant diagnostic studies
  5. Age considerations
  6. Planned choice of anesthesia
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21
Q

ASA physical status classification system

A

ASA P1- a normal healthy pt

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22
Q

What is the classification of a pt with severe systemic disease?

A

ASA P3

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23
Q

What is ASA P2?

A

A pt with mild systemic disease

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24
Q

What is the classification of a pt with severe systemic disease that is a constant threat to life?

A

ASA P4

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25
Q

What is ASA P5?

A

A moribund pt who is not expected to survive without operation?

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26
Q

What is the classification of a pt declared brain dead whose organs are being removed for donor purposes?

A

ASA P6

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27
Q

How does the preoperative nurse promote healthy behavior and and improve pt outcomes with a pt education plan?

A
  1. making the plan individualized to each pt

2. Involving the pt in his or her own care and decision making

28
Q

what is health literacy?

A

ability to obtain, process, and understand basic health information and services needed to make appropriate decisions

29
Q

Three ways to effectively communicate to pt?

A
  1. visual
  2. print
  3. audio
30
Q

what is teach-back?

A

Requires the caregiver ask the pt or family member to demonstrate or explain information that been presented to them.

31
Q

What method is a proven way to assess and confirm a pt and family member’s understanding of information presented to them?

A

teach back method

32
Q

Discharge planning begins during which phase?

A

preoperative interviewing

33
Q

What is the asc consideration for staffing?

A
  1. Number of pt( day surgeries and pre-assessments)
  2. Type of pt being served ( pediatric and special needs)
  3. Number of ORs
  4. Type of anesthesia being provided
  5. Average time in preoperative area
  6. Unit needs
34
Q

Asc staff consideration for nurses who perform preoperative assessment?

A
  1. Be proficient in interviewing, assessment, identification, and documentation of preoperative process
  2. Use critical thinking skills to evaluate complex patient data and select appropriate interventions
35
Q

Legal responsibilities for asc include?

A

Adhering to nursing practice standards facility policies and procedures and state licensure laws.

36
Q

Postoperative care in the ASC setting includes the same care provided in the inpatient PACU which includes what phases?

A

Phase 1- immediate anesthesia recovery
Phase 2- ready to resume self care
Phase 3 -extended observation

37
Q

What is ASPAN?

A

The American Society of Peri-anesthesia Nursing is a professional specialty nursing organization

38
Q

What is the ratio of nurse to pt on initial entry to PACU?

A

1:1

39
Q

What is the ratio of nurse to pt after pt is stable and conscious in the PACU?

A

1:2

40
Q

What is considered phase 1 for a postoperative care pt arriving in the PACU?

A

The pt requires immediate recovery from anesthesia using the Aldrete Scale

41
Q

What is considered phase 2 for a postoperative care pt arriving in the PACU?

A

Pt has met discharge criteria from phase 1 and has progressed to pre-surgical level for activities of daily living and other appropriate criteria for discharge.

42
Q

What is considered the extended level of care postoperative recovery phase?

A

Pt requires admission for extended observation because he or she has not met discharge criteria for phase 2

43
Q

Pt physical arrival to PACU in Phase 1 level of care ?

A
  1. stable secure airway

2. Be hemodynamically stable and free from agitation, restlessness, and combative behavior

44
Q

Pt management for phase 1 includes?

A
  1. vital signs (frequency determined by facility)
  2. oxygenation
  3. ventilation
  4. level of consciousness
  5. temperature
  6. pain management
  7. n/v
  8. i/v fluids
  9. drains
45
Q

When does a pt move to Phase 2 ( also known as step down)?

A

Once they meet the PACU discharge criteria for phase 1

46
Q

What is fast track?

A

When pt bypasses phase 1 level of care and goes to phase 2

47
Q

What is the criteria to be considered for fast track?

A
  1. Must be classified as ASA1 or ASA2
  2. Thorough preoperative pt education
  3. Use of collaborative approach
  4. Use of appropriate anesthetic
  5. Ability for anesthesia to make patient assessment
48
Q

Postoperative education in phase 2?

A
  1. pt are told what to do after they are home
  2. they are taught how to empty drains and change dressings
  3. ICOUGH
  4. Prescriptions are reviewed
  5. Pt must urinate before discharge
  6. A peripheral nerve or spinal pt must be weight bearing before discharge
49
Q

What is the ratio for nurse to pt in phase 2?

A

1: 3 pt over 8
1: 2 pt under 8

50
Q

Discharge for phase 2 includes?

A
  1. transfer by wheelchair with responsible caregiver

2. not allowed to drive unless they had local anesthesia or exempt by attending physician

51
Q

Assessment criteria in all phases of PACU?

A
  1. Respiratory evaluation (airway, O2 sats)
  2. Circulatory evaluation ( BP, pulse, echocardiogram, estimated blood loss)
  3. temperature
  4. Skin color
  5. level of consciousness
  6. Surgical dressing
  7. pain level
  8. N/V
52
Q

Postoperative Nausea and Vomiting (PONV) risk factors?

A
  1. Hx of PONV
  2. Hx of motion sickness
  3. Use of volatile inhalants( isoflurane, sevoflurane, desflurane)
  4. Use of nitrous oxide
  5. Use of postoperative opioids
  6. Female gender
  7. Non smoking status
53
Q

Pharmacological interventions for PONV?

A
  1. Ondansetron
  2. Phenergan
  3. Droperidol
  4. Dexamethasone
54
Q

A major complication associated with vomiting?

A
  1. Pulmonary aspiration of gastric contents
55
Q

Pain management in pediatric pts?

A
  1. Faces scale for preschool and school age children
56
Q

Anesthesia reversal agents ?

A
  1. Flumazenil

2. Naloxone

57
Q

Discharge protocol for ASC postoperative care?

A
  1. Post surgical needs must be addressed and included in the discharge note
  2. Pt must be evaluated by a physician or anesthetists
  3. pt must have written discharge order signed by physician who performed surgery( pt leaves 15-30 minutes following the discharge signature)
58
Q

Discharge criteria for ASC postoperative care?

A
  1. Stable vs
  2. acceptable level of orientation and alertness
  3. adequate respiratory function( 93% or higher)
  4. Ability to ambulate or move extremity
  5. Acceptable pain levels
  6. acceptable degree of n/v
  7. ability to void
  8. ability to tolerate oral fluids
  9. no swelling or discharge at surgical site
  10. acceptable skin color and condition
59
Q

follow up phone call for asc postoperative?

A

usually 24-72 hours

60
Q

CDC criterion for wound infection?

A
  1. Surgical infection include incisional infections and deep infections
  2. presence of purulent drainage from incision or drainage located above the incision
  3. organism isolated from culture or fluid from primarily closed wound
  4. surgeon must reopen wound( unless negative culture)
  5. Surgeon/ attending physician has made a diagnosis of infection
61
Q

Incisional wound infections occur?

A
  1. within 30 days of surgery

2. Involves skin, subcutaneous tissue, and muscle above the fascial layer

62
Q

Deep surgical wound infection?

A
  1. At operative site within 30 days after surgery(if no implant is present)
  2. At operative site within a year if an implant is present
    the infection appears to be related to surgery and involves tissue or spaces at or beneath the fascial layer
63
Q

Deep surgical wound infection criteria?

A
  1. presence of purulent drainage from drains
  2. spontaneous wound dehiscence or surgeon has to deliberately open wound if febrile> 100.4
  3. abscess or other evidence of infection seen on direct examination
  4. The surgeon has made a diagnosis of infection
64
Q

Duration of stay for Extended level of care asc postoperative care?

A
  1. Determined by license the facility applied for and granted by the state and federal agency
  2. Most are 23 hours
  3. Medicare does not allow pt to stay overnight in ambulatory services
65
Q

Nursing ratio for extended level of care asc postoperative care?

A

1:3/5 ( support staff)

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