Ch 30: Perioperative nursing Flashcards
Give the three phases of perioperative periods
Perioperative:
decision to have surgery
➡️
transferred to operating room
Intraoperative:
Transferred to OR bed
➡️
transferred to post anesthesia care unit (PACU)
Postoperative “recovery”:
From admission to PACU/recovery
➡️
Complete recovery last follow up
 What is our ultimate surgical go
after surgery what is the pre-screening process
When should discharge planning begin perioperative

Ultimate surgical goal = shorter length of stay
Post surgery:
Pre-screening = intake
-Health history, meds, family nutrition, Elimination, rest, psychosocial, falls
Perioperative discharge planning begins when meeting the patient as you begin to anticipate needs after surgery


When giving discharge instructions
- how should instructions be given
- what should instructions include
As you are discharging a patient what is the mode of transportation for discharge and what must you watch from discharge
 What do you want to tell patients not to bring to surgery
When giving discharge instructions:
- WRITTEN instructions given
- include wound care, activity level allowed
As are discharging a patient:
- discharge MUST BE BY WHEELCHAIR
- you must watch the patient get into the car
When having surgery do not bring valuables
- may be lost
What does the AORN perioperative patient focused model study
Give the 4 AORN areas of focus
- 
- if you’re trying to manage physiologic responses what do you focus - 
- what do you want to recognize an empathized with the patient and family
3.
- typical results of a PREOP needle biopsy
- name for normal biopsy
4.
-how are patients during surgery
The AORN perioperative patient focus model studies what can be improved Perioperatively for patient focus and safety
AORN 4 areas of focus:
- physiologic➡️ response to anesthesia
- if managing physiologic responses focus on meeting patients needs - behavioral (family and individual)
- recognize an empathize with patient and family about the fear of unknown - Health system
- PREOP needle biopsy is usually inconclusive
- normal biopsy = lumpectomy - Safety
- patients usually restrained during surgery
- Give physiological responses to surgery post op
1. •BP/hormone changes • ⬆️ in total fluid volume • blood shunted to vital organs •⬇️ immune/inflammatory response • ⬇️ insulin ⬆️ glucose
Define types of surgical procedures And give examples
Urgency:
- elective + I.E
- urgent
- emergency
Risk
- give types
- done where/types of complications
Elective:
-planned by healthy people
•tonsillectomy
Urgent:
-done within 24 to 48 hours to PRESERVE PATIENTS HEALTH
•appendicitis

Emergency:
-IMMEDIATE to preserve life involves major Oregon
• Partial amputation/intracranial bleeds
Risk:
- minor or major
- done outpatient minimal complications
Define types of surgical procedures And give examples
Purpose: -diagnostic - ablative -palliative -reconstructive -transplant 
Diagnostic:
-make or confirm diagnosis
• biopsy
Ablative:
-remove a diseased part
• amputation/appendicitis
Palliative:
-to relieve or reduce intensity of illness
• bowel blockage
Reconstructive:
-Restore function to tissue

Transplant:
-New Organ
What is the ethical principles of anesthesia
What IS VITAL that you want to ensure EVERYTIME AFTER a procedure and how
No malfeasance
:Spare from harm and pain as much as possible
After procedure ensure patient can SWALLOW by assessing GAG REFLEX

Describe general surgery
- highest what? what is the risk?
- how do you administer
- what happens to the patient and body
- common post op reactions 
- What age/procedures require general anesthesia
General surgery
-highest risk and 😵 rate
-administered: inhalation or IV
-physiologic response
• loss of consciousness
• Skeletal muscle relaxation (paralysis)
-Postop reactions:
• N/V
• bronchospasm
• children violently wake
-any age any procedure
Describe moderate sedation/analgesia
- aka?
- when is it used
-  How do you administer
- what is reversal time
-  Give an example of moderate sedation/analgesia
moderate sedation/analgesia
- A.k.a. “ conscious sedation/analgesia”
- used for short term minimally invasive
-administered:
•intravenous
•sedatives
•analgesics
-PROMPTLY Reversed
-propofol

Describe regional anesthesia
-Preferred for and why?
-how do you administer
-patients response to anesthesia (physiologic)
-Best for what type of surgery
-examples of the type of medication classifications

Regional anesthesia
-preferred for OLDER as it
• ⬇️ hospital staying
• carries LOWER risk
-administered
• injected near nerve//Nerve pathway
• around operative site
-physiological effects:
• loss of sensation
• ⬇️ reflex
-Best for lower abdominal surgery
- nerve blocks/epidurals
- spinal blocks
Describe topical and local anesthesia
- used on
- physiologic response to anesthesia
-  What kind of tissues targeted
Topical and local anesthesia  -used on: •mucous membranes •open skin •wounds • burns
-physiologic response to topical/local
• prolonged relief
• two underlying tissues
-Target specific tissues

Give 2 reversal medications
Give a few medications for your “oscopy”

Reversal medication’s
-Narcan
-Romazicon (Flumazenil)
• V. conscious sedation
Drugs for”oscopy” -Versed -fentanyl -morphine -valium 
Give the 3 phases of general anesthesia
What do you want to watch for with general anesthesia
- induction
-from administration
➡️
Ready for incision - Maintenance
Incision
➡️
Near completion of procedure
3.
emerges from anesthesia
➡️
Ready to leave operating room
- with general anesthesia watch for bronco/laryngospasm

Give the 5 p’s of surgery
(part of the 7 p’s)
 wanna patient loses consciousness what do they lose
What may relaxed skeletal muscles lead to
What kind of reflexes get depressed during surgery
-Pain
- pallor
• poikilothermia
-paresthesia
- paralysis
-pulse
When patients lose consciousness: lose control
Relaxed skeletal muscles may lead to respiratory depression
 depressed reflexes: gag and cough reflex
Types of regional anesthesia
- Nerve blocks
-  for what purpose - Spinal anesthesia
- injected to where
- for what locations
- what do you want to ensure and why -  epidural anesthesia
- injected to where
- risk for - Caudal anesthesia
- to where
- for what body locations
Nerve blocks:
- jaw, extremities, LABOR
 spinal anesthesia: -injected into subarachnoid space by lumbar puncture • for for lower abdomen/legs • ensure patient can urinate as it may cause urinary retention and hypotension + headache  Epidural anesthesia: -anesthesia to intravertebral spaces • risk of G.I. complications
Caudal anesthesia:
-to epidural space via sacrum
• for lower extremities/perineum
What is a Nurses responsibility relating to informed consent
Who’s responsibility is it to give the details of the surgery
What is the ethical principle within informed consent
Nurses must ensure:
-patient have signed the permission for surgery
-be a witness to signature
+ Advocate and support patients decision
It is the surgeons/doctors responsibility to give the details of the surgery
 ethical principle of informed consent:
-AUTONONY: patient’s ability to make personal decisions even if not in best interest
What does the informed consent form have
- description of/alternative
- underlying/natural course
- what about the person performing procedure
- what is explained (#’s)
- what rights do patients have
- expected (4)
Description of procedure an alternative therapies
Underlying disease process and its natural course
Name and qualification of person performing procedure
Explanation of risks and how often they occur
Explanation of right to refusal and withdrawal consent at ANYYYYY time
Explanation of expected outcome, recovered, rehab plan, course of treatment

When should you get the signature for informed consent (before what)
If there’s an emergency and facility cannot contact family how is consent given
Patient must sign before narcotic given
If emergency and faculty cannot contact family
-2 doctors sign the document
How many times do you ask for an advance directive
Define an advanced directive
Define a living will
Define a durable power of attorney
Ask three times if patient has an advanced directive
Advanced directive:
-specific instructions for health care treatment if unable
living wills:
-end of life care instructions
durable power of attorney:
-person who makes healthcare decisions on behalf of patient if pt not competent
What does the self-determination act Allow patient to do
self-determination act allows the right of a patient to make healthcare decisions (accepting and denying care) + The right to make an advance directive
Advantage:
- what kind of risk do outpatient/same day surgeries carry
- what is reduced for the patient
advantage: same day/outpatient surgery
-  very low risk
- decrease hospital state length and anxiety
Disadvantage:
-May require additional teaching and home care service
WE MUST KNOW AHEAD OF TIME 
What are a few outcomes for surgical patients
- Receive respectful culturally age-appropriate care
- be free from injury/ADR
- be free from infection/DVT
-maintain fluid and electrolyte balance,
skin integrity, normal temperature
• especially an elderly : Deep breathing to prevent increase in temperature
- have pain managed
- have understanding of physiologic/psychological responses to surgery
- participate in rehab

When we look at a patient holistically what are three factors were looking at
What kind of stressor is surgery, define the specific fear, What does this fear do
What are a few social cultural needs
Holistically: body mind and spirit
Surgery is a psychological stressor (fear of unknown) leads to increased risk of surgery because of the physical stress already happening
Socio cultural needs:
- food preferences (so they will eat)
- language difference
- cultural beliefs (stoic)
- family interaction
Give developmental differences perioperatively
-infant
• Lower volume ,drug metabolism, liver
-adolescent
•need for what
-Older
• tolerance, CO/wound healing, kidneys,liver
What medications are vital to know if patient is going into surgery
Infant:
- ⬇️ total blood volume
- ⬇️ drug metabolism + immature liver
Adolescent:
-⬆️ need for control and privacy
Older:
- ⬇️ tolerance to amnesia
- ⬇️ cardiac output/wound healing
- ⬇️ renal blood flow + hepatic function
Vital medications to ask for: -diuretics -anticoagulant -Tranquilizers -steroids -aspirin 
What two medications do you never want to abruptly withdraw before surgery
What nutritional supplement is needed for healing
What kind of blood supply and healing does fatty tissue have
Do not abruptly withdraw:
- antibiotics
- relaxants
Protein is needed for healing
Fatty tissue has low blood supply with delayed wound healing

If your patient is an alcoholic what will their analgesic dose look like
-Rx for DT
What complications will smokers have
- secretions
- postop risk
If alcoholic, there is an increased need for larger doses of analgesic
-use Librium for alcoholic Delirium Tremens
Smoker will have surgical resp complications
- ⬆️secretions
- post op ⬆️ risk for pneumonia
What surgical risk will anticoagulants cause?
Surgical risk tranquilizers
-increase what risk for anesthetics
Surgical risk for adrenal steroids
-what will abrupt withdrawal cause
What will “mycin” antibiotic cause?
Anticoags will cause hemmorage
Tranquilizers ⬆️ hypotension effects of anesthetic
Abrupt withdraw of Adrenal steroids can cause cardiovascular collapse
“Mycin” antibiotics may cause:
-resp paralysis When + with muscle relaxers
Presurgical screening tests
What will chest x rays show
ECG show?
Complete WBC COUNT
Electroytes
When do you do glucose testing?
Chest x show
- Pn
- chronic bronchitis
ECG: dysrhythmias
WBC count: H&h:12-18
Electrolytes:
Urinalysis
Glucose testing done PREOP and surgery day
What is a nurses role in pre surgical testing
Ensure tests are explained to the patient
Collects specimens
Ensure results recoded in chart pre op
Update abnormal results
Nursing interventions:
-when teaching post op what do you want establish with a patient and what will it allow
- what do you want to use to identify anxiety and fear
- how do you demonstrate genuine empathy and caring
- be prepared to respond to common patient questions
If you do not know the answer to a patient question what do you do (2 things) 
- Postop establish therapeutic relationship with patients that will allow patients to verbalize fears and concerns
- Use active listening to identify anxiety and fear
- use touch to demonstrate genuine empathy and caring
If you do not know the answer
- find out
- refer the question to a doctor or surg
What do you wanna do if patient says “ I think I’m going to die during surgery”
Give to nursing diagnosis for peri operative
Notify Dr immediately 
Nursing diagnosis:
- anxiety
- risk for infection
Give the construction techniques for deep breathing
Frequency of physical activity
Position: semi Fowler‘s hands over ribs Technique: -exhale gently and completely -inhale through nose - Hold 3-5 seconds - exhale pursed lips -repeat three times
Q 1 – 2 hours for the first 24 hours postop
Give the technique for effective coughing
Position: semi Fowlers leaning forward splinting abdomen with pillow
technique:
- inhale exhale through nose slowly 3 times
- inhale hold 3 seconds
- hack out 3 short breaths
- with mouth open take quick breath
- cough deeply one or two times
- take another breath
repeat q2h !!!
Describe leg exercises
Position: semi Fowler’s
Technique:
- Bend knee and raise foot
- Extend lower leg lower to bed five times each leg
- Point toes
- dorsiflex
- circular motion
repeat 3 times
What are physical activities you can do to prepare a patient
Deep breathing coughing Incentive spirometer leg exercises :⬆️ Venus return turning patient in bed early ambulation
 When does planning for the perioperative period Happen
Planning for ENTIRE perioperative period done preop
How should pt bath and shower
Why do you not use razors what do you use instead
Regarding elimination:
- when does peristalsis usually return after surgery
- what kind of sign is flatus
- !!!What do you want to ask a patient to do before receiving preoperative Mets
Patients should be in the shower in a 3 to 4 step process
-apply lather rinse
Use clippers instead of razors because of Knicks
Elimination:
-Peristalsis returns 24 to 48 hours post bowel surgery
-flatus (gas) = good sign 
-ask patients to use the restroom before giving preop meds!!!


If a patient is going to receive a colonoscopy what are teaching instructions you want to give them the night before
When going in for surgery what must you remove
If colonoscopy:
- NPO at midnight of surgery + sign on door
- take away fluids
When going for surgery:remove :
- jewelry
- dentures
- nail polish
- contacts
- void
When are preop meds usually given
(timeframe)
Give examples of sedative and what are used for
Give examples of anti-cholinergics what are used for
Give examples of narcotic analgesics
Give examples of neuroleptic analgesic agents and what are used for
Give examples of H2 antihistamines and what are used for
Preop meds given
45 to 75 minutes before surgery
Sedatives: ⬇️ anxiety
- valium
- Versed
Anti-cholinergics: ⬇️ salvation
-Robinul/atropine
Narcotic
- morphine
- Demerol
Neuroleptic analgesic agents: V psych behaviors
-fentanyl
H 2 antihistamines:⬇️ stress ulcers
-Tagamet
How does the joint commission prevent wrong person, site, procedure
1 Perioperative patient ID process
- Marking the operative site
- “Time out” Final verification just before procedure
-done by nurse checking all 3 criteria and documents

How often do you do post op assessments until when
How often do you do child postop assessments
What is the priority Prevention. post op
Assess adult clients postop q10-15 minutes
Assess children postop q5min
post op priority is to prevent anesthesia complications
When do you remove an artificial airway!!!
What is the # 1 problem post ANESTHESIA what is the intervention you want to do
 what temperature do you want to keep a patient postop
 if a patient first  Wound dressing is leaking what do you do
Do not move artificial airway until patient has gag reflex!!!
1 problem post ANESTHESIA is a respiratory obstruction suction
Keep patient warm post op
If first one dressing out of surgery is leaking reinforce and wait for surgeon

If pt is awake but not oriented what do you do
if patient is awake and oriented what do you do
How many children wake up from anesthesia
Awake but not oriented: continue to monitor
Awake and oriented: report to nurse receiving patient
Children may wake up violent (thrashing) from anesthesia
Cardiovascular complications
Signs and symptoms of hemorrhage
Interventions to do if hemorrhage #1 #2
Hemorrhage S & S:
- restless
- ⬇️ BP⬆️ HR ⬆️resp rate
-  Cold and clammy skin
Interventions: #1 stop bleeding with pressure #2 call Doc
Cardiovascular complications: shock
Issues
Look for
Intervention
Shock:
Issues:
-circulatory failure due to volume loss (hypovolemic shock)
Look for:
- hemorrhage
- poor tissue refusion
- poor capillary refill
Interventions:
- elevate legs 30 to 45°
- airway/02/ABG/warmth
Define thrombophlebitis
Thrombophlebitis signs and symptoms to call Doc
Pulmonary embolism signs and symptoms
Thrombophlebitis: inflammation of vein
Thrombophlebitis S&S
-CB + SOB = CALL DOC NOW‼️‼️
Pulmonary embolism S&S
-CP + SOB = CALL DOC NOW‼️‼️ possible PE
DVT signs and symptoms
DVT S and S:
•Calf, thigh , cramp pain
• swollen legs
• increase temperature
DVT interventions #1 put compression socks
Patients at risk for DVT
-obese comorbidities
Signs and symptoms of atelectasis
 intervention for atelectasis

Atelectasis S & S:
- dyspnea
- decrease breath sounds
- crackles
- cyanosis
Atelectasis = incentive spirometer
Signs of symptoms of hydrostatic bacteria
- aspiration ammonia
- fever/chills
- chest pain
- ⬆️ heart rate/resp
What is the acronym ICOUGH stand for And why is used
 ICOUGH used as interventions to prevent respiratory complications
I-incentive spirometer (q1-2hr)
C-coughing/ deep breathing (splint pillow
O-oral care
U-understand exercise important
G-get out of bed minimum three times daily
H-Head of bed elevated 30 to 45°
As a patient postop how long are you NPO For
When Does a patient urinary and bowel retention resolve postop
NPO Until gag reflex V aspiration pneumonia
Patient urinary and bowel retention resolves four hours postop

