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
