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Med-Surg > Exam 1 perioperative/rehab > Flashcards

Exam 1 perioperative/rehab Flashcards

1
Q

What is SCIP?

A

Surgical Care Improvement Project. A plan developed for the reduction and eventual elimination of preventable surgical complications.

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2
Q

What core areas are the interventions set out to improve? (SCIP)

A

Infection prevention, prevention of serious cardiac events, prevention of venous thromboembolism, and maintaining normothermia.

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3
Q

What are the interventions used for infection prevention? (SCIP)

A

Prophylactic antibiotic received within one hour prior to surgical incision. Prophylactic antibiotic selection for surgical patients. Prophylactic antibiotics discontinued within 24 hours after surgery end time. Cardiac surgery patients with controlled 6:00 AM postoperative blood glucose. Surgery patients with appropriate hair removal. Urinary catheter removed on post op day one or post-op day two with they of surgery being day zero. Surgery patients with postoperative temperature management.

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4
Q

What are the interventions used for cardiac event management? (SCIP)

A

Surgery patients on beta-blocker therapy prior to arrival who received a beta-blocker during the perioperative period.

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5
Q

What are the interventions used for VTE prevention? (SCIP)

A

Surgery pts with recommended venous thromboembolism prophylaxis ordered. Surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hours prior to surgery to 24 hours after surgery.

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6
Q

What are some factors that increase surgical risk and post-op complications?

A

Age( older than 65), medications, medical history, prior surgical experiences, health hx, family hx, and type of surgical procedure planned.

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7
Q

Post op complications: medications

A

Antihypertensives, tricyclic antidepressants, anticoagulants, nonsteroidal anti-inflammatory drugs (NSAIDS) and immunosuppressives.

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8
Q

Post op complications: medical hx

A

Decreased immunity, diabetes, pulmonary disease, cardia disease, hemodynamic instability, multi system disease, coagulation defect or disorder, anemia, dehydration, infection, hypertension, hypotension, and any chronic disease.

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9
Q

Post op complication: prior surgical experiences

A

Less than optimal emotional reaction, anesthesia reactions of complications, postoperative complications

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10
Q

Post op complications: health hx

A

malnutrition or obesity, drug, tobacco, alcohol, or illicit substance use or abuse, altered coping ability, or herbal use.

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11
Q

Post op complications: Family hx

A

malignant hyperthermia, cancer, bleeding disorder, anesthesia reactions or complications.

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12
Q

Post op complications: type of surgical procedure

A

neck, oral, or facial procedures (airway complications), chest or high abdominal procedures (pulmonary complications) and abdominal surgery (paralytic ileus, venous thromboembolism)

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13
Q

What is an informed consent?

A

A written record that patients must sign stating they were given sufficient information to understand: nature of/reason for surgery, who is preforming the surgery and others who will be present, all available options with their risks and benefits, risks associated with surgier procedure and possible outcomes, risks of anesthesia, risks/benefits/alternatives to using blood products during surgery.

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14
Q

Who is responsible for obtaining informed consent?

A

Surgeon

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15
Q

What is the nurse’s role in informed consent?

A

To verify that the consent form is signed, and he or she may serve as a witness to the signature, not to the fact that the patient is informed.

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16
Q

What is a patient is not able to sign a informed consent?

A

Family members consent is first option, otherwise the court can appoint a legal guardian to represent the patients best interest.

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17
Q

How does patient use of tobacco make surgery risky?

A

Tobacco increases the risk of pulmonary complications because of changes to the lungs, blood vessels, and chest cavity.

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18
Q

How does patient use of alcohol and illicit substance make surgery risky?

A

Alcohol and illicit substance use can alter the patients responses to anesthesia and pain medication. Withdrawal of alcohol before surgery may lead to delirium tremens.

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19
Q

What does smoking increase the patients risk? (complications)

A

Carboxyhemoglobin= carbon monoxide on oxygen binding sides of the hemoglobin molecule which decreases oxygen delivery to organs.

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20
Q

What are autologous blood donations?

A

blood donations made by the patient a few weeks before the scheduled surgery date.

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21
Q

What are directed blood donations?

A

Blood donations made by family and friends exclusively for patients use if needed.

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22
Q

What other alternative blood donations are available?

A

Bloodless surgery with the use of a cell saver.

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23
Q

What are the 3 core components of identification in the time out/pause for a cause procedure?

A

Verify the correct site, patient, and procedure.

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24
Q

When is the time out/pause for a cause procedure done and who is responsible?

A

Before starting the operative procedure. The perioperative nurse.

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25
Q

What should be included in the focused assessment prior to surgery?

A

Cardiopulmonary assessment, take and record vital signs. Assess for and report any signs or symptoms of infection, assess for the report s/s that could contraindicate surgery, assess for and report other clinical conditions that may need further evaluation before proceeding with the surgical plans, assess and determine functionality of any implantable cardiovascular decides, evaluate pt and family past medical hx that may need further evaluation.

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26
Q

What needs to be reported to surgeon/anesthesia prior to surgery?

A

Hypotension/hypertension, HR less than 60/more than 120, irregular HR, chest pain, SOB, tachypnea, Pulse ox less than 94%. Fever, purulent sputum, foul smelling urine, red/swollen/drainage from IV site, increased WBC, increased PT time, hypo/hyperkalemia, possible/positive pregnancy, change in mental status, vomiting, rash, recent administration of anticoagulant drug, pacemaker, ICDs, hx of ischemic hearth disease, hx of cerebrovascular disease.

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27
Q

What are common labs drawn prior to surgery and what’s the reason for each?

A

Urinalysis, blood type and screen, CBC or hemoglobin/hematocrit, clotting study (PT, INR, aPTT, platelet count), electrolyte levels, serum creatinine and blood urea nitrogen levels, pregnancy test.

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28
Q

What electrolyte abnormality puts the patient at highest risk during surgery?

A

Hypokalemia (decreased potassium levels) and Hyperkalemia (increased potassium levels)

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29
Q

What labs help identify nutritional status pre-operatively.

A

decreased serum protein levels and abnormal serum electrolyte values.

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30
Q

Why must patients be NPO prior to surgery and what are the accepted parameters?

A

To reduce the risk of aspiration. 6 or more hours for easily digested solid food and 2 hours for clear liquids.

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31
Q

What type of meds are given preoperatively and why?

A

Drugs for cardiac disease, respiratory disease, seizures, and hypertension should be taken with a sip of water.

32
Q

What medication might be prescribed to a surgical patient who is at risk for cardia problems.

A

Beta-blocker

33
Q

What important topics should be taught preoperatively to prepare the patient for post op treatments/exercises? (DVT, pneumonia prevention)

A

Breathing exercises, Incentive spirometry, coughing and splinting, TED or jobst stockings (antiembolism stockings) pneumatic compression devices (PCA), leg exercises, and mobility.

34
Q

What client is at greatest risk for DVT?

A

Obesity, 40 yrs of older, cancer, decreased mobility/immobility, spinal cord injury, hx of VTE, DVT, PE, varicose veins, or edema, oral contraceptive use, smoking, decreased cardia output, and hip fx/total hip/knee surgery.

35
Q

Primary responsibility of the surgeon?

A

Manages the surgical procedure and makes surgical judgements about the patients care.

36
Q

Primary responsibility of the surgical assistants

A

preforms specific tasks during the surgical procedure under direction of the surgeon

37
Q

Primary responsibility of the anesthesiologist

A

administers anesthetic agents and continually monitors patient status

38
Q

Primary responsibility of the circulating nurse

A

uses clinical decision making skills to develop a plan of care and coordinates care delivery to pt and their family members. Coordinates, oversees, and implements nursing care interventions to support the pt during surgical procedure.

39
Q

Primary responsibility of the scrub nurse

A

Provides pt care at the surgical field, assisting the surgeon and assistant. maintains the integrity, safety, and efficiency of the sterile field during the procedure.

40
Q

What is a “surgical scrub” and who is required to preform it?

A

A scrub using antimicrobial solution used to reduce the number of organism from the hands, arms, and nails. Preformed by surgeon, assistants, and the scrub nurse.

41
Q

What is general anesthesia?

A

A reversible loss of consciousness induced by inhibiting neuronal impulses in areas of the central nervous system.

42
Q

What are the routes used to administer general anesthesia?

A

Inhalation and Intravenous

43
Q

What is malignant hyperthermia?

A

An inherited muscle disorder that is acute and life threatening complication of certain drugs used for general anesthesia. It is characterized by many problems including inadequate thermoregulation, increased calcium and potassium levels, acidosis, dysrhythmias, and high body temps.

44
Q

What drugs increase risk of malignant hyperthermia?

A

halothane, enflurane, isoflurane, desflurane, sevoflurane, and succinylcholine.

45
Q

What drug reduces the symptoms of malignant hyperthermia?

A

Dantrolene Sodium (skeletal muscle relaxant)

46
Q

Other interventions to help with malignant hyperthermia?

A

Administer iced saline IV at a rate of 15mL/hg every 15 minutes as needed. Apply cooling blanket over torso, pack ice bags at axillae, groin, neck, and head. Lavage the stomach, bladder, rectum, and open body cavities with sterile iced normal saline.

47
Q

What is local anesthesia?

A

topically applied to the skin or mucous membranes for the area to be anesthetized.

48
Q

What is regional anesthesia?

A

type of local anesthesia that blocks multiple peripheral nerves and reduces sensation in a specific body region.

49
Q

Types of regional anesthesia?

A

Field block, nerve block, spinal, and epidural.

50
Q

What is moderate sedation (conscious sedation)?

A

IV delivery of sedative, hypnotic, and opioid drugs to reduce sensory perception but allow the pt to maintain a patent airway.

51
Q

Benefits of conscious sedation?

A

Short action and the pt has a rapid return to normal function and activities.

52
Q

When is conscious sedation used?

A

During minor surgical procedures like endoscopy, cardia catheterization, closed fracture reduction, and cardioversion.

53
Q

What is the most critical assessment that a PACU nurse should assess on a new patient coming into the recovery room?

A

Respiratory System. Assess for a patent airway and adequate gas exchange. Continuously monitor pulse ox and oxygen saturation. Assess rate/pattern/depth of breathing.

54
Q

Who are at increased risk for respiration complications after surgery?

A

Older pts, obesity, smokers, and pts with a hx of lung disease.

55
Q

What is the antidote for opioids?

A

naloxone hydrochloride (Narcan) 0.4 mg-2mg

56
Q

What is the antidote for benzodiazepines?

A

Flumazenil (romazicon) 0.2-1mg IV

57
Q

What elements of the cardiovascular system need to be assessed?

A

Vital signs, cardiac monitoring, peripheral vascular assessment.

58
Q

What pt. symptoms might indicate the cardiovascular system is compromised?

A

Blood pressure changes (15-20 point difference systolic or diastolic), abnormal heart sounds indicate cardia depression, fluid volume deficit, shock, hemorrhage, or effects of drugs,. Bradycardia could indicate anesthesia effect of hypothermia. Pulse deficit (difference between the apical and peripheral pulses) indicate dysrhythmia.

59
Q

Antidote of Warfarin

A

Vitamin K

60
Q

Antidote of Heparin

A

Protamine sulfate

61
Q

What elements of the neurologic system need to be assessed?

A

Cerebral functioning, level of consciousness, observe for lethargy, restlessness, and irritability and test coherence and orientation. Motor and sensory function after general anesthesia and spinal/epidural anesthesia.

62
Q

What is the minimum volume of urine output a patient should have ml/hr?

A

30ml/hr

63
Q

What are common acid-base imbalances might be seen in the post op patient?

A

loss of acids or bases from drainage. NG tube drainage or vomitus causes a loss of hydrochloric acid and leads to metabolic alkalosis.

64
Q

What types of IV fluids are commonly used post operatively?

A

Isotonic solutions= lactated ringers, 0.9% sodium chloride, and 5% dextrose with lactated ringers.

65
Q

What elements of the Renal/Urinary system need to be assessed?

A

Control of urination has returned after surgery. Urinary retention, bladder distention.

66
Q

What key UA lab findings indicate a UTI?

A

leukocyte esterase, nitrites, blood

67
Q

Nausea and vomiting treatment?

A

Zofran (ondansetron). sedating H2, histamine antagonist such as dimenhydrinate (Dramamine).

68
Q

What is dehiscence?

A

A partial or complete separation of the outer wound layers. “splitting open of the wound”

69
Q

What is evisceration?

A

a total separation of all wound layers and protrusion of internal organs through the open wound.

70
Q

What does a nurse do during a dehiscence?

A

apply a sterile nonadherent, or saline dressing to the wound and notify the surgeon.

71
Q

What does a nurse do during a evisceration?

A

Call surgeon and rapid response. Use sterile techniques, place moistened sterile dressings over the exposed area and place a sterile waterproof drape over the dressings. Do not reinsert protruding organs. Keep dressing wet with warm saline. Prepare pt for emergency surgery.

72
Q

What is important about assessing pain post op?

A

Pain is poorly assessed by elderly due to lack of communication and cognitively impaired. Pain can increase after surgery when pt is more awake

73
Q

Nonpharmacologic interventions for pain/

A

Positions of comfort, cushion/elevate painful areas, provide adequate rest, relaxation techniques, cluster care.

74
Q

What needs to be monitored in pts receiving opioid pain medicaiton?

A

Hypotension, respiratory depression, and other side effects. Respiratory Rate less than 12.

75
Q

What should be done during a opioid overdose?

A

Administer narcan, maintain open airway, administer oxygen, have suction equipment available in case of vomiting, monitor vital signs

76
Q

What are different types of wound dressings?

A

Gauze, nonadherent pads covered with large absorbent pad help in place by tape, tubular stretchy net, or Montgomery straps. Some are covered with transparent plastic surgical dressing or a spray in the OR

Med-Surg (5 decks)

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