Exam # 1 Pre-Operative Phase Flashcards
What are the 6 reasons surgeries are performed?
1) Diagnosis - i.e., lymph node biopsy
2) Curative - i.e., excision of a tumor or inflamed appendix
3) Palliative - i.e., cutting nerve root to relieve pain, colostomy to bypass obstruction.
4) Cosmetic - i.e., scar revision
5) Prevention - i.e., removal of pre malignant mole, mastectomy if strong family Hx of breast cancer exists.
6) Exploratory - i.e., exploratory laparotomy (ostomies & otomies)
Define Ambulatory Surgery Centers (ASC)
Includes centers that provide outpatient surgical services not requiring an overnight stay, independent diagnostic and testing facilities, and health provider’s offices.
What are the 5 classifications of surgery?
1) Emergent - PT requires immediate attention without delay.
2) Urgent - PT requires prompt attention within 24-48 hours.
3) Planned/Required -PT needs to have surgery within a few weeks or months.
4) Elective - PT should have surgery but failure to have surgery will not be catastrophic.
5) Optional - PT decides wether or not to have the surgery base on personal preference.
Give 6 examples of circumstances that require Emergency Surgeries?
1) Severe bleeding
2) Bladder or intestinal obstruction
3) Fractured skull
4) Extensive burns
5) Gunshot or stab wounds
6) Abdominal Aortic Aneurism
Give 2 examples of circumstances that require Urgent Surgery?
1) Acute gallbladder infection
2) Kidney or ureteral stones
Give 4 examples of circumstances that necessitates Planned/Required Surgeries?
1) Prostatic hyperplasia without bladder obstruction
2) Thyroid disorders
3) Cataracts
4) Tumor removal
Give 4 examples of circumstances that require Elective Surgery?
1) Repair of scars
2) Simple hernia
3) Vaginal repair
4) Hysterectomy
Give an example of an optional surgery?
Cosmetic surgery
When does the Preoperative Phase begin and end?
The Preoperative Phase begins when the decision to proceed with the surgical intervention is made, and ends with the transfer of the patient onto the OR table.
In which 4 circumstances are informed consent necessary?
1) Invasive Procedures - Such as surgical incisions, biopsies, cystoscopy, or paracentesis.
2) Procedures requiring sedation/anesthesia.
3) Non surgical procedures such as arteriography that carries more than slight risk to the patient.
4) Procedures involving radiation.
What are the 4 BMI categories?
1) Underweight - < 18.5
2) Normal - 18.5 - 24.9
3) Overweight - 25 - 30
4) Obese - > 30
When does the Intraoperative Phase of surgery begin and end?
The Intraoperative begins when the patient is transferred into the OR table and ends with admission to the PACU
What are the 3 areas of the surgical area?
1) Unrestricted Zone - Where street clothes can be worn.
2) Semi-restricted Zone - Scrub clothes and caps.
3) Restricted Zone - Scrub clothes, shoe covers, caps and masks.
Define the following:
1) Ectomy
2) Lysis
3) Orrhaphy
4) Scopy
5) Ostomy
6) Otomy
7) Plasty
1) Ectomy - To take out
2) Lysis - To breakdown
3) Orrhaphy - To to repair or suture
4) Scopy - To look/view
5) Ostomy - To make an opening
6) Otomy - To cut into or make an incision
7) Plasty - To repair or rebuild
What can cause an Abdominal Aortic Aneurism
Can be caused by old age or trauma
What is the difference between the 2 following surgical settings:
1) Inpatient
2) Ambulatory Care (Outpatient)
1) Inpatient - Includes same day admission and patients are admitted (meaning they stay for an extended time).
2) Ambulatory Care (Outpatient) - Cheaper, typically uses regional anesthesia, and only does minor surgery.
What are the 9 things that should be included in a complete preoperative nursing assessment ?
1) Psychological Status - Fear, anxiety, etc.
2) Physiological Factors - Individual risk factors
3) Baseline Data - Used for comparison
4) Documentation - Surgical site and side
5) Medication - Includes OTC meds, herbs, alcohol, tobacco and recreational drugs.
6) Lab and Diagnostic Tests
7) Cultural/Ethnic Factors - JWs and Muslims
8) Consent Signed
9) Allergies
Which electrolyte is the most important to monitor perioperatively and why?
Potassium, because it can cause arrhythmias
Who’s responsible for explaining the procedure to the patient Nd who signs the informed consent?
The Surgeon is responsible for explaining the procedure and the nurse is responsible for making sure the patient understands the procedure.
Informed Consent is signed by both the Surgeon and the patient.
How can you assess for latex allergy in a patient?
Ask the patient if they Re allergic to stone fruits, i.e., Kiwi, bananas etc.
What is the effect of recreational drug when the patient is in the hospital setting?
Medication administration (i.e., opioids) may not be as effective because the have built up a tolerance.
What are the 8 common fears patients generally have of surgery?
1) Fear of the unknown
2) Loss of control
3) Pain
4) Death
5) Disfigurment
6) Anesthesia
7) Financial ramifications
8) Irrational fears
What are two ways to promote psychological readiness before surgery?
1) Active Listening - Ask open ended questions
2) PreOp Teaching - May include I/S, C&DB, early ambulation, and pain control after surgery.
Give 4 examples of teaching that can be done preoperatively?
1) Post-op equipment and dressings (i.e., tubes, sore throat from ET).
2) Elastic Compression Stockings
3) Intermittent Compression Devices
4) Family Teaching (i.e., visiting, OR communication, PACU)
Name 3 postop exercises a patient can be taught to do in bed that will help return blood to the heart.
1) Isometric quads
2) Gluteal squeeze
3) Ankle pumps
What are the 5 components of the nursing assessment for the cardiovascular system?
1) Baseline vitals should be recorded
2) Bleeding and clotting times
3) Lab reports
4) Prophylactic antibiotics
5) EKG
Your patient has a productive cough with green sputum. Who should you report this to and what might he or she order?
Report it to the surgeon who may order a culture and sensitivity
What should be involved in a preoperative nursing assessment of the respiratory system?
1) Inquire about recent airway infections - procedure may be cancelled because of increased risk of Laryngotracheobronchitis/bronchospasm or ⬇ SaO2
2) Inquire if patient smokes
Who can sign the consent form on behalf of the patient?
Anyone noted on the power of attorney
Renal dysfunction contributes to what 4 complications which are contraindicated for surgery?
1) F&E imbalances
2) ⬆ risk of infection
3) Impaired wound healing
4) Altered response to drugs and their elimination
Who should you report problems affecting neck or lumbar spine to?
The Anethesiologist
(T/F) The patient can still have hyperglycemia even when he or she is NPO because they might be under stress
True
Patients should be asked preoperatively about diabetes and insulin use. What 5 conditions are diabetic patients at risk for?
1) Hypo/hyperglycemia
2) Ketosis
3) Cardiovascular alterations
4) Delayed wound healing
5) Infection
(T/F) Serum glucose test must be done the morning of surgery in order to establish a baseline.
True
What things can affect F&E status?
1) Vomiting, diarrhea, or difficulty swallowing
2) Certain drugs like diuretics
3) Bowel preps
4) NPO status (may lead to dehydration)
(T/F) Poor nutrition and dehydration affects wound healing, which is why surgeons sometimes hold off surgeries of older people until they are properly nourished and hydrated.
True
How do you calculate Cardiac Output
CO = SV x HR
What are the preoperative gerontological concerns for the following systems:
1) Cardiovascular
2) Respiratory
3) Renal
4) Musculoskeletal
1) Cardiovascular - ⬇ CO, ⬆ BP, ⬇ peripheral circulation, arrhythmias.
2) Respiratory - ⬇ vital capacity, ⬇ O2 sat
3) Renal - ⬇ GFR, ⬇ renal blood flow
4) Musculoskeletal - ⬇ lean body mass, osteoperosis, osteoarthritis
Why might a bolus of corticosteroids be given IV immediately before and after surgery?
Because cardiovascular collapse can occur if discontinued suddenly.
What is the effect of the interaction of Anesthetics with the following drugs:
1) Corticosteroids
2) Diuretics
3) Phenothiazines (Thorazine)
4) Tranquilizers (Diazepam)
5) Antibiotics
6) Anticoagulants
7) MAO Inhibitors
1) Corticosteroids - CV collapse can occur if discontinued suddenly, so a bolus is given immediately before and after surgery
2) Diuretics - ⬆ respiratory depression from electrolyte imbalance
3) Phenothiazines (Thorazine) - ⬆ hypotension
4) Tranquilizers (Diazepam) - ⬆ anxiety, tension and seizures
5) Antibiotics - Apnea and respiratory paralysis
6) Anticoagulants - ⬆ bleeding
7) MAO Inhibitors - ⬆ hypotension
Name 12 herbs that potentiate the effects of or increase bleeding when taken with NSAIDs.
1) Bilberry fruit
2) Chondroitin
3) German or Hungarian chamomile
4) Dong quai
5) Fenugreek
6) Garlic
7) Ginger
8) Melatonin
9) Pau D’arco
10) Red clover
11) Tumeric
12) Willow
What is the effect of taking St. John’s Worth with Ibuprofen?
Mean residence time of ibuprofen may be ⬇
What is the effect of taking Acetaminophen with Watercress?
Watercress inhibits the oxidative pathway of acetaminophen metabolism
What is the effect of taking Gingko with Aspirin
Increases bleeding tendencies
Which 4 herbs are contraindicated when taking Opioids?
1) Dan Shen
2) Kava Kava
3) Sarsaparilla - ⬆ elimination of sedatives
4) Valerian - ⬆ effects of sedatives
What is the effect of taking taking Fentanyl with the following herbs:
1) Grapefruit
2) St. John’s Wort
1) Grapefruit - ⬆ concentration of fentanyl leading to adverse effects
2) St John’s Wort - Affects metabolism of fentanyl
List the 4 integral parts of a Legal Consent?
1) Adequate disclosure
2) Sufficient comprehension
3) Voluntary consent
4) Signature - by MD, the patient and sometimes the RN will sign verifying that it was the patient who signed the form.
What are the 6 key components of the “Adequate Disclosure” portion of an informed consent?
1) Diagnosis
2) Nature and purpose of Tx
3) Risks and consequences of Tx
4) Benefits/Probability of success
5) Alternative Tx
6) Prognosis without Tx
Legal preparation for surgery requires that all forms are signed and in the patient’s chart. Name 4 such forms.
1) Informed consent
2) Blood transfusions
3) Advance directive - Ask upon admission
4) Power of attorney
(T/F) Permission for an informed consent may be withdrawn at any time.
True
(T/F) It is the mechanical motion of hand washing, not the chemical makeup of the soap, that effectively eliminates microbes.
True
Why is it important to make sure that chlorohexadine is dry before beginning a procedure that involves cauterizing?
Because chlorohexadine is alcohol based and is therefore flammable and a fire hazard.
What is the difference between pharmacodynamics and pharmacokinetics?
1) Pharmacodynamics - What a drug does to the body
2) Pharmacokinetics - What the body does to the drug
What are the 3 things possibly involved in bowel prep for surgery?
1) NPO status
2) Enema
3) Cathartics (i.e., GoLytely) - Do not give over ice
What are the 4 adjuncts to general anesthesia discussed in class and which one produces amnesia?
1) Benzodiazapines
2) Versed (produces amnesia)
3) Valium
4) Ativan
What are the 6 properties of the following Anesthetic Adjuncts discussed in class: Benzodiazapines, versed, valium and ativan?
1) Relieve anxiety
2) Induce sleep
3) Produces amnesia
4) Metabolized by the liver
5) Rapidly absorbed
6) Increases respiratory depression
* Remember that adjuncts do not have analgesic properties!!!
What are the 7 side effects of the following Anesthetic Adjuncts discussed in class: Benzodiazapines, versed, valium and ativan?
1) CNS depression
2) Respiratory depression
3) Hypotension
4) Bradycardia
5) Drowsiness and ataxia (loss of coordination)
6) Fatigues and confusion
7) Weakness and dizziness
What is the reversal agent (antidote) of the following Anesthetic Adjuncts discussed in class: Benzodiazapines, versed, valium and ativan?
Flumazenil (Romazicon)
What are the 2 properties of the following opioids discussed in class: Morphine, Demerol, and fentanyl?
1) Analgesia
2) Sedation
What are the 5 side effects of the following opioids discussed in class: Morphine, Demerol, and fentanyl?
1) Respiratory depression
2) Nausea and Vomitting
3) Drowsiness
4) Hypotension and orthostatic hypotension
5) Bronchospasm in asthmatics
What is the reversal agent (antidote) of the following opioids discussed in class: Morphine, Demerol, and fentanyl?
Naloxone (narcan)
How long should you wait between the 3 BP measurements taken during an orthostatic BP hypotension measurement?
2-3 minutes
Why should you be ready to restrain a patient to whom you have just administered Narcan?
Because the sudden return of the sensation to the pain receptors cause them to flail about.
(T/F) The stomach makes more acid during the PeriOp process because of stress and therefore acid reducing meds are prescribed prophylactically to prevent stress ulcers.
True
What are the 5 types H2 Receptor Antagonists discussed in class, how do they work and what forms are they available in?
1) Tagamet, pepcid, zantac, prilosec, and prevacid
2) They inhibit gastric secretion
3) They are available PO, IV and IM
What are the 2 side effects of the H2 Receptor Antagonists discussed in class?
1) Skin rash (hypersensitivity)
2) ⬇ RBCS, WBCs, and platelet synthesis
What are the 4 types Antiemtics discussed in class, how do they work and what forms are they available in?
1) Reglan, droperidol, zofran, and phenegran
2) Indicated for N & V
3) Available PO, IM, IV, rectal, and transdermal
What are the 5 side effects of the Antiemtics discussed in class?
1) Drowsiness from the CNS depression
2) Hypotension
3) Dry mouth from the anticholinergic effect
4) Blurred vision caused by anticholinergic dilation
5) ⬇ Coordination
What are the 3 types of Anticholinergics discussed in class, how do they work and what forms are they available in?
1) Atropine, glycopyrolate, and scopolamine
2) They are used to ⬇ salivation, which prevents aspiration, prevent bradycardia, and inhibit smooth muscle contraction in the GI tract.
3) Available PO, IM, IV
What are the 5 side effects of the Anticholinergics discussed in class?
1) ⬇ Parasympathetic stimulation
2) ⬇ Peristalsis
3) ⬇ Salivation
4) Urinary retention
5) CNS disturbances
Why is it important to remove all jewelry before surgery?
Because the electric cauterizing used during surgery can conduct electricity through the body which can exit through jewelry anywhere on the body. If patient refuses to remove jewelry, then tape it to their body.
Wy is it important the patient not wear any cosmetics for the surgery?
It is important to be able to observe the skin color. Also nail polish must be removed to for the pulse oximeter to work.
(T/F) DNRs are suspended in the OR room.
True - MDs will resuscitate if the patient is dying in the OR.
What are the 5 rights of delegation?
1) Right task
2) Right person
3) Right communication - Clearly state objectives & expectations
4) Right feedback - Evaluation during/after task completed
5) Right time
(T/F) Before delegating nursing tasks to CNAs, a nurse must check for other available nurses to delegate the task to first.
True
Define Delegation
the transfer of responsibility for the performance of an activity to another individual WHILE RETAINING ACCOUNTABILITY for the outcome. (You are still responsible)
What is the main reason a patient is made NPO hour before surgery?
To prevent aspiration
What are the 4 stages of General Anesthesia?
1) Stage 1 (Beginning Anesthesia) - As the patient breathes in the anesthesia mixture, warmth, dizziness and a feeling of detachment may be experienced.
2) Stage 2 (Excitement) - Characterized variously by struggling, shouting, talking, singing, laughing or crying is often avoided if the anesthetic is administered smoothly and quickly.
3) Stage 3 (Surgical Anesthesia) - Patient is unconscious.
4) Stage 4 (Medullary Depression) - When too much anesthesia has been administered. Cyanosis develops and patient could die.
Nausea vomiting and pain may occur during surgery when spinal anesthesia is used. What can be administered to counteract this?
IV administration of thiopental and inhalation of nitrous oxide may prevent this.
What three methods can be used to manage pos-op spinal anesthesia headache?
1) Maintain a quiet environment
2) Keep the patient lying flat
3) Keep the patient well hydrated
(T/F) Post-op hiccups may be produced by intermittent spasms of the diaphragm and can lead to vomiting, exhaustion, and possibly wound dehiscence.
True
Wy is it important to avoid the use of blanket rolls, pillow rolls, and any for of leg elevation under the knees.
Because they pose a risk of constricting the vessels in the leg which increases the risk of DVTs.
Within which timeframe does Malignant Hypothermia usually manifest?
Malignant hypothermia usually manifests about 10-20 mins after induction of anesthesia, but can occur during the first 24 hours after surgery.
Corticosteroids have which affect on wound healing?
They mask the presence of infection by impairing the normal inflammatory response.
What is the difference between Evisceration and Dehiscence?
1) Evisceration - The protrusion of abdominal organs through the surgical incision.
2) Dehiscence - The partial or complete separation of wound edges.
