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acute > exam 1 preop > Flashcards

exam 1 preop Flashcards

1
Q

preoperative

A

schedule time to transfer to surgical suite. Emphasis is on assessment, patient teaching, and completion of preparations for surgery

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2
Q

intraoperative

A

within the surgical suite. Concerns are for patient safety; examples-surgical asepsis, electrical safety, sponge counts, etc

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3
Q

postoperative

A

transfer to the PACU and after, concerns focus on immediate recovery to discharge planning

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4
Q

inpatient

A

the patient stays in the hospital

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5
Q

outpatient

A

the patient can go home

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6
Q

when and where of surgery

A

decisions for surgery, timing of surgery depends on severity, urgency, response to treatment

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7
Q

diagnostic surgery

A

to confirm a diagnosis–biopsy

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8
Q

ablative or curative

A

removes or repairs damaged and diseased tissue/organs

ex appendecotmy, hysterectomy, colectomy

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9
Q

reconstructive (or restorative)

A

restore function or appearance due to diseased or traumatized tissue
ex breast reconstruction

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10
Q

palliative

A

to relieve symptoms but not to cure

ex remove intestinal obstruction due to colon cancer

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11
Q

cosmetic

A

to improve the appearance

ex skin grafts

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12
Q

exploratory

A

to confirm diagnosis/ determine extent of disease/damage

ex figure out where bleeding is coming from in an exploratory laparotomy

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13
Q

constructive

A

restore function due to an anomaly

ex repair of cleft palate

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14
Q

transplant

A

replace malfunctioning organs

ex- kidneys, lung, heart, etc

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15
Q

4 domains of nursing practice in the preoperative period

A

safety, physiologic response, behavioral response, health care systems

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16
Q

patient safety through the preoperative period

A
  • WHO, TJC, AORN (association of operating room nurses)
  • implementation of the SCIP core measures is mandatory (surgical care improvement plans)
  • actions to prevent complications
  • preparation is crucial
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17
Q

minor surgery

A

minimal physical assault: skin lesion removal, cataract extraction, D&C

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18
Q

major surgery

A

extensive physical assault or serious risk: transplant, TJA, colostomy

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19
Q

emergent surgery

A

maybe life threatening, without delay

ex- ob emergency, ruptered aneurysm

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20
Q

urgent surgery

A

prompt attention, 1-2 days

ex heart bypass, amputation from gangrene

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21
Q

required surgery

A

plan within a few weeks, months

ex rbph without bladder obstruction, cataracts

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22
Q

elective surgery

A

decision usually to improve quality of life

ex total knee arthroplasty

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23
Q

optional surgery

A

personal preference

ex cosmetic surgery

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24
Q

simple surgery

A

only affected area

ex finger amputation

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25
Q

radical surgery

A

surgery beyond affected area

ex radical hysterectomy

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26
Q

minimally invasive surgery

A

athroscopy, laparoscopy

ex through an endoscope, arthroscopy, tubal ligation, lobectomy

27
Q

types of surgery that increases risk

A

neck, oral, facial–airway
chest or high abdominal–pulmonary
abdominal–parylytic ileus, VTE
orthopedic and fat emboli

28
Q

recognizing risk factors prior to surgery-nurse must access needs and factors that may increase surgical risk

A

overall physical/psychological health
cognitive status
financial concerns
spiritual needs

29
Q

factors that increase surgical risk

A

age, chronic disease hx, malnutrition, obesity, poverty, multiple drug use, heart disease, bleeding disorders, respiratory orders, endocrine disorders, hepatic disorders, renal disease, immune disorders, dental disease, previous history of surgical or postop complications, addictions, altered coping

30
Q

relation to dental disease and surgery

A

teeth can get knocked out during intubation and can cause occlusions

31
Q

medications that can increase surgical risk

A 
corticosteroids
immunosuppressants
diuretics
phenothiazines
tranquilizers
insulin
antibiotics
anticoagulants
anti-seizure medications
thyroid hormone
opioids
some OTC, herbals, and supplements
32
Q

importance of prep screening

A
  • identifies risk factors through assessment
  • reduces risk for potential complications
  • intiates teaching needs
  • verifies all preop diagnostics are complete
  • discusses advanced directives (what to do when the patient codes)
  • involves family in interview
  • begins discharge planning-assesses need for post op care
33
Q

common preop diagnostic tests

A

often done 1-2 weeks prior to surgery if elective, ordered by surgeon or primary care physician
cxr, ecg, urinanalysis, blood work (cbc, electrolytes/chem, coagulation studies (pt, inr, ptt, platelets), serum creatining, bun, and gfr, pregnancy test

34
Q

preop assessment

A

nutritional, fluid status, dentition, drug or alcohol abuse, respiratory status, cardiovascular status, hepatic/renal function, endocrine function, immune function, previous medication use, psychosocial factors, spiritual/cultural needs

35
Q

important CV assessment information to report

A

hypo/hypertension, brady or tachycardia, irregular heart rate, chest pain, SOB or dyspnea, tachypnea, O2 sat

36
Q

important s/s of infection to report

A

fever, purulent sputum, dysuria or cloudy, foul smelling urine, red, swollen, draining IV or wound site, elevated WBCs

37
Q

important preop assessment to report bleeding/etc

A

increased PT, INR, aPTT time, hypo or hyperkalemia, possible or validated pregnancy

38
Q

preop assessment important to report clinicical conditions that need further evaluations

A

change in mental status, vomiting, rash, recent anticoagulant intake
vomiting increases risk for aspiration
rash is an adverse reaction to meds

39
Q

importance of preop education

A

reduces length of stay
facilitates recovery
decreases frequency and severity of complications–pain and vomiting, and patient knows what to expect which reduces anxiety

40
Q

preop teaching topics

A 
required by TJC
informed consent
dietary restrictions
specific preparations for surgery
exercises post surgery
plans for pain management
plan of care
fears and anxiety
surgical type description
diagnostic tests-reason and preparation
arrival time
surgery prep including what to do with valuables
sedatives/hypnotics
any meds to take prior to surgery
expected time table for surgery and recovery
method to inform family
transfer to surgery department
location of surgical waiting room
transfer to PACU
anticipated postop routine devices and equipment
plans for pain control
appropriate clothing needed for discharge
fasting orders--fasting does not ensure the stomach will be empty or contents less acidic
41
Q

preop teaching about postop things

A

diaphragmatic breathing-with or without incentive spirometer
coughing and splinging
dorsiflexion and plantar flexion, ankle exercises, early ambulation
TED hose, SCDs

42
Q

preop teaching for postop ADLs

A 
meals
toileting
transfers and turning
ambulation expectations
splinting
43
Q

legal preparations preop

A

informed consent
blood transfusions
advance directives
power of attorney

44
Q

preop teaching documentation

A

must be documented and reported to postoperative nurses

  • avoid duplication of information
  • assess learning
45
Q

nursing decisions postop

A

what route of medication is best to take when NPO

best practice-consult with surgeon or anesthesiologist due to potential interactions

46
Q

preop medications

A

necessary for the nurse to access medication action before administering preop medications for safety and consent concerns

  • does the patient need to be alert to answer questions
  • has the patient had all questions answered
  • is the consent signed
  • is it anticipated that the patient will need to get out of bed?
47
Q

insulin considerations

A

may be held if NPO or dose ajusted
depends on time of surgery
EBP supports glycemia levels

48
Q

day of surgery preparations

A

final preop teaching
assessment and report of pertinent findings
verify signed consent
labs
history and physical assessment
baseline vitals
consultation records
nurses notes
assist with gown, changing, bathing
ensure NPO status
remove nail polish, lipstick, makeup, assists with CV status assessment
ID, blood, allergy bands are secure
remove hairpins, jewelry, rings may be taped
complete bowel/skin prep if ordered
insert urinary catheter, IV, NG tube if ordered
remove dentures, artificial eyes, contact lenses, prosthetic limbs

49
Q

preop preparation

A

Check policy about hearing aids—leave them in or take them out—and when
Verify consent has been signed
Document ht and wt or weigh and measure
Have pt. empty bladder, measure and document
Adm. Pre-operative meds if ordered***-see next slide
Obtain and record vitals
Document all pre operative care on proper forms
Verify pt identity and all prep with surgical personal
Assist with transfer from bed to stretcher
Provide ongoing support
Prepare room for post operative care-anticipated supplies

50
Q

attend to family

A

explain length of surgery-holding and prep time included

reassure that updates will be given and that the surgeon will talk with them after

51
Q

preop checklist

A

to ensure all documentation, preop procedures, and orders are complete (npo, gown only, labs/diagnostic results,

52
Q

informed consent for surgery

A 
should be in writing
patient should have understanding and comprehension of:
Need for procedure related to dx
Description and purpose
Risk vs benefit 
Adequate disclosure of risk with/without surgery
Likelihood of successful outcome
Alternative to surgery
Straight forward advice
Right to refuse and ask questions
53
Q

voluntary consent

A

for consent to be valid must be freely given without coercion, patients must be over 18 unless emancipated, must be obtained by a physician, signature must be witnessed by a professional staff member

54
Q

incompetent for informed consent

A

not autonomous, cannot give or withhold consent-cognitively impaired, mentally ill, neurologically incapacitated

55
Q

role of nurse for informed consent

A

Witness to signing of consent
Can broadly explain/translate
Determine understanding
Patient to feel comfortable with decision/can withdraw at anytime

If the patient has questions or concerns not discussed or made clear by the surgeon the surgeon is responsible for supplying further information

56
Q

aspects of consent

A

medical emergency may override need for consent

legally appointed representative of family may consent if patient is-child, unconscious, mentally incompetent

57
Q

SCIP measures (surgical care improvement project)

A

based on ebp
perioperative nurses should support these measures
reduce surgical/medical complications
-infection prevention
-cardiac protection protocols
-VTE prevention
-ventilation acquired pneumonia prevention

58
Q

examples of SCIP measures

A

no longer shave the skin
administer antibiotic 1/2 hour prior to incision
foley catheter removed 48 hours or less post insertion
time out
SCDs

59
Q

*more SCIP measures *

A

SCIP Inf-1 Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision
SCIP Inf-2 Prophylactic Antibiotic Selection for Surgical Patients
SCIP Inf-3 Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time
SCIP Inf-4 Cardiac Surgery Patients With Controlled 6 A.M. Postoperative Blood Glucose
SCIP Inf-6 Surgery Patients with Appropriate Hair Removal
SCIP Inf-9 Urinary catheter removed on Postoperative Day 1 (POD 1) orPostoperative Day 2 (POD 2) with day of surgery being day zero@
SCIP Inf-10 Surgery Patients with Perioperative Temperature Management@
SCIP Card-2 Surgery Patients on Beta-Blocker Therapy Prior to Arrival Who Received a Beta-Blocker During the Perioperative Period
SCIP VTE-1 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered
SCIP VTE-2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery

60
Q

medication reconciliation

A

vital at every stage of surgical/hospitalization

all meds including OTC and supplements

61
Q

medications in surgery

A

preop- 45-70 minutes prior–sedation, anxiety reducing, antibiotic
preop and interoperative-analgesics, gastric acidity and volume reducing agents, gastric emptying increasing agents, antiemetics, anticholinergics

62
Q

what meds are gastric acidity and volume reducing agents

A

PPI, H2

regalin empties stomach not used with nausea

63
Q

discharge teaching

A 
Begins at time of entering into pre-op care
Teaching points:
Infection prevention
Care of the incision
Management of drains, catheters, etc
Nutrition
Pain management
Drug therapy and home meds
Activity progression
VTE prevention/recognition

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