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Periop > Exam 1 Week 2 (Preparing the Pt for Surgery) > Flashcards

Exam 1 Week 2 (Preparing the Pt for Surgery) Flashcards

1
Q

Preop Initial Assessment: Develop a nursing ____ this may be initiated in (2)

A

history

- HCP’s office or Patient Record

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2
Q

Preop Initial Assessment

1) Signed _____ form
2) Explain what ___ ___ are needed and why
3) Initial A_____

A

1) Consent
2) Lab studies
3) Assessment

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3
Q

Determine following during initial assessment

1) ____ and ___ status
2) O____, D____, L____
3) A____, M____ (2), R____ drugs
4) Condition of ____
5) B__ P__ problems, major ____
6) Past _____
7) S____, Severe H___, S______

A

1) Physical, Psychological
2) Overweight, disabilities, limitations
3) Allergies, Medications (OTC, Herbals), Recreational
4) Teeth (dentures, caps, crowns) - choking precautions
5) Blood Pressure, illnesses
6) Surgeries
7) Seizures, HA, Smoker

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4
Q

Instruct Patients to:

1) Notify HCP immediately if (3)
2) Arrive:
3) _ _ _ from 12 pm
4) Do not wear (2)
5) Wear ___ clothing
6) Leave ____ at home
7) ____ ___ in the AM but do not swallow
8) Shower at
9) Have a responsible adult (3)

A

1) cold, fever, illness
2) on time
3) NPO
4) Makeup, Nail polish (O2)
5) comfortable
6) valuables/jewelry
7) Brush teeth
8) night before or day of
9) Accompany, Drive home, Stay for 24 hrs

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5
Q

Important things to consider preop

1) Stop what meds? How long before?*
2) Encourage no ___ for - wks, at least __ hr before
3) Monitor _____ pt closely for ____
4) Surgery contraindicated if?*
5) Control ___ prior to surgery*
6) ____ increases risk of? *

A

1) ASA 7-10 days before, Herbals 2-3 wks before
2) smoking 4-8 wks, 24 hrs
3) immunocompromised, infection
4) Acute Renal Failure*
5) HTN
6) Obesity, risk and severity of complications

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6
Q 
Preop Common Anxieties 
Fear of: 
- U\_\_\_\_* 
- P\_\_\_\_/dis\_\_\_\_
- m\_\_\_/dis\_\_\_
- an\_\_\_\_
- disruption of life \_\_\_\_ (3)
- d\_\_\_\_/not \_\_\_ \_\_
- not being in \_\_\_\_\_
A
  • unknown*
  • pain/discomfort
  • mutilation/disfigurement
  • anesthesia
  • patterns (sep from family, sexual, financial)
  • death/not waking up
  • control
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7
Q

Common preop lab tests

A
  • WBC, Hgb, Hct, Platelets
  • type cross and matching
  • electrolytes
  • PT/PTT
  • Bilirubin/BUN
  • Urine
  • Liver (ALT/AST)
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8
Q

Purposes of Preop Teaching

  • To answer ___/____ about surgery
  • To ascertain client’s present ____ of surgery
  • To ascertain the n____ or d____ for + info
  • To provide info in a manner:
A
  • questions/concerns
  • knowledge
  • need, desire
  • most conducive to learning
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9
Q

Pre-Operative Care Generally

  • Protect from _____
  • Manage ____ (___)
  • Prepare ___ or ____ (if appropriate)
A
  • injury
  • nutrition/fluids (NPO)
  • bowel, skin
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10
Q

Preop Care Immediate

  • G____
  • C___ (___ long hair, no hair__)
  • Remove d___/p____
  • No ____
  • Void immediately ___ transport
  • Cover with bath ___
  • Administer ____ meds if ordered
A
  • Gown
  • Cap (braid, pins)
  • dentures/plates
  • jewelry
  • before
  • blanket
  • preanesthetic
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11
Q

Preoperative Client Preparation

  • Prosthesis (3)
  • Aides h___, gl___, c___
  • Arm bands: id___, __ status, ___ trans, __ risk bracelet
  • Misc: ____ lenses, h___
  • Nail ___, artificial ___
  • Empty ____
  • Preop m____
  • safe ___ to surgical suite
A
  • dentures, wigs, limbs
  • hearing, glasses, cane
  • identification, code, blood, fall
  • contact, hairpins
  • polish, nails
  • bladder
  • meds
  • transfer
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12
Q

Informed Consent =

A

= A legal form signed by the client and witnessed by another person that grants permission to the client’s physician to perform the procedure prescribed by the physician

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13
Q

Surgeon’s responsibility in informed consent =

A

To explain procedure, alternatives, risks, benefits

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14
Q

Nurse’s role in informed consent =

A
  • Advocate*

- Witness*

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15
Q

Informed consent purpose

  • to ensure i___ c___
  • helps protect from ____
  • adults must be ____ and not sedated to sign
  • can they consent over the phone?
  • consent is ____
A
  • informed consent
  • liability
  • oriented
  • yes
  • witnessed
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16
Q

Informed Consent is required when:

1) When (3) is used
2) Procedure is considered ____
3) Procedure is nonsurgical but?

A

1) Anesthesia, Radiation, Cobalt therapy
2) invasive
3) more risky than normal

17
Q

Family Needs

  • Explain where to ____
  • Surgeon will ___ to them after surgery (keep family ___)
  • Never judge seriousness by?
  • Prepare them for what they will see ___ op
  • Explain post-op p___ and r___
A
  • wait
  • talk, update
  • length of surgery
  • post op
  • protocol, routines
18
Q

Psychosocial Assessment

  • _____ ___ can influence a person’s ____ of surgery
  • client’s should be provided the opportunity to ____ their ____ ____
A
  • Cultural beliefs, perception

- Express, spiritual beliefs/values

19
Q

Physiologic Assessment

  • The outcome of surgical tx is tremendously enhanced by accurate preop nursing ____ and careful ___
  • Info from preop assessment and screenings is later used for p____ of surgical ____, surgical p____, and as comparitive basis for postop a____ and c____ screening
A
  • preop assessment and preparation

- preparation, site, positioning, assessment, complication

20
Q

Psychological condition

  • Psychological condition can have a ?
  • Encourage clientes to (2) for (2)
  • Observe for nonverbal cues of ____
  • To reduce anxiety ->
A
  • stronger influence than physical condition
  • express feelings/fears about anesthesia/surgery
  • anxiety
  • explain what will be happening throughout the surgical experience
21
Q

Physical Preparation

  • Identify ___ and verify ____
  • ____ operative ___
  • Check client’s ____ ___
  • Assist in putting on (3)
  • Verify a____
  • Verify _ _ _ status
  • Identify any ____ deficits
A
  • client, procedure
  • prepare, site
  • vital signs
  • gown, cap, compression hose (if ordered)
  • allergies
  • NPO
  • sensory
22
Q

Variables Affecting Surgical Status

A
  • Age, Ethnicity, Language
  • Nutrition status, F/E status
  • Respiratory, Cardiac, Neurological, Musculoskeletal, Integumentary
  • Medications
  • Cognition
23
Q

DANGERS* (6)

A

1) Poor Nutrition
2) F/E balance
3) Cardiovascular Disease
4) Diabetes Mellitus
5) Presence of Alcoholism
6) Presence of Pulmonary and Upper Respiratory Disease

24
Q

1) Poor Nutrition

  • Greatly impairs =
  • Increases risk (2)
A

= wound healing

- infection, shock

25
Q

2) F/E Imbalance

  • Dehydration and electrolyte imbalances can have adverse effects in terms of general ____ and anticipated v___ l___ asctd w surgery
  • can cause s____ and cardiac d_____
A
  • anesthesia, volume loss

- shock, dysrhythmias

26
Q

3) Cardiovascular Disease causes

A

Many surgical problems

27
Q

4) Diabetes Mellitus

  • ___glycemia is potentiated by increase in (2) dt surgical stress
  • recognize s/s of ____
A
  • Hyperglycemia, catecholamines/glucocorticoids

- ketoacidosis

28
Q

5) Presence of Alcoholism

  • same problem as those with ___
  • pts may also have increased tolerance to ____
A
  • malnutrition

- anesthesia

29
Q

6) Presence of Pulmonary and URD

- may be contraindicated in pt who has URI bc might potentiate a more ___ illness such as p____

A
  • serious, pneumonia
30
Q

Universal Protocol* (3)

A

1) Preoperative Verification (Identifying/Interviewing Pts)
2) Marking the Operative Site
3) Time Out

31
Q

1) Pre-operative Verification

Purpose:

Process:

A

: to ensure effective and safe transition

: continuous sharing of pertinent information

32
Q

2) Marking the Operative Site

Purpose:

Process:

A

: to identify correct operative procedure site

: clearly marking the surgical site to eliminate any ambiguity and correct bilaterally/level

33
Q

3) Time Out

Purpose:

Process:

A

: to prevent medical errors/ by conducting a final verification of correct pt, procedure, site

: two way communication

34
Q

Time Out Consists of

A

1) team members name, role
2) pt name, MR #
3) Allergies
4) Antibiotics adm by anesthesia
5) preop diagosis (preop note)
6) procedure (from informed consent)
7) correct site/side
8) surgical site marking visible
9) state position
10) implants (displayed expiration date)
11) equipment sterility verified
12) level x-ray verification
13) imaging films confirmed by surgeon
14) surgeon reviews (critical/unexpected steps, operative duration, anticipated blood loss, anticipated specimens)
15) medical history concerns
16) were BB given

35
Q

Last step of Time out =

A

Verbal agreement by all

36
Q

Sign Out “Must be Done Prior to Closing Skin”

1) Surgeon asked “Do you have any ___ specimens?”
2) Surgeon confirms all _____
3) Specimens are legibly ___ w pt ___/sp___
4) Team has discussed the ___ of pt
5) Name of ___/___ procedures
6) ____ classification conf. by surgeon
7) Instrument, sponge, needle ____

A

1) additional
2) specimens
3) labeled name, specimen name
4) recovery
5) primary/secondary
6) wound
7) count

37
Q

Hand Off Communication Intraop -> Postop nurse

  • Pt ___, __ #, Pr____
  • Patient S____/A____
  • ____ Products, ____ info, D____ (jackson pratt, hemovac)
  • ___ items, ___ members
A
  • Name, MR, procedure
  • status, allergies
  • Blood, Implant, Drains
  • Personal, Family

Periop (9 decks)

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