Exam 1 Week 2 (Preparing the Pt for Surgery) Flashcards
Preop Initial Assessment: Develop a nursing ____ this may be initiated in (2)
history
- HCP’s office or Patient Record
Preop Initial Assessment
1) Signed _____ form
2) Explain what ___ ___ are needed and why
3) Initial A_____
1) Consent
2) Lab studies
3) Assessment
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______
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
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)
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
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? *
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
Preop Common Anxieties Fear of: - U\_\_\_\_* - P\_\_\_\_/dis\_\_\_\_ - m\_\_\_/dis\_\_\_ - an\_\_\_\_ - disruption of life \_\_\_\_ (3) - d\_\_\_\_/not \_\_\_ \_\_ - not being in \_\_\_\_\_
- unknown*
- pain/discomfort
- mutilation/disfigurement
- anesthesia
- patterns (sep from family, sexual, financial)
- death/not waking up
- control
Common preop lab tests
- WBC, Hgb, Hct, Platelets
- type cross and matching
- electrolytes
- PT/PTT
- Bilirubin/BUN
- Urine
- Liver (ALT/AST)
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:
- questions/concerns
- knowledge
- need, desire
- most conducive to learning
Pre-Operative Care Generally
- Protect from _____
- Manage ____ (___)
- Prepare ___ or ____ (if appropriate)
- injury
- nutrition/fluids (NPO)
- bowel, skin
Preop Care Immediate
- G____
- C___ (___ long hair, no hair__)
- Remove d___/p____
- No ____
- Void immediately ___ transport
- Cover with bath ___
- Administer ____ meds if ordered
- Gown
- Cap (braid, pins)
- dentures/plates
- jewelry
- before
- blanket
- preanesthetic
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
- dentures, wigs, limbs
- hearing, glasses, cane
- identification, code, blood, fall
- contact, hairpins
- polish, nails
- bladder
- meds
- transfer
Informed Consent =
= 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
Surgeon’s responsibility in informed consent =
To explain procedure, alternatives, risks, benefits
Nurse’s role in informed consent =
- Advocate*
- Witness*
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 ____
- informed consent
- liability
- oriented
- yes
- witnessed
Informed Consent is required when:
1) When (3) is used
2) Procedure is considered ____
3) Procedure is nonsurgical but?
1) Anesthesia, Radiation, Cobalt therapy
2) invasive
3) more risky than normal
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___
- wait
- talk, update
- length of surgery
- post op
- protocol, routines
Psychosocial Assessment
- _____ ___ can influence a person’s ____ of surgery
- client’s should be provided the opportunity to ____ their ____ ____
- Cultural beliefs, perception
- Express, spiritual beliefs/values
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
- preop assessment and preparation
- preparation, site, positioning, assessment, complication
Psychological condition
- Psychological condition can have a ?
- Encourage clientes to (2) for (2)
- Observe for nonverbal cues of ____
- To reduce anxiety ->
- stronger influence than physical condition
- express feelings/fears about anesthesia/surgery
- anxiety
- explain what will be happening throughout the surgical experience
Physical Preparation
- Identify ___ and verify ____
- ____ operative ___
- Check client’s ____ ___
- Assist in putting on (3)
- Verify a____
- Verify _ _ _ status
- Identify any ____ deficits
- client, procedure
- prepare, site
- vital signs
- gown, cap, compression hose (if ordered)
- allergies
- NPO
- sensory
Variables Affecting Surgical Status
- Age, Ethnicity, Language
- Nutrition status, F/E status
- Respiratory, Cardiac, Neurological, Musculoskeletal, Integumentary
- Medications
- Cognition
DANGERS* (6)
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
1) Poor Nutrition
- Greatly impairs =
- Increases risk (2)
= wound healing
- infection, shock
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_____
- anesthesia, volume loss
- shock, dysrhythmias
3) Cardiovascular Disease causes
Many surgical problems
4) Diabetes Mellitus
- ___glycemia is potentiated by increase in (2) dt surgical stress
- recognize s/s of ____
- Hyperglycemia, catecholamines/glucocorticoids
- ketoacidosis
5) Presence of Alcoholism
- same problem as those with ___
- pts may also have increased tolerance to ____
- malnutrition
- anesthesia
6) Presence of Pulmonary and URD
- may be contraindicated in pt who has URI bc might potentiate a more ___ illness such as p____
- serious, pneumonia
Universal Protocol* (3)
1) Preoperative Verification (Identifying/Interviewing Pts)
2) Marking the Operative Site
3) Time Out
1) Pre-operative Verification
Purpose:
Process:
: to ensure effective and safe transition
: continuous sharing of pertinent information
2) Marking the Operative Site
Purpose:
Process:
: to identify correct operative procedure site
: clearly marking the surgical site to eliminate any ambiguity and correct bilaterally/level
3) Time Out
Purpose:
Process:
: to prevent medical errors/ by conducting a final verification of correct pt, procedure, site
: two way communication
Time Out Consists of
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
Last step of Time out =
Verbal agreement by all
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 ____
1) additional
2) specimens
3) labeled name, specimen name
4) recovery
5) primary/secondary
6) wound
7) count
Hand Off Communication Intraop -> Postop nurse
- Pt ___, __ #, Pr____
- Patient S____/A____
- ____ Products, ____ info, D____ (jackson pratt, hemovac)
- ___ items, ___ members
- Name, MR, procedure
- status, allergies
- Blood, Implant, Drains
- Personal, Family
