Exam 2; Week 2 CLASS Flashcards
What is surgery?
planned alteration of the human body
What is surgery designed to do?
- arrest
- alleviate
- eradicate some pathologic process
How are surgical procedures classified?
according to seriousness, urgency, and purpose
What is preoperative nursing?
a nomenclature that covers Preoperative, Perioperative, and Post operative phases of surgical care.
What do nurses do when they are in preoperative nursing?
- They provide pre- and post-op teaching, perform various roles in the operating room
- care for patients in the recovery room (post-anesthesia care unit (PACU)
- provide post-surgical care on medical-surgical units
true or false: perioperative nursing is the newest nursing specialty on record.
false; it is the oldest
What is important to assess for in the preoperative assessment?
- Age
- Allergies
- Vital Sign Trend
- Nutritional Status
- Habits affecting tolerance to anesthesia
- Presence of Infections
- Use of drugs that are contraindicated prior to surgery
- -> Blood pressure medications - Physiological Status
- Psychological state of the patient
What are we most worried about with anesthesia?
hypothermia
What are some preoperative nursing interventions?
- Explore client’s feelings
- Allow client’s to speak openly about fears/concern.
3.Give accurate information regarding surgery (brief, direct to the point and in simple
terms) - Give empathetic support
- Consider the person’s religious preference and arrange for visit by a priest / minister as desired.
What are 2 important reasons for doing a CBC before operating?
- RBC, Hgb, Hct are important to the oxygen carrying capacity of blood. If Hgb and Hct are too low, then they are going to bleed a lot.
- WBC are indicator of immune function
Why is it important to do a blood grouping/X matching before a surgery?
in case blood transfusion is required during or after surgery
Why is it important to do a serum electrolyte before a surgery?
to evaluate fluid and electrolyte status
Why is important to do a fasting blood glucose before a surgery?
high levels may indicate undiagnosed DM
Why is it important to do a BUN/creatinine test before a surgery?
evaluate renal function
Why is it important to do a ALT/AST/LDH and Bilirubin test before a surgery?
evaluate liver function
Why is it important to do a serum albumin and total CHON before a surgery?
evaluate nutritional status
Why is it important to do a urinalysis before a surgery?
determine urine composition
Why is important to do a chest x-ray before a surgery?
evaluate resp. status/heart size
Why is it important to do an ECG before a surgery?
identify preexisting cardiac problems
What are things that you want to teach a patient preparation?
- Incentive Spirometer
- Diaphragmatic Breathing
- Like a baby breathing
- Coughing
- Splinting
- -> Hold a pillow against chest, cough, to make sure that they don’t splint - Turning
- Foot and Leg Exercise
- Compression hose
- Early Ambulation
What is informed consent?
an active, shared decision making process between the provider and recipient of care.
What are the 3 components of informed consent that make it valid?
- adequate disclosure
- understanding and comprehension of above
- voluntary consent
Who is legally required to obtain consent?
the physician
What is the role of the nurse in consent?
patient advocate. Nurse can “witness” consent, and try to answer questions.
What is really important with consent?
very important that patient is consenting voluntarily and with knowledge of the situation.
What may override the need to obtain consent?
a medical emergency
When medical care is needed to protect the life of an individual, who can give consent?
- next of kin
2. power of attorney
What can also be used to assist in justifying consent, other than next of kin/POA?
advanced directive
If someone is not available, and the doctor deems the procedure necessarily for life, can the doctor go through with the procedure?
yes; the doctor can chart that it was necessary
What will the nurse fill out after a doctor does an emergency surgery?
an incident report and state that the emergency caused a deviation in the normal policy
Who is on the team of a surgery?
- the patient
- the anesthesiologist or anesthetist
- the surgeon
- first assistant
- nurse circulating
- surgical technologies
- supporting staff
What is the role of a surgeon?
- responsible for the preoperative medical history and physical assessment.
- Performance of the procedure
- primary decision maker regarding surgical technique
- may assist with position and prepping the patient or may delegate this task to other members
Who is a first assistant during a surgery?
- may be a resident, intern, physician’s assistant or a perioperative nurse
What does the first assistant assist with?
Assists with retracting, hemostasis, suturing and any other tasks requested by the surgeon to facilitate speed while maintaining quality during the procedure.
What does the anesthesiologist or anesthetist do during a surgery?
Selects the anesthesia, administers it, intubates the client if necessary, manages technical problems related to the administration of anesthetic agents, and supervises the client’s condition throughout the surgical procedure.
Who is an anesthesiologist?
A physician who specializes in the administration and monitoring of anesthesia while maintaining the overall well-being of the patient.
Who is a circulating nurse?
must a registered nurse who, after additional education and training, specialized in perioperative nursing practice.
What is the circulating nurse responsible for?
- responsible and accountable for all activities occurring during a surgical procedure including the management of personnel equipment, supplies and the environment during a surgical procedure.
- Patient advocate, teacher, research consumer, leader and a role model.
What is the surgical technologist responsible for?
- Reviews anatomy, physiology and the surgical procedures.
- Assists with the preparation of the room.
- Scrubs, gowns and gloves self and other members of the
surgical team. - Prepares the instrument table and organizes sterile equipment for functional use.
- Assists with the draping procedure.
- Passes instruments to the surgeon and assistants by anticipating their need.
- Counts sponges, needles and instruments.
- Monitor practices of aseptic technique in self and others.
- Keeps track of irrigations used for calculations of blood loss
What is the role of the support staff?
- Transport staff to the
- Preoperative Area
- Transport Labs
- Retrieve Blood as Needed
- Cleans Equipment used before, during, and after procedures.
- Assist with positioning patients.
- Setting up specialized equipment used during procedures.
- Cleans room after procedures
How are gas anesthetics administered? What are they combined with?
administered by inhalation; combined with oxygen
What is the most commonly used gas anesthetic?
nitrous oxide
How do anesthetics work?
When inhaled, the anesthetics enter the blood through the pulmonary capillaries and act on cerebral centers to produce loss of consciousness and sensation
Why are people not allowed to eat before a surgery?
if they are intubated, there is a chance that food or water or anything that has been in your mouth will come up and cause respiratory problems
What are 3 complications during surgery?
- anaphylaxis
- postoperative hypothermia
- postoperative hyperthermia
What do you want to watch for with anaphylaxis?
- hypotension
- tachycardia
- bronchospasm
- pulmonary edema
What is a direct effect of the anesthesia?
postoperative hypothermia
What increases the risk for postoperative hypothermia?
longer surgeries
What does postoperative hyperthermia result from?
results from inflammatory meds/cytokines that are released in the post operative period to enhance healing?
What can drop with hypothermia?
H and H; blood can’t clot
What do you need to do in order to make sure that patients don’t develop malignant hyperthermia?
need to assess the patient and the family for any untoward reactions to anesthesia
What are 2 things used to treat malignant hyperthermia?
- dantrolene
2. piling ice
What are 3 examples of nursing diagnoses for nausea?
- ineffective airway clearance
- deficient knowledge
- impaired physical mobility
What are 2 examples of nursing diagnoses for anxiety?
- delayed surgical recovery
2. risk for infection
What are 2 examples of nursing diagnoses for fear?
- risk for deficient fluid volume
2. acute pain
What is there also a risk for with surgical operations?
risk for perioperative positioning injury
What are 4 intraoperative goals?
- asepsis
- homeostasis
- safe admin of anesthesia
- hemostasis
What are 4 ongoing duties for surgical patients?
- The circulating nurse conducts an ongoing evaluation to ensure that interventions such as patient position are implemented correctly during the intraoperative phase of surgery.
- Circulating nurse evaluates the patient’s ongoing clinical status. Continuously monitor vital signs and intake and output.
- The nurse responsibilities include reviewing the preoperative assessment, establishing and implementing the intraoperative plan of care, evaluating the care, and providing for continuity of care after surgery.
- Families expect an estimate of when surgery begins and the length of time it will likely last. When you give an update to a family member, ask whether he or she has additional questions or concerns.
What is involved in the postoperative assessment?
- assess the patient
- maintain a patient airway
- maintain cardiovascular stability
- relieving pain and anxiety
- assessing and managing the surgical site
- assessing and managing GI function
- assess voluntary voiding
- Encourage activity
What are 6 postoperative complications?
- shock
- hemorrhage
- DVT
- pulmonary embolism
- urinary retention
- intestinal obstruction
What is best practice
best practice is best defined as a protocol or procedure guideline that has been develop and shown to improve outcomes.
What is an example of best practice?
the national patient safety goals, SCIP protocols
What are best practice items for this year?
- antimicrobial prophylaxis
- CHG bathing
- Glycemic control
- normothermia
- postoperative oxygenation and patient eduction
Describe fetal circulation:
- Oxygenated blood from the placenta enters the fetus via the umbilical vein –> blood bypasses the liver through the ductus venosus –> combines with deoxygenated blood in the inferior vena cava –> blood joins deoxygenated blood from the superior vena cava –> empties into the RA –> flows through the foramen ovale into the LA –> LV –> Aorta –> fetus.
- Some blood flows from the RA to the RV –> small amount of blood flows out the PA –> majority of blood flows through the ductus arteriosus to the aorta –> fetus.
- Deoxygenated blood returns to the placenta via the umbilical arteries.
What happens when a newborn takes its first breath?
- Pressure in LA > Pressure in RA–> Foramen ovale closes
- Blood oxygen level increases
- Ductus arteriosus starts to close
- Blood stops getting shunted away from lungs
- Blood flows through the pulmonary vasculature where it is oxygenated and then pumped out to the body
What is a major cause of death in the first year of life?
congenital heart disease
What is the most common anomaly with CHD?
ventricular septal defect
What are the 2 types of pediatric cardiac disease?
- congenital - structural/anatomic malformation
2. acquired - infection, autoimmune, environmental factors, familial tendencies
What are the etiologies of CHD from most common to least common?
- multifactoral cause - random events, environment, predisposition
- chromosomal abnormalities
- maternal or environmental cause - maternal drug use, maternal illness
What are s/s of CHD?
- Poor feeding
- Tachypnea
- Tachycardia
- Diaphoresis
- Crackles
- Hepatomegaly
- Cyanosis
- Murmur
- Sternal lift
What are the 2 former classifications of CHD?
- acyanotic - pink
2. cyanotic - blue
What are the newer classifications of CHD?
- hemodynamic characteristics
- Increased pulmonary blood flow
- Decreased pulmonary blood flow
- Obstruction to blood flow
- Mixed blood flow
What happens with increased pulmonary blood flow CHD?
abnormal connection between the two sides of the heart –> increased blood volume on right side of heart
What is the clinical presentation of increased pulmonary blood flow CHD?
- tachypnea
- poor feeding
- poor weight gain
- failure to thrive
What happens with a left-sided obstruction?
decreased systemic blood flow
What is the clinical presentation of someone with left-sided obstruction?
- decreased pulses
- unequal limb blood pressures
- mild to extremely ill presentation
Where does a right-sided obstruction occur?
at entrance to the pulmonary artery
What happens with right-sided obstruction?
decreased pulmonary blood flow
What is the clinical presentation of someone with right sided obstruction?
- cyanosis
- murmur
- HF
What does decreased pulmonary blood flow CHD cause?
unsaturated blood to shunt to the left side of the heart, into systemic circulation
What are 3 types of decreased pulmonary blood flow CHDs?
- tetralogy of fallout
- tricuspid atresia
- pulmonary atresia
What is the presentation of someone with decreased pulmonary blood flow CHDs?
- hypoxemia
2. cyanotic
What are the four components of tetrology of fallot?
- pulmonary stenosis
- overriding aorta
- ventricular septal defect
- right ventricular hypertrophy
What is the presentation of hypo plastic left heart syndrome with mixing CHD?
varies greatly depending on anatomy and amount of mixing of oxygenated and deoxygenated blood – purple blood
What happens with the transposition of the great vessels?
the great vessels, aorta, and pulmonary artery arise from the wrong ventricle
What happens with the aorta with transposition of the great vessels (TGA)?
comes off of RV
What happens with the pulmonary artery with transposition of the great vessels (TGA)?
comes off of LV
What happens with total anomalous pulmonary venous return (TAPVR)?
all four pulmonary veins drain abnormally to the right atrium by way of an abnormal connection
How is total anomalous pulmonary venous return (TAPVR) classified?
based on how and where the pulmonary veins drain to the heart:
- supra cardiac
- cardiac
- infra cardiac
What is hypo plastic left heart syndrome a group of?
cardiac anomalies involving the left sided structures of the heart.
What is hypo plastic left heart syndrome one of the most of? (2 things)
- one of the most complex forms of CHD
2. one of the most challenging to manage
What is the clinical presentation of hypoplastic left heart syndrome?
- cyanosis
- tachycardia
- tachypnea
- pale, clammy, and/or cool skin
What is the treatment for hypoplastic left heart syndrome?
surgical 3-stage palliation and/or heart transplantation
What is the first stage of palliation hypoplastic left heart syndrome?
Norwood procedure
When is the Norwood procedure done?
shortly after birth
Describe the Norwood procedure?
- The main pulmonary artery (PA) and the aorta (AO) are connected
- The main pulmonary artery is cut off from the 2 branching pulmonary arteries
- A shunt is placed between the pulmonary arteries and the aorta in order to supply blood to the lungs
What is the second stage of palliation hypoplastic left heart syndrome?
bi-directional glenn procedure
When is the bi-directional glenn procedure done for palliation hypoplastic left heart syndrome?
usually performed about 6 months after the Norwood procedure
Describe the bi-directional glenn procedure:
- The shunt to the pulmonary arteries is disconnected
- The right PA is connected directly to the SVC.
- -> This sends half of the deoxygenated blood directly to the lungs without going through the ventricle.
What is the third stage of palliation hypoplastic left heart syndrome?
fontan procedure
When is the Fontan procedure performed?
Usually performed 18-36 months after the Glenn
Describe the Fontan procedure:
- Connects the IVC to the PA by creating a channel through or just outside the heart to direct blood to the pulmonary artery
- At this stage, all deoxygenated blood flows passively through the lungs
What are important nursing care of child after heart surgery?
- observe vitals
- -> HR and RR for 1 min
- -> monitor for dysrhythmias
- -> monitor temp for hypo. or fever - assess breath sounds
- monitor for post-operative bleeding
- monitor for signs of infection
- Monitor fluids and I/O
