Intra-Op & Post-Op Flashcards
role of intraoperative nurse (4)
1) provide emotional support
2) ensure safe environment & prevent injury
3) maintain asepsis (ESP in wound/surgical site)
4) promote wound healing
role of circulating nurse (RN)
- documents procedure on computer, calls for X-rays, ppl sterile
- manages care
- ensures safety
role of scrub nurse (RN or LPN or Scrub tech)
- think/anticipate what surgeon might need
- “scrubs in”
- instruments & equipment COUNT
Intra-operative Nursing;
Assessment
- TIME OUT
- verification of client
- necessary documentation (allergies, labs, vitals)
- client comfort
Grounding pad used for what
-help prevent risk of pt getting burned
intra-operative nursing interventions
- monitor vital signs
- safety
- needle & sponge count
- maintain surgical asepsis
- monitor skin on grounding pad
- client positioning to prevent injury
intra-operative nursing interventions cont.
- *monitor for malignant hyperthermia**
- genetic (autosomal)
- jaw muscle rigidity
- ventricular dysrhythmia
- tachypnea
- cyanosis
- unstable BP
- increase in body temp
- LIFE THREATENING
general anesthesia (steps 4) -will come back through the stages
- beginning
- excitement
- surgical phase
- medullary depression
stage 1 of general anesthesia
1) beginning
just got meds, just going under
stage 2 of general anesthesia
2) excitement
- talk, shout, cry, laugh
stage 3 of general anesthesia
3) surgical phase
- light / deep anesthesia
* WHERE THEY START INCISION*
stage 4 of general anesthesia
4) medullary depression
- BAD!!
what is the last sense to leave & the first to come back
HEARING
2 general anesthesia types
1) intravenous
2) inhalation
6 types of regional anesthesia
1) spinal
2) epidural
3) caudal
4) topical
5) local infiltration
6) block
spinal anesthesia
pushed into nervous system
ex/ suberacnoid space, abdominal
epidural anesthesia
for lower extremity surgeries
ex/ ankle, knee
caudal anesthesia
below umbilicus
ex/ lower limb, skin graph
topical anesthesia
for biopsy
local infiltration anesthesia
litocain, root canal
block anesthesias
hit nerve bundle
ex/ breast biopsy, lymph node biopsy
uses for regional anesthesia
- surgery below diaphragm
- surgery on extremity
- surface biopsies
conscious of moderate sedation
- moderately sedated
- drowsy but can still follow directions; respond purposefully to verbal stimuli
- no intibation; can maintain airway
ex/ colonoscopy, breast biopsy
____ is the responsibility of everyone in the OR suite
asepsis
sutures & staples
immediate assessment post-op on RESPIRATORY
- check airway & monitor respiratory rate/depth
- auscultate breath sounds
- observe symmetrical chest expansion
immediate assesmnt post-op on CARDIAC
-BP & HR and rhythmn atleast every 15 min
immediate assessmnt post-op on NEUROLOGIC
- check pupil response
- monitor muscle strength
immediate assesmnt post-op on DRESSINGS
- monitor for drainage
- observe for hemorrhage or hematoma formations
immediate assessment post-op on PAIN
- assess for both subjective & objective manifestation of pain
- administer analgesics prn
immediate assessmnt for renal fx post-op
-monitor urinary output (atleast 30ml/hr)
post-op nursing
- type of anesthesia
- medications & dosages
- amount of blood loss
- intubated
- complications
post-op complications:
RESPIRATORY
(develop within first 48hrs)
- atelectasis (collapse of alveoli)
- pneumonia (lung infection: crackles)
- pulmonary embolism (blood clot in lung)
post-op intervention for respiratory
1) cough & deep breathing q 2 hrs
2) hydration (2,000ml/day)
3) check for respiratory depression
- rate & depth -> symmetry
4) sputum: yellow/green = infection
5) incentive spirometer BREATH IN
6) early ambulation
Heparin/lovanox given post-op to prevent what?
blood clots
Post-op complications:
Circulatory
- hemorrhage (early postop prob, call surgeon ASAP)
- thromophlebetis
- DVT
post-op interventions:
Circulatory
- leg exercises hourly
- early ambulation
- TEDs and SCDs (esp at night)
- hydration
- low-dose Heparin (lovenox) air lock
- promote proper positioning
- adequate fluid intake
post-op complications:
metabolic & urinary
- dehydration (skin turgor, mucous membranes)
- fluid overload
- difficulty voiding (void every 8 hours)
post-op interventions:
nutrition & hydration
-IV fluids (fluid volume deficit)
-progressive dietary intake DAT:
clear liquid, full liquid, soft diet
post-op interventions:
metabolic & elimination
- accurate I & O
- asses serum electrolytes (K so <3 beat regular rhythm)
- catheterize if unable to void
- give fluids as soon as client tolerates
post-op complications:
elimination
- nausea
- vomiting
- paralytic ileus (motility doesn’t fx normally d/t anesthesia) -> generally no bowel mvmnt
- abdominal distention (w/ air, common in laproscopic surgeries)
nursing interventions:
gastrointestinal
- obtain order for antiemetic
- bowel rest
- NPO
- N/G tube in stomach
normal bowel progression
- gradual progression w/ diet
- promote ambulation & exercise
- maintain fluids
- foods client likes
- administer fiber, stool softeners, suppositories as ordered
- clear -> full -> soft diet*
wound care complications
- infection (3-6 days post-op)
- dehiscence (wound splits open)
- evisceration (organ protrusion)
skin and incision interventions post-op
- splinting w/ mvmnt
- hydration & nutrition
- abdominal binder
- prevent infection
steps you take when evisceration happens
1) semi-fowler’s position
2) notify doctor
3) cover intestine w/ sterile normal saline moist dressing
4) monitor vitals
5) prepare for surgery
mobility & self-care interventions
- early ambulation w/ assistance
- assist with care but encourage SELF CARE
- comfort & rest -> nonpharmacologic interventions along w/ pain meds
comfort measures post-op
- narcotics (#1)
- PCA pump (set amount of dose/hour)
- back rubs
- imagery (bella ruth: close eyes, guided imagery)
- distraction
psychological post-op complications
- maintain/enhance self-concept
- provide privacy
- maintain clients hygiene
- empty drainage devices
- client to discuss feelings
- family support
home and community care post-o
- activity restrictions
- incision care
- dietary instructions
- when to call doctor
- post-op meds
