Managing the Surgical Experience Flashcards
Exam 1
What is the role of the preoperative nurse?
Educator
Advocate
What is included in the preoperative checklist?
Documentation
Assessment
Physical preparation
Educational needs
Informed Consent components include: name of who?
Name of surgeon to perform surgery
Informed Consent components include: consent for?
Consent for procedure itself
Consent for anesthesia
Consent to administer blood products
Informed Consent includes reason for what?
Reason intervention will benefit the patient
Informed Consent also include alternatives to what?
Alternative options to surgery
What is included in Time Out/Pause for a Cause?
Correct patient
Correct procedure
Correct surgical site
Patient Assessment includes (include 6 things)
Patient History
Age
Allergies and sensitivities to latex
Current medications, including over-the-counter medications, vitamins, and herbal supplements
Medical history and treatment plans
Surgical history
Patient Assessment includes (include 5 things)
Previous anesthesia and responses to anesthesia
Last oral intake
Any medical implants or devices
Any piercings
Dental implants
Patient Assessment: What is included in Patient History?
Nutrition deficiencies
Family history
Social history, including smoking and drug and alcohol habits
History of mental illness or abuse
Support system and living conditions
Advance directives
What systems are assessed?
Cardiovascular
Respiratory
Neurological
Liver/renal
Integumentary
Gastrointestinal
Genitourinary
Patient Preparation for the Surgical Experience includes:
Laboratory assessment
Radiological assessment
Patient teaching
Anticipatory guidance
Recovery
D V T prophylaxis
Mobility
Preventing pneumonia
Patient Preparation for the Surgical Experience: What is included in patient teaching
Patient teaching
Anticipatory guidance
Recovery
D V T prophylaxis
Mobility
Preventing pneumonia
Physical Preparations
Intravenous line
Bowel and bladder preparation
Skin preparation
Medications
Physical Preparations: What should you ensure prior to transfer?
Consents completed
History and assessment complete
Learning needs met
Skin and bowel prep complete
Preoperative medication administered
Intraoperative Management includes
Roles and responsibilities of O R team members
Priority assessments
Anesthesia
Airway management
Risks and complications
Support strategies
Surgical Settings
Inpatient surgical settings
Ambulatory or outpatient surgical settings
Surgical Categories
Elective surgery
Urgent surgery
Surgical Team Members: Sterile team members include:
Surgeon
Surgical assistants
Scrub nurse or surgical technologist
Priority Assessments and Procedures (continued): What is included in the surgical pause?
Surgical pause
Correct patient
Correct procedure
Correct surgeon
Correct position
Correct equipment
Correct imaging studies
Surgical scrub- What do you use?
Long-acting antimicrobial soap
What occurs during a surgical scrub?
Long-acting antimicrobial soap
3-5 minutes
Jewelry removed
Nails clean and short
Priority Assessments and Procedures (continued): What is done with attire?
Donning of surgical attire
Scrubs
Surgical attire
Two types of anesthesia
- General anesthesia
- Regional anesthesia
General anesthesia
Being put to sleep
Reversible unconscious state
Variety of methodologies
Anesthesia: Variety of methodologies
Volatile agents
IV agents
Muscle relaxants
Complications
Regional anesthesia includes:
Spinal
Epidural
Caudal
Nerve block
What does airway management mean in surgery?
Protecting and ensuring proper oxygenation and ventilation
What are complications associated with airway management?
- Laryngo-spasm
- Bronchial intubation
- Tracheal and esophageal perforation
- Aspiration
Common Intraoperative Positions include:
- Supine
- Trendelenburg
- Reverse Trendelenburg
- Fowler’s
Positioning Devices
O R bed
Headrest
Arm boards
Arm restraints
Padding
Blankets
Pillows
Safety straps
Sandbags
Bean bags
Towels
Foam pads
Gel devices
Nursing Management: Nursing Diagnoses
Risk for impaired tissue and skin integrity
Risk for infection
Risk for injury
Risk for knowledge deficit
Risk for potential unplanned hypothermia
Risk for potential thrombus
Nursing Management: Assessments- What are RNs ensuring?
Ensure OR consent is signed
Ensure correct patient positioning
Ensure supplies are available
Nursing Management: Assessments- What are RNs monitoring?
Monitor donning of OR attire
Check fluid and instruments for temperature
Confirm flashed instruments are cool
Nursing Management: Actions of the nurse include:
Keep patient warm
Maintain sterile field
Accurately record number of sponges and sharps
Accurately measure irrigation fluid
Keep OR doors closed
Keep hallways clear of equipment
Postoperative management occurs when:
- Begins immediately after surgery
- Continues until first follow up appointment
What occurs in Post-Anesthesia Care Unit (PACU)?
- Close observation after anesthesia
- Control pain
- Prevent complications
What are the three levels of PACU care?
- Phase I
- Phase II
- Phase III
What does Phase I of PACU care involve?
Phase I involves the nursing care provided in the immediate postanesthesia period.
What occurs during Phase I?
There is intense, close monitoring, including blood pressure, respiratory rate, oxygen levels, cardiac monitoring, level of sedation, and end-tidal CO2 monitoring, or capnography.
What is the goal of Phase I?
The goals of care in this phase are to stabilize the patient’s vital signs, allow the patient to wake up from anesthesia, and achieve adequate pain control.
When would a patient transfer from Phase I to Phase II?
● An awake patient with a stable airway
● Adequate oxygen saturation
● Stable vital signs and hemodynamic status
What is the focus of phase II?
In phase II, the focus of nursing care is on preparing the patient to be discharged to an extended-care environment or home.
What occurs during Phase II?
While in phase II, nursing staff and the multidisciplinary team will work with the patient and their care team to bring the patient to an optimal level of functioning, including mobility and taking food by mouth, if appropriate.
What does Phase III focus on?
Phase III, or extended observation of postanesthesia care, focuses on providing ongoing care for patients remaining in the postoperative care area after discharge criteria have been met.
What occurs during phase III?
The nurse continues to monitor and provide care to this patient.
What is the goal of Phase III?
The goal is to prepare the patient for transfer to an inpatient unit when a transfer bed is made ready or for self-care and discharge home.
Patient Care in the Post-Anesthesia Care Unit includes:
Assessment and monitoring
Timely interventions
Evaluation of interventions
Reassessment of patient condition
Evaluation
Patient Care in the Post-Anesthesia Care Unit - What are the priority assessment?- list 5
Airway patency
Respiratory status
Viral signs
Neurologic function
Temperature and skin color
Patient Care in the Post-Anesthesia Care Unit - What are the priority assessment?- list 5 more.
Pain
Condition of dressings
Condition of visible incisions
Patency of I V catheters and drains
Hydration status
Patient Care in the Post-Anesthesia Care Unit: Diagnostic tests
Labs
Chest radiograph
Electrocardiogram
Patient Care in the Post-Anesthesia Care Unit: Pain Management includes:
Pain management
Analgesics
Non-pharmacologic interventions
Patient-controlled analgesia
Patient Care in the Post-Anesthesia Care Unit: Managing postoperative nausea and vomiting
Complications
Risk factors
Treatment
Patient Care in the Post-Anesthesia Care Unit: Potential complications
Respiratory depression
Pain
Bleeding
Nursing Management: Assessments in the PACU?
Neurological
Vital signs
Peripheral pulses, temperature, color
Urine output
Pain
Skin/surgical incision/wounds
Nursing Management: ACTIONS in the PACU?
Connect to cardiac monitor
Start admission assessment immediately
Document vital signs
Handoff from O R
Continuous monitoring
Medicate as ordered
Handoff to inpatient unit
Patient Care on the Inpatient Unit: Review orders of :
Vital sign parameters
Activity
Diet
Pain, nausea, vomiting control
Patient Care on the Inpatient Unit: Potential Post-operative complications- respiratory
Atelectasis
Pneumonia
Pulmonary embolism
Patient Care on the Inpatient Unit : Potential Postoperative Complications – Cardiovascular
Fluid and electrolyte imbalance
Tachycardia
Vasoconstriction
Dehydration
Surgical fluid/blood loss
Clot formation
Patient Care on the Inpatient Unit: Nursing Management – Assessment
Respiratory
Vital signs
Peripheral perfusion
Neurological
Gastrointestinal
Genitourinary
Skin/drains
Pain
Fluid and electrolyte balance
