Module 1 part 2: Perioperative and Intraoperative Nursing Care Flashcards
What are the peroperative phases and what happens during these phases?
Pre-perioperative: Decision for surgery –> OR doors/table
Intra-operative: OR –> PACU doors
Post-operative: PACU –> PCU –> follow-up evaluation
PACU: Post Anesthesia Care Unity (recoery room)
When do you start discharge teaching?
- right away prior to surgery
- Go over discharge teaching many times
What are the different kinds of Sx?
- Diagnostic - biopsy
- Curative
- Elective
- Palliative - life prolonging, alleviate symptoms
- Reconstructuve/cosmetic
Gerontological considerations for Sx?
- slow metabolism
- poor circulation - keep warm!
- Longer recoery time
- Less physiological reserve
- Less sensory fxn - fall risk, risk for delirium post op, risk for vulnerability and misunderstanding
Gerontological considerations for Sx?
- slow metabolism
- poor circulation - keep warm!
- Longer recoery time
- Less physiological reserve
- Less sensory fxn - fall risk, risk for delirium post op, risk for vulnerability and misunderstanding
Obese pt considerations for Sx?
More susceptible to infection – risk for resp. Infection
What are some special considerations for surgery
- Gerontological
- Obesity
- Disabililties
- System Considerations
- Nutrients involved in healing
- What is in their stomach
Why would a pt be NPO prior to surgery?
Gastric secretions can cause aspiration and increases risk of pneumonia
What are some supportive measures for Sx?
- Safety measures
- pschoogical, spiritual, and cultural beliefs
- Family needs
- Teaching
How can a nurse reduce perioperative anxiety in pediatric pts?
- play
- coping strategies
- Parental support
- Reducing Anxiety - teddy bear, familiar language appropriate for age, familiarity with surroundings and ppl
What are the perioperative nursing considerations for each stage of development?
Toddler: Autonomy, sensorimotor, participation
Preschooler: increased language skills, the role of choice
School-age: Language, knowledge acquisition, control
Adolescent: Reasoing, appearance, independence
Considerations for medication history
Abx, steroids , anticoags, antiHTN, insulin, diuretics, NSAIDs, herbal remedies
Consideration for pt on steroids going into Sx:
decreases immune fxn
Consideration for pt on antiHTN going into Sx:
anesthetics also lower BP
Consideration for pt on insulin going into Sx:
risk for hyper/hypoglycemia bc NPO
Pre-op meds?
- IV started (often but not always)
- Anxiolytics, sedation - benzodiazepines (AFTER consent)
- Abx (1hr pre or on-cal to OR)
- Gastric acid reduction - lower risk of aspiration
Preparations requirements for Sx
- NPO
- Skin prep: do not shave bc inc. risk of infectin, clip instead
- Medication teaching regarding usual regimen
- Bowel preparation
- Leave valuables at home
- Support system in place
- Post- op pain management
- Post-op exercises
- Discharge planning
Categories for Sx
Emergent: w/o delay. Hypovolemic shock Urgent: within 24-30hrs. Appendicitis Required: plan for a few weeks or months Elective: failure is not catastrophic Optional: personal preference
Common preoperative nursing diagnoses
- risk of infxn
- anxiety and fear
- knowledge deficit
- risk of adverse response to anesthetics, medications
- Risk of adverse outcomes r/t to risk factors
- improper consent process
Adjunct anesthesia?
drugs used in combination with anesthetic drugs to control the adverse effects of
anesthetics or to help maintain anesthetic state in patient.
Anesthetics:
drugs that depress the CNS or peripheral nerves to decrease sensation or relax muscles.
Anesthesia:
loss of the ability to feel pain resulting from the administration of an anesthetic drug
General anesthesia:
A drug-induced state in which CNS nerve impulses are altered to reduce pain and other
sensations throughout the entire body.
Normally involves complete loss of consciousness and depression of normal respiratory drive. Used for surgical procedures and in electroconvulsive therapy for severe depression.
Parenteral General Anesthetic Drugs:
propofol,
Inhaled General Anesthetic Drugs ( 2 types)
Inhaled gas: Nitrous Oxide
Inhaled Volatile liquid: Isoflurane
Local anesthesia:
Drug-induced state in which peripheral/spinal nerve impulses are altered to reduce or
eliminate pain & other sensations in tissues innervated by these nerves. Can be injectable or topical. Prevents
generation/conduction of nerve impulses through all types of nerve fibres (sensory, motor, autonomic). Used for
dental procedures, suturing of lacerations, diagnostic procedures (lumbar punctures, thoracentesis, biopsy).
Central Anesthesia
Spinal: local anesthesia induced by injection of an anesthetic drug near the spinal
cord to anesthetize nerves that are distal to the site of injection. Used when loss of
consciousness is undesirable or unnecessary, such as childbirth.
Intrathecal: anesthetic drugs are injected into subarachnoid space. Used for major abdominal/orthopedic surgeries (C-Section), or recently for at-home pain
management for severe persistent pain from things like occupational injuries.
Epidural: Anesthetic drugs are injected into epidural space without
puncturing dura. Commonly used during labour/delivery, for planned C-sections, ortho
procedures, etc.
Peripheral Anesthesia
Infiltration: Small amounts of anesthetic solution are injected into tissue that surrounds the
operative site. Used for wound suturing, dental procedures, etc.
Nerve Block: Anesthetic solution is injected into site where nerve innervates a specific area,
allowing large amounts of anesthetic to be delivered to a specific area without affecting whole
body. Used for difficult to treat pain syndromes, like cancer pain and chronic orthopedic pain.
Topical Anesthesia: Anesthetic drug is applied directly to surface of skin, eye, or any other
mucous membrane to relieve pain and prevent sensation. Used for diagnostic eye exams and
suturing. Ex. Benzocaine, lidocaine.
Procedural sedation
A milder form of general anesthetic that causes partial or complete loss of consciousness
but does not generally reduce normal respiratory drive (aka conscious sedation). Used to reduce anxiety during
minor procedures. Pt. can maintain open airway and respond to commands. Precautions must be used in case of
adverse reaction (advanced cardiac life support training, someone able to intubate if needed). Common drugs
used are midazolam + opioids like fentanyl/morphine, or propofol. Safer and more rapid recovery than GA.
How do esters and amides differ?
differ in two important ways: (1) method
of inactivation and (2) promotion of allergic responses.
