Module 1 part 2: Perioperative and Intraoperative Nursing Care

Question 1

What are the peroperative phases and what happens during these phases?

Answer 1

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)

Question 2

When do you start discharge teaching?

Answer 2

• right away prior to surgery

- Go over discharge teaching many times

Question 3

What are the different kinds of Sx?

Answer 3

• Diagnostic - biopsy
• Curative
• Elective
• Palliative - life prolonging, alleviate symptoms
• Reconstructuve/cosmetic

Question 4

Gerontological considerations for Sx?

Answer 4

• 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

Question 5

Gerontological considerations for Sx?

Answer 5

• 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

Question 6

Obese pt considerations for Sx?

Answer 6

More susceptible to infection – risk for resp. Infection

Question 7

What are some special considerations for surgery

Answer 7

• Gerontological
• Obesity
• Disabililties
• System Considerations
• Nutrients involved in healing
• What is in their stomach

Question 8

Why would a pt be NPO prior to surgery?

Answer 8

Gastric secretions can cause aspiration and increases risk of pneumonia

Question 9

What are some supportive measures for Sx?

Answer 9

• Safety measures
• pschoogical, spiritual, and cultural beliefs
• Family needs
• Teaching

Question 10

How can a nurse reduce perioperative anxiety in pediatric pts?

Answer 10

• play
• coping strategies
• Parental support
• Reducing Anxiety - teddy bear, familiar language appropriate for age, familiarity with surroundings and ppl

Question 11

What are the perioperative nursing considerations for each stage of development?

Answer 11

Toddler: Autonomy, sensorimotor, participation
Preschooler: increased language skills, the role of choice
School-age: Language, knowledge acquisition, control
Adolescent: Reasoing, appearance, independence

Question 12

Considerations for medication history

Answer 12

Abx, steroids , anticoags, antiHTN, insulin, diuretics, NSAIDs, herbal remedies

Question 13

Consideration for pt on steroids going into Sx:

Answer 13

decreases immune fxn

Question 14

Consideration for pt on antiHTN going into Sx:

Answer 14

anesthetics also lower BP

Question 15

Consideration for pt on insulin going into Sx:

Answer 15

risk for hyper/hypoglycemia bc NPO

Question 16

Pre-op meds?

Answer 16

• 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

Question 17

Preparations requirements for Sx

Answer 17

• 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

Question 18

Categories for Sx

Answer 18

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

Question 19

Common preoperative nursing diagnoses

Answer 19

• 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

Question 20

Adjunct anesthesia?

Answer 20

drugs used in combination with anesthetic drugs to control the adverse effects of
anesthetics or to help maintain anesthetic state in patient.

Question 21

Anesthetics:

Answer 21

drugs that depress the CNS or peripheral nerves to decrease sensation or relax muscles.

Question 22

Anesthesia:

Answer 22

loss of the ability to feel pain resulting from the administration of an anesthetic drug

Question 23

General anesthesia:

Answer 23

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.

Question 24

Parenteral General Anesthetic Drugs:

Answer 24

propofol,

Question 25

Inhaled General Anesthetic Drugs ( 2 types)

Answer 25

Inhaled gas: Nitrous Oxide | Inhaled Volatile liquid: Isoflurane

Question 26

Local anesthesia:

Answer 26

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).

Question 27

Central Anesthesia

Answer 27

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.

Question 28

Peripheral Anesthesia

Answer 28

 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.

Question 29

Procedural sedation

Answer 29

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.

Question 30

How do esters and amides differ?

Answer 30

differ in two important ways: (1) method | of inactivation and (2) promotion of allergic responses.