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N106 Perioperative Nursing > N106 Perioperative Nursing > Flashcards

N106 Perioperative Nursing Flashcards

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1
Q

What are the two classifications of surgery?

A

Major : Extensive reconstruction of or altercation in body parts. (ie. Coronary artery bypass, gastric resection)
Minor: Minimal altercation in body parts (ie. cataracts, tooth extraction)

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2
Q

What are the three levels of urgency regarding surgery?

A

Elective - Not medically necessary. Patient’s choice. (ie. Plastic Surgery)
Urgent - Necessary for patient’s health (ie. excision of tumor, gallstones)
Emergency - Must be done immediately to save life or preserve function (ie. control of hemmorrhage)

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3
Q

What type of surgery restores function lost or reduced as a result of congenital anomalies? (ie. repair of cleft palate, closure of atrial-septal defect in heart)

A

Constructive Surgery

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4
Q

What type of surgery involves the excision or removal of a diseased body part or removal of a growth or harmful substance? (ie, amputation, cholecystectomy, removal of appendix)

A

Abalation Surgery

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5
Q

What type of surgery is done to confirm a diagnosis? (ie. exploratory laparotomy, breast mass biopsy)

A

Diagnostic Surgery

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6
Q

What type of surgery replaces malfunctioning organs or structures? (ie. kidney, cornea, joints)

A

Transplant Surgery

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7
Q

What type of surgery restores function or appearance to traumatized or malfunctioning tissue? (ie. internal fixation of fractures, car revusion, breast reconstruction)

A

Reconstructive Surgery

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8
Q

What type of surgery relieves or reduces intensity of disease symptoms? (ie. colostomy, debridement of necrotic tissue)

A

Palliative Surgery

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9
Q

Name the three stages of perioperative nursing

A

Preoperative - before surgery
Intraoperative - during surgery
Postoperative - after surgery

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10
Q

What three factors can influence patient post-surgical outcomes?

A

Age: older patients have slower recovery than younger patients.
Physical Condition: patients with coexisting health problems have slower recovery than healthy patients.
Nutritional Factors: Malnurished and obese patients have slower recovery than patients with healthier diets.

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11
Q

What preoperative preparation is done to the surgical site to reduce the risk of surgical site infection?

A

An antiseptic shower or antiseptic wipe and prep of the surgical site with Chlorhexidine.

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12
Q

What can effective preoperative teaching reduce?

A
  1. anxiety
  2. the amount of anesthesia needed
  3. postsurgical pain
  4. corticosteroid production
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13
Q

Ideally, in what time frame should preoperative teaching take place?

A

1-2 days before surgery

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14
Q

What nursing interventions are done to prevent a thrombus?

A
  • Early ambulation (6hrs post surgery, then every 1-2 hrs)
  • Antiembolism stockings (TEDS)
  • Sequential Compression Devices
  • Leg exercises (flexion and extension, dorsiflexion, plantar flexion and pedal pushes)
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15
Q

What are the duties of a circulating nurse?

A
  • Prepares equipment and supplies
  • Arranges supplies-sterile and non sterile
  • Sends for patient
  • Visits with patient preoperatively: verifies informed consent signed. identifies patient and answers questions, pre-op patient education
  • Performs patient assessment
  • Checks medical record
  • Assists in transfer of patient
  • Positions patient on operating table
  • Scrubs the patient post anesthesia
  • Maintains and documents counts of sponges, sharps and instruments throughout the procedure
  • Provides supplies to scrub nurse as needed
  • Observes sterile field closely and updates counts as items are used and/or added to sterile field
  • Cares for surgical specimens
  • Documents operative record and nurse’s notes
  • Recounts sponges, sharps and instruments when closure of wound begins
  • Transfers patient to the stretcher for transport to recovery area
  • Accompanies patient to the recovery room and provides a report.
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16
Q

What are the duties of a scrub nurse/tech?

A
  • Is surgically scrubbed and dons sterile gown and gloves aseptically.
  • Arranges sterile supplies and instruments
  • Checks instruments for proper functioning.
  • Counts sponges, sharps and instruments with circulating nurse
  • Gowns and gloves surgeons as they enter operating room
  • Assists with surgical draping of patient
  • Maintains neat and orderly sterile field
  • Corrects breaks in aseptic technique
  • Observes progress of surgical procedure
  • Hands surgeon instruments, sponges, and necessary supplies during procedure
  • Identifies and handles surgical specimens correctly
  • Maintains count of sponges, sharps and instruments so none will be misplaced or lost.
17
Q

When are the four times that sponges are counted during surgery?

A
  1. Before the procedure to establish a baseline
  2. Before closure of a cavity within a cavity
  3. Before wound closure begins
  4. At skin closure or end of procedure
18
Q

What are the guidelines for marking the surgical site?

A
  • The surgeon or designee marks at or near the incision site, no other marks.
  • The mark should be positioned to be visible after patient preping.
  • The method of marking and type of marking should be organization wide (per policy)
  • Patient should be involved in marking (Mark while patient is awake and alert)
  • Final verification of the site mark should take place during the “Time Out”
19
Q

What are the components of a “Time Out”?

A
  • It should be conducted in the OR/procedure room before procedure/incision
  • It should involve the entire operative team
  • Use active communication, and be briefly documented per policy
  • Confirm correct patient identity
  • Confirm correct side and site
  • Confirm premedication antibiotics
  • Agreement on the procedure to be done confirmed by all.
20
Q

What information must be included in a patient hand off to the PACU/ICU?

A
  • Name of patient
  • Name of surgeon
  • Type of anesthesia
  • Procedure performed
  • Fluids given
  • Antibiotics given
  • Blood loss
  • Local infiltrated into the wound
  • Equipment, tubes, drains, wound vacs, etc.
21
Q

What is the priority for immediate observation and assessment by the PACU nurse?

A
  1. AIRWAY
  2. LOC
  3. Circulation
  4. Process through all systems
22
Q

What is the purpose of the Alderte Score and what is assessed?

A

Purpose: Identifies when patients are ready for discharge from PACU. Score must be 8-10 before discharge.
Evaluated when patient first comes to PACU then again every 30min-1hr after arrival.
Assesses Respiration, O2 Sat, Consciousness, Circulation & Activity.

23
Q

Term for thin, watery, exudate composing the serum portion of the blood.

A

Serous

24
Q

Term for wound complication that involves separation of a surgical wound; when sutures pull loose

A

Dehiscence

25
Q

Term for wound complication resulting in protrusion of an internal organ through a wound or surgical incision.

A

Evisceration

26
Q

What is the normal expectation for post-operative urinary function?

A

Assess every 2 hours for distention
Patient should have urine output w/in 8 hrs post-op
Output of at least 30 mL per hour

27
Q

When should postoperative ambulation occur and what are the benefits of early ambulation?

A

*Patient should be out of bed 6-8 hours post-op

Benefits: Increases circulation, rate and depth of breathing, urination, metabolism, peristalsis

28
Q

What is the post-op timeframe for bowel activity to return?

A

3-4 days

29
Q

What is the definition of singultus?

A

Hiccup; an involuntary contraction of the diaphragm followed by rapid closure of the glottis; irritation of the phrenic nerve
Causes could be abdominal distention or internal bleeding.

30
Q

What is the term for a genetic disorder characterized by sustained skeletal muscle contractions leading to hyperthermia?
What cooling measures are done to prevent death in patients who develop this syndrome?

A

Malignant hyperthermia
Cooling Measures:
Cover patient in ice
IV given cold - dantrolene, succinylcholine

31
Q

What post-op complication involves the collapse of the alveoli?
When does this generally occur?
What are signs/symptoms?
What is the treatment for this?
What interventions can help to prevent this?

A

Atelectasis
In the first 48 hours post-op
Signs/Symptoms: tachypnea, tachycardia, decreased breath sounds, crackles, decreased PaO2, decreased SaO2
Treatment: Deep breathing, incentive spirometer, nebulizer treatment (bronchodialators)
Prevention: Pre-op education and practice of TCDB, early post-op ambulation, medicate to reduce pain and splinting.

32
Q

What post-op complication is defined as the migration of a thrombus from a deep vein to the pulmonary arterial system?
What is the common onset timeframe?
What are the signs/symptoms?
What is the treatment for this?
What interventions can help to prevent this?

A

Pulmonary Embolism
Commonly occurs between the 7th-10th day post-op.
Signs/Symptoms: sharp, stabbing pain with breathing, SOB, tachycardia, restlessness
Treatment: oxygen, anticoagulants, hydration, analgesia for pain and anxiety
Prevention: Early ROM and ambulation post-op, DVT prophylaxis

33
Q

What post-op complication is defined as the paralysis of intestinal peristalsis?
What is the potential onset timeframt?
What are the signs/symptoms?
What is the treatment for this?
What interventions can help to prevent this?

A

Paralytic Ileus
Onset: First 3-4 days post-op
Signs/Symptoms: No bowel sounds, abdominal distention, anorexia, nausea
Treatments: Treat cause (electrolyte imbalance, pneumonia, decreased cardiac output)
NG Tube, monitor for intestinal obstruction.

N106 Perioperative Nursing (1 decks)

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