N106 Perioperative Nursing Flashcards
What are the two classifications of surgery?
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)
What are the three levels of urgency regarding surgery?
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)
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)
Constructive Surgery
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)
Abalation Surgery
What type of surgery is done to confirm a diagnosis? (ie. exploratory laparotomy, breast mass biopsy)
Diagnostic Surgery
What type of surgery replaces malfunctioning organs or structures? (ie. kidney, cornea, joints)
Transplant Surgery
What type of surgery restores function or appearance to traumatized or malfunctioning tissue? (ie. internal fixation of fractures, car revusion, breast reconstruction)
Reconstructive Surgery
What type of surgery relieves or reduces intensity of disease symptoms? (ie. colostomy, debridement of necrotic tissue)
Palliative Surgery
Name the three stages of perioperative nursing
Preoperative - before surgery
Intraoperative - during surgery
Postoperative - after surgery
What three factors can influence patient post-surgical outcomes?
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.
What preoperative preparation is done to the surgical site to reduce the risk of surgical site infection?
An antiseptic shower or antiseptic wipe and prep of the surgical site with Chlorhexidine.
What can effective preoperative teaching reduce?
- anxiety
- the amount of anesthesia needed
- postsurgical pain
- corticosteroid production
Ideally, in what time frame should preoperative teaching take place?
1-2 days before surgery
What nursing interventions are done to prevent a thrombus?
- 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)
What are the duties of a circulating nurse?
- 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.
What are the duties of a scrub nurse/tech?
- 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.
When are the four times that sponges are counted during surgery?
- Before the procedure to establish a baseline
- Before closure of a cavity within a cavity
- Before wound closure begins
- At skin closure or end of procedure
What are the guidelines for marking the surgical site?
- 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”
What are the components of a “Time Out”?
- 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.
What information must be included in a patient hand off to the PACU/ICU?
- 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.
What is the priority for immediate observation and assessment by the PACU nurse?
- AIRWAY
- LOC
- Circulation
- Process through all systems
What is the purpose of the Alderte Score and what is assessed?
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.
Term for thin, watery, exudate composing the serum portion of the blood.
Serous
Term for wound complication that involves separation of a surgical wound; when sutures pull loose
Dehiscence
Term for wound complication resulting in protrusion of an internal organ through a wound or surgical incision.
Evisceration
What is the normal expectation for post-operative urinary function?
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
When should postoperative ambulation occur and what are the benefits of early ambulation?
*Patient should be out of bed 6-8 hours post-op
Benefits: Increases circulation, rate and depth of breathing, urination, metabolism, peristalsis
What is the post-op timeframe for bowel activity to return?
3-4 days
What is the definition of singultus?
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.
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?
Malignant hyperthermia
Cooling Measures:
Cover patient in ice
IV given cold - dantrolene, succinylcholine
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?
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.
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?
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
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?
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.
