N1B Periop Flashcards
Types of surgeries are based on 3 categories. What are the categories and the subcategories?
1) Purpose
- diagnostic, palliative, constructive, ablative, transplant
2) Urgency
- emergency, elective
3) Degree of risk
- major, minor
Locations of perioperative nursing are…
1) Hospital based inpatient
2) Outpatient surgical/laser/endoscopy suits aka ambulatory surgical center (ASC)
Factors influencing surgical risk are:
Age, general health, nutritional status, obstructive sleep apnea, meds, mental status, fluids and electrolyte imbalance
Infants and toddlers are at greater risk during procedure due to…
developmental status, higher metabolic rate, smaller blood volume, immature temperature regulation, immature kidneys, livers and immune system
Older adults are at greater risk during procedure due to…
reduced kidney and liver function, poor nutrition, presence of dementia, preexisting conditions and comorbities
How does each of the following meds pose a danger for surgery
- anticoagulants
- tranquilizers
- antibiotics - aminoglycosides
- diuretics
- antihypertensives
- long-term steroid therapy
- increases risk for bleeding
- respiratory depression
- cefazolin, vancomycin, gentamicin are prophylactic. Can reduce normal gut flora
- affect fluid and electrolyte, B/p
- decrease inflammation and wound healing
Steps of Preoperative Phase are:
- Informed consent
- Assessment
- nursing hx, physical assessment, psychosocial assessment, sociocultural assessment - Screening tests
- Diagnosing
- Planning
- Preop teaching
- Physical preparation
- Preop Meds
5 Nursing Preop diagnoses
1) Deficient knowledge
2) Anxiety
3) Disturbed sleep pattern
4) Anticipatory Grieving
5) Ineffective coping
Pre-op teaching examples
1) Improve peripheral circulation, prevent thrombus formation. Postop exercises are important for circulation and body function
2) Volume Incentive Spirometers
3) Pneumatic compression devices
4) Anti-embolism stocking (TED or Jobst stocking) and elastic (Ace) wraps.
PREOP Physical Preparation
Nutrition and fluids Elimination Hygiene Rest and sleep Valuables/ Prostheses Special order Skin preparation Vital signs Safety Protocols TEDS/ SCD
Preop Meds
Sedatives & tranquilizers Narcotics Anticholinergics H2 antagonist Neuroleptanalgesic
Describe 3 types of anesthesias
1) General anesthesia
2) Regional anesthesia
-Topical
-Local
-Nerve block
-Spinal anesthesia
-Epidural
3) Conscious Sedation
Minimal depression of the LOC in which the client retains ability to maintain a patent airway and respond appropriately to commands
nursing process Intraoperative Phase steps
- Assessment - id, client, checklist review
- Diagnosing
- Planning - goal is client safety and homeostasis
- Implementing - surgical skin prep, positioning, helping with sterility, keep discarded sponges collected and counted
- Evaluating
Role of the nurse in monitoring blood loss during implementation and role in documenting and reporting
Assisting in monitoring blood loss
Obtaining blood products for transfusion as necessary
Monitoring the condition of the patient at all times
Preparing and labeling specimens for laboratory analysis
Complete the requiring charting and paperwork
Monitor for breaks in sterile technique
Count sponges, sharps, and instruments after surgery
Assist with postop procedures
Transferring the pt to the recovery room and giving report
Scrub nurse vs Circulating nurse
SCRUB NURSE: Prepares the Surgical Instruments
Prepares the sterile field, surgical supplies and equipment
During the surgery, assists the surgeon by passing instruments, suctioning blood and maintaining the sterile field
CIRCULATING SCRUB: Prepares the patient for surgery by setting up the I.V., attaching the monitoring devices and helping the anesthesiologist
Prepares the operating room for surgery and helps the scrub nurse place the instruments on the table
Describe Postoperative Assessment
Receive report from PACU RN Assess ABC and LOC! Review surgeon orders VS q15min x4, q30min x4, q1hour x4, q4hours x48, or per protocol Lung sounds Skin color and temperature
What do you assess for in a surgical client
Comfort
Fluid Balance
Dressings
Drains and tubes
Postoperative DX
Acute Pain Risk for Infection Risk for Injury Risk for Deficient Fluid Volume Ineffective Airway Clearance Self-Care Deficit Disturbed Body Image Ineffective thermoregulation… High risk for alteration in comfort: nausea, vomiting Urinary retention… Impaired skin integrity… Anxiety Ineffective airway clearance… Impaired gas exchange
Implementation and interventions in postoperative phase
-Client positioned on side
-Artificial airway is still in place (waiting for cough and swallowing reflexes return.
-Suction at bedside
-Vital signs
-Use Aldrete scale to assess patient post surgery
Pain management: PCA, IVP,IM or Oral
Positioning
Deep breathing and Coughing
Suctioning airway
Leg exercises
Moving/ambulation
Hydration
Diet
Urinary Elimination
NG Suction
Wound care/ Dressings
Drains
Sutures
Patient teaching
Possible PostOp complications
Pneumonia Atelectasis Pulmonary embolism Hypovolemia Hemorrhage Hypovolemic shock Thrombophlebitis Thrombus Embolus Depression Urinary retention Urinary tract Infection Nausea and vomiting Constipation Tympanites Postoperative ileus Wound infection Wound dehiscence Wound evisceration
Which straps hold the dressing in place
Montgomery straps
Name vacuum devices to suction drainage
Jackson-Pratt
Hemovac closed wound drainage system
Name post-surgery assessment tool to evaluate patient’s stability
Aldrete Scale
What B/P range is acceptable preop/postop
+/- 20 mmHg
Drainage tube placed in the body near
an operative site and attached to a round collapsible
reservoir with springs that, when compressed, estab-
lishes low negative pressure, which pulls drainage
into the device.
Hemovac drain
Spilling of abdominal contents from a
surgical abdominal wound as a result of dehiscence.
Evisceration—
Separation of one or more layers of a sur-
gical abdominal wound before healing.
Dehiscence
Thin tube placed in the body near
an operative site and connected to a self-suction bulb
that is compressed to establish low negative pressure,
which pulls drainage into the bulb.
Jackson-Pratt Drain
Soft, flat tube placed in the body near an operative site to drain blood, pus, tissue, and debris
into a gauze dressing via gravity and capillary action.
Penrose drain
Safety measure performed at
various times before surgery to verify the patient’s
name, surgical procedure, and surgical site.
Safety “time out” check
Tube placed in the common bile duct to maintain patency of the duct and drain bile into a small
collection bag via gravity.
T-tube
Surgery needed within 24 hours of diagnosis
Urgent surgery
appendectomy, colectomy, amputation, and obliteration of ectopic foci in the heart).
Example of _________ surgery
Ablative
liposuction, facelift, and rhinoplasty
example of _______ surgery
Cosmetic
complete removal of a cancerous tumor and repair of an aortic aneurysm).
Example of ______ surgery
Cosmetic
cardiac catheterization, biopsy
of a mass, and identification of a cause of
gastrointestinal [GI] bleeding).
Example of ________ surgery
Diagnostic/explorative
resection of a nerve root, partial removal of a mass to provide for comfort is an example of ________ surgery
Palliative
Cardiac surgery, nephrectomy, removal of a section of colectomy, and organ transplantation. Open abdominal or thoracic surgery is an example of ____
Major surgery
Hernia repair, arthroscopy, and
cataract extraction example of ______
Minor surgery
Nutritional status during wound healing
Increased protein, zinc, and vitamins C and A
intake support wound healing.
c. Daily requirement of 1,500 kcal is needed to
maintain basic metabolic needs; because the
metabolic rate increases during wound healing,
this amount may have to be increased.
How does surgery affect fluid and electrolyte balance
- negative nitrogen balance due to breakdown of proteins
- increased glucose
- hypernatremia, retention of water
- hypokalemia
Where could these surgeries be performed:
Biopsy, minor plastic surgery, and
dermal procedures.
Doctor’s office
Where could these surgeries be performed?
Hernia repair, lumpectomy, laparoscopic cholecystectomy, angioplasty, tonsillectomy, and arthroscopy.
ASC
Where do you perform these surgeries?
Joint replacement, gastric bypass,
and emergency exploratory surgery.
Hospital
Disadvantages of general anesthesia are:
(1) Depresses the respiratory system, including
cough and gag reflexes, increasing the risk
of pneumonia and atelectasis.
(2) Depresses the circulatory system, increasing
the risk of thrombophlebitis.
(3) Causes postoperative throat discomfort
when an endotracheal tube is used.
(4) Can lead to life-threatening complications,
such as brain attack, malignant hyperthermia,
and cardiac arrest.
Stages of general anesthesia
(1) Stage I: Beginning anesthesia, drowsiness,
dizziness, and depressed pain sensation.
(2) Stage II: Excitement, spasmodic muscles,
irregular breathing, intact swallowing
reflexes, and possible vomiting.
(3) Stage III: Regular, rhythmic breathing; de-
pressed reflexes and vital functions; relaxed
skeletal muscles; constricted pupils; absent eye-
lid reflexes; and patient readiness for surgery.
(4) Stage IV: Complete respiratory depression;
rapid, thready pulse.
