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NUR 118 Lecture > NUR 118 Lecture 5 - Perioperative Nursing > Flashcards

NUR 118 Lecture 5 - Perioperative Nursing Flashcards

1
Q

3 Phases of Perioperative Nursing

A

Preoperative
- From the decision to have the surgery to OR
intraoperative
- When the patient enters the OR until the PACU
Postoperative
- From end of operation until healing

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2
Q

What are the 4 ways surgeries are classified?

A

By body system
By purpose
- Why?
By degree of urgency
- Ex: Aesthetic surgery vs. infection
By degree of risk

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3
Q

Define an Ablative surgery

A

Removal of diseased body part

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4
Q

Define diagnostic surgery

A

Confirm or R/O A DX
-Not curing anything
-See what’s going on
Ex: Liver biopsy, cardiac catheter

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5
Q

Define a Palliative surgery

A

Not curative, relieves symptoms/pain
Ex: Tumor debulking

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6
Q

Define a Reconstructive surgery

A

Restores function
Ex: Torn ligament

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7
Q

Define a Cosmetic surgery

A

Improves appearance
- Ex: Face lift

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8
Q

Define a Transplant surgery

A

Replace a failing body part or organ
- Ex: Kidney

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9
Q

Define a Procurement surgery

A

Organs and tissue harvested to transplant to another

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10
Q

List the Degrees of Surgery Urgencies

A

Elective - Recommended course of action but not time sensitive

Urgent - Must be done within 24-48 hours
Ex: Symptom relief - Body part repair (fractures)

Emergency - Surgery done as soon as possible, save a patient’s life or function
Ex: Trauma, open fractures, organ rupture

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11
Q

Degrees of Surgical Risk

A

Major surgery - High risk
Ex: cardiac bypass
Minor surgery - low risk
ex: outpatient, endoscopies

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12
Q

Factors contributing to surgical risk

A

Allergies - analgesics, latex, anesthesia, shellfish (iodine)

Type of wound - Pre-existing or post-op

Pre-existing conditions - Acute or chronic

Mental status - Confused/mentally ill

Age - Very old or very young

Medications - Prescribed/OTC/Herbal

Personal Habits - Smoking/illegal drugs/alcohol

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13
Q

Pre-Operative Nursing Responsibilities

A
  • History and physical:

History, what happened; physical, how are you now

  • lab and diagnostic tests
  • pre-op teaching
  • Informed consent
    -Prepare the client physically and mentally
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14
Q

What are the three systems where surgery is “clean-contaminated”

A
  • Gastro-Intestinal (GI)
  • GenitoUrinary (GU)
  • Respiratory system
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15
Q

PreOp Nursing Responsibilities:

List what to assess for History & Physical

A

History
- Health history
- Physical status
-Medications
-Allergies
-Mental status
Physical
- Respiratory system
- Vital Signs
- Risk for thrombophlebitis

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16
Q

List examples for Diagnostic Testing preop assessments

A
  • Complete Blood count
  • Urinalysis
  • Comprehensive metabolic panel
    Electrolytes, glucose, albumin
  • Fasting blood sugar
  • electrocardiogram
    -Chest x-ray
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17
Q

List examples for Pre-Op teaching

A
  • Pain management
  • Deep breathing/coughing & Incentive spirometer
  • Splinting
  • Leg Exercising
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18
Q

How is an incentive spirometer used?

A

Inhale 10 times, helps to prevent alveoli from collapsing in atelectasis

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19
Q

What does informed consent/surgical consent entail?

A

Includes:
-Type of surgery
-Risks & benefits
- Statement that patient has right to refuse

Protects patient from surgery that’s unwanted or not understood
Protects agency and workers from later claims that patient did not consent

20
Q

Pre-Op Medications

A

Opiod:
>Morphine - can cause respiratory depression

Anti-infective:
>Ampicillin -
>azithromycin

Anesthetic sedation:
>Midazolam
>Propofol

Anticholinergic:
>Atropine - Reduces secretions, prevents aspiration pneumonia

Antiemetic:
>ondansetron - Helps with nausea

21
Q

What is the universal protocol - Three step process?

A

Preoperative
1. Pre-verification process
- Verify the correct procedure, for the correct patient, at the correct site
- When possible, involve the patient in verification process
2. Marking Site
Intraoperative
3. “Time out” - Initiated by nurse, when everything is ready right before operation

22
Q

List and describe the types of anesthesia

A

Local:
Loss of pain at the desired site, injected or topical

Moderate Sedation:
CONSCIOUS (drowsy) sedation and analgesia, IV

Regional:
Patient awake/alert, numb @ surgical site

General:
Rapid unconsciousness + loss of sensation, may cause stroke, death, heart attack

23
Q

Intraoperative: Nursing Roles in OR for Circulating Nurse

A
  • Part of “Clean Team”, works around sterile field
  • Client advocate
  • Monitors client and sterile field
  • Docuents
  • Handles specimens
24
Q

Intraoperative: Nursing Roles in OR for Scrub Nurse

A
  • Part of “Sterile Team”
  • Set up and maintain sterile field
  • Prepares instruments
  • Passes instruments to surgeons
25
Q

What are the two phases of postoperative care?

A

Phase 1
- Recvoery from anesthesia in the Post Anesthesia Care Unit (PACU)
Phase 2
- Recovery from surgery
(On the surgical unit, at home, in rehab)

26
Q

What’s a big concern regarding pain post-operatively?

A
  • They probably won’t do deep breathing which may lead to pneumonia or atelectasis
27
Q

What are PACU responsibilities & assessments?

A
  1. Airway
    - If unconscious, turn patient on side
  2. Breathing
    - Respiratory rate, lung sounds, skin color
    - Pulse oxi
  3. Circulation
    - Blood pressure, pulse rate
  4. Nausea, pain
28
Q

What are some perioperative nursing diagnoses?

A

Pre-Op:
-Knowledge deficit
- Anxiety
-Pain

Intra-Op:
-Risk for injury

Post-Op:
-Acute pain
-Risk for: (all complications)

28
Q

How often to take vitals in PACU?

A

Every 15 minutes for 1 hour

29
Q

Signs of anxiety in a Pre-Operative patient may manifest as:

A

Tachycardia
Inability to concentrate
Diaphoresis (sweating for no reason)

30
Q

A Cardiac Catheterization is considered which “purpose” of surgery?

A

Diagnostic
- Used to diagnose and treat heart problems

31
Q

What degree of surgical urgency is a rotator cuff repair?

A

Elective Surgery

32
Q

Which blood test evaluates renal function?

A

BUN and Creatinine

33
Q

Which diagnostic test evaluates respiratory/pulmonary disease?

A

Chest X-Ray

34
Q

Which blood test evaluates WBC, Hgb & Hct?

A

CBC (Complete Blood Count)

35
Q

Which blood test is needed if a patient requires a blood transfusion?

A

Type and Screen/Cross Match

36
Q

Which diagnostic test is used to identify infection, kidney function & pregnancy?

A

Urinalysis

37
Q

A patient who vomits in the PACU post-operatively is at risk for what?

A

Aspiration

38
Q

What class of medication can be administered to the pre or post operative patient to prevent nausea & vomiting?

A

Anti-Emetic

39
Q

Physical preparation of the patient for surgery includes?

A

-Maintaining Normo-thermia​
-Ensuring NPO status​
-Skin prep​
-Bowel prep​
-Last void or catheterization​
-Pre-op meds​
-Status of routine medications
-Removal of dentures, artificial limbs, contact lenses, wigs, jewelry. *eye glasses, *nail polish​
-Anti-embolism stockings or sequential compression devices

40
Q

Preparing patient mentally for surgery?

A

Communicate what will happen before, during, and after surgery.​

Discuss how the patient or caregiver can participate in the care​

Encourage expression of feelings and concerns that patient may have about surgery.

41
Q

A nurse is caring for a client with the following type of portable wound drainage device. Which should the nurse do when caring for a client with this type of drainage system?

Jackson-Pratt Drain

A

Empty container, compress collection container, close port and release hand compression

Keep collection container below insertion site

Empty collection container when HALF-full

Attach tubing to clothing (prevents tension on cord)

42
Q

The nurse is reviewing diagnostic screening tests. Which test evaluates renal function, fluid & electrolyte status, and serum electrolytes? ​

A

Comprehensive Metabolic Panel (CMP)

NOT urinalysis.

Urinalysis is for detecting UTIs and presence of glucose or protein in urine.

43
Q

Purpose of Urinalysis?

A

Detect: UTIs, presence of glucose & proteins
- Can also detect poorly managed diabetes, renal disease and pregnancy

44
Q

What is the major purpose of withholding food and fluid before surgery?

A

It prevents aspiration and respiratory complications?

45
Q

In which phase of perioperative care will the nurse ​prepare the client’s skin, encourage the client to void, ​and remove the client’s dentures?​

​

A

PreOperative

46
Q
A

NUR 118 Lecture (10 decks)

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