NUR 118 Lecture 5 - Perioperative Nursing Flashcards
3 Phases of Perioperative Nursing
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
What are the 4 ways surgeries are classified?
By body system
By purpose
- Why?
By degree of urgency
- Ex: Aesthetic surgery vs. infection
By degree of risk
Define an Ablative surgery
Removal of diseased body part
Define diagnostic surgery
Confirm or R/O A DX
-Not curing anything
-See what’s going on
Ex: Liver biopsy, cardiac catheter
Define a Palliative surgery
Not curative, relieves symptoms/pain
Ex: Tumor debulking
Define a Reconstructive surgery
Restores function
Ex: Torn ligament
Define a Cosmetic surgery
Improves appearance
- Ex: Face lift
Define a Transplant surgery
Replace a failing body part or organ
- Ex: Kidney
Define a Procurement surgery
Organs and tissue harvested to transplant to another
List the Degrees of Surgery Urgencies
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
Degrees of Surgical Risk
Major surgery - High risk
Ex: cardiac bypass
Minor surgery - low risk
ex: outpatient, endoscopies
Factors contributing to surgical risk
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
Pre-Operative Nursing Responsibilities
- 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
What are the three systems where surgery is “clean-contaminated”
- Gastro-Intestinal (GI)
- GenitoUrinary (GU)
- Respiratory system
PreOp Nursing Responsibilities:
List what to assess for History & Physical
History
- Health history
- Physical status
-Medications
-Allergies
-Mental status
Physical
- Respiratory system
- Vital Signs
- Risk for thrombophlebitis
List examples for Diagnostic Testing preop assessments
- Complete Blood count
- Urinalysis
- Comprehensive metabolic panel
Electrolytes, glucose, albumin - Fasting blood sugar
- electrocardiogram
-Chest x-ray
List examples for Pre-Op teaching
- Pain management
- Deep breathing/coughing & Incentive spirometer
- Splinting
- Leg Exercising
How is an incentive spirometer used?
Inhale 10 times, helps to prevent alveoli from collapsing in atelectasis
What does informed consent/surgical consent entail?
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
Pre-Op Medications
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
What is the universal protocol - Three step process?
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
List and describe the types of anesthesia
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
Intraoperative: Nursing Roles in OR for Circulating Nurse
- Part of “Clean Team”, works around sterile field
- Client advocate
- Monitors client and sterile field
- Docuents
- Handles specimens
Intraoperative: Nursing Roles in OR for Scrub Nurse
- Part of “Sterile Team”
- Set up and maintain sterile field
- Prepares instruments
- Passes instruments to surgeons
What are the two phases of postoperative care?
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)
What’s a big concern regarding pain post-operatively?
- They probably won’t do deep breathing which may lead to pneumonia or atelectasis
What are PACU responsibilities & assessments?
- Airway
- If unconscious, turn patient on side - Breathing
- Respiratory rate, lung sounds, skin color
- Pulse oxi - Circulation
- Blood pressure, pulse rate - Nausea, pain
What are some perioperative nursing diagnoses?
Pre-Op:
-Knowledge deficit
- Anxiety
-Pain
Intra-Op:
-Risk for injury
Post-Op:
-Acute pain
-Risk for: (all complications)
How often to take vitals in PACU?
Every 15 minutes for 1 hour
Signs of anxiety in a Pre-Operative patient may manifest as:
Tachycardia
Inability to concentrate
Diaphoresis (sweating for no reason)
A Cardiac Catheterization is considered which “purpose” of surgery?
Diagnostic
- Used to diagnose and treat heart problems
What degree of surgical urgency is a rotator cuff repair?
Elective Surgery
Which blood test evaluates renal function?
BUN and Creatinine
Which diagnostic test evaluates respiratory/pulmonary disease?
Chest X-Ray
Which blood test evaluates WBC, Hgb & Hct?
CBC (Complete Blood Count)
Which blood test is needed if a patient requires a blood transfusion?
Type and Screen/Cross Match
Which diagnostic test is used to identify infection, kidney function & pregnancy?
Urinalysis
A patient who vomits in the PACU post-operatively is at risk for what?
Aspiration
What class of medication can be administered to the pre or post operative patient to prevent nausea & vomiting?
Anti-Emetic
Physical preparation of the patient for surgery includes?
-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
Preparing patient mentally for surgery?
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.
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
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)
The nurse is reviewing diagnostic screening tests. Which test evaluates renal function, fluid & electrolyte status, and serum electrolytes?
Comprehensive Metabolic Panel (CMP)
NOT urinalysis.
Urinalysis is for detecting UTIs and presence of glucose or protein in urine.
Purpose of Urinalysis?
Detect: UTIs, presence of glucose & proteins
- Can also detect poorly managed diabetes, renal disease and pregnancy
What is the major purpose of withholding food and fluid before surgery?
It prevents aspiration and respiratory complications?
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?
PreOperative
