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Medsurg Exam 1 > Operative Care > Flashcards

Operative Care Flashcards

1
Q

diagnostic surgical procedures

A

biopsy
exploratory lap

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2
Q

curative surgical procedures

A

excision of a tumor or inflamed appendix

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3
Q

reparative surgical procedures

A

multiple wound repair

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4
Q

cosmetic surgical procedures

A

mammoplasty or facelift

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5
Q

palliative surgical procedures

A

to relieve pain or correct a problem (gastrostomy tube)

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6
Q

who obtains consent

A

provider

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7
Q

nurses responsibility pre-op

A

Ensure the patient has all the information needed to make an informed decision about the procedure

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8
Q

components of informed consent

A

Name, type, and reason for the surgery
Name of the surgeon to perform the surgery
Reason that intervention will benefit the patient
All alternative options to surgery
Potential outcomes if surgery is not performed
Consent for anesthesia
Consent to administer blood products

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9
Q

time-out or “pause for cause” starts when:

A

patient enters surgical facility

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10
Q

components of time-out

A

Patient receives a wristband containing identifying information upon admission
Patient confirms that all the information is correct

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11
Q

second time-out performed when and by who:

A

By circulating nurse upon transfer to surgical suite
Immediately preceding incision by the entire team

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12
Q

components of pre-op patient assessment

A

Medical history
Surgical and anesthesia history
Age
Allergies
Medications
Last oral intake
Alcohol, smoking and drug use
Special considerations

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13
Q

how long to be NPO before surgery

A

6-8 hours

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14
Q

BP medications not to stop cold turkey before a surgery

A

beta blockers

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15
Q

Defines a patient’s wishes if deemed incompetent to express their wishes in a medical emergency

A

Patient Self-Determination Act of 1991

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16
Q

Directive covering IV abx use, parenteral feedings, additional preferences

A

NC Medical Orders for Scope of Treatment (MOST) form

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17
Q

for advanced directives, let patients express desires related to:

A

organ donation
end of life issues

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18
Q

pre-op physical assessment includes:

A

height and weight
vital signs
systems assessment
pain!!

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19
Q

systems assessment

A

Cardiovascular assessment
Respiratory assessment
Neurological assessment
Liver/renal assessment
Integumentary assessment
Gastrointestinal assessment
Genitourinary assessment

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20
Q

nurse checklist when preparing a pt for a surgical procedure:

A

lab assessment
radiological assessment
pt teaching
physical preparations
transfer

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21
Q

what is assessed in pre-op lab assessment

A

type and screen to determine blood type and presence of antibodies

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22
Q

physical preparations for surgery

A

Intravenous line (at least 2)
Bowel and bladder preparation
Skin preparation
Medications

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23
Q

final responsibility of preoperative nurse

A

preparing pt for OR transfer

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24
Q

surgical settings

A

inpatient
ambulatory

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25
surgical categories
Elective surgery - could be helpful - not detramental Urgent surgery - within 24-30 hours - possibly a week Emergency surgery - without delay - threat of life or limb
26
sterile team members
surgeon surgical assistants scrub nurse surgical technologist OR technician
27
nonsterile team members
Anesthesia provider Circulating RN Unlicensed assistive personnel OR Director/Coordinator/Manager
28
preoperative assessment
Patient’s knowledge of surgery, complications, and interventions Validate and confirm informed consent was obtained Patient’s level of anxiety to manage preoperative fears and postoperative concerns
29
Verify important information prior to procedure
the surgical pause
30
prevent surgical site infections follow hand hygiene procedures
surgical scrub
31
unrestricted zone of surgical area allows what attire
street clothes
32
semirestricted zone of surgical area includes what attire
scrubs and caps
33
restricted zone of surgical area includes what attire
scrub clothes shoe covers caps masks
34
goals of anesthesia
Amnesia Analgesia Depression of reflexes Muscle relaxation Manipulation of physiological systems/functions
35
4 types of anesthesia
General anesthesia Regional anesthesia Local anesthetics Monitored anesthesia care (MAC) or conscious sedation
36
-not arousable, not even to painful stimuli -lose the ability to maintain ventilatory function -require assistance in maintaining a patent airway -Cardiovascular function may be impaired as well
general anesthesia
37
4 stages of general anesthesia
stage 1 - beginning anesthesia stage 2 - excitement stage 3 - surgical anesthesia stage 4 - medullary depression
38
used to block nerves in the peripheral nervous system and CNS
local anesthesia
39
form of local anesthesia in which an anesthetic agent is injected around nerves, so that the area supplied by these nerves is anesthetized.
regional
40
forms of anesthesia that involve the IV administration of sedatives and/or analgesic medications to reduce patient anxiety and control pain during diagnostic or therapeutic procedures.
Monitored anesthesia care (MAC) or conscious sedation
41
4 standard positions for surgical procedures
Supine/dorsal recumbent (Trendelenburg, reverse Trendelenburg, and Fowler’s are modifications Prone (jackknife is a modification) Lateral Lithotomy
42
high risk positioning demographics
Geriatric patients Pediatric patients Extremely thin patients Obese patients Paralyzed patients Diabetic patients
43
high risk positioning circumstances
Prosthetic/arthritic joints Patients with edema and circulatory limitations Patients with medical conditions Patients with infections Trauma
44
situations putting pts at high risk
long surgical procedures vascular surgery demineralizing bone conditions excessive sustained pressure on body
45
reason for risk in vascular surgery
blood perfusion may already be compromised iodine contrast - kidneys metformin - diabetic
46
demineralizing bone conditions
malignant metastasis osteoporosis
47
immediate recovery phase - intensive nursing care provided
phase 1 PACU
48
pt prepared for self-care or care in the hospital recliners instead of beds
phase 2 PACU
49
Post-anesthesia care provided in which settings
Inpatient PACU Intensive care unit (ICU) Outpatient PACU Procedure areas
50
postoperative nursing management
-Assessment and monitoring of the patient’s response to surgery and anesthesia -Timely interventions to resolve problems -Evaluation of interventions including effects or adverse effects of medications -Reassessment of patient’s condition -Evaluation of achievement of discharge criteria
51
priority nurse post-op assessment
Vital signs Pain level/comfort level Neurological function Temperature and color of skin Condition of dressings and of visible incisions Presence and patency of IV catheters and drains Hydration status and fluid therapy
52
post-op handoff of care
Patient identification using two identifiers Surgical procedure Team members’ names and contact information Fluid intake and estimated blood loss Placement of IV lines and drains Important home medications Medications administered and to be administered Discussion of actual and/or potential clinical issues Nonclinical information Plan of care
53
primary hemorrhage
occurs at the time of surgery
54
intermediary hemorrhage
occurs during the first few hours after surgery when the rise of blood pressure to its normal level dislodges insecure clots from untied vessels.
55
secondary hemorrhage
may occur some time after surgery if a suture slips because a blood vessel was not tied securely, became infected, or was eroded by a drainage tube.
56
capillary vessel hemorrhage
slow, general ooze
57
venous vessel hemorrhage
darkly colored blood - bubbles out quickly
58
arterial vessel hemorrhage
blood is bright red and appears in spurts with each heartbeat
59
discharge criteria post-op
Stable vital signs Return to baseline LOC Uncompromised pulmonary function and adequate airway Pulse oximetry readings indicating adequate blood oxygen saturation Intake and output Nausea and vomiting absent or under control Pain level Sensory and motor function Condition of surgical site
60
things to ask pt when dealing with post-op pain management
Patient’s pain location and intensity Fears about pain medication Chronic or past use of opioid medications Methods patient uses to reduce anxiety and improve comfort Is having family at bedside helpful or prefer to be alone
61
it is believed that family visits
Decrease anxiety for both the patient and loved ones Improve family satisfaction Encourage family support
62
prior to family visiting, the nurse ensures pt:
Is awake and pain is well controlled Sets expectations regarding intended length of visit Explains environment to the family member
63
potential post-op complications
Respiratory depression from anesthesia and pain medication Bleeding from the surgical procedure itself
64
post-op nursing assessment
ABCs Pain Surgical wound

Medsurg Exam 1 (4 decks)

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