Operative Care Flashcards
diagnostic surgical procedures
biopsy
exploratory lap
curative surgical procedures
excision of a tumor or inflamed appendix
reparative surgical procedures
multiple wound repair
cosmetic surgical procedures
mammoplasty or facelift
palliative surgical procedures
to relieve pain or correct a problem (gastrostomy tube)
who obtains consent
provider
nurses responsibility pre-op
Ensure the patient has all the information needed to make an informed decision about the procedure
components of informed consent
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
time-out or “pause for cause” starts when:
patient enters surgical facility
components of time-out
Patient receives a wristband containing identifying information upon admission
Patient confirms that all the information is correct
second time-out performed when and by who:
By circulating nurse upon transfer to surgical suite
Immediately preceding incision by the entire team
components of pre-op patient assessment
Medical history
Surgical and anesthesia history
Age
Allergies
Medications
Last oral intake
Alcohol, smoking and drug use
Special considerations
how long to be NPO before surgery
6-8 hours
BP medications not to stop cold turkey before a surgery
beta blockers
Defines a patient’s wishes if deemed incompetent to express their wishes in a medical emergency
Patient Self-Determination Act of 1991
Directive covering IV abx use, parenteral feedings, additional preferences
NC Medical Orders for Scope of Treatment (MOST) form
for advanced directives, let patients express desires related to:
organ donation
end of life issues
pre-op physical assessment includes:
height and weight
vital signs
systems assessment
pain!!
systems assessment
Cardiovascular assessment
Respiratory assessment
Neurological assessment
Liver/renal assessment
Integumentary assessment
Gastrointestinal assessment
Genitourinary assessment
nurse checklist when preparing a pt for a surgical procedure:
lab assessment
radiological assessment
pt teaching
physical preparations
transfer
what is assessed in pre-op lab assessment
type and screen to determine blood type and presence of antibodies
physical preparations for surgery
Intravenous line (at least 2)
Bowel and bladder preparation
Skin preparation
Medications
final responsibility of preoperative nurse
preparing pt for OR transfer
surgical settings
inpatient
ambulatory
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
sterile team members
surgeon
surgical assistants
scrub nurse
surgical technologist
OR technician
nonsterile team members
Anesthesia provider
Circulating RN
Unlicensed assistive personnel
OR Director/Coordinator/Manager
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
Verify important information prior to procedure
the surgical pause
prevent surgical site infections
follow hand hygiene procedures
surgical scrub
unrestricted zone of surgical area allows what attire
street clothes
semirestricted zone of surgical area includes what attire
scrubs and caps
restricted zone of surgical area includes what attire
scrub clothes
shoe covers
caps
masks
goals of anesthesia
Amnesia
Analgesia
Depression of reflexes
Muscle relaxation
Manipulation of physiological systems/functions
4 types of anesthesia
General anesthesia
Regional anesthesia
Local anesthetics
Monitored anesthesia care (MAC) or conscious sedation
-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
4 stages of general anesthesia
stage 1 - beginning anesthesia
stage 2 - excitement
stage 3 - surgical anesthesia
stage 4 - medullary depression
used to block nerves in the peripheral nervous system and CNS
local anesthesia
form of local anesthesia in which an anesthetic agent is injected around nerves, so that the area supplied by these nerves is anesthetized.
regional
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
4 standard positions for surgical procedures
Supine/dorsal recumbent (Trendelenburg, reverse Trendelenburg, and Fowler’s are modifications
Prone (jackknife is a modification)
Lateral
Lithotomy
high risk positioning demographics
Geriatric patients
Pediatric patients
Extremely thin patients
Obese patients
Paralyzed patients
Diabetic patients
high risk positioning circumstances
Prosthetic/arthritic joints
Patients with edema and circulatory limitations
Patients with medical conditions
Patients with infections
Trauma
situations putting pts at high risk
long surgical procedures
vascular surgery
demineralizing bone conditions
excessive sustained pressure on body
reason for risk in vascular surgery
blood perfusion may already be compromised
iodine
contrast - kidneys
metformin - diabetic
demineralizing bone conditions
malignant metastasis
osteoporosis
immediate recovery phase - intensive nursing care provided
phase 1 PACU
pt prepared for self-care or care in the hospital
recliners instead of beds
phase 2 PACU
Post-anesthesia care provided in which settings
Inpatient PACU
Intensive care unit (ICU)
Outpatient PACU
Procedure areas
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
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
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
primary hemorrhage
occurs at the time of surgery
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.
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.
capillary vessel hemorrhage
slow, general ooze
venous vessel hemorrhage
darkly colored blood - bubbles out quickly
arterial vessel hemorrhage
blood is bright red and appears in spurts with each heartbeat
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
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
it is believed that family visits
Decrease anxiety for both the patient and loved ones
Improve family satisfaction
Encourage family support
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
potential post-op complications
Respiratory depression from anesthesia and pain medication
Bleeding from the surgical procedure itself
post-op nursing assessment
ABCs
Pain
Surgical wound
