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MedSurg > Operative Nursing > Flashcards

Operative Nursing Flashcards

1
Q

Time Out/Pause for Cause

A
  • Performed by patient & entire healthcare team (nurse, surgeon, anesthesiologist, resident, tech)
  • Confirm pt identity, surgical procedure, surgical site
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2
Q

Time Out Elements

A

*Correct patient: state full name as printed on ID band + 2nd identifier (dob, SS, telephone, address, photo)
*Correct procedure: pt state
*Correct surgical site: pt state & signed by surgeon/pt

  • Other things reported: positioning, medications, etc.
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3
Q

When are time outs done

A
  • Preoperative period
  • Entry into surgical suite prior to anesthesia
  • Before incision
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4
Q

Informed consent for?

A

Surgery & anesthesia

  • Communication between surgeon and pt
  • Legal and ethical requirement
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5
Q

Role of surgeon/anesthesiologist in informed consent

A

Obtain informed consent

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6
Q

Role of nurse in informed consent

A
  • Double check: clarify info, ensure pt understanding, correct misconceptions
  • Emotional: ease concern of pt/family/support person
  • Witness to process and sign form
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7
Q

Components of surgical informed consent

A
  • Consent for procedure/anesthesia
  • Name of surgeon/anesthesiologist
  • Reason surgery/anesthesiology will benefit pt
  • Alternative options for surgery/anesthesia
  • Consent to administer blood products for surgery
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8
Q

Inability to consent

A

Cognitive impairment, Deaf/foreign language, Cannot physically sign, Minors, Emergencies

  • Durable power of attorney signs eg. guardian
  • Hospital interpret, can’t sign – mark an X
  • Minors: parent/legal guardian, old enough
  • Emergency: verbal consent or two providers sign
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9
Q

Nurse role before surgery for advanced directive

A

Document existence of AD/Living Will and place a copy of these documents in chart

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10
Q

Nursing management: preoperative history

A
  • *Allergies/sensitivities (latex)
  • *Last oral intake
  • *Any medical implants or devices
  • *Any piercings
  • Previous anesthesia + response
  • Surgical history, healing history
  • Social history: alc, smoking, etc.
  • History of mental illness/abuse
  • Support systems
  • Advanced directives
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11
Q

Preoperative nursing assessment

A

*Medications assessment: lab analysis or focused physical exam
- Anticoags: heparin, warfarin, lovenox –> bleeding risk
- Glucose metabolism altering meds: insulin, oral hypoglycemic agents, chronic steroid use –> hyperglycemia or hypoglycemia
- Antihypertensives: diuretics, beta blockers, ACE inhibitors –> hypotension in combo w other meds, hypertension without

  • *Confirm skin and bowel prep completed
  • Vital signs
  • Head-to-toe physical exam
  • Radiology tests
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12
Q

Nursing management: preoperative interventions

A
  • *IV insertion
  • *Ensure removal of jewelry and prosthetics
  • Administer any preoperative meds, like anti-anxiety
  • Foley catheter (usually done in OR)
  • Skin prep (shaving usually done in OR)
  • Inform anesthesia and surgical team of implants
  • Time-out
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13
Q

Nursing management: preoperative teaching

A
  • Anticipatory guidance (relieve anxiety)
  • OR experience
  • Recovery
  • DVT prophylaxis: SCD, heparin, Ted hose, mobility
  • Mobility prior to surgery
  • Prevent pneumonia: cough + deep breathing
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14
Q

Sterile team members

A

Surgeon(s), Surgical assistants, Scrub nurses, Surgical techs, OR techs

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15
Q

Surgeon role

A
  • Leader of surgical team
  • May be more than one
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16
Q

Surgical assistant roles (NP, PA)

A
  • Work interdependently w surgeon
  • Provide preoperative and postoperative pt care
17
Q

Scrub nurse, Surgical tech, OR tech roles

A
  • Pass instruments, sponges & other items
  • Prepare OR by setting up surgical instruments
  • Help surgical team don sterile gowns and gloves
18
Q

Non-Sterile team members

A

Anesthesia provider, Circulating RN

19
Q

Anesthesia provider role (MD or CRNA)

A
  • Constantly aware of surgeon’s actions
  • Preoperative evaluation & postoperative care in PACU
20
Q

Circulating RN role

A
  • Observe procedure, assist surgical team, maintain pt safety
  • Assess in preop arena and on admit to OR
  • Assist anesthesia in monitor and line placement and pt positioning
  • Anticipate supply and medication needs, label specimens
  • Count number of needles, instruments, sponges
21
Q

Surgical scrub procedure

A
  • Prevent surgical infection
  • Remove all jewelry and ensure clean nails (no gel or acrylic nails)
  • Wash hands thoroughly
  • Wash w disposable scrub sponge from clean (hand) to less clean area (arm), 3-5 mins
  • Dry w sterile towel provided by scrub nurse
22
Q

Surgical attire

A
  • All OR roles: scrubs, caps, masks, designated OR shoes or covers
  • Sterile field members: all the above + sterile gloves, gown and protective eyewear
23
Q

Types of intraoperative anesthesia

A

General (GA), Regional (RA), Monitored-Anesthesia Care (MAC)

24
Q

General anesthesia

A

Reversible unconscious states

  • Variety of methods: volatile agents (gases), IV agents, muscle relaxants
  • Anesthesia w muscle relaxant require endotracheal intubation for ventilation support
25
Q

Complications of GA

A
  • Hypoxia
  • Respiratory/CV dysfunction
  • Hypertension/hypotension
  • Fluid/electrolyte imbalance
  • Residual muscle paralysis
  • Malignant hyperthermia
26
Q

Regional anesthesia

A

Local anesthetic block or anesthesizes nerve/nerve fiber (pt = awake)

Types of RA:
- Spinal, epidural, caudal, nerve block
- Lidocaine, Bupivacaine, Cocaine

27
Q

RA adverse effects

A
  • Hypotension
  • Spinal headache
  • Resp paralysis or nerve damage
  • Seizure
28
Q

Monitored-Anesthesia Care

A

Anesthesia without unconsciousness
Decreased lvl of consciousness, respond to verbal command, maintain airway

  • Benzos, narcotics (Valium/Versed + Fentanyl/Dilaudid)
29
Q

Intraoperative positioning devices

A
  • OR bed
  • Arm board/restraint
  • Foam pads, sandbags
  • Padding
  • Blankets, sheets
  • Pillows/towels
  • Safety straps
  • Bean bags
  • Gel type padding
30
Q

Intraoperative positioning complications

A
  • Pressure injuries
  • DVT
  • Nerve injury/damage
  • Falling
  • Diminished lung capacity
31
Q

High risk pts in intraoperative positioning

A
  • Obese & extremely thin
  • Pediatric & geriatric
  • Paralyzed
  • Diabetes
  • Cancer
  • Infections
  • Trauma
  • Prosthetic or arthritic joints
32
Q

Intraoperative nursing assessment

A
  • Ensure OR consent signed
  • Correct pt positioning
  • Monitor donning of OR attire
  • Ensure supplies available
  • Check fluid and instruments for temp
  • Confirm flashed instruments are cool
  • Fire safety
33
Q

Intraoperative nursing interventions

A
  • Perform time out
  • Perform equipment safety and number check
  • Sterile technique
  • Assist anesthesia provider during intubation
  • Properly ground pt as indicated, keep pt safety belt in place
  • Apply support hose and sequential compression devices
  • Keep pt warm
  • Keep OR doors closed, clear hallway of equipment
34
Q

Postoperative care timing

A
  • Begin right after surgery
  • End at first follow-up postoperative provider visit
  • Insurance carriers end postop care at 90 days post-surgery
35
Q

Phases of post-op care

A
  • Phase I: immediate post-anesthesia period (CV, resp, neuro, ECG, pain/temp)
  • Phase II: prepare to transfer to floor/home (void, oral intake, n/v)
  • Phase III: observation d/t bed availability (standard postop nursing care)
36
Q

PACU settings

A
  • Inpt PACU: major to minor surgeries w varying complications
  • ICU: critically ill pts require complex monitor
  • Outpt PACU: ambulatory surgery centers (plastics, dental, eye)
  • Procedure areas: endoscopy, interventional cardiology, IV sedation
37
Q

Nursing management: PACU postoperative essentials

A
  • Resp status and oxygenation
  • Cardiovascular
  • Pain management: analgesics, PCA, nonpharm interventions
  • Lab monitoring: labs, chest x-ray, EKG
  • Fluid and electrolyte replacement
38
Q

Nursing management: PACU to Med-Surg floor transfer communication

A
  • SBAR
  • Fluid status and blood loss
  • Description of surgical procedure performed
  • IV access, location, peripheral/central, etc.
39
Q

Types of surgery

A
  • Elective eg. fat removal
  • Urgent eg. CA
  • Emergency eg. gunshot wound

MedSurg (15 decks)

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