Operative Nursing Management Flashcards
What are the three phases of perioperative nursing, and when do they occur?
preoperative phase - decision to proceed –> xfer to OR bed
intraoperative phase - xfer to OR bed –> admission to PACU
postoperative phase - admission to PACU –> f/u eval
What are the different surgical classifications and some examples?
diagnostic - laparoscopy, laparotomy
curative - tumor excision
reparative - wound repair
reconstructive - mammoplasty
cosmetic - facelift
palliative - pain relief, ostomy
rehabilitative - joint replacement
emergent - without delay
urgent - within 24-30 hours
required - within a few weeks or months
elective
optional
What is done during the preoperative assessment?
- health history
- physical exam
- nutritional status
- fluid status
- dentition status
- drug/alcohol use
- respiratory/cardiovascular function
- hepatic/renal function
- lab tests and baselines
- blood type and screen
- risk assessment
- signed consent form
- plan of action
- patient education
- advanced directive
- discharge planning
- preop orders and preparation
What can indicate a latex allergy?
- hx of latex or balloon allergy
- allergy to kiwi, avocado, banana
What are some gerontological considerations for surgery?
- increased risk for complications, morbidity, mortality
- altered drug metabolism d/t decreased renal/GI/hepatic fxn
- sensitivity to temperature
- skin at risk for abrasion d/t decreased perspiration & dryness
- delayed wound healing d/t poor nutrition, perfusion
What are some considerations for obese patients?
- higher risk for infection
- poor healing and breathing d/t increased cardiac/oxygen demand
- difficulty intubating
What are some risk factors that may complicate intubation during the administration of anesthesia?
- dentures or other dental items that may become dislodged
- obesity causing obstruction or narrowed airways
- sleep apnea
When is informed consent required?
- invasive procedures
- procedures requiring sedation/anesthesia
- procedures with higher risks
- procedures with radiation
- blood product administration
What is required for a valid signature on an informed consent form?
- Legal age
- mentally capable
- voluntary consent, or from legal guardian except when they cannot be reached
What protections do patients have when it comes to consent for procedures?
Right to know and understand procedure
right to refuse, change opinion, or ask for a second opinion at any time
What are the nurse’s responsibilities in the informed consent procedure?
- witness signature
- clarify information or seek out physician to do so
- administer premed only AFTER consent is signed
- place signed consent form in medical record that will travel with the patient to OR
What are the responsibilities of the surgeon in the informed consent procedure?
- provide clear and simple explanation of surgery
- inform patient of benefits, risks, alternatives, complications, expectations, and any removal of body parts
At what time prior to surgery:
stop smoking
stop consumption of fatty food
stop milk products
stop clear liquids
stop use of aspirin
void
smoking- 30 days
aspirin - 7-10 days
fatty foods - 8 hours
milk products - 4 hours
clear liquids - 2 hours
void - immediately prior to OR xfer
What are the different types of anesthesia delivery systems & common medications?
inhalation - “fluranes” (“thane), nitrous oxide
intravenous
- benzodiazepines: propofol (Diprivan), diazepam (Valium), lorazepam (Ativan), midazolam (Versed)
- opiates: fentanyl
- muscle relaxants: succinylcholine
regional - lidocaine + epinephrine
epidural - lidocaine (Xylocaine), procaine (Novocaine)
- common SE: headache, hypotension
spinal - lidocaine
- common SE: headache, N/V
General anesthesia
induces suppression of consciousness, relaxation, analgesia, and reflexes by suppressing the CNS.
What are the four stages of general anesthesia?
beginning anesthesia - dizziness, buzzing in ears, feelings of detachment, sensitivity
excitement - pupil dilation, rapid pulse, irregular respirations, involuntary movements
surgical anesthesia - pupil still constricts to light, regular respirations, skin pink and flushed
medullary anesthesia - shallow respirations, weak & thready pulse, pupils dilated, cyanosis
Anesthesia awareness
- risk factors
- S/Sx
return of consciousness, movement, and awareness despite being under anesthesia
- risk factors: cardiac, obstetric, major trauma, hx substance use, fHx
- S/Sx: increase in BP, rapid pulse, patient movement
What is the antidote for anesthesia?
flumazenil
Moderate sedation
partial sedation, decreased awareness of environment, decreased anxiety
- fentanyl + midazolam (Versed)
Malignant hyperthermia
- genetic muscular disorder caused by anesthesia sensitivity
- S/Sx: tachycardia, hypercapnia, hypotension, oliguria, muscle rigidity, tetany, hypocalcemia, ventricular dysrhythmia, cardiac arrest, increased body temp
- Tx: stop anesthesia, administer dantrolene, administer O2, infuse iced NS, correct dysrthythmia, xfer to ICU
When is a patient considered recovered from anesthesia?
motor and sensory function returns
A&Ox 4
stable VS
hypopharyngeal obstruction
- S/Sx
- Tx
S/Sx: choking, noisy respirations, low O2 sat, cyanosis
Tx: tilt head back and move lower jaw into underbite position. Emergency intubation prepared.
What parameters are necessary for discharge?
aldrete score >7
return of reflexes (gag, cough, swallow)
urine output >30mL/hr
return of bowel sounds & passing of flatus
Postop diet education
high calorie, high protein, high vitamin C
medications used for N/V
metoclopramide (Reglan)
promethazine (Phenergan)
hydroxyzine (Atarax)
scopolamine (Devil’s breath)
ondansetron (Zofran)
Shock
- S/Sx
- Tx
S/Sx
- pallor, cool & moist skin
- tachypnea
- cyanosis
- rapid, weak & thready pulse
- decreasing pulse pressure
- low BP
- concentrated urine
Tx
- volume replacement
- administer O2
- vasopressors
- elevate legs
hemorrhage
-S/Sx
-Tx
S/Sx
- feeling of apprehension, decreased CO, labored breathing, air hunger, tinnitus
- hypotension
- rapid, thready pulse
- restlessness, disorientation
- oliguria
- cold, pale, skin
Types
- time
- vessel
- visibility
Treatment
- blood transfusion
- inspect surgical site
- sterile wet gauze + pressure
- elevate site of bleeding to heart level
- shock position (flat on back, legs elevated, knees straight)
anticoagulants
short acting: heparin, enoxaparin (Lovenox) (PTT 46-70)
long acting: warfarin (INR 2-3)
antiplatelets
aspirin
clopidogrel (Plavix)
alderete score
ACROC (activity, consciousness, respiration, O2 sat, circulation)
