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NUR 155 med surg > Peri-op > Flashcards

Peri-op Flashcards

1
Q

Preoperative

A

Begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the OR table

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2
Q

Intraoperative

A

Begins when the patient is transferred onto the OR table and ends with a mission to PACU

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3
Q

Postoperative

A

Begins with the omission of the patient to the PACU and ends with the follow up evaluation in the clinical setting or home

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4
Q

Surgical classifications

A

1) Diagnostic
2) Curative- remove cancerous tissue
3) Reparative- restore function
3) Reconstructive/ Cosmetic
4) Palliative- to make symptoms less severe, make quality of life better

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5
Q

Surgery timing

A

1) Emergent- Immediate intervention, Life threatening
2) urgent - prompt attention within 24-30 hours
3) Required- within a few wk/ months
4) Elective- should have, failure not catastrophic
5) Optional- personal preference of the patient

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6
Q

Consideration for elderly surgery

A
  • Disease corse VS life expectancy
  • State of independence
  • Personal motivation
  • Surgical risk factors VS. non-operative management
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7
Q

Surgical considerations for Bariactic/ obesity

A

Increase risk and severity of complications

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8
Q

Surgical Considerations for the disabled

A

need for additive devices

Teaching modification

Positioning and transferring assistance

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9
Q

Preoperative Informed consent

A
  • must be voluntary and written
  • patient has legal right to make informed decisions
  • must be in chart before surgery
  • ensure patient is provided with information necessary to enable them to evaluate the surgery before agreeing to it
  • protects patient from unsanctioned surgery
  • protects surgeons from claims of unauthorized operation
  • patient can refuse surgery
  • wording must be understandable ( appropriate language/ interpreter)
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10
Q

Informed consent is necessary for

A
  • invasive procedure
  • procedures requiring sedation
  • non surgical procedure with higher risk
  • procedures with radiation
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11
Q

Nurses role in informed consent

A

Verify that the patient is who they say they are when signing the consent

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12
Q

Preoperative nursing assessment

A

1) Health history
2) vital signs

3) blood test, x-eat etc
- pregnant test for all women of child bearing age

4) identify risk factors for surgery

5) Nutrition / Fluid status
- nutrition for wound healing
- F/E imbalances due to bowl prep should be addressed prior to surgery

6) Drug/ Alcohol
- patience, care, nonjudgmental
- may need different anesthesia
- increase risk for complications, longer hospital stay

7) respiratory status
- asthma, COPD
- smoking cessation : educate to stop 30 days prior
- educate to us incentive spirometer

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13
Q

Risk factors for surgical complications

A

During Pre-Op assessment nurses need to make every attempt to identify and address risk factors that may contribute to complications or delayed recovery

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14
Q

Cardiovascular status Pre-Op

A

Uncontrolled hypertension

- may need cardinal clearance prior to surgery

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15
Q

Hepatic and renal function Pre-Op

A
  • Meds, Anesthetics, Body Wastes, Toxins need to be adequately processed and removed from the body
  • Liver helps breakdown anesthesia; kidneys excrete
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16
Q

Endocrine function Pre-Op

A

Diabetes

- prevent extremes of hyper/ hypoglycemia

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17
Q

Immune function Pre-Op

A
  • Allergies

- Medication sensitivity or reactions

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18
Q

Medication use Pre-Op

A
  • Aspirin: STOP 7-10 day before surgery
  • Drug interactions
  • Ask about herbs and supplements; d/c 2 weeks prior to surgery
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19
Q

Psychosocial factors Pre-Op

A
  • Anxiety
  • Fear
  • Assess support system
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20
Q

Spiritual/ Cultural beliefs Pre-Op

A
  • As requested by the patient
  • Special issues:
    • Jehovah witness- declines blood transfusions
    • will ask if can give transfusion during surgery, part of informed surgical consent
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21
Q

Pre-Op teaching

A
  • Initiate as soon as possible
  • Use different modalities
  • Descriptions and Explanations
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22
Q

Pre-Op education includes

A
  • Deep breathing, coughing, incentive spirometer
  • Promoting Mobility
  • Pain management
  • Cognitive coping techniques
  • Ambulatory surgery education ( d/c teaching)
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23
Q

Pre-Op care

Preparing for surgery

A
  • NPO
  • Bowl Prep: depending on the type of surgery (colon/rectal)
  • Skin Prep/ Hair
    • chlorhexidine gluconate antiseptic solution: antimicrobials to clean skin
  • Hospital gown/ Hair cap
  • No dentures/ jewelry
  • No assistive devices
  • Void immediately before
24
Q

What does the nurse complete for Pre-Op record

A
  • Pre-Op assessment
  • plan of care
  • universal protocol / safety checklist
  • document marked surgical site
25
Q

Completed chart to the OR includes

A
  • Pre-op checklist
  • H & P
  • anesthetic assessment
  • surgical consent
  • Labs
26
Q

Before induction of anesthesia checklist includes

A

1) confirm identity, procedure and consent
2) site marked
3) anesthesia machine and medication check completed
4) pulse ox on patient and functioning
5) allergies
6) difficult breathing/ aspiration risk
7) risk of > 500 ml blood loss

27
Q

Before skin incision check list

  • with nurse, anaesthetist and surgeon
A

1) identify team members by name and role
2) confirm patient name, procedure, and incision location
3) antibiotic prophylaxis given w/in last 60m

28
Q

Pre-Op: Administer any preanesthetic meds

A
  • In bed, side rails up
  • observe for reactions
  • keep surrounding quiet
  • ordered at specific time it “on call to OR”
29
Q

Pre-Op: transport to pre surgical area

A
  • 30 to 60 min before anesthesia

- patient identification

30
Q

Pre-op: family care

A
  • in waiting room

- keep updated

31
Q

Intraoperative surgical team

A
  • surgeon
  • anesthesiologist
  • certified registered nurse anesthetist
  • circulating nurse and scrub nurse
  • registered nurse first assistant
  • certified surgical technicians
32
Q

Intraoperative “Time Out”

A

In OR every team member verified the patient name, procedure and surgical site

33
Q

Surgical environment zones

A

1) unrestricted zone: street clothes
2) semi-restricted: scrub cloths/ cap
3) restricted: scrubs/ shoe covers/ caps/ mask

  • no artificial nails
  • access limited
  • surgical asepsis
  • proper attire
34
Q

Surgical environment

A
  • frequent cleaning and sterilizing

- special ventilation

35
Q

OR safety

A

Exposure to blood and body fluids—- double gloving !

36
Q

Anesthesia

A

State of narcosis, analgesia, relaxation and reflex loss

Not arousable
Need assistance with patent airway and ventilators fun’s toon

37
Q

Stages of anesthesia

A

Stage 1: beginning anesthesia
- calm, can talk, R and pain feeling decrease

Stage 2: excitement
Uncontrolled movement, possible vomit, increase HR

Stage 3: surgical anesthesia
- eyes stop moving, muscle relax, may stop breathing w/o machine

Stage 4: medullary depression

38
Q

General anesthesia

A

Inhaled or IV

39
Q

Regional anesthesia

A

Spinal: injected into subarachnoid space at lumbar (L4 and L5)

Epidural: injected into epidural space

Local blocks: specific area

  • awake and aware of surroundings
40
Q

Local anesthesia

A

Injected into the tissue at the planned incision site

Often combined with local block

41
Q

Protecting from injury intraoperative

A

1) Positioning
- braces/ padding
- safety straps and side rails
- safe transfer

2) verify information
3) check chart for completeness

4) obtain the necessary equipment
- circulating RN set up suction, monitor, assist w/ vascular access insertion, comfort measures, and “counts”

42
Q

Intraoperative complications nurses should report

A
  • N/V
  • Anaphylaxis
  • Resp complications (hypoxia)
  • hypothermia
    • due to anesthesia, corse body temp <98
    • warming should be gradual
  • Malignant hyperthermia
  • Anesthesia awareness
43
Q

Malignant hyperthermia

A

Acute life threatening emergency

Inherited muscle disorder caused by anesthetic agent

Usually occur in the first 10-20 mins after induction but can occur 24 hr after surgery

44
Q

Malignant hyperthermia signs and symptoms

A
  • tachycardia ( >150) early sign
  • ventricular dysrhythmia
  • hypotension
  • oliguria (decrease urine)
  • eventually cardiac arrest
  • increase CO2 (early sign)
  • generalized muscle rigidly (early)
  • rise in temp is late sign
    • T raise 2-4 degree every 5 min until core exceed 107
45
Q

Malignant hyperthermia treatment

A
  • d/c anesthesia

- stop surgery

46
Q

Post Op

A
  • Go to PACU
  • may be 4-6 he depending on surgery
  • recover from effects of anesthesia until return of baseline cognition, stable VS and no evidence of complications
47
Q

Post Op initial assessment

A
  • Airway, RR/ function
  • HR/ function
  • VS and LOC
  • baseline assessment
  • Meds/ IV fluids as needed
48
Q

Post op assessment AFTER initial

A
  • VS
  • LOC
  • General physical status assessed and documented very 15 mins
49
Q

Post op care

Respiratory and cardiac

A

1) maintain patent airway
- may have plastic airway in mouth to maintain patent airway
- should no be removed until gag reflex is intact

2) maintaining cardiovascular stability
- VS, Cardinal rhythm, Skin temp/ color and urine output

50
Q

Post-Op complications

A

1) Hypotension/ shock
- blood loss, hypoventilation, position changes, pooling of blood in extremity, side effect of meds

2) Hemorrhage
- early s/s: anxiety/ fear, decreased cardiac output, breathing labored “air hunger”

3) Hypertension/ Arrhythmia
- HTN: secondary to pain, hypoxia, bladder distention
- Arrhythmia: secondary to electrolyte imbalance, pain, stress, hypothermia, altered R function, anesthetics

4) Hematoma
- may need to remove large clot from wound

5) infection
- care for dressing and drain
- monitor VS, administer antibiotics

6) wound Dehiscence/ evisceration
- prevent with abd binder
- cover aseptically with moist saline dressing
- notify MD immediately

7) paralytic ileus

8) adhesion
- scar tissue fused two surfaces together

51
Q

Post-op Pain & N/V management

A
  • pain is 5th vital sign
  • reposition
  • relaxing/ diversion techniques
  • medications
    • opioids
    • antiemetic : drug that is effective against vomiting and nausea
52
Q

Post Op elderly considerations

A
  • recover slowly, longer hospital stay, greater risk for complications
- treats to recovery include: 
  • pneumonia 
   • decrease functional ability 
  • exacerbation of comorbid conditions
  • pressure ulcers / Falls 
  • decrease oral intake / GI output 
  • post op delirium
  • slow medication clearance
53
Q

Post-op respiratory complications

A
  • decrease effects of opioids
  • FVO: crackles
  • Use of IS, TCDB “turn cough deep breath” ( can splint while coughing) early ambulation
54
Q

Post op intervention wounds

A
  • wound healing: ongoing assessment of surgical site
  • drains: assessment of insertion site, proper placement/ drainage
  • dressing changes: fist change is by member of surgical team, follow orders after that, monitor for drainage and output on Surgical site
55
Q

Post-op complications DVT & PE

A
  • DVT: pain or craning in extremity, edema, red, warm, fever, chills, diaphoresis
    • compression device or socks
    • early ambulation or leg exercises
  • PE: sudden SOB, tachypnea, tachycardia, low grade temp, chest pain, anxiety
56
Q

Wound dehiscence

A

Wound separates

57
Q

Wound evisceration

A

Wound and muscle separate and organ protrude

NUR 155 med surg (15 decks)

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