Peri-Op

Question 1

What is diagnostic surgery? What are 2 examples?

Answer 1

Determines origin & cause.

Colonoscopy & laparoscopy

Question 2

What is curative surgery? What are 2 examples?

Answer 2

Resolves the problem by repair or removal.

Appendix or gallbladder

Question 3

What is restorative surgery? What is an example?

Answer 3

Improves functionality.

Knee replacement

Question 4

What is palliative surgery? What is an example?

Answer 4

Relives a symptom but may not be a cure.

Cancer or tumor

Question 5

Risks related to elderly: what is DECREASED in elderly?

1.
2.
3.

Answer 5

Cardiac output
Periphery
Circulation

Question 6

Risks related to elderly: what is INCREASED in the elderly?

1.
2.
3.
4.
5.

Answer 6

Blood pressure
Skin damage
Infection
Sensory deficits
Deformities

Question 7

What is MIS (minimally invasive & robotic surgery) preferred for?

1-7

Answer 7

Cholecystectomy (gallbladder)
Joint surgery
Cardiac surgery
Spinal surgery
GYN surgery
Urology surgery 
Splenectomy

Question 8

What is one advantage to cancer patients using MIS?

Answer 8

They will know if they are cancer free 1 month after surgery vs. 2 years of radiation with other measures.

Question 9

What are the 4 types of anesthesia?

Answer 9

General
Regional
Local
Moderate sedation

Question 10

What is general anesthesia?

Answer 10

Reversible loss of consciousness induced by inhibiting neuronal impulses in areas of the CNS.

Question 11

How can general anesthesia be administered?

Answer 11

Inhalation
IV injection
Balanced

Question 12

What is regional anesthesia?

Answer 12

Blocks multiple peripheral nerves in specific to body region.

Field, nerve, spinal and epidural.

Question 13

What reverses local or regional anesthesia?

Answer 13

Lipids

Question 14

What are the side effects that occur when a local or regional anesthetic gets into the blood stream?

Answer 14

Ringing of ears
Metallic taste in mouth
Seizures

Question 15

What is moderate sedation anesthesia?

Answer 15

IV delivery of a sedative, hypnotic or opioid drug used to reduce the level of consciousness.

Allows patient to maintain airway and can respond to verbal commands.

Short action.

Question 16

Who is responsible of maintaining airway in surgery?

Answer 16

Circulating nurse assists anesthesia provider.

Question 17

What are common surgical positions?

6 positions

Answer 17

Supine
Lithotomy
Trendelenburg
Lateral
Jackknife
Prone

Question 18

What are interventions to avoid potential injury?

Answer 18

Prevent pressure ulcer formation-
Proper body position.
Prevent obstruction of circulation, respiration and nerve conduction.

Question 19

What are the 3 phases of Post-Op?

Answer 19

Phase I: intensive, close monitoring
Phase II: less intensive monitoring (usually discharged from here)
Phase III: extended observation

Question 20

What members on the surgical team are STERILE?

Answer 20

Surgeon
Surgical assistants 
Scrub nurse
Surgical technologist 
OR tech

Question 21

What members on the surgical team are NON-STERILE?

Answer 21

Anesthesia provider
Circulating RN
Unlicensed assistive personnel
OR director/coordinator/manager

Question 22

What is included in the Pre-Op assessment?

Answer 22

Patient knowledge of surgery, complications and interventions.

Validate and confirm consent was obtained.

Patient’s level of anxiety to manage pre-op and post-op concerns.

Question 23

What are the goals of anesthesia?

Answer 23

Amnesia
Analgesia
Depression of reflexes
Muscle relaxation 
Manipulation of physiological systems and functions.

Question 24

What are high-risk surgery risks?

Answer 24

Long procedures
Vascular surgery
Demineralizing bone conditions (malignant metastasis or osteoporosis)
Excessive sustained pressure on the body

Question 25

Who is at high-risk for positioning complications?

Answer 25

``` Geriatric Pediatric Skinny Obese Paralyzed Diabetic Prosthetic/arthritic joints Edema/circulatory limitations Infections Trauma ```

Question 26

What are some examples of positioning devices?

Answer 26

``` OR bed Headrest Arm boards Arm restraints Padding bony prominences Blankets Pillows Safety straps Sand bags Bean bags Towels and sheets Foam pads Gel-devices ```

Question 27

Post-anesthesia care is provided in what settings?

Answer 27

Inpatient PACU Outpatient PACU ICU Procedure areas

Question 28

What are the priority assessments during Post-Op?

Answer 28

Vital signs Pain level/comfort level Neurological function Temp & color of skin Condition of dressings & visible incisions Presence and patency of IV caths & drains Hydration status & fluid therapy

Question 29

What does Post-Op handoff include?

Answer 29

``` 2 identifiers Procedure Name & contact info Fluid intake & estimated blood loss Placement of IV & drains Important home meds Meds administered & to be administered Any clinical issues (actual or potential) Plan of care ```

Question 30

What is malignant hyperthermia (MH)?

Answer 30

A genetic, hyper-metabolic state that causes sustained muscular contractions (increase in intracellular calcium). Most common sign is skeletal muscle rigidity, unexplained tachycardia and myoglobinuria (amber to brown urine)

Question 31

How do you treat malignant hyperthermia (MH)?

Answer 31

Administer DANTROLENE and cool the patient.