Peri Op Flashcards
Preoperative phase:
- Begins when pt is scheduled for surgery
- Ends when pt is transferred to surgical suite
Intraoperative phase:
Period of time from when patient is transferred into operating room to admission to postanesthesia care unit (PACU)
Postoperative phase:
Period of time from when patient is admitted to PACU to follow-up evaluation in clinical setting or at home
What are the three main categories of Surgical Procedures?
Elective
Urgent
Emergent
Diagnostic surgery:
To determine origin and cause of a disorder and or the cell type for cancer
Ex: breast biopsy, exploratory laparotomy, arthroscopy
Curative surgery:
To resolve a health problem by repairing or removing the cause
Ex: Cholecystectomy, appendectomy, hysterectomy
Transplant surgery:
To replace malfunctioning structures
Ex: Kidney transplant, heart transplant, liver transplant
Restorative surgery:
To improve a patient’s functional ability
-Ex: Total knee replacement, finger re-implantation
Palliative surgery:
To relieve sxs of a disease process but does not cure
Ex: Colostomy, nerve root resection, tumor debulking ileostomy
Cosmetic surgery:
Performed primarily to alter or enhance personal appearance
Ex: Liposuction, revision of scars, rhinoplasty, blepharoplasty
Elective surgery:
Planned for correction of non-acute problem
Urgent surgery:
Requires prompt intervention; may be life threatening if treatment is delayed more than 24-48 hours
Minimally invasive surgery:
Performed in a body cavity or body area through one or more endoscopes
Radical surgery:
Extensive surgery beyond the area obviously involved; is directed at finding a root cause
Emergency surgery:
Requires immediate intervention because of life-threatening consequences
What are the seven selected factors that increase the risk of surgical complications?
- Age
- Medications
- Medical history
- Prior surgical experiences
- Health history
- Family history
- Type of surgical procedure planned
What types of medications may be given with sips of water on the day of surgery to prevent complications?
Drugs for cardiac disease, respiratory disease, seizures, and HTN are commonly allowed with a sip of water before surgery.
What is the responsibility of the Scrub Nurse?
- Provides patient care at the surgical field
- Assists surgeon and assistants
- Maintains integrity, safety, and efficiency of sterile field during the procedure
What is the responsibility of the Circulating Nurse?
- Uses decision -making skills to develop a plan of care
- Coordinates care delivery to patient’s and their family members
- Coordinates, oversees and implements nursing care interventions to support the patient during the surgical procedure
Define moderate sedation (conscious sedation):
- IV delivery of sedative, hypnotic, and opioid drugs to reduce sensory perception but allow the patient to maintain a patent airway.
- Amnesia action is short, and the pt has rapid return to normal function and activities.
Moderate sedation is used to reduce the level of consciousness during:
Minor surgical procedures, endoscopy, cardiac catheterization, closed fracture reduction, and cardioversion.
Define “autologous donation” – what is its advantages, restrictions?
-Patient donates ones own blood for scheduled surgery a few weeks before the scheduled surgery date
- Advantages:
o Eliminates transfusion reactions and reduces risk for acquiring bloodborne disease
o Patient receives his or her own blood instead of donor blood, so there is no risk of contracting outside diseases
o Blood is recirculated, there is no limit to the amount of blood that can be given back to the patient
o Cell salvage is cost effective and safe option for autologous transfusion.
o Cell salvage is viable alternative for patients with religious objections to receiving blood transfusion
- Restrictions:
o Some techniques used limit blood sample available
o Specific patient criteria must be met to qualify for autologous transfusion
What is Malignant Hyperthermia (MH)?
Inherited muscle disorder that causes a fast rise in body temp and severe muscle contractions when under general anesthesia
Early sxs of malignant hyperthermia:
o Tachycardia
o Low O2 saturation
o Unexpected rise in the end-tidal carbon dioxide level with a decrease in O2 sat and tachycardia.
Late sxs of malignant hyperthermia:
Extremely elevated temperature
Tx for malignant hyperthermia:
Dantrolene sodium (muscle relaxant)
Dedicated MH cart containing drugs for management (normal saline, dantrolene sodium bicarbonate, insulin, 50% dextrose, lidocaine, calcium chloride)
List factors that may lead to anesthetic overdose in a patient?
- Patient’s metabolism and drug elimination are slower than expected especially
in older patients or patients with liver or kidney problems - Drugs can alter metabolism and interactions can occur between the anesthetic and the patient’s regular drugs.
o Eg. Anti-hypertensives, diuretics. and herbal supplements - Note: Accurate information about the patient’s height, weight, and decimal history, especially liver and kidney function is vital in determining the anesthetic type and dosage
Define “wrist drop” and the intervention to prevent it?
- Wrist and the fingers cannot extend at the metacarpophalangeal joints.
- The wrist remains partially flexed due to an opposing action of flexor muscles of the forearm.
How to prevent wrist drop?
o Support the wrist with padding
o Be careful not to over tighten wrist straps
When does the post-operative period begin?
With the completion of surgery and transfer to PACI, ICU, or ambulatory care
What is the most accurate indication that peristaltic activity has returned in the post-op patient?
- Passage of flatus or stool
- Presence of active bowel sounds
