Peri Op

Question 1

Preoperative phase:

Answer 1

• Begins when pt is scheduled for surgery

- Ends when pt is transferred to surgical suite

Question 2

Intraoperative phase:

Answer 2

Period of time from when patient is transferred into operating room to admission to postanesthesia care unit (PACU)

Question 3

Postoperative phase:

Answer 3

Period of time from when patient is admitted to PACU to follow-up evaluation in clinical setting or at home

Question 4

What are the three main categories of Surgical Procedures?

Answer 4

Elective
Urgent
Emergent

Question 5

Diagnostic surgery:

Answer 5

To determine origin and cause of a disorder and or the cell type for cancer

Ex: breast biopsy, exploratory laparotomy, arthroscopy

Question 6

Curative surgery:

Answer 6

To resolve a health problem by repairing or removing the cause

Ex: Cholecystectomy, appendectomy, hysterectomy

Question 7

Transplant surgery:

Answer 7

To replace malfunctioning structures

Ex: Kidney transplant, heart transplant, liver transplant

Question 8

Restorative surgery:

Answer 8

To improve a patient’s functional ability

-Ex: Total knee replacement, finger re-implantation

Question 9

Palliative surgery:

Answer 9

To relieve sxs of a disease process but does not cure

Ex: Colostomy, nerve root resection, tumor debulking ileostomy

Question 10

Cosmetic surgery:

Answer 10

Performed primarily to alter or enhance personal appearance

Ex: Liposuction, revision of scars, rhinoplasty, blepharoplasty

Question 11

Elective surgery:

Answer 11

Planned for correction of non-acute problem

Question 12

Urgent surgery:

Answer 12

Requires prompt intervention; may be life threatening if treatment is delayed more than 24-48 hours

Question 13

Minimally invasive surgery:

Answer 13

Performed in a body cavity or body area through one or more endoscopes

Question 14

Radical surgery:

Answer 14

Extensive surgery beyond the area obviously involved; is directed at finding a root cause

Question 15

Emergency surgery:

Answer 15

Requires immediate intervention because of life-threatening consequences

Question 16

What are the seven selected factors that increase the risk of surgical complications?

Answer 16

• Age
• Medications
• Medical history
• Prior surgical experiences
• Health history
• Family history
• Type of surgical procedure planned

Question 17

What types of medications may be given with sips of water on the day of surgery to prevent complications?

Answer 17

Drugs for cardiac disease, respiratory disease, seizures, and HTN are commonly allowed with a sip of water before surgery.

Question 18

What is the responsibility of the Scrub Nurse?

Answer 18

• Provides patient care at the surgical field
• Assists surgeon and assistants
• Maintains integrity, safety, and efficiency of sterile field during the procedure

Question 19

What is the responsibility of the Circulating Nurse?

Answer 19

• 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

Question 20

Define moderate sedation (conscious sedation):

Answer 20

• 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.

Question 21

Moderate sedation is used to reduce the level of consciousness during:

Answer 21

Minor surgical procedures, endoscopy, cardiac catheterization, closed fracture reduction, and cardioversion.

Question 22

Define “autologous donation” – what is its advantages, restrictions?

Answer 22

-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

Question 23

What is Malignant Hyperthermia (MH)?

Answer 23

Inherited muscle disorder that causes a fast rise in body temp and severe muscle contractions when under general anesthesia

Question 24

Early sxs of malignant hyperthermia:

Answer 24

o Tachycardia
o Low O2 saturation
o Unexpected rise in the end-tidal carbon dioxide level with a decrease in O2 sat and tachycardia.

Question 25

Late sxs of malignant hyperthermia:

Answer 25

Extremely elevated temperature

Question 26

Tx for malignant hyperthermia:

Answer 26

Dantrolene sodium (muscle relaxant)

Dedicated MH cart containing drugs for management (normal saline, dantrolene sodium bicarbonate, insulin, 50% dextrose, lidocaine, calcium chloride)

Question 27

List factors that may lead to anesthetic overdose in a patient?

Answer 27

• 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

Question 28

Define “wrist drop” and the intervention to prevent it?

Answer 28

• 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.

Question 29

How to prevent wrist drop?

Answer 29

o Support the wrist with padding

o Be careful not to over tighten wrist straps

Question 30

When does the post-operative period begin?

Answer 30

With the completion of surgery and transfer to PACI, ICU, or ambulatory care

Question 31

What is the most accurate indication that peristaltic activity has returned in the post-op patient?

Answer 31

• Passage of flatus or stool

- Presence of active bowel sounds