1. Assess for ABC’s - Why? 2. Assess for hypoxia – Why? 3. Assess respirations - Why? 4. Observe for return of gag reflex - Why? These are interventions are implemented during what phase of peri-operative care?

1. priority Airway Breathing Circulation 2. O2 sat and remember to look at the patient color? dyspnea? 3. Loud, irregular may indicate obstruction R/T secretions, emesis, bad positioning which can allow the tongue to fall to the back of the throat blocking the airway > Nurse will insert an artificial airway to pevent tongue from the back of the throat. 4. so that they can safely eat without worry of aspiration Post-Operative Care on the Post Anesthesia Care Unit (PACU)

Peri-Op Lecture 1 Flashcards by Delia Archer

The patient will be somnolent and nurse needs to make sure the patient doesnt have difficulty waking when using this type of anesthesia.

General Anesthesia

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__________ is also used as an adhesive in surgery to help close wounds. This is a form of a wound approximation nursing intervention.

Suture Glue

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Wears: sterile gown, mask, headgear, eye protection, gloves, shoe covers and can be an RN but most of the time they are not an RN
What member of staff has this role during surgery?

Scrub Person

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Name the three distinct phases of Perioperative Nursing?

Preoperative-before surgery
Intraoperative-during surgery
Post-operative-after surgery

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Causes analgesia, amnesia, relaxation, and results in a sleep like state
What type of anesthesia has this pathology?

General Anesthesia

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___________ can begin before they enter the hospital it can take place over the phone and prior to their arrival to the hospital or surgery center.

Pre-Operative Care

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Dark and Light colors can vary depending on whether they are absorbable or non-absorbable.
What form of wound approximation intervention does this describe?

Sutures

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Type of regional anesthesia but in a much smaller area
Ex. suturing a finger or at the dentist you get lidocaine
What type of anesthesia has these indications?

Local Anesthesia

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Report: Type and extent of surgical procedure and how long the surgery lasted
Type of anesthesia used during surgery
Dosages and times medications given during surgery and in PACU
Excessive Blood Loss
I/O on both OR and PACU – TOTAL amount of fluid given in and out
What fluids?
Any complications that occured during surgery
Discharge plans: Is the patient going to a SNF home, recovery/rehabilitation center, or their home
This type of report is given between what two nursing units for a surgical patient?

Report from the nurse on the PACU to nurse on the Medical - Surgical Unit during a patient transfer.

Fluids: NG Drainage, Blood, Urine, and other fluids measurements are combined from both OR and PACU

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Manages patient care in the Operating Room
Protects safety/health needs are met
Ensures patient’s rights are protected
What member of nursing staff has this role during surgery?

Circulating Nurse

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Reduce tissue trauma they don’t pierce through as much tissue or as deep as needle would they use a gun.
What form of wound approximation intervention does this describe?

Skin Staples

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When you give a patient an IV before surgery what gauge do you use? & why?

18 gauge preferred for fluids given at a rapid rate or blood products.
[Patient Preparation for Pre-Operative Care]

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Transport by operating Room RN to Post Anesthesia Care Unit (PACU) _______days after surgery is complete.

30 days

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When you inspect dressings for drainage and bleeding during the Post Anesthesia Care Unit (PACU) phase what should be the priority?

Check UNDER patient for bleeding
Move the gown and the blankets to observe for bleeding.
DO NOT JUST LOOK AT THE DRESSING.
Patient could bleed to death while the dressing is dry.

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Placing the patient in a position of comfort during surgery depends on:
Surgical site
Access to airway
Safety
Comfort to avoid unnecessary pain post-op
What member of nursing staff has this role during surgery?

Circulating Nurse

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This type of anesthesia has the risk for death, MI, CVA (stroke), and malignant hyperthermia.

General Anesthesia

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Assess for ABC’s - Why?
Assess for hypoxia – Why?
Assess respirations - Why?
Observe for return of gag reflex - Why?
These are interventions are implemented during what phase of peri-operative care?

priority Airway Breathing Circulation
O2 sat and remember to look at the patient color? dyspnea?
Loud, irregular may indicate obstruction R/T secretions, emesis, bad positioning which can allow the tongue to fall to the back of the throat blocking the airway > Nurse will insert an artificial airway to pevent tongue from the back of the throat.
so that they can safely eat without worry of aspiration

Post-Operative Care on the Post Anesthesia Care Unit (PACU)

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History and Physical Exam
Proposed surgery (Why are you here?) – What surgery are you going to have?
History of previous surgeries
Co-morbidities- what illnesses do you currently have, chronic diseases, acute illnesses they currently have
These are interventions are implemented during what phase of peri-operative care?

Pre-Operative Care

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To sign a consent form the patient must have the ___________ to sign
If not capable or minor child parent, legal guardian, spouse, etc may sign.

legal competence

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Discharge planning for a surgical patient begins during the__________ phase and continues throughout the following 2 phases.

Pre-Operative Care

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This is absolutely NECESSARY to have prior to surgery/procedure. The nurse needs to verify that this has been signed before any drugs are administered so the patient is in a clear state of mind.

Informed Consent

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When educating a patient include family/significant others when possible; more ears that hear the instructions the more the patient will follow instructions and the nurse must remember that both ________ and __________ instructions must be given to the patient to reinforce the teaching.

Written and Verbal

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Education on post-op care:
Educate the patient on Turning, coughing, deep breathing (TCDB) and the proper way to use an incentive spirometer(IS)
Educate the patient on the importance of early ambulation. Why?
This patient teaching is implemented during what phase of peri-operative care?

Pre-Operative Care Teaching

The importance of moving, early and frequent; leg exercises

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Patients should be urged to cease smoking __________ prior to surgery.

4-6 weeks

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How are Pre-Op medications administered in Patient Preparation for Pre-Operative Care?

Antibiotics are given at a time so when the physician opens up the patient the antibiotics are at their peak effect while the knife cuts that area, the antibiotic is at its peak to decrease the risk for infection after surgery Given atropine before the surgery Given relaxation meds before the surgery

Teach turning coughing and deep breathing exercises and use of _____________ before surgery so that the patient will have experience with it when they come out of surgery it won't be difficult to use.

Incentive Spirometer

Educate the patient on post-op care: Moving in bed as tolerated Application of anti-embolic hose and SCDs (sequential compression devices) This patient teaching is implemented during what phase of peri-operative care?

Pre-Operative Care Teaching

The________ is legally responsible for giving information to the patient and determining patient competence to legally sign the consent.

Surgeon

The ________ is legally responsible for verifying the informed consent form is signed and verifying that the signing of the informed consent is witnessed.

RN Study Tip:The nurse as the witness just need to verify that the correct person signed the form. RN

The nurse verify that information was presented to, and understood by, patient. We as nurses do not need to be present during the explanation, but we should ask the patient questions to verify that they understand and want the procedure This is an example of what nursing role?

Patient Advocate

This anesthesia affects only the selected body areas and parts This anesthesia is given spinally so it only affects from insertion site and below with pain relief Commonly used for lower extremities and other localized sites Ex. This anesthesia is used for transurethral resection and prostate removal What type of anesthesia has these indications?

Regional Anesthesia

General orientation to the room and the nurse Education to prevent post-op complications This patient teaching is implemented during what phase of peri-operative care?

Pre-Operative Care Teaching

Nurse should document: Name of Patient Name & Qualifications of surgeon (Ex. Dr. Jones MD) Name & Description of proposed surgery or procedure (Ex. Correct Spelling) Risks of the surgery, benefits from the surgery, and the probability of success Why the surgery is needed (Indications) Consequences of nonsurgical treatment Any limits on confidentiality These are examples of what intervention in peri-op care?

What does a nurse have to fill in on an informed consent form. Informed Consent

While signing an informed consent form the patient has the right to: Ask any questions Withdraw consent at any point prior to surgery (Patient does not have to have surgery.) These are interventions are implemented during what phase of peri-operative care?

Pre-Operative Care

In an emergency situation such as a life threatening accident __________ may sign the informed consent form.

Two Physicians

What are three common examples of limits on confidentiality and what does it mean?

Forms or information that the patient will need to sign to show they are aware of breeches in confidentiality. Consent for photos to be taken for the patients use Consent to students may be in the room to watch the surgery Consent for disposal of body parts. Study Tip: The patient can refuse any body parts disposed of after an amputation. Patient wanted to be buried with that leg after death for fear of spending eternity without a leg.

Arizona has a ____________ which is available that states who is allowed to sign an informed consent form. During an emergency; 2 physicians can sign if it is life threatening and no one is available to sign the consent.

Chain of Surrogacy Law

Make sure NO _________ are given to the patient that can inhibit the patient’s ability to make an informed decision the surgery must be postponed until the patient has signed consent.

medications

What is the appropriate time to get informed consent from a patient with ATC pain medications?

Wait until the pain medication is about to be due again before getting informed consent signature from the patient.

ASK ARBOGAST? What if the patient hasn’t signed the consent and they dont understand or remember talking to the Dr. about it and they are going to surgery quickly? What do we do?

1. If patient does NOT want to sign the notify the physician. 2. Find out reason why the patient does not want the surgery?

NPO Patients – clarify what should be given or not with the Anesthesiologist; Meds that need to be paid close attention to ________ and ________; find out if an medication has to be held prior to surgery. These are interventions are implemented during what phase of peri-operative care?

antihypertensive or antidiabetics | Patient Preparation for Pre-Operative Care

Anesthesiologist makes decisions about pre op meds being given and held before the surgery. When people are under stress their _________ levels will go up so diabetic patients need to have their insulin adjusted.

Blood Glucose | Study Tip: Investigate further if there is no order written.

NG Tube insertion by nurse if ordered. Skin preparation: shaving/hair clipping/scrub to an area These are interventions are implemented during what phase of peri-operative care?

Patient Preparation for Pre-Operative Care

This is part of legal record prior to surgery. It needs to be placed in the patient’s chart immediately following the signing which will also be verified by the surgical team to complete the pre-op checklist.

Informed Consent

How is bowel preparation implemented in Patient Preparation for Pre-Operative Care?

Cathartics or enemas for patients for bowel surgery. Antibiotics given IV and PO to sterilize the bowels so that during a bowel resection the bacteria in the bowels will not escape into the bowel cavity and cause infection later on.

In order for a patient to be discharged from the PACU to the Med-Surg Unit they must meet what criteria?

Patient should have: Stable VS, including temperature Absence or control of any anesthetic or surgical complications Patent airway Control of bleeding and drainage Full or almost full recovery from anesthetic Orientation to environment > ability to request help due to decreased lower level of attention when compared to the PACU Adequate fluid balance 30 mL urinary output to show that the kidneys are working

Blocks nerve pathways resulting in decreased sensation/pain in selected body parts and areas What type of anesthesia has this pathology?

Regional Anesthesia

If visually impaired leave _________ on as long as possible they may want them until they are sent down to OR and put to sleep and in post op until they go under anesthesia.

Glasses

__________ will also be on the checklist with glasses and jewelry. Know your anesthesiologist and their preferences because some like to leave them in during the surgery.

Denture removal

Pain relief and pain prevention without unconsciousness; we can communicate with patient IV sedation, pain relief without unconsciousness Patient able to talk, cooperate May have amnesiac affect What type of anesthesia has these indications?

Conscious Sedation

Risks of anesthesia complications is increased in _________ patients.

Geriatric Anesthetic agents take longer to wear off due to their higher concentration of body fat so their recovery time and the amount of time it takes for the anesthetic to be removed from the body will increase recovery time.

A surgeon may have their own specific _________. This person is the surgeon's personal assistant can be an RN or a Tech. They work closely together and they can usually predict what the surgeon will want or need for a particular surgery which creates synchronicity and makes the surgery run smoother.

Scrub Person

Superficial peripheral nerves depressed, blocking pain conduction just in that specific area What type of anesthesia has this pathology?

Local Anesthesia

What intervention means that the: Physician presented necessary information to the patient Patient understands information and wasn’t forced into signing

Informed Consent

Note cards may be kept at each nurses station that wil tell you what instruments each surgeon wants for each procedure. This person prepares sterile tables prior to surgery. What member of nursing staff has this role during surgery?

Scrub Person

Frequent minor complaints: Sore throat because of the EndoTracheal tube placement Nausea Vomiting Headache Confusion related to the anesthesia Shivering What type of anesthesia has these indications?

General Anesthesia

1. Mobility issues – Assess mobility before surgery during surgery, and after surgery. care is based on what they can physically do prior to surgery 2. Assess for allergies to medications, foods, and latex PRIOR to any admnistering interventions/medications; need to get non-latex equipment if necessary These are interventions are implemented during what phase of peri-operative care?

Pre-Operative Care

____________ Increases oxygen consumption and increases metabolic rate during surgery this is NOT considered a minor complaint.

Shivering

Not every patient is healthy enough to be capable of lying on their back for hours Be mindful of old injuries/ physical limitations/physical deformities What member of staff has this role during surgery?

Circulating Nurse

CAN BE A MAJOR ISSUE Too much of this complication can lead to MI They are now using warming blankets post-op for forced warming to minimize this surgical complication.

Shivering due to increased risk for MI

Prevention of complications: | Educate patients that they are NPO 8 hours pre-op to prevent __________ which is a HIGH RISK during surgery.

aspiration pneumonia

Provide Emotional Support Elicit cooperation while the patient is awake Educate with appropriate information/explanations What member of nursing staff has this role during surgery?

Circulating Nurse

What are four safety checks that are necessary during a surgery? & why is each check necessary?

Equipment safety-make sure it’s functioning correctly Malfunction on monitoing equipment Electrical safety-patient needs to be grounded to avoid electrical shock Chemical safety-Chemicals are used for their specific purpose Radiation safety-only expose the area of the body that we want exposed to the radiation Positioning

__________ may ONLY be administered by anesthesiologist or Certified Registered Nurse Anesthetist (CRNA).

Anesthesia

IV sedation without unconsciousness, patient is easily arousable What type of anesthesia has this pathology?

Conscious sedation

Advantages: pain & anxiety controlled with a rapid recovery time Not practical for highly anxious patients What type of anesthesia has these indications?

Conscious Sedation

This medication is given if there is too much sedation from the Versed. What is the antidote to Midazolam / Versed?

Flumazenil / Romazicon

Material used to sew incision together once the surgery is finished. What form of wound approximation intervention does this describe?

Sutures

Client may be awake so be mindful of your conversations around the patient This type of anesthesia can be used to control post-operative pain What type of anesthesia has these indications?

Regional Anesthesia

Advantage: Quicker to apply Usually removed 7-10 days post op with a mechanical hand held remover; apply steri strips for support to the tissue after removal. What form of wound approximation intervention does this describe?

Skin Staples

Circulating nurse, anesthetist, and surgeon transport patient to PACU with what 3 priorities?

1. Patent Airway maintenance 2. Documentation completed and given to nurses in recovery room 3. Notification of PACU nurses of patient’s impending arrival; pre-notify the nurses in the PACU that the patient is coming.

Advantages (over general anesthesia): Minimizes pulmonary/GI complications Quicker recovery time with this type of anesthesia What type of anesthesia has these indications?

Regional Anesthesia

Teaching for a surgical patient begins during the __________ phase and continues throughout all phases of the process.

Pre-Operative Care

____________ often used as a medication for concious sedation.

Midazolam / Versed

Educate the patient on Preoperative preparation: what to bring, when they will be NPO, what meds to take or not to take, and showering info Education on Post-op care: what they will be doing once they go home This patient teaching is implemented during what phase of peri-operative care?

Pre-Operative Care Teaching

Can be Given IV or inhalation Disadvantages: Requires mechanical ventilation What type of anesthesia has this indication?

General Anesthesia

What is the difference between absorbable and non absorbable sutures?

Absorbable- they absorb in the skin and tissues; usually used internally; will not need to be removed Non-absorbable- will need to be removed

What information is given in report from nurse on the OR to nurse on the PACU after the surgery is successfully completed?

Type and extent of surgical procedure so the nurse will know what to expect when assessing the patient Type of anesthesia used - so the nurse will know what was used and will know what to expect when they assess the patient Dosages/times of medications given Estimated blood loss (EBL) Respiratory status Any complications that occured during surgery? Discharge plans Study Tip: the nurse will see this physical assessment with the usage of these anesthesias general anesthesia : somnolence and nurse needs to make sure the patient doesnt have difficulty waking regional anesthesia: awake and nurse assess for return of sensation Respiratory status is the patient still intubated? Discharge plans-Where is the patient ging after they leave PACU Are they going home or will they be admitted to the hospital in med-surg?

In order for a patient to be discharged from the Ambulatory Care Surgical Center they must meet what criteria?

Patient should: Void Ambulate Be alert and oriented Have minimal Nausea and Vomiting Require no pain meds in last hour and may have started their PO pain medicine Have no excess drainage or bleeding Have received discharge teaching/written and verbal instructions Have a responsible person to accompany home and to be with them when they are at home. Receive a follow-up phone call from the nurse either that day or the next day

In order for a patient to be transfer from PACU to the Medical Surgical Unit they must meet what criteria? What information is given in report from the nurse on the PACU to nurse on the Medical - Surgical Unit during a patient transfer? Report to the nurse should include: Type and extent of surgical procedure and how long the surgery lasted Type of anesthesia used during surgery Dosages and times medications given during surgery and in PACU Excessive Blood Loss I/O on both OR and PACU – TOTAL amount of fluid given in and out Ex. NG Drainage, Blood, Urine ect and other fluids measurements are combined from both OR and PACU Any complications that occured during surgery Discharge plans: Is the patient going to a SNF home, recovery/rehabilitation center, or their home

Accompanied by PACU RN from PACU to Med-Surg Floor

Provide Comfort Provide emotional support for family/significant others and provide the family with information during the surgery What member of nursing staff has this role during surgery?

Circulating Nurse

``` Laboratory and Diagnostic Tests: Blood studies - What labs? PT INR - Why? UA- Why? EKG - Why? CXR -Why? Type and cross- Why? These are interventions are implemented during what phase of peri-operative care? ```

Blood studies - CBC, electrolytes, coagulation PT INR - Monitor for bleeding time. UA- Used to verify that there is no infections EKG -Monitor for MI after surgery CXR - Monitor for aspiration pneumonia Type and cross- Match blood in case it is needed and without delay Pre-Operative Care

What intervention protects the: Patients from having surgery they don’t want or understand Healthcare workers from future claims that patient didn’t consent to procedure

Informed Consent

Provides surgeon with: instruments, drains, sponges, sutures. Anticipates needs of surgeon by providing sterile table and sterile instruments that the surgeon wants for each procedure because it can vary. What member of nursing staff has this role during surgery?

Scrub Person

Coordinates care of the patient Responsible for counting all instruments and sponges at close of surgery Documents everything that happens during the procedure including any medications given and any complications What member of nursing staff has this role during surgery?

Circulating Nurse

Respiratory/cardiac status Smoking history Height/weight - prefereable to weigh when they come in Vital signs These are interventions are implemented during what phase of peri-operative care?

Pre-Operative Care

Educate the patient on where, when, what time, who they need to talk to prior to surgery Education the patient on what they will experience before/during/after the surgery This patient teaching is implemented during what phase of peri-operative care?

Pre-Operative Care Teaching

No smaller than a ______ gauge IV catheter for surgical patients.

Placing the patient in a position of comfort during surgery depends on: Ability to monitor vital signs BP cuff needed during surgery to monitor unless they have an invasive blood pressure monitor. Patient positioning needs to leave a free arm available. What member of nursing staff has this role during surgery?

Circulating Nurse

Usually local anesthesia administered by the surgeon RN monitors patient’s response to the local anesthesia What type of anesthesia has these indications?

Local Anesthesia

Patient will be awake and the nurse will assess for return of sensation when using this type of anesthesia.

Regional Anesthesia

Circulation: EKG monitoring - Why? Monitor BP and Pulse - Why? Skin: Cool, clammy skin, and cyanosis Why? Inspect dressings for drainage and bleeding. These are interventions are implemented during what phase of peri-operative care?

EKG monitoring - Monitor for MI after surgery. Monitor BP and Pulse - Decreasing pulse and increasing BP could be caused by hemmorhage Cool, clammy skin, and cyanosis could indicate impaired tissue perfusion or shock Post-Operative Care