Peri-Op Lecture 1 Flashcards
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
__________ is also used as an adhesive in surgery to help close wounds. This is a form of a wound approximation nursing intervention.
Suture Glue
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
Name the three distinct phases of Perioperative Nursing?
Preoperative-before surgery
Intraoperative-during surgery
Post-operative-after surgery
Causes analgesia, amnesia, relaxation, and results in a sleep like state
What type of anesthesia has this pathology?
General Anesthesia
___________ 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
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
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
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
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
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
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]
Transport by operating Room RN to Post Anesthesia Care Unit (PACU) _______days after surgery is complete.
30 days
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.
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
This type of anesthesia has the risk for death, MI, CVA (stroke), and malignant hyperthermia.
General Anesthesia
- 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)
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
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
Discharge planning for a surgical patient begins during the__________ phase and continues throughout the following 2 phases.
Pre-Operative Care
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
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
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
Patients should be urged to cease smoking __________ prior to surgery.
4-6 weeks
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.
