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Block 2 Week 6 Peri-Operative > Peri-Op Lecture 2 > Flashcards

Peri-Op Lecture 2 Flashcards

0
Q

In order for a patient to be transferred from PACU to Medical - Surgical Unit they must be accompanied by a _________?

A

Accompanied by a PACU RN

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1
Q

Why does hyperglycemia occur in diabetic patients during surgery?

A

High blood sugar may occur R/T increased stress from anticipation of surgery and illness. Stress stimulates the SNS which causes the fight or flight response to release the stress hormone Cortisol which increases blood glucose to be used for energy by the body. Increased levels of stress hormones cause blood glucose to go up.

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2
Q

Education on changes in appetite and diet
Prescribed diet and activity (Nutrition and Rationale)
Educate on S/sx of complications requiring follow up
S/sx of infection and when to call the Dr.
F/U appointments
Lifestyle changes (Educate to prevent complications)
Community resources (Educate)
Provided education and instruction in writing as well as verbally
These are interventions are implemented during what phase of peri-operative care?

A

Post-Operative Care

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3
Q

__________ just a checksheet not part of the permanent record.

A

Surgical Checklist

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4
Q

___________ is timed to be given so that the maximum amount of medication peaks at the moment the incision is made.

A

Antibiotic

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5
Q

Dressing changes
Exercises
Activity
These are interventions that are implemented during what phase of peri-operative care?

A

Post -Operative Care

Study Tip: These are a priority. Educate patient about activity restrictions if any and include rationale send supplies home for dressing changes.

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6
Q 
Report:
PEG Tube Insertion that lasted 3 hours 
General Anesthesia
IVF 2500 mL given at @0700
No excessive blood loss occurred
Total Input: 3400 mL Total Output: 3300 mL
No complications occurred during surgery
What is wrong with this report?
A

No information was given related to discharge planning for this patient.

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7
Q

Hypoglycemia may develop during anesthesia the blood sugar of the patient is monitored by the __________ during the surgical procedure.

A

Anesthetist

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8
Q

What is the pharmacological and genetic cause of Malignant Hyperthermia in a patient?

A

Caused by Succinyl Choline which is found in the anesthetic this causes malignant hyperthermia for some patients.
The surgeon will use a different type of anesthetic if this patient has a history of reactions with this type of anesthetic.

Caused by an autosomal dominant trait

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9
Q

What are three possible Respiratory complications after surgery?

A

Aspiration pneumonia
Atelectasis
Pulmonary embolism

Study Tip: Atelectasis could be the cause of a fever 24 hours after surgery is completed. Bacteremia is the cause of fever during and up to 24 hours after surgery.

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10
Q

Monitor blood sugar levels.
Diabetic patients at risk for hypoglycemia and hyperglycemia

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Endocrine

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11
Q

Patient should have:
Stable VS, including temperature b/c not watched as closely - Q15mins
Absence or control of any anesthetic/surgical complications - Nurse will monitor VS
Patent airway - Independent tongue movement and gag reflex A/O x5 alert enough to cough and turn their head to prevent aspiration
Control of bleeding/drainage - drainage amount is within normal limits
Full or almost full recovery from anesthetic - sleepy but not difficult to arouse
Orientation to environment, ability to request help - patient can press call light
Adequate fluid balance and 30ml/hr urinary output -monitor I/Os

In order for a patient to be discharged from the they must meet this criteria?

A

PACU to Surgical Unit

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12
Q

Report:
Cesarean Section with a C-Section Repair that lasted 4 hours
IVF given 1500mL given at @1000
No excessive blood loss occurred
Total Input: 5500 mL Total Output: 5600 mL
No complications occurred during surgery
Patient will be discharged home with family
What is wrong with this report?

A

No information was given regarding the type of anesthesia used

Study Tip: This information is needed so the nurse will know what is expected as far as mental alertness and acuity when this person comes onto the unit.

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13
Q

D/C ______ order after surgery to prevent infection.

A

Foley

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14
Q

What is the treatment for Malignant Hyperthermia? And why is it difficult to administer?

A

Dantrolene sodium / Dantrium
This med is difficult to administer because of complicated directions related to the method of reconstitution required and is very expensive medication; short shelf life most pharmacies dont carry it because it expires quickly.

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15
Q

Early and frequent patient ambulation [Collaborative]
Encourage leg exercise [Collaborative]
Application of TED hose, SCDs [Collaborative]
Hydration / IVF – [Collaborative]
Patient Education is IMPORTANT
-NO CROSSING LEGS
These are interventions that a nurse implements prevents what type of complications after surgery?

A

Respiratory

Study Tip:
Early, frequent patient ambulation-this is evidence based to prevent clotting even in someone who has already had a clot as long as they are anticoagulated
Encourage leg exercises, NO CROSSING LEGS – will create a pressure point deceases venous return and more at risk for clots
TED hose, SCDs (collaborative intervention)
Hydration (use of IV – collaborative intervention)
Patient Education is IMPORTANT

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16
Q

What are three possible genitourinary complications after surgery?

A

Renal failure (most serious)
Urinary retention can lead to renal failure
UTI can lead to renal failure

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17
Q

First Assess:

  1. Dressings for drainage: (turn or slide your hand under the patient and check for bleeding drainage from the dressing; blood can pool under patient and the dressing will appear dry.)
  2. Drains for amount of drainage (drainage should decrease from the initial amount)
  3. If there is internal bleeding there will be increased pain and increased abdominal girth (distension)
  4. Tachycardia and hypotension-together they can represent hemorrhage/hypovolemia (heart has to beat faster to circulate the decreased amount of blood)
  5. Decreased urine output
  6. Thirst and dehydration (assess for dry mucus membranes)

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Fluid Volume

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18
Q

What are five possible gastrointestinal complications after surgery?

A 
Nausea
Vomiting
Distention
Constipation
Paralytic Ileus
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19
Q

Report:
Bowel Resection with biopsy that lasted 10 hours
General Anesthesia
IV blood products 5000 mL given at @1000
Excessive blood loss occurred
Total Input: 6000 mL Total Output: 9000 mL
Patient will be admitted to the hospital on the medical surgical unit.
What is wrong with this report?

A

This report is missing what complication occurred

Study Tip: Investigate what required the patient to need a blood transfusion?

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22
Q

First Assess:

  1. Assess bowel sounds. Complete an abdominal assessment / Look for distension / Listen for bowel sounds / Feel for Distension or Masses.
  2. Ask patient if their abdomen is distended for them sometimes it is difficult to tell from a patients normal size.
  3. Assess for Nausea, Vomiting, Retching (Ex. Dry heaves/No emesis)
  4. Assess for Abdominal Discomfort, Bloating, and Pain

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Gastrointestinal

23
Q

Immunosuppression is commonly caused by what 4 nursing interventions?

A

Corticosteroid therapy (patients that have immune disorders need these meds to suppress the immune system)
Organ transplantation / Anti-Rejection Drugs (suppress the immune system to prevent organ rejection)
Radiation Therapy (Loss of red blood cells in the long bones can cause immunosuppression)
Chemotherapy (wipes out all cells)

24
Q

What are two possible fluid volume complications after surgery?

A

Hemorrhage
Hypovolemia
(Related to cardiac and renal complications)

24
Q 
Report:
Appendectomy that lasted 9 hours 
Regional Anesthesia
No excessive blood loss
Total Input: 5400 mL Total Output: 4900 mL 
Respiratory Distress occurred during the procedure
Patient will be discharged to a SNF
What is wrong with this report?
A

This report is missing what medications were given and when they were given.

25
Q

Maintain NPO [Collaborative]
Advance diet slowly [Collaborative]
Manage pain [Independent and Collaborative]
Encourage mobilization [Collaborative]
Encourage increase of fiber and fluids once eating. [Collaborative]
Patient Education

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Gastrointestinal

Study Tip:
Maintain NPO (collaborative intervention) until their condition verifies that they can eat
Advance diet slowly (collaborative intervention)
No straws or ice chips increases air in the stomach and cause pain
Start with sips/small portions
Manage pain (independent and collaborative intervention ): guided imagery, music, relaxation, distraction, pain meds
Encourage mobilization (collaborative intervention): need an activity order and the nurses judgment; safety first ( use to advance activity as tolerated only take the patient half the distance you want them to walk so that way they can walk back)
Encourage increase of fiber and fluids once eating (collaborative intervention)
Patient Education

25
Q

Maintain patient on bed rest
Head Of Bed elevated at 20 degrees, knees flexed (to remove pressure from the abdomen)
Notify physician
Abdominal binder may be applied to prevent evisceration (collaborative intervention) - order needed
These are interventions for what type of complication after surgery?

A

Dehiscence

26
Q

What are three possible surgical incision complications after surgery?

A

Dehiscence (the edges of the surgical incision separate)
Evisceration (internal organs (intestines) are coming out; this is an emergency)
Wound infection

27
Q

ASK ARBOGAST? Monitor I/O and monitor for s/sx of fluid imbalance [Independent]
Monitor lab values [Collaborative]
Foley Catheter PRN [Collaborative]
Monitoring for s/sx of UTI [Independent]
Aseptic technique for Foley Catheter Insertion [Independent]
Aseptic technique for Peri-Care [Collaborative]
Adequate hydration [Collaborative and Independent] ???
Patient Education
These are interventions that a nurse implements prevents what type of complications after surgery?

A

Genitourinary

Study Tip:
Monitor I/O- (independent intervention) no physician order needed to monitor I/O
Monitor lab values (collaborative intervention) labs must be ordered by the Dr
Foley Catheter prn (collaborative) Dr must order only if necessary
Patient Education
UTI
Monitor for s/sx above
Aseptic technique for cath insertion/peri-care: remember if the pt gets a UTI, Medicare and the insurance will not pay for the treatement unless patient was diagnosis when admitted to the hospital. Do peri-care on foley patients to prevent CAUTI.
Adequate hydration (patient may be on fluid restriction)
Patient Education

28
Q

Frequent monitoring of VS, dressings, and drainage collection device especially immediately after the surgery.
These are interventions that a nurse implements prevents what type of complications after surgery?

A

Fluid Volume

29
Q

Foley if appropriate [Collaborative]
Identify possible causes of VS changes [Independent]
IV’s as ordered [Collaborative]
Encourage oral intake when ordered [Collaborative]
Administer blood/blood products [Collaborative]
Patient Education
These are interventions that a nurse implements prevents what type of complications after surgery?

A

Hypovolemia

Study Tip:
Foley if appropriate (collaborative intervention) – if we want to closely monitor I/O
Identify possible causes of VS changes
IV’s as ordered (collaborative intervention)-if IV goes bad, we do not need to get another order to change it fo a peripheral IV
Encourage oral intake when ordered (collaborative intervention)
Administer blood/blood products (collaborative intervention)
Patient Education

30
Q

Why does hypoglycemia occur in diabetic patients during surgery?

A

Low blood sugar is caused by inadequate intake of CHO pre-op related to NPO dietary restriction or it could be caused by
Excessive insulin administration before surgery to control blood sugar spikes during the surgical procedure.

31
Q

Pallor R/T decreased blood circulation to the skin
Cool, moist skin R/T decreased blood circulation to the skin
Tachypnea (patientswill breathe faster to get more oxygen because of decreased blood volume)
Circumoral cyanosis-defined as cyanosis around the mouth; never a good sign
Rapid, weak, thready pulse
Decreasing pulse pressure-Measured in mm/HG
difference (subtraction) between the systolic and the diastolic;
low pulse pressure is less than 25% of systolic value; for example: 100/80=20 (less than 25%)
Unusually low BP and concentrated urine (not enough fluid circulating. the kidneys have no fluid being absorbed from the cells to dilute the urine so it becomes concentrated

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Hemorrhage

Study Tip: Be aware-very important
These are Classic signs of shock.

32
Q

First Assess:

  1. Sensation of popping or tearing (especially with coughing, vomiting, and position changes) Ask the patient.
  2. Assess intactness of incision - Edges need to be well approximated
  3. Assess for swelling (normal at first but should decrease), redness, heat, and fever
  4. Assess for foul smelling drainage, change in color of drainage from the incision and the drainage collection device.

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Surgical Incision

33
Q

NPO until GI motility (bowel sounds and passing gas), swallowing difficulty returns- to avoid aspiration
Suction PRN-also to avoid risk of aspiration at the bedside
Encourage patient to Turn Cough Deep Breathing, Incentive Spirometry, ambulation, moving in bed side to side
Leg exercises, Sequential Compression Devices, TED hose-ROM of legs hips and feet, wiggle toes
Patient education: much more likely to follow directions if they pt knows why they are doing it

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Respiratory

34
Q

Skin prep before surgery according to guidelines (shaving)
Monitor for s/sx of infection pain drainage and redness is normal but it should be decreasing not increasing, if it gets worse it could be a problem.
Inspect incision/drain sites/dressings for drainage, redness and odor; but it should be decreasing
Hand hygiene (patient too!) before they eat to wash hands also after using bedpan or urinal
Sterile saline for wound cleaning up to 48 hours post op (collaborative intervention)
Food and fluid intake to increase healing
Patient Education
Encourage patient not touch touch the wound too much to prevent infection

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Surgical Incision

35
Q

First Assess:

  1. Breath sounds: listen in all fields AP & L (laterally)
  2. Assess for Cough and Sputum - color, consistency, and odor (does a cough clear adventitious lung sounds R/T ineffective airway clearance if unable to cough and clear airways
  3. Assess for dyspnea- need to ask the patient and look at them patient may look like having difficulty but could be fine.
  4. Assess for fever - s/sx of Infection causes increased metabolic rate
  5. Monitor Labs: WBCs for inflammatory process
  6. Oxygen saturation

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Respiratory

35
Q

Orient/reorient to unfamiliar surroundings/people (introduce yourself everytime you come in the room)
Maintain safe/comfortable environment
Monitor medications (can cause increase in confusion especially in geriatrics)
Just because a patient is confused does not mean that they are not in pain.
Promote increased visual and auditory input during waking hours
Promote a quiet, restful environment during hours set aside for sleep/rest

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Complications created by a confused patient.

35
Q

Need to monitor for infection
Very important high fever can kill a patient.
Even a slight temperature MUST be investigated notify physician asap even 100.8
MUST EVALUATE.

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Immunosuppression

38
Q 
Report:
Tonsillectomy that lasted 6 hours 
Conscious Sedation 
Morphine given IV at 0800 hours
No excessive blood loss
Input: 2500 mL Output: 2400 mL in PACU 
Input: 5000 mL Output: 1700 mL in OR 
No complications during surgery 
Patient will be discharged home with family 
What is wrong with this report?
A

I/O’s must be total for both OR and PACU

39
Q

What is Malignant Hyperthermia?

A

A spike in temperature that can be hereditary and can happen during surgery or within a couple of days after surgery.

40
Q

Postoperative Nursing Care: Nursing Care After anesthesia and surgery is directed at prevention of what six types of surgical complications?

A
  1. Respiratory
  2. Cardiac
  3. Gastrointestinal
  4. Genital/urinary
  5. Hemorrhage/hypovolemia
  6. Surgical incision

Study Tip: Patient education - very important to help to prevent the above complications

40
Q

First Assess:

  1. Urine output, MINIMUM 30 mL/hr - less than this indicates inefficient perfusion to the kidneys
  2. BUN and creatinine levels - Kidney specific
  3. Bladder distention and related pain
  4. Suprapubic pain related to retention
  5. Output can be less than intake initially after surgery but the patient should increase to become equal. This is because patients come out of surgery dehydrated R/T Loss of fluid due to evaporation duing surgery
  6. Inability to void or small frequent voiding
  7. Hypertension - Monitor their blood pressure R/T retaining fluid
  8. Restlessness could indicate discomfort R/T urinary retention

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Genitourinary

41
Q

What are two possible Cardiac complications after surgery?

A

Thrombophlebitis

Embolus

42
Q

What are signs and symptoms of Malignant Hyperthermia?

A

High fever and Muscle rigidity

Study Tip: Temp of 105 degrees or higher

43
Q

Report:
Type and extent of surgical procedure; (limb amputation) what occurred during the surgery (biopsy)
Type of anesthesia used (recovey time)
Dosages and times medications given including the dosage and times (pain meds) (antibiotics given for 24-48 hrs from the first dose)
EBL (estimated blood loss)
I/O in OR and PACU- is renal function satisfactory (BP and Hypovolemia can afftect the kidneys and lead to acute kidney failure)
Any complications-anything out of the ordinary BS Blood Pressure Difficulty coming out of anethesia
Discharge plans- Where are they going when they are discharged?
(Rehab for hip implants/ SNF because no family / Home with family)

This type of report is given between what two nursing units for a surgical patient?

A

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

45
Q

First Assess:

  1. Assess for s/sx of pulmonary embolism
  2. Breath sounds: listen in all fields AP & L (laterally)
  3. Assess for Cough and Sputum - color, consistency, and odor (does a cough clear adventitious lung sounds R/T ineffective airway clearance if unable to cough and clear airways
  4. Assess for dyspnea- need to ask the patient and look at them patient may look like having difficulty but could be fine.
  5. Assess extremities for color, temperature, pain, edema could be caused by a blood clot

These are interventions that a nurse implements prevents what type of complications after surgery?

A

Respiratory

46
Q

Rare, emergent condition
IMMEDIATELY cover with sterile dressing/towels soaked in sterile saline
Keep patient on bed rest (patient will be woozy)
Notify physician
Prepare patient for surgery (Pre-Op Checklist, Call Dr., Signed Consent Form for Surgery)

These are interventions for what type of complication after surgery?

A

Evisceration

47
Q

What are the Discharge Instructions a nurse is required to give a surgical patient?

A

Educate patient on how to continue to help their healing and care

48
Q

Immunosuppression is commonly caused by what 5 genetic immune disorders?

A 
Sarcoidosis
Rheumatoid Arthritis
Diabetes
Lupus
Scleraderma
49
Q

Why is an activity restriction placed on patients after surgery?

A

If patient can only lift a small amount because it can harm the internal surgical tissue. The exterior of the wound heals faster than the interior of the wound which can cause adhesions and bowel obstructions R/T scar tissue which would require more surgeries.

50
Q

Patients who are immunoseuppressed do not get ________ easily so something really bad is causing it because immune system is suppressed.

A

High temperatures

51
Q

What are complications of malignant hyperthermia?

A

Can result in cardiac arrest and death.

This is a rare condition but often fatal.

Block 2 Week 6 Peri-Operative (3 decks)

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