Peri-op nursing Flashcards
What is an elective surgery?
A surgery with no immediate emergency, so it can be scheduled
What is an urgent surgery?
A surgery needed soon
What is an emergency surgery?
A surgery needed immediately
What is a diagnostic surgery?
For testing; biopsy
What is an ablative surgery?
Surgery taking care of a diseased part
What is a palliative surgery?
A surgery to improve the quality of life
Why is the assessment important in periop nursing?
It’s used to ID patient’s norms to recognize, prevent, and minimize postop complications of surgery
Why is nutrition a risk factor for surgery?
Need a balanced diet for healing
No eating for ~8 hrs beforehand
Need to have conversation pre-op on post-op diet
Why is obesity a risk factor for surgery?
Medication needed Potential increased blood loss Mobilization Post-op complications Breathing Healing slower
Why is sleep apnea a risk factor for surgery?
At risk for cardiac disease
Important for knowing if you get intubated
What is the nursing implication for the CV system during surgery?
Vital signs, fluid balance; leg exercises (for DVT)
What is the surgery risk for the pulmonary system?
Cough and deep breathe, ambulate
What is the surgery risk for the renal system?
Baseline urinary output/ response to meds
What is the surgery risk for the neuro system?
Orient; Inspect for signs of pressure (ulcers)
What is the surgery risk for the metabolic system?
Monitor labs
What age tends to have lower urine output?
Elderly pts
Can have a problem with incontinence
What is the rule for older patients and medication?
Start low, go slow
What types of medications need to be considered preop?
Anticoagulants Insulin NSAIDS OTC Supplements/herbs Rec drugs
Why might Heparin be given in the hospital?
Anticoagulant with a short half life
What can be used to counteract Coumadin?
Vitamin K
Is insulin given in the hospital even if the pt isn’t eating?
Yes
What diagnostic tests should be done?
CBC, serum electrolytes, coagulation, serum creatinine & BUN
What is autologous blood donation?
Taking blood from the pt preop and giving them back their own blood postop
Which surgeries have the biggest blood loss?
Orthopedic surgeries
When should postop care be taught?
Preop
In which pts is delayed surgical recovery seen?
Diabetic pts
When should intervention be provided for pain?
During discomfort because it’s easier to slow the progression
Who gets informed consent?
Physicians. Nurses can witness it
What is included in preop teaching?
Reasons for preop instructions and exercises
Time of surgery
Postop unit and location of family during surgery and recovery
Anticipated postop monitoring and therapies
Surgical procedures and postop treatment
Postop activity resumption
Pt verbalizes pain relief measures
Pt expressing feelings
Sensations related to surgery and anesthesia
Instructions on preop orders
Invasive procedures (IV, NG, catheters)
Turn, cough & deep breathe/splinting/positioning
Lower extremity exercises/DVT prevention
Early ambulation
Pain management
What is included in the preop check list?
Patient’s name band Consents obtained Allergies Vital signs Hygiene/Skin prep Personal belongings IV access; blood availability Marking OR site Bowel/bladder prep (document time) Preop med (safety - complete necessary activities before meds) Transport Family
When are prophylactic antibiotics used?
For anaerobic organisms
Are razors used for hair removal?
No
What is a circulating nurse?
Nurse that evaluates the patient’s ongoing clinical status
Continuously monitor vital signs and intake and output
What is general anesthesia?
Loss of sensation/consciousness
Risks associated
What is regional anesthesia?
Loss of sensation in one area of the body
Nerve block, epidural or spinal
What is local anesthesia?
Loss of sensation at a site
Topical/local infiltration
What is a time out?
Procedure aimed to prevent medical and surgical errors. Conduction of a final verification of the correct pt, procedure, surgical site.
When is a time out done?
As the pt is brought into the OR
What is included in the operative report postop?
Procedure, anesthesia, blood loss, blood products, fluids, drains
What is impt in postop care?
Maintaining resp function Preventing circulatory complications Achieving rest and comfort Temp regulation Maintaining neurological function F&E balance Bowl elimination/adequate nutrition Urinary elimination Wound healing Self-concept
What surgery puts a pt at the highest risk for DVT?
Pelvic surgeries
What is paralytic ileus?
When a portion of the ileum remains sleeping after surgery
Can be medically or surgically treated
When is risk for hemorrhage greatest?
First 24 hours
Later - DVT
When is a distended abdomen expected?
After laparoscopic surgery
What are risk factors for dehiscence?
Conditions that impair circulation, tissue oxygenation, and wound healing
Mechanical stress on the wound
How can we avoid dehiscence?
Stool softeners to prevent straining during defecation and alleviate constipation
Antiemetics PRN to prevent straining that can occur with vomiting
Abdominal binder - reduce mechanical stress
Monitoring blood sugar to maintain tight glycemic control (<140 mg/dL [7.8 mmol/L] fasting glucose, <180 mg/dL [10 mmol/L] random glucose)
Splinting
