Periop 2 Flashcards
1
Q
poor oral hygiene, management: mouth wash with diluted hydrogen peroxide
A
Acute parotitis
2
Q
Nurse assesses the patient’s decision-making capacity, confirms that patient has been given the necessary information to give informed consent and clarifies any misconception
A
patient’s advocate
3
Q
what to assess in consciousness
A
GCS scoring, checking for reflexes unless contraindicated, monitor LOC or patient’s responsiveness
4
Q
last sense to be depressed is
A
hearing
5
Q
o Explaining the risks and benefits of the surgical procedure to thepatient/legal guardian
A
surgeon
6
Q
begins with the cessation of
respiration and leads to death.
A
Stage IV (stage of danger/ medullar stage)
7
Q
authorizes the attending physician and staff to render standard day-to day treatment or to perform generalized treatment and care as the physician deemed
advisable
A
general consent
8
Q
s/s for Hemorrhage and Shock
A
Decreased BP
Rapid, thread pulse
Apprehension
Restlessness
Weakness
9
Q
o Ensures that sponge, instruments and sharp counts are completed
and appropriately documented
A
Circulating Nurse
10
Q
fever etiologies
A
atelectasis
dehydration
wound infection
UTI
Thrombophlebitis
11
Q
legal aspects PURPOSE:
A
o Ensure patient understanding to the nature of the treatment
o Indicate patients, decision
o Protect patient from unauthorized procedure
o Protect the surgeon and hospital against legal action
12
Q
scrub nurse may be performed by
A
RN, licensed Practical Nurse (LPN), or OR scrub technologist
13
Q
o In the immediate postoperative period, the anesthesiologist assumes medical responsibility for the patient
A
Anesthesiologist
14
Q
where the patient is minor, unconscious or mentally unsound, the following may give consent (arranged according to legal interstate succession):
A
o Spouse
o Adult child
o Parent
o Sibling
o For minors: legal guardian
15
Q
GI complications
A
Abdominal distention
constipation
paralytic ileus
16
Q
types of regional anesthesia
A
Topical Surface
Local
Peripheral Nerve Block (tetracaine)
Spinal anesthesia
Epidural block
Acupuncture
Cryothermaia
17
Q
pstn for hemorrhoidectomy, repair of vaginal laceration
A
Lithotomy
18
Q
position: prone position with extremities lowered and hips over center break of table (i.e. oral surgeries)
A
Kroske/Jack Knife
19
Q
o Anesthetizing the patient, provide appropriate levels of pain relief
A
Anesthesiologist
20
Q
Urine output should be at least
A
at least 30 mL/h
21
Q
begins with the onset of regular
breathing and ends with the cessation of respirations.
A
Stage III (stage of surgical anesthesia)
22
Q
o Documenting intraoperative nursing care and ensuring surgical specimens are identified and placed in the appropriate media
A
Circulating Nurse
23
Q
examples of inhalation general anesthesia
A
halothane, ether, nitrous oxide, cyclopropane
24
Q
Secondary to decreased activity, decreased peristalsis
A
constipation
25
manifestations of thrombophlebitis
Pain in the part of the body affected
Skin redness of iflamation( not always present)
Swelling (edema) of the extremities ( ankle and foot)
26
Post-operative psychosis manifestations
Insomnia, restlessness, anorexia, irritability/suicidal tendency
27
Must have a thorough knowledge and understanding on the specific surgical procedure and the anatomy and physiology of the involved system.
scrub nurse
28
General anesthesia is accomplished in 4 phases:
Pre-induction
Induction
Maintenance.
Reversal/extubation
29
what to give for patients with decreased level of consciousness
mouth guard
30
etiologies that varies in fever types
dehydration, wound infection, thrombophlebitis
31
position: the patient lies flat on bed with the patient facing the bed (i.e. spinal operation, posterior leg)
Prone
32
an RN whose responsibility is to serve as the patient’s advocate while coordinating events before, during and after a surgical procedure
circulating nurse
33
o Monitoring patients’ physiologic status
Anesthesiologist
34
intervention of thrombophlebitis
Bed rest with feet elevated
35
o Monitoring the scrubbed team members for breaks in the sterile technique
scrub nurse
36
pstn for biliary tract surgery
Reverse Trendelenburg
37
Components of a consent:
o Patient’s full legal name
o Surgeon’s name
o Specific procedures to be performed
o Signature of the patient, next of kin, legal guardian
o Witnesses
o Date
38
has the obligation to provide the patient or legal guardian full disclosure regarding the risk and benefits of anesthetic agents that are to be used to the patient
anesthesiologist
39
phase that Begins as soon as the patient is brought to the procedure room and ends immediately before the induction of the anesthesia
pre-induction
40
o Providing nursing care to the patient
Circulating Nurse
41
late sign of atelectasis
cyanosis
42
Manifestation:
Productive cough
High Grade fever accompanied by chills
pneumonia
43
phase that Begins with the induction of anesthetic agents and ends with stabilization of the patient. Involves putting the patient safely to sleep. A patent airway and adequate ventilation must be ensured
induction
44
length of stay in the PACU is generally ***; for a patient to be transferred to the ward, the patient should be stable and free form signs and symptoms of postoperative complications
less than 24 hours
45
o Preparing supplies and equipment in the sterile field
scrub nurse
46
mgt thrombophlebitis
Bed rest with the affected limb elevated
Warm compress
Administration of thrombolytics or anticoagulants as ordered
47
o Providing appropriate sterile instrumentation, sutures, and supplies to the operating surgeon.
scrub nurse
48
Paralysis of the intestinal peristalsis
paralytic ileus
49
abdominal distention mgt
Insertion of NGT
Lavage
IVFluid replacement of electrolytes
50
intervention of atelectasis
Cough, deep breathing
exercises
51
o Determining the pre-operative diagnosis
surgeon
52
may be attributed to grief of lost body part, body image disturbance, standing emotional problem, exhaustion
Post-operative psychosis
53
An inflammatory condition of lung (alveoli) characterized by consolidation of the lungs
pneumonia
54
o Managing post-operative care
surgeon
55
evisceration mgt
Position patient flat or low fowlers position
Cover the protruding organ with sterile moist dressing
Instruct patient not to cough
NPO
Notify the surgeon STAT
Prepared the patient for surgery for immediate closure of wound
56
Types of general anesthesia
Inhalation
Intravenous anesthesia
Rectal anesthesia
57
pstn for spinal operation, posterior leg)
prone
58
anesthesia commonly employed as induction agent prior to inhalation anesthesia
intravenous anesthesia
59
Factors to consider in determining the type of anesthesia:
* Age and physical condition of the patient
* Type, location and duration of surgery
* Degree of technical intricacy of surgery
* Previous anesthetic history
* Personal preference, expertise and judgment of anesthesiologist
* Patient’s preference
60
position: legs are flexed at right angles and placed on stirrups (to expose perineal and rectal areas) [i.e. hemorrhoidectomy, repair of vaginal laceration]
Lithotomy
61
patients become what in stage 1 of guedel's stages
drowsy, dizzy
62
Secondary to failure of cardiac muscles to contract, may be due to effects of anesthesia
cardiac arrest
63
begins with the loss of consciousness and ends with the onset of regular breathing and loss of eyelid reflexes; often companied by involuntary muscle activity; the patient should no receive auditory or physical stimulation during this period
Stage II (stage of delirium/ excitement)-
64
o Refers to partial or complete separation of the wound edges
o Usually occurs on the 6th-7th post-operative day when sutures heal
o Caused by excessive strain, severe coughing, malnutrition
dehiscence
65
phase that starts when stabilization is accomplished and ends when reversal of anesthesia is initiated near the procedure’s end.
maintenance
66
introducing anesthetic agent into the epidural space (through the intervertebral space into the space surrounding the dura matter in the spinal column)
epidural block
67
position for gallbladder
modified supine with shoulders elevated
68
intervention of UTI
Antibiotics, increase fluid,
ambulate
69
o Identifying and performing the appropriate surgical procedure
surgeon
70
onset fever of UTI
day 5-8
71
o Communicate relevant information to individuals outside the OR
Circulating Nurse
72
s/s for shock
decreased BP, increased PR, cold clammy skins, oliguria
73
o Consent in the form of a telephone call is permissible in such situations provided that there should be *** persons to witness the call
two
74
suspension of sensation on affected site of the body; temporarily prevents generation and conduction of nerve impulses and may not affect motor functions; used for patients whom general anesthesia is contra indicated
Regional anesthesia
75
Post-surgical atelectasis is treated
through
physiotherapy (DBCE, incentive spirometer, ambulation)
76
position for thyroid surgery
modified supine with neck extended
77
Vital signs are monitored every **** for two hours
until stable, every **** for two ours then every *** until
stable
15 minutes
30 minutes
4 hours
78
intervention of dehydration
Increase oral fluid intake, I&O
monitoring
79
Role of the NURSE:
To become the patient’s advocate
80
The surgical team
Surgeon
Anesthesiologist
Scrub Nurse
Circulating Nurse
81
pstn surgery of lower abdomen
Trendelenburg
82
Refers to the inflammation of a vein secondary to blood clot
thrombophlebitis
83
anesthesia that is rarely used today; indicated for anesthetizing a child when facial surgery makes it difficult to maintain airway
Rectal anesthesia
84
Who are qualified to give consent:
Those of legal age
o Those of sound mind (during their lucid interval)
85
may be an evidence of post-operative complications
fever
86
examples of Intravenous general anesthesia
pentothal, ketalar
87
If no family or legal guardian can be contacted,**** with the procedure may take the decision for surgical intervention. In this circumstance a relative must sign an operative consent as soon as possible
two physicians who are not associated
88
dehiscence mgt
Resuturing, application of adhesive to pull edges
89
intervention of wound infection
Antibiotics, proper wound care
90
Types of consent
general
informed
91
Fever persisting after 3rd day
General body malaise
Increased RR
Swelling, tenderness of the wound
Purulent discharge
infection
92
position: patient lies on back with the body section raised 45o to 90o (i.e. thoracotomy)
Sitting/Fowler’s
93
position: the patient is positioned in supine position, with the neck extended (thyroid
surgery) or shoulders elevated (gallbladder), dorsal recumbent (knees flexed), arm extension (arm
board)
Modified Supine
94
injection into the surgical area making the receptor unresponsive to stimuli
local
95
manifestation of paralytic ileus
Absent bowel sounds
No flatus
96
what to avoid When transferring the patient to the PACU:
Avoid exposure
Avoid rough handling
Avoid hurried movements and rapid changes in position
97
process (not mere documentation) explanations of the procedures,
risks, benefits and alternative therapy made verbally to the patient’s level of
understanding.
Informed Consent
98
injection of certain local anesthesia into subarachnoid space between l3 and l4 using a lumbar interspace, usually employed for almost any type of major operation below the level of diaphragm
Spinal anesthesia
99
o Obtaining informed consent for the surgical procedure
surgeon
100
partial or total loss of sensation with or without loss of consciousness deliberately induced to prevent pain perception and promote relaxation during surgery
Anesthesia
101
In case of emergency, the surgeon may operate without the written permission of the patient or family although every effort is made to contact a family member if time permit
102
blocks sensory receptor by penetrating thru sensory nerve endings reducing responses to stimuli
topical surface
103
onset fever of wound infection
day 3-5
104
refers to the depression of the central nervous system by administration of drugs or inhalation agents; patients under this usually require ventilator assistance
general anesthesia
105
wound complications
infection
dehiscence
evisceration
106
urinary complications
urinary retention, UTI, Renal failure
107
fever type of UTI
low grade
108
secondary to decreased mobility, decreased circulation
decubitus ulcer
109
o Before and during the induction of anesthetic, provides emotional
support to the patient and assists the anesthesia team during the
induction period
Circulating Nurse
110
o Managing the activities outside the sterile field
Circulating Nurse
111
pstn for oral surgeries
Kroske/Jack Knife
112
o Identifying and making the surgical procedure
surgeon
113
treatment for Hemorrhage and Shock
Ligation of blood vessels
114
urinary retention mgt
catheterization
115
occurs when blood loss is too extensive that the body is not capable of maintain adequate blood flow throughout the system
shock
116
position: for sigmoidoscopy, induction of spinal anesthesia
knee-chest
117
should be the one to provide information about the procedure, its nature and known possible consequences
Surgeon
118
injection of an agent
into the large trunk or nerve plexus
Peripheral Nerve Block (tetracaine)
119
o Creating a safe environment for the patient
Circulating Nurse
120
Post-operative psychosis mgt
Verbalization, 24 hour responsible watcher
121
phase that begins with closure of the wound and ends before patient transport to PACU
Reversal/extubation
122
UTI mgt
Administration of antibiotics as prescribed, increase fluid intake
123
position: head part is lower than the foot part (surgery of lower abdomen)
Trendelenburg
124
Types of anesthesia
General Anesthesia
Regional Anesthesia
125
position for exploratory laparotomy, abdominal surgeries
supine
126
renal failure mgt
I&O monitoring, regulate IVFluid
127
position: flat on bed with arms at sides or supported by arm boards (i.e. exploratory laparotomy,
abdominal surgeries)
supine
128
anesthesia that administered through (1) open drop [anesthesia is roped directly into layers of gauze that is held on the patients’ mouth (2) mask
inhalation
129
pstn for thoracotomy
Sitting/Fowler’s
130
o Obtains supplies and equipment for the sterile team members
Circulating Nurse
131
mgt for cardiac arrest
CPR, cardiac stimulants
132
begins with the administration of anesthetic agent and ends with the loss of consciousness; patients become drowsy, dizzy; the last sense to be depressed is hearing and first to return.
Stage I (stage of analgesia)
133
Characterized by frequent vomiting of small amounts without effort which may impose
strain or diaphragm causing dyspnea
abdominal distention
134
paralytic ileus mgt
Ambulation
Gastric decompression
IVFluid
135
other complications
Acute parotitis
Decubitus ulcer
Post-operative psychosis
136
Commonly Used Operative Positions
Supine
Modified Supine
Prone
Sitting/Fowler’s
Trendelenburg
Reverse Trendelenburg
Lithotomy
Kroske/Jack Knife
Knee-Chest
137
to assist the patient in returning to optimal functioning as quickly as possible
post operative phase
138
onset fever of dehydration
day 2-3
139
There is a separation of all the tissue layers in an abdominal wound and prostrusion of
the abdominal content.
evisceration
140
proper positioning for spinal anesthesia
flat on bed
141
position: head part is elevated and is higher than the foot part (i.e. billiary tract surgery)
Reverse Trendelenburg
142
onset fever of atelectasis
Within the first 24
hours
143
most common cause of pneumonia
microaspiration of bacteria
144
o Evaluates the patient to determine the appropriate anesthetic to administer
Anesthesiologist
145
fever type of atelectasis
low grade
146
Refers to a physician who specializes in administering agents and monitoring the patient’s response to the agents
Anesthesiologist
147
onset fever of thrombophlebitis
day 7-14
148
four stages of Guedel’s Classification of the Stages of Anesthesia
stage of analgesia
stage of delirium/ excitement
stage of surgical anesthesia
stage of danger/ medullar stage
149
Major complications of anesthesia:
Respiratory arrest
Cardiac arrest
