Periop 2 Flashcards
poor oral hygiene, management: mouth wash with diluted hydrogen peroxide
Acute parotitis
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
patient’s advocate
what to assess in consciousness
GCS scoring, checking for reflexes unless contraindicated, monitor LOC or patient’s responsiveness
last sense to be depressed is
hearing
o Explaining the risks and benefits of the surgical procedure to thepatient/legal guardian
surgeon
begins with the cessation of
respiration and leads to death.
Stage IV (stage of danger/ medullar stage)
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
general consent
s/s for Hemorrhage and Shock
Decreased BP
Rapid, thread pulse
Apprehension
Restlessness
Weakness
o Ensures that sponge, instruments and sharp counts are completed
and appropriately documented
Circulating Nurse
fever etiologies
atelectasis
dehydration
wound infection
UTI
Thrombophlebitis
legal aspects PURPOSE:
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
scrub nurse may be performed by
RN, licensed Practical Nurse (LPN), or OR scrub technologist
o In the immediate postoperative period, the anesthesiologist assumes medical responsibility for the patient
Anesthesiologist
where the patient is minor, unconscious or mentally unsound, the following may give consent (arranged according to legal interstate succession):
o Spouse
o Adult child
o Parent
o Sibling
o For minors: legal guardian
GI complications
Abdominal distention
constipation
paralytic ileus
types of regional anesthesia
Topical Surface
Local
Peripheral Nerve Block (tetracaine)
Spinal anesthesia
Epidural block
Acupuncture
Cryothermaia
pstn for hemorrhoidectomy, repair of vaginal laceration
Lithotomy
position: prone position with extremities lowered and hips over center break of table (i.e. oral surgeries)
Kroske/Jack Knife
o Anesthetizing the patient, provide appropriate levels of pain relief
Anesthesiologist
Urine output should be at least
at least 30 mL/h
begins with the onset of regular
breathing and ends with the cessation of respirations.
Stage III (stage of surgical anesthesia)
o Documenting intraoperative nursing care and ensuring surgical specimens are identified and placed in the appropriate media
Circulating Nurse
examples of inhalation general anesthesia
halothane, ether, nitrous oxide, cyclopropane
Secondary to decreased activity, decreased peristalsis
constipation
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)
Post-operative psychosis manifestations
Insomnia, restlessness, anorexia, irritability/suicidal tendency
Must have a thorough knowledge and understanding on the specific surgical procedure and the anatomy and physiology of the involved system.
scrub nurse
General anesthesia is accomplished in 4 phases:
Pre-induction
Induction
Maintenance.
Reversal/extubation
what to give for patients with decreased level of consciousness
mouth guard
etiologies that varies in fever types
dehydration, wound infection, thrombophlebitis
position: the patient lies flat on bed with the patient facing the bed (i.e. spinal operation, posterior leg)
Prone
an RN whose responsibility is to serve as the patient’s advocate while coordinating events before, during and after a surgical procedure
circulating nurse
o Monitoring patients’ physiologic status
Anesthesiologist
intervention of thrombophlebitis
Bed rest with feet elevated
o Monitoring the scrubbed team members for breaks in the sterile technique
scrub nurse
pstn for biliary tract surgery
Reverse Trendelenburg
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
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
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
o Providing nursing care to the patient
Circulating Nurse
late sign of atelectasis
cyanosis
Manifestation:
Productive cough
High Grade fever accompanied by chills
pneumonia
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
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
o Preparing supplies and equipment in the sterile field
scrub nurse
mgt thrombophlebitis
Bed rest with the affected limb elevated
Warm compress
Administration of thrombolytics or anticoagulants as ordered
o Providing appropriate sterile instrumentation, sutures, and supplies to the operating surgeon.
scrub nurse
Paralysis of the intestinal peristalsis
paralytic ileus
abdominal distention mgt
Insertion of NGT
Lavage
IVFluid replacement of electrolytes
intervention of atelectasis
Cough, deep breathing
exercises
o Determining the pre-operative diagnosis
surgeon
may be attributed to grief of lost body part, body image disturbance, standing emotional problem, exhaustion
Post-operative psychosis
An inflammatory condition of lung (alveoli) characterized by consolidation of the lungs
pneumonia
o Managing post-operative care
surgeon
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
Types of general anesthesia
Inhalation
Intravenous anesthesia
Rectal anesthesia
pstn for spinal operation, posterior leg)
prone
anesthesia commonly employed as induction agent prior to inhalation anesthesia
intravenous anesthesia
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
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
patients become what in stage 1 of guedel’s stages
drowsy, dizzy
Secondary to failure of cardiac muscles to contract, may be due to effects of anesthesia
cardiac arrest
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)-
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
phase that starts when stabilization is accomplished and ends when reversal of anesthesia is initiated near the procedure’s end.
maintenance
introducing anesthetic agent into the epidural space (through the intervertebral space into the space surrounding the dura matter in the spinal column)
epidural block
position for gallbladder
modified supine with shoulders elevated
intervention of UTI
Antibiotics, increase fluid,
ambulate
o Identifying and performing the appropriate surgical procedure
surgeon
onset fever of UTI
day 5-8
o Communicate relevant information to individuals outside the OR
Circulating Nurse
s/s for shock
decreased BP, increased PR, cold clammy skins, oliguria
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
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
Post-surgical atelectasis is treated
through
physiotherapy (DBCE, incentive spirometer, ambulation)
position for thyroid surgery
modified supine with neck extended
Vital signs are monitored every ** for two hours
until stable, every ** for two ours then every *** until
stable
15 minutes
30 minutes
4 hours
intervention of dehydration
Increase oral fluid intake, I&O
monitoring
Role of the NURSE:
To become the patient’s advocate
The surgical team
Surgeon
Anesthesiologist
Scrub Nurse
Circulating Nurse
pstn surgery of lower abdomen
Trendelenburg
Refers to the inflammation of a vein secondary to blood clot
thrombophlebitis
anesthesia that is rarely used today; indicated for anesthetizing a child when facial surgery makes it difficult to maintain airway
Rectal anesthesia
Who are qualified to give consent:
Those of legal age
o Those of sound mind (during their lucid interval)
may be an evidence of post-operative complications
fever
examples of Intravenous general anesthesia
pentothal, ketalar
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
dehiscence mgt
Resuturing, application of adhesive to pull edges
intervention of wound infection
Antibiotics, proper wound care
Types of consent
general
informed
Fever persisting after 3rd day
General body malaise
Increased RR
Swelling, tenderness of the wound
Purulent discharge
infection
position: patient lies on back with the body section raised 45o to 90o (i.e. thoracotomy)
Sitting/Fowler’s
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
injection into the surgical area making the receptor unresponsive to stimuli
local
manifestation of paralytic ileus
Absent bowel sounds
No flatus
what to avoid When transferring the patient to the PACU:
Avoid exposure
Avoid rough handling
Avoid hurried movements and rapid changes in position
process (not mere documentation) explanations of the procedures,
risks, benefits and alternative therapy made verbally to the patient’s level of
understanding.
Informed Consent
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
o Obtaining informed consent for the surgical procedure
surgeon
partial or total loss of sensation with or without loss of consciousness deliberately induced to prevent pain perception and promote relaxation during surgery
Anesthesia
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
blocks sensory receptor by penetrating thru sensory nerve endings reducing responses to stimuli
topical surface
onset fever of wound infection
day 3-5
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
wound complications
infection
dehiscence
evisceration
urinary complications
urinary retention, UTI, Renal failure
fever type of UTI
low grade
secondary to decreased mobility, decreased circulation
decubitus ulcer
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
o Managing the activities outside the sterile field
Circulating Nurse
pstn for oral surgeries
Kroske/Jack Knife
o Identifying and making the surgical procedure
surgeon
treatment for Hemorrhage and Shock
Ligation of blood vessels
urinary retention mgt
catheterization
occurs when blood loss is too extensive that the body is not capable of maintain adequate blood flow throughout the system
shock
position: for sigmoidoscopy, induction of spinal anesthesia
knee-chest
should be the one to provide information about the procedure, its nature and known possible consequences
Surgeon
injection of an agent
into the large trunk or nerve plexus
Peripheral Nerve Block (tetracaine)
o Creating a safe environment for the patient
Circulating Nurse
Post-operative psychosis mgt
Verbalization, 24 hour responsible watcher
phase that begins with closure of the wound and ends before patient transport to PACU
Reversal/extubation
UTI mgt
Administration of antibiotics as prescribed, increase fluid intake
position: head part is lower than the foot part (surgery of lower abdomen)
Trendelenburg
Types of anesthesia
General Anesthesia
Regional Anesthesia
position for exploratory laparotomy, abdominal surgeries
supine
renal failure mgt
I&O monitoring, regulate IVFluid
position: flat on bed with arms at sides or supported by arm boards (i.e. exploratory laparotomy,
abdominal surgeries)
supine
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
pstn for thoracotomy
Sitting/Fowler’s
o Obtains supplies and equipment for the sterile team members
Circulating Nurse
mgt for cardiac arrest
CPR, cardiac stimulants
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)
Characterized by frequent vomiting of small amounts without effort which may impose
strain or diaphragm causing dyspnea
abdominal distention
paralytic ileus mgt
Ambulation
Gastric decompression
IVFluid
other complications
Acute parotitis
Decubitus ulcer
Post-operative psychosis
Commonly Used Operative Positions
Supine
Modified Supine
Prone
Sitting/Fowler’s
Trendelenburg
Reverse Trendelenburg
Lithotomy
Kroske/Jack Knife
Knee-Chest
to assist the patient in returning to optimal functioning as quickly as possible
post operative phase
onset fever of dehydration
day 2-3
There is a separation of all the tissue layers in an abdominal wound and prostrusion of
the abdominal content.
evisceration
proper positioning for spinal anesthesia
flat on bed
position: head part is elevated and is higher than the foot part (i.e. billiary tract surgery)
Reverse Trendelenburg
onset fever of atelectasis
Within the first 24
hours
most common cause of pneumonia
microaspiration of bacteria
o Evaluates the patient to determine the appropriate anesthetic to administer
Anesthesiologist
fever type of atelectasis
low grade
Refers to a physician who specializes in administering agents and monitoring the patient’s response to the agents
Anesthesiologist
onset fever of thrombophlebitis
day 7-14
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
Major complications of anesthesia:
Respiratory arrest
Cardiac arrest
