perioperative Flashcards
1
Q
AORN
A
- association of perioperative registered nurses
- ethical/saftey guidelines
- main body for perioperative surgery
2
Q
cosmetic
A
- reshape normal body structures
- improve patients appearance/self-image
3
Q
curative
A
- resolve health problems
- repairs or removes the cause
ex) coronary artery bipas, hernia, gallbladder
4
Q
diagnostic
A
- determine origin or cause of the disorder
- taking of a tissue sample
ex) biopsy
5
Q
palliative
A
- increases quality of life
- often done to reduce pain
Ex) helps with pain control, no impact in disease process, cancer pt. resecting a mass
6
Q
preventative
A
- intention is that conditon will not develop
- prevent disease process from happening
ex) braca 1 gene in breast cancer
7
Q
reconstructive
A
- performed to imprve functional ability
- abnormal or damaged body structures
ex) burns, skin grafts, joint replacement
8
Q
transplant
A
- replaces malfunctioning strcture or organ
9
Q
elective
A
- planned for correction on a non acute problem
- time Is not an issue
ex) cataract removal, hernia repair
10
Q
urgent
A
- requires prompt intervnetion
- potentially life threatening if delayed more than 24 hr to 48 hour
ex) intestinal obstruction, bone fracture
11
Q
emergent
A
- requires immediate intervention
- life threatening consequences
ex) gunshot/stab wounds, severe bleeding, appendectomy
12
Q
national patient safety goals
A
- correct procedure, patient, site
- marking the surgical site
- pausing before surgery
- time out- calling recognition to pt. (preventing wrong site)
13
Q
surgical care improvement plan (SCIP)
A
- core compliance measures
- reduce surgical complications
- prophlyatic antibiotics admin 30-60 min before surgery
- correct hair removal process
- vte prophylaxis- heparin/lovanex/ted stockings
- urinary catheter- timed removal- morning after surgery
14
Q
risk factors for surgical complications
A
- pregnancy
- respiratory disease
- cardiovascular disease
- diabetes
- liver disease
- kidney disease
- coagulation disorders
- medications
15
Q
risk factors for surgical complications: pregnancy
A
- fetal risk associated with anesthesia
16
Q
risk factors for surgical complications: respiratory diease
A
- sleep apnea: airway obstruction
- COPD, pneumonia, asthma
- difficulty with anesthesia
17
Q
risk factors for surgical complications: cardiovascular disease
A
- heart failure
- MI
- dysthymias
- increased work load
18
Q
risk factors for surgical complications: diabetes
A
delayed healing
19
Q
risk factors for surgical complications: liver disease
A
- increased risk for bleeding
20
Q
risk factors for surgical complications: kidney disease
A
- altered elimination/med excretion
- risk for fluid overload
21
Q
risk factors for surgical complications: coagulation disorders
A
- increased risk for clotting/bleeding
- clot dislodgement
- heparin drip
22
Q
risk factors for surgical complications: medications
A
- anticoagulants: stopped 48 hours prior
- NSAIDS
- immunosuppressants
23
Q
perioperative phase time
A
- begins when pt. is scheduled for surgery; ends at time of transfer to surgical suite
focus:
- preparing pt. for surgery
- ensuring safety
24
Q
perioperative phase nursing role
A
- detailed history
- physical assessment
- ensure site is marked
- review consent
- prepare pt.
- transfer to operating room
25
Q
perioperative phase need for health teaching
A
- ensure INFORMED conset is obtained
Surgeon: - detailed description of the procedure
- obtains consent
nurse:
- verifies and clarifies facts
- confirms consent is signed, dates, and times
- may serve as witness
ensure site marking
- patient arrow
- surgeon initials
implement dietary restrictions
- NPO min 8 hours
- reinforce HCP instructions
- meds taken morning of small sip of water
- explain tubes, drains, vascular access
- minimize anxiety
26
Q
skin procesure
A
- first step in reducing surgical site infection
- pt may use antiseptic solution at home to shower night before
- hair removal usually performed in peri-op phase not at home
- betadine or chlorhexadine
27
Q
post op teaching
A
pain
- splinting
- discuss medications
preventing respiratory complications
- coughing, deep breathing
- turning
- incentive spirometer
preventing cardiovascular complications
- stockings/pneumatic compression devices
- early ambulation
28
Q
periop phase pt. prepartion
A
- remove all clothing: provide gown
- secruse valuables
- ensure pt. is wearing ID band
- apply allergy band
- follow agency policy : dentures, eyeglasses, prosthetics devices, fingernail polish or artificial nails
- admin medications: antibiotics within 1 hr, betablockers morning of, minimize cardiac events/ mortality
29
Q
intraoperative phase
A
- begins upon arrival to surgical suit
includes:
- admin of anesthesia
- performance of surgical procedure
- ends when pt. is transported to post anesthesia care unit
30
Q
what happens in operating room
A
- transfer pt. to OR table
- position patient
- advoid/pad bony prominences
- apply safety straps
- perform time out
- sedate pt.
- perform sugeru
- pt. briefly wakes up in or before extubating
- transfer to pacu
31
Q
time out
A
- perform immediately before starting invasive procedure or making incision
- involves immediate members of the team: anesthesia providers, circulating nurse, operating room tech, surgeon, assistant
- all members of team actively participate
- must agree to correct pt identification, correct site, procedure to be performed
32
Q
phase 1
A
- immediately after sugery
- 1 hour- days
- depends of surgery, vitals
33
Q
phase 2
A
transition phase
- 30 min to 2 hours
- pt. returning to presurgical loc
34
Q
phase 3
A
- extended care
- continuous monitoring of vs
- typical med surg units
35
Q
pacu nurse
A
- skilled in care of pt. with multiple problems after surgery
- has acls training
- makes knowledgeable critical decisions
- facilitates discharge or hands off to nurse generalist
36
Q
hand off report
A
- type and extent of surgery
- type of anesthesia and length of time
- past medical history
- intraoperative complications
- intake and output: IVF & blood product
- medications: pain meds & antibiotics
- incision: location and dressing status
- catheters, tubes, drains
- current status
37
Q
post op phase recognizing cues… at risk for
A
at risk for
- pneumonia
- shock
- cardiac arrest
- vte
- gi bleeding
- early recognition of assessment findings
- decrease potential for serious surgical complications
38
Q
post of improving gas exchange
A
- monitor gas exchange
- semi-fowlers to high fowlers
- side lying if needed
- oxygen therapy
- breathing exercises: coughing and deep breathing, incentive spirometer, splint incision
- early ambulation
- out of bed
- turn and repositon
39
Q
post op promoting circulation
A
- early ambulation
- antiembolism stockings
- TEDS: gradual compression of legs make sure it is the appropriate fit
- pneumatic compression devices
- leg exercises
- drug therapy: lovenox 1-2x day, heparin q8hr
40
Q
bowl sounds
A
- decreased bowl sounds not uncommon for 24 hours post op
- get pt. to move
41
Q
post op assessment integumentary system
sanguineous
serosanguineous
serous
A
- may take 6m-2 years
drainage:
- sanguineous- bloody
- serosanguineous- watery/yellowish, blood tinged
- serous- serium like yellow
- impaired wound healing seen 5 to 10 days after surgery
42
Q
wound complications
A
- dehiscence- partial or complete separtion of the wound edges
- evisceration- protrusion of intestinal organs
43
Q
dressings
A
- surgeons choice
- first dressing changed by surgeon
- hand hygiene and aseptic technique
- count sutures and staples
- document
44
Q
drains
A
- penrose
- jackson pratt
- hemovac- most common
- monitor insertion site, change dressing, empty draining system, document
45
Q
nutritonal therpay post op
A
- vit c and protein promote wound healing
- glycemic control in diabetics
- increased blood glucose- delays wound healing/increased risk for infection
46
Q
emergency care post op
A
- cover wound with sterile nonadherent dressing
- call rapid response
- place pt supine
- do not reinsert protruding organs
47
Q
managing pain
A
- pca
- basal rate: very small amount continuously infused
- bolus dose- given to pt. when the push button
opioids
- monitor vs
- decrease in bp and rr
- emergency treatment- nalxone
- increased risk for constipation
nonpharmacologic:
- positioning
- relaxation
- diversion
