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Med Surg 1 > perioperative > Flashcards

perioperative Flashcards

1
Q

AORN

A
  • association of perioperative registered nurses
  • ethical/saftey guidelines
  • main body for perioperative surgery
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2
Q

cosmetic

A
  • reshape normal body structures

- improve patients appearance/self-image

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3
Q

curative

A
  • resolve health problems
  • repairs or removes the cause
    ex) coronary artery bipas, hernia, gallbladder
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4
Q

diagnostic

A
  • determine origin or cause of the disorder
  • taking of a tissue sample
    ex) biopsy
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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
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6
Q

preventative

A
  • intention is that conditon will not develop
  • prevent disease process from happening
    ex) braca 1 gene in breast cancer
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7
Q

reconstructive

A
  • performed to imprve functional ability
  • abnormal or damaged body structures
    ex) burns, skin grafts, joint replacement
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8
Q

transplant

A
  • replaces malfunctioning strcture or organ
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9
Q

elective

A
  • planned for correction on a non acute problem
  • time Is not an issue
    ex) cataract removal, hernia repair
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10
Q

urgent

A
  • requires prompt intervnetion
  • potentially life threatening if delayed more than 24 hr to 48 hour
    ex) intestinal obstruction, bone fracture
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11
Q

emergent

A
  • requires immediate intervention
  • life threatening consequences
    ex) gunshot/stab wounds, severe bleeding, appendectomy
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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)
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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
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14
Q

risk factors for surgical complications

A
  • pregnancy
  • respiratory disease
  • cardiovascular disease
  • diabetes
  • liver disease
  • kidney disease
  • coagulation disorders
  • medications
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15
Q

risk factors for surgical complications: pregnancy

A
  • fetal risk associated with anesthesia
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16
Q

risk factors for surgical complications: respiratory diease

A
  • sleep apnea: airway obstruction
  • COPD, pneumonia, asthma
  • difficulty with anesthesia
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17
Q

risk factors for surgical complications: cardiovascular disease

A
  • heart failure
  • MI
  • dysthymias
  • increased work load
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18
Q

risk factors for surgical complications: diabetes

A

delayed healing

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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

Med Surg 1 (25 decks)

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