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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
perioperative phase need for health teaching
- 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
skin procesure
- 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
post op teaching
pain - splinting - discuss medications preventing respiratory complications - coughing, deep breathing - turning - incentive spirometer preventing cardiovascular complications - stockings/pneumatic compression devices - early ambulation
28
periop phase pt. prepartion
- 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
intraoperative phase
- 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
what happens in operating room
- 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
time out
- 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
phase 1
- immediately after sugery - 1 hour- days - depends of surgery, vitals
33
phase 2
transition phase - 30 min to 2 hours - pt. returning to presurgical loc
34
phase 3
- extended care - continuous monitoring of vs - typical med surg units
35
pacu nurse
- 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
hand off report
- 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
post op phase recognizing cues... at risk for
at risk for - pneumonia - shock - cardiac arrest - vte - gi bleeding - early recognition of assessment findings - decrease potential for serious surgical complications
38
post of improving gas exchange
- 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
post op promoting circulation
- 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
bowl sounds
- decreased bowl sounds not uncommon for 24 hours post op | - get pt. to move
41
post op assessment integumentary system sanguineous serosanguineous serous
- 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
wound complications
- dehiscence- partial or complete separtion of the wound edges - evisceration- protrusion of intestinal organs
43
dressings
- surgeons choice - first dressing changed by surgeon - hand hygiene and aseptic technique - count sutures and staples - document
44
drains
- penrose - jackson pratt - hemovac- most common - monitor insertion site, change dressing, empty draining system, document
45
nutritonal therpay post op
- vit c and protein promote wound healing - glycemic control in diabetics - increased blood glucose- delays wound healing/increased risk for infection
46
emergency care post op
- cover wound with sterile nonadherent dressing - call rapid response - place pt supine - do not reinsert protruding organs
47
managing pain
- 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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