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MEDICAL SURGICAL > PERIOPERATIVE > Flashcards

PERIOPERATIVE Flashcards

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USMLE® Step 1 flashcards
1
Q

preoperative phase is

A

the time before the surgery

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2
Q

what is the primary purpose of patient interview (3)

A

1 obtain client’s information
2 provide & clarify information about surgery and anesthesia
3 assess client’s emotional state

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3
Q

overall goal of the preparative assessment to ___ and ___ to ensure ___ throughout surgical experience

A

identify risk factors
plan of care
patient safety

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4
Q

what are the subjective data for preoperative px? (6)

A

1 check client’s physiologic status
2 check physiologic factors directly or indirectly related to the surgical procedure
3 identification and documentation of the surgical site
4 check prescription drugs/ OTC drugs and herbs
5 identify cultural and ethnic factors
6 informed consent

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5
Q

what are the psychosocial assessment (5)

A 
1 situational changes
2 concerns with the unknown
3 concerns with body image
4 past experiences
5 lack of knowledge
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6
Q

what should you consider for situational changes

A

the impact of the surgery and hospitalization and possible effects on lifestyle

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7
Q

what should you explain to the patient when he/ she has concerns with the unknown

A

identify the expectations of surgery, changes in current health status, effects on daily living, and sexual activity

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8
Q

what should you do with patient when he/she has concerns with body image

A

identify current roles or relationships and view of self

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9
Q

what should the nurse assess for the patient’s past experiences

A

previous surgical experiences. hospitalization and treatments

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10
Q

what should the nurse do when the patient has lack of knowledge when it comes to surgery

A

assess understanding of surgical procedure, including preparation, care. intervention, preop activities, restriction and expected outcomes

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11
Q

effect of psychological factor

A

it can impair cognition, decision making and coping abilities

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12
Q

what is unique about Jehovah’s witness

A

they refuse blood transfusion and products

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13
Q

what are the common fears (4)

A

1 fear of death or permanent disability
2 fear of pain and discomfort
3 fear of mutilation
4 fear of disruption of life functioning

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14
Q

what is the strongest method of coping

A

hope

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15
Q

what can a nurse do to reduce anxiety and fear (4)

A

1 provide psychosocial support
2 be a good listener, be empathetic, and provide information
3 give opportunities to ask
4 acknowledge their concerns

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16
Q

what should you check for the patient past health history

A

ask about previous health problems and surgeries

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17
Q

effect of antidepressants

A

causes drowsiness

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18
Q

effect of antihypertensive

A

inhibit platelet aggregation

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19
Q

for diabetic patients, what medications should be monitored

A

insulin/oral hypoglycemic drugs

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20
Q

effect of antiplatelet drugs/ non steroidal anti-inflammatory drugs

A

causes post op bleeding

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21
Q

give examples of long-term anticoagulation therapy (2)

A

1 warfarin

2 IV heparin

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22
Q

effect of herb and dietary supplements

A

affects the sedation

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23
Q

why should patient undergoing surgery avoid astragalus and ginseng

A

suppress immune system and causes bleeding

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24
Q

why should patient undergoing surgery avoid garlic, vitamin e, ginkgo and fish oil

A

increases bleeding

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25
Q

what can tobacco, alcohol, opioids, marijuana do

A

it can cause repercussions during surgery

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26
Q

what happens when patient has decreased liver function

A

prolongs the metabolism of anesthetic agents, alters nutritional status, and increases the potential for post op complications

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27
Q

if patient is taking any complementary and alternative therapies how long should this be with hold before surgical procedure

A

2-3 weeks before

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28
Q

what does local anesthetic agents contain

A

bisulfite

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29
Q

yes/no

should you report sulfur containing drugs? why?

A

yes, because patient may have allergy

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30
Q

aside from bisulfite and sulfur allergy what allergy can be present for patient

A

iodine and betadine used for cleansing before surgery

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31
Q

when a patient has a cardiac condition, what risk can this lead to

A

increases the operative risk and could lead to decreased tissue perfusion with impairment of surgical healing

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32
Q

when a patient has a chronic respiratory disease/ infection, what risk can this lead to

A

increase the risk for bronchospasm, laryngospasm, decreased O2 sat & problems with respiratory secretions

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33
Q

cannot proceed to surgery if patient has (3)

A

1 asthma
2 COPD
3 bronchitis

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34
Q

what should the nurse check in the neuro system of patient and why

A

ability to pay attention, concentrate and respond appropriately to establish base line data for post op complication

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35
Q

what should the nurse check in the genitourinary system of the patient

A

renal function is necessary to eliminate protein waste to preserve fluid and electrolyte balance, and to remove anesthetic agents

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36
Q

give examples of renal disorders that may affect the outcome of the surgery (3)

A

1 CKD
2 Acute Nephritis
3 BPH Benign Prostatic Hyperplasia

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37
Q

what should the nurse check in the hepatic system

A

hepatic dysfunction can increased periop risk for clotting abnormalities and adverse responses to drugs

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38
Q

what to check for the integumentary system before a surgery and why

A

skin problems can affect wound healing

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39
Q

what should the nurse check in the musculoskeletal system of a patient

A

mobility restriction influence intra-op and post-op positioning and ambulation

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40
Q

what is the appropriate position for spinal anesthesia

A

dorsal recumbent

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41
Q

a patient with diabetes mellitus are risk for

A

risk for adverse effects of anesthesia and surgery

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42
Q

when do you administer drug for patient with thyroid dysfunction

A

day surgery

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43
Q

for patient with Addison’s disease what special consideration should be done during surgery

A

IV corticosteroids therapy should be given to prevent Addison’s crisis/shock

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44
Q

why is it important to check the immune system of patient before surgery

A

impairment of the immune system can lead to delayed wound healing & increased risk for infections

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45
Q

yes/ no

if there is a patient with AIDS in need of surgery can he/ she be scheduled early in the morning

A

no, since dirty cases dapat last scheduled for OR

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46
Q

why is fluid and electrolyte status important for older adults

A

reduced adaptive capacity leaves narrow margin of safety overhydration and underhydration

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47
Q

why is it important to check the nutritional status before surgery

A

nutritional problems impair the stability to recover from surgery

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48
Q

objective data (7)

what should the nurse check in the cardiovascular system of patient undergoing surgery

A

1 check acute/ chronic problems
2 check drugs
3 check prosthetic heart valves, pacemakers or implantable cardioverter-defibrillators
4 assess for edema
5 assess neck vein distention
6 check BP
7 assess capillary refill, pulses for rates, rhythm and quality

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49
Q

objective data (5)

what should the nurse check in the gastrointestinal system of patient undergoing surgery

A 
1 patterns of food & fluid intake and any recent changes in weight
2 pattern of bowel movements
3 presence of dentures and bridges
4 weight patient
5 auscultate abdomen
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50
Q

objective data (4)

what should the nurse check in the genitourinary system of patient undergoing surgery

A

1 infection
2 determine ability to void
3 note color, amount and characteristic of urine
4 pregnancy status

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51
Q

objective data (2)

what should the nurse check in the hepatic system of patient undergoing surgery

A

1 substance use

2 skin color and sclera of eyes

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52
Q

objective data

what should the nurse check in the immune system of patient undergoing surgery

A

immunodeficiency or autoimmune disorders

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53
Q

objective data

what should the nurse check in the integumentary system of patient undergoing surgery

A

skin rashes, boils, or infection

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54
Q

objective data

what should the nurse check in the musculoskeletal system of patient undergoing surgery

A

skin around bone pressure joints

55
Q

objective data (2)

what should the nurse check in the neurologic system of patient undergoing surgery

A

1 orientation to person, place and time

2 mental status

56
Q

objective data (2)

what should the nurse check in the respiratory system of patient undergoing surgery

A

1 O2 saturation and RR and rhythm

2 cough, dyspnea and use of accessory muscles of respiration

57
Q

anesthesia administration

ASA1

A

healthy patient (can proceed to surgery)

58
Q

anesthesia administration

ASA2

A

mid to moderate systemic disease/ controlled

59
Q

anesthesia administration

ASA3

A

severe to disease process/ comorbid

60
Q

anesthesia administration

ASA4

A

severe incapacitating disease/ threat to life

61
Q

anesthesia administration

ASA5

A

moribund patient not expected to survive 24 hours

62
Q

anesthesia administration

ASA6

A

brain dead

63
Q

ABG & pulse oximetry checks for

A

respiratory & metabolic function, oxygenation status

64
Q

blood glucose checks for

A

metabolic status

65
Q

BUN, creatinine checks for

A

renal function

66
Q

chest x-ray checks for

A

lung disorders, cardiac enlargement, heart failure

67
Q

cbc checks for

A

anemia, immune status, infection

68
Q

ecg checks for

A

heart disease, dysrhythmias

69
Q

electrolytes checks for

A

metabolic status, renal function, side effects of diuretics

70
Q

hcg checks for

A

pregnancy status

71
Q

liver function test checks for

A

hepatic status

72
Q

pt, ptt, inr, platelet checks for

A

coagulation status

73
Q

pulmonary function test checks for

A

pulmonary status

74
Q

serum albumin checks for

A

nutritional status

75
Q

type & crossmatch checks for

A

blood availability

76
Q

urinalysis checks for

A

renal status, hydration & UTI

77
Q

t/f

the patient has a right to know what to expect and how to take part effectively during the surgical procedure

A

true

78
Q

what are the three types of information

A

sensory
process
procedural

79
Q

identify what type of information is this

1 pre-op holding area may be noisy
2 drugs and cleaning solutions may be odorous
3 OR can be cold
4 talking may be heard but may be distorted because of mask

A

sensory information

80
Q

identify what type of information is this

1 admission area
2 pre-op holding area, OR and post anesthesia care unit (PACU)
3 caregivers can usually stay in prep holding area
4 identification of any technology that may be present on awakening

A

process information

81
Q

identify what type of information is this

1 fluid and food restrictions
2 teach deep breathing, and coughing after surgery
3 insertion of IV lines
4 procedure for anesthesia administration
5 surgical site may be marked

A

procedural information

82
Q

what type of information should the client receive before surgery

A

surgery specific information

83
Q

Give examples of a general survey information (5)

A

client receive instruction about

1 deep breathing
2 coughing
3 turning
4 pain control
5 early ambulation
84
Q

what is ICOUGH

A 
1 incentive spirometry
2 cough  and breath deeply
3 oral care
4 understand icough practice
5 get out of bed and walk the hallway
6 head of bed elevation
85
Q

what should you tell your patient during incentive spirometry

A

have the client hold their breaths for 5 seconds

86
Q

what is the effect of incentive spirometry

A

help improve pulmonary function

87
Q

what should you instruct to your patient before doing the coughing excercise

A

give a pillow to the client to “hug” against their abdominal or chest wall before they cough

88
Q

what is necessary to clear secretion that may accumulate in the lungs

A

coughing

89
Q

what should be the position of the patient when doing diaphragmatic breathing

A

semi-fowlers

90
Q

what is the benefit of diaphragmatic breathing

A

helps prevent pneumonia

91
Q

t/f

make sure that the client is turned from one side to back and vice versa every 3 hours

A

false

2 hours only

92
Q

t/f

repeat 5 times with one leg and the other every 3-5 hours

A

true

93
Q

what is important to maintain good blood circulation in your legs, maintain muscle strength, and prevent joint stiffness

A

leg exercises

94
Q

what should you tell your patient patient who is undergoing elective surgery

A

tell patient NPO starting midnight on the night before surgery

95
Q

what is the minimum fasting period for “clear liquids”

A

2 hours before surgery

96
Q

what is the minimum fasting period for “ non-human milk”

A

6 hours before surgery

97
Q

what is the minimum fasting period for “light meal”

A

6 hours before surgery

98
Q

what is the minimum fasting period for “fried foods, fatty foods/ meat

A

additional fasting time of 8 hours to 10 hours before surgery

99
Q

child’s procedure

what is the minimum fasting period for “breast milk”

A

4 hours

100
Q

child’s procedure

what is the minimum fasting period for “clear liquids”

A

2 hours

101
Q

child’s procedure

what is the minimum fasting period for “infant formula and non-human milk”

A

6 hours

102
Q

child’s procedure

what is the minimum fasting period for “light meals”

A

6 hours

103
Q

child’s procedure

what is the minimum fasting period for “heavy meals”

A

8-10 hours

104
Q

child’s procedure

what is the minimum fasting period for “medications”

A

usual time with sip of water

exceptions: hold ACE inhibitors and ARBs on day of surgery

105
Q

what is NPO

A

nothing by mouth

106
Q

what is the purpose of informed consent

A

to ensure that the client understands the nature of this or her treatment including the possible complications and disfigurement

107
Q

what is informed consent

A

is an active, shared decision making process between the HCP and recipient of care

108
Q

what are the three conditions for consent

A

1 adequate disclosure
2 clear understanding of information
3 give consent voluntarily

109
Q

in the consent form

what is the role of the surgeon

A

obtaining the consent

110
Q

in the consent form

what is the role of the nurse

A

witness the client’s signature

111
Q

in the consent form

what is the role of the patient

A

aware that consent, even when signed, can be withdrawn at any time

112
Q

when do you legally appoint a representative to responsible family member (3)

A

1 minor
2 unconscious
3 mentally incompetent

113
Q

who is younger that the legal age of consent but is recognized as having the legal capacity to provide consent

A

emancipated minor

114
Q

when can you override the need to obtain consent

A

medical emergency

115
Q

when preparing for the skin of the patient undergoing a surgery, what should be done before going surgery

A

shower/ bathing the night before a scheduled surgery

116
Q

what nursing intervention should be done to prevent trauma in the skin during transfer

A

put padding on bony prominences

117
Q

what preparations should be done for the gastrointestinal tract of a patient

A

1 restrict foods & fluids 8-10 hrs

2 inform the diet and nutrition department and family

118
Q

when is enema indicated for patient undergoing a surgery

A

especially operation in GIT, perianal area and pelvic cavity

119
Q

what should you verify at the day of surgery (7)

A 
1 signed informed consent form
2 results of lab and diagnostic
3 history & physical exam
4 record any consultations
5 baseline vs
6 proper skin preparation
7 completed nursing notes
120
Q

how often do you give eye drops prior to cataract

A

every 5 mins

121
Q

give examples of tranquilizers and sedatives (4)

A

1 diazepam
2 midazolam
3 lorazepam
4 diphenhydramine

122
Q

effects of tranquilizers

A

decreased anxiety, induce sedation, for relaxation

123
Q

give examples of analgesics (4)

A

1 nalbuphine
2 fentanyl
3 meperidine
4 morphine SO4

124
Q

effects of analgesics

A

relieves pain during preoperative procedure

125
Q

give examples of H2 agonist and proton pump inhibitors (4)

A

1 cimetidine
2 ranitidine
3 famotidine
4 omeprazole

126
Q

effects of H2 agonist and proton pump inhibitors

A

decrease HCL acid secretions, increased PH, decreased gastric volume

127
Q

give example of anticholinergic

A

atropine sulfate

128
Q

effects of anticholinergic

A

decrease oral and respiratory secretions

129
Q

give examples of antibiotics

A

1 amoxicillin
2 cefazolin
3 ampicillin

130
Q

effects of antibiotics

A

prevent postoperative infection

131
Q

what is the importance of giving preoperative checklist

A

this is important before the patient receives any sedating drugs

132
Q

how must you transfer an inpatient

A

transport staff move the patient by stretcher or OR

133
Q

how must you transfer for ambulatory surgical center

A

may use a stretcher/ wheelchair

MEDICAL SURGICAL (3 decks)

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