PERIOPERATIVE Flashcards
1
Q
preoperative phase is
A
the time before the surgery
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
3
Q
overall goal of the preparative assessment to ___ and ___ to ensure ___ throughout surgical experience
A
identify risk factors
plan of care
patient safety
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
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
6
Q
what should you consider for situational changes
A
the impact of the surgery and hospitalization and possible effects on lifestyle
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
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
9
Q
what should the nurse assess for the patient’s past experiences
A
previous surgical experiences. hospitalization and treatments
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
11
Q
effect of psychological factor
A
it can impair cognition, decision making and coping abilities
12
Q
what is unique about Jehovah’s witness
A
they refuse blood transfusion and products
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
14
Q
what is the strongest method of coping
A
hope
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
16
Q
what should you check for the patient past health history
A
ask about previous health problems and surgeries
17
Q
effect of antidepressants
A
causes drowsiness
18
Q
effect of antihypertensive
A
inhibit platelet aggregation
19
Q
for diabetic patients, what medications should be monitored
A
insulin/oral hypoglycemic drugs
20
Q
effect of antiplatelet drugs/ non steroidal anti-inflammatory drugs
A
causes post op bleeding
21
Q
give examples of long-term anticoagulation therapy (2)
A
1 warfarin
2 IV heparin
22
Q
effect of herb and dietary supplements
A
affects the sedation
23
Q
why should patient undergoing surgery avoid astragalus and ginseng
A
suppress immune system and causes bleeding
24
Q
why should patient undergoing surgery avoid garlic, vitamin e, ginkgo and fish oil
A
increases bleeding
25
what can tobacco, alcohol, opioids, marijuana do
it can cause repercussions during surgery
26
what happens when patient has decreased liver function
prolongs the metabolism of anesthetic agents, alters nutritional status, and increases the potential for post op complications
27
if patient is taking any complementary and alternative therapies how long should this be with hold before surgical procedure
2-3 weeks before
28
what does local anesthetic agents contain
bisulfite
29
yes/no
should you report sulfur containing drugs? why?
yes, because patient may have allergy
30
aside from bisulfite and sulfur allergy what allergy can be present for patient
iodine and betadine used for cleansing before surgery
31
when a patient has a cardiac condition, what risk can this lead to
increases the operative risk and could lead to decreased tissue perfusion with impairment of surgical healing
32
when a patient has a chronic respiratory disease/ infection, what risk can this lead to
increase the risk for bronchospasm, laryngospasm, decreased O2 sat & problems with respiratory secretions
33
cannot proceed to surgery if patient has (3)
1 asthma
2 COPD
3 bronchitis
34
what should the nurse check in the neuro system of patient and why
ability to pay attention, concentrate and respond appropriately to establish base line data for post op complication
35
what should the nurse check in the genitourinary system of the patient
renal function is necessary to eliminate protein waste to preserve fluid and electrolyte balance, and to remove anesthetic agents
36
give examples of renal disorders that may affect the outcome of the surgery (3)
1 CKD
2 Acute Nephritis
3 BPH Benign Prostatic Hyperplasia
37
what should the nurse check in the hepatic system
hepatic dysfunction can increased periop risk for clotting abnormalities and adverse responses to drugs
38
what to check for the integumentary system before a surgery and why
skin problems can affect wound healing
39
what should the nurse check in the musculoskeletal system of a patient
mobility restriction influence intra-op and post-op positioning and ambulation
40
what is the appropriate position for spinal anesthesia
dorsal recumbent
41
a patient with diabetes mellitus are risk for
risk for adverse effects of anesthesia and surgery
42
when do you administer drug for patient with thyroid dysfunction
day surgery
43
for patient with Addison's disease what special consideration should be done during surgery
IV corticosteroids therapy should be given to prevent Addison's crisis/shock
44
why is it important to check the immune system of patient before surgery
impairment of the immune system can lead to delayed wound healing & increased risk for infections
45
yes/ no
if there is a patient with AIDS in need of surgery can he/ she be scheduled early in the morning
no, since dirty cases dapat last scheduled for OR
46
why is fluid and electrolyte status important for older adults
reduced adaptive capacity leaves narrow margin of safety overhydration and underhydration
47
why is it important to check the nutritional status before surgery
nutritional problems impair the stability to recover from surgery
48
objective data (7)
what should the nurse check in the cardiovascular system of patient undergoing surgery
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
49
objective data (5)
what should the nurse check in the gastrointestinal system of patient undergoing surgery
```
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
```
50
objective data (4)
what should the nurse check in the genitourinary system of patient undergoing surgery
1 infection
2 determine ability to void
3 note color, amount and characteristic of urine
4 pregnancy status
51
objective data (2)
what should the nurse check in the hepatic system of patient undergoing surgery
1 substance use
| 2 skin color and sclera of eyes
52
objective data
what should the nurse check in the immune system of patient undergoing surgery
immunodeficiency or autoimmune disorders
53
objective data
what should the nurse check in the integumentary system of patient undergoing surgery
skin rashes, boils, or infection
54
objective data
what should the nurse check in the musculoskeletal system of patient undergoing surgery
skin around bone pressure joints
55
objective data (2)
what should the nurse check in the neurologic system of patient undergoing surgery
1 orientation to person, place and time
| 2 mental status
56
objective data (2)
what should the nurse check in the respiratory system of patient undergoing surgery
1 O2 saturation and RR and rhythm
| 2 cough, dyspnea and use of accessory muscles of respiration
57
anesthesia administration
ASA1
healthy patient (can proceed to surgery)
58
anesthesia administration
ASA2
mid to moderate systemic disease/ controlled
59
anesthesia administration
ASA3
severe to disease process/ comorbid
60
anesthesia administration
ASA4
severe incapacitating disease/ threat to life
61
anesthesia administration
ASA5
moribund patient not expected to survive 24 hours
62
anesthesia administration
ASA6
brain dead
63
ABG & pulse oximetry checks for
respiratory & metabolic function, oxygenation status
64
blood glucose checks for
metabolic status
65
BUN, creatinine checks for
renal function
66
chest x-ray checks for
lung disorders, cardiac enlargement, heart failure
67
cbc checks for
anemia, immune status, infection
68
ecg checks for
heart disease, dysrhythmias
69
electrolytes checks for
metabolic status, renal function, side effects of diuretics
70
hcg checks for
pregnancy status
71
liver function test checks for
hepatic status
72
pt, ptt, inr, platelet checks for
coagulation status
73
pulmonary function test checks for
pulmonary status
74
serum albumin checks for
nutritional status
75
type & crossmatch checks for
blood availability
76
urinalysis checks for
renal status, hydration & UTI
77
t/f
the patient has a right to know what to expect and how to take part effectively during the surgical procedure
true
78
what are the three types of information
sensory
process
procedural
79
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
sensory information
80
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
process information
81
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
procedural information
82
what type of information should the client receive before surgery
surgery specific information
83
Give examples of a general survey information (5)
client receive instruction about
```
1 deep breathing
2 coughing
3 turning
4 pain control
5 early ambulation
```
84
what is ICOUGH
```
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
what should you tell your patient during incentive spirometry
have the client hold their breaths for 5 seconds
86
what is the effect of incentive spirometry
help improve pulmonary function
87
what should you instruct to your patient before doing the coughing excercise
give a pillow to the client to "hug" against their abdominal or chest wall before they cough
88
what is necessary to clear secretion that may accumulate in the lungs
coughing
89
what should be the position of the patient when doing diaphragmatic breathing
semi-fowlers
90
what is the benefit of diaphragmatic breathing
helps prevent pneumonia
91
t/f
make sure that the client is turned from one side to back and vice versa every 3 hours
false
2 hours only
92
t/f
repeat 5 times with one leg and the other every 3-5 hours
true
93
what is important to maintain good blood circulation in your legs, maintain muscle strength, and prevent joint stiffness
leg exercises
94
what should you tell your patient patient who is undergoing elective surgery
tell patient NPO starting midnight on the night before surgery
95
what is the minimum fasting period for "clear liquids"
2 hours before surgery
96
what is the minimum fasting period for " non-human milk"
6 hours before surgery
97
what is the minimum fasting period for "light meal"
6 hours before surgery
98
what is the minimum fasting period for "fried foods, fatty foods/ meat
additional fasting time of 8 hours to 10 hours before surgery
99
child's procedure
what is the minimum fasting period for "breast milk"
4 hours
100
child's procedure
what is the minimum fasting period for "clear liquids"
2 hours
101
child's procedure
what is the minimum fasting period for "infant formula and non-human milk"
6 hours
102
child's procedure
what is the minimum fasting period for "light meals"
6 hours
103
child's procedure
what is the minimum fasting period for "heavy meals"
8-10 hours
104
child's procedure
what is the minimum fasting period for "medications"
usual time with sip of water
exceptions: hold ACE inhibitors and ARBs on day of surgery
105
what is NPO
nothing by mouth
106
what is the purpose of informed consent
to ensure that the client understands the nature of this or her treatment including the possible complications and disfigurement
107
what is informed consent
is an active, shared decision making process between the HCP and recipient of care
108
what are the three conditions for consent
1 adequate disclosure
2 clear understanding of information
3 give consent voluntarily
109
in the consent form
what is the role of the surgeon
obtaining the consent
110
in the consent form
what is the role of the nurse
witness the client's signature
111
in the consent form
what is the role of the patient
aware that consent, even when signed, can be withdrawn at any time
112
when do you legally appoint a representative to responsible family member (3)
1 minor
2 unconscious
3 mentally incompetent
113
who is younger that the legal age of consent but is recognized as having the legal capacity to provide consent
emancipated minor
114
when can you override the need to obtain consent
medical emergency
115
when preparing for the skin of the patient undergoing a surgery, what should be done before going surgery
shower/ bathing the night before a scheduled surgery
116
what nursing intervention should be done to prevent trauma in the skin during transfer
put padding on bony prominences
117
what preparations should be done for the gastrointestinal tract of a patient
1 restrict foods & fluids 8-10 hrs
| 2 inform the diet and nutrition department and family
118
when is enema indicated for patient undergoing a surgery
especially operation in GIT, perianal area and pelvic cavity
119
what should you verify at the day of surgery (7)
```
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
how often do you give eye drops prior to cataract
every 5 mins
121
give examples of tranquilizers and sedatives (4)
1 diazepam
2 midazolam
3 lorazepam
4 diphenhydramine
122
effects of tranquilizers
decreased anxiety, induce sedation, for relaxation
123
give examples of analgesics (4)
1 nalbuphine
2 fentanyl
3 meperidine
4 morphine SO4
124
effects of analgesics
relieves pain during preoperative procedure
125
give examples of H2 agonist and proton pump inhibitors (4)
1 cimetidine
2 ranitidine
3 famotidine
4 omeprazole
126
effects of H2 agonist and proton pump inhibitors
decrease HCL acid secretions, increased PH, decreased gastric volume
127
give example of anticholinergic
atropine sulfate
128
effects of anticholinergic
decrease oral and respiratory secretions
129
give examples of antibiotics
1 amoxicillin
2 cefazolin
3 ampicillin
130
effects of antibiotics
prevent postoperative infection
131
what is the importance of giving preoperative checklist
this is important before the patient receives any sedating drugs
132
how must you transfer an inpatient
transport staff move the patient by stretcher or OR
133
how must you transfer for ambulatory surgical center
may use a stretcher/ wheelchair
