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kol- Med Surg 320 Spring > Perioperative > Flashcards

Perioperative Flashcards

1
Q

3 phases of perioperative nursing care

A

preoperative, intraoperative, postoperative

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2
Q

Define an elective surgery, how many surgeries are elective?

A

surgery that can be scheduled >24-48 hours away

  • most! 90%
  • it is not something you don’t have to have
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3
Q

5 reasons for surgery

A
  1. diagnostic
  2. curative
  3. restorative
  4. palliative
  5. cosmetic
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4
Q

type of surgery that provides person with comfort and extension of time, ex: remove tumor but can’t get rid of completely but makes person more comfortable and extends life

A

palliative

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5
Q

type of surgery that is done to regain original function

A

restorative

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6
Q

3 extents of surgery

A
  • Simple: removing part of a toe nail
  • Minimally Invasive: Laparoscopic
  • Radical: amputation, radical hysterectomy- take everything out
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7
Q

when does PREoperative phase begin?

A

-Begins the time the surgery is scheduled until the patient goes into the surgical suite

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8
Q

Nursing priorities for preoperative phase

A
  • preparing patient for surgery
    • pt education
    • pt safety
    • patient advocacy
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9
Q

increase risk of latex allergy with

A

strawberry/banana allergy

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10
Q

what allergy correlates with propofol allergy?

A

nuts

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11
Q

what allergy correlates with betadine/IV contrast?

A

shellfish

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12
Q

Let surgeon know if BP is > _____ due to increase risk of bleeding/CV event

A

180

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13
Q

Why do we care about renal status of patient preoperative?

A

will determine how well body will clear anesthetic

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14
Q

Lab test preoperatively

A
  • Urinalysis
  • Pregnancy test
  • Blood Work
  • CBC: check for infection, low platelets for increase bleeding risk
  • BMP: renal fxn, electrolytes, low potassium = CV events in surgerty
  • Blood Type and Screen
  • Blood coagulation
  • PT
  • INR: if stopped coumadin
  • aPTT- blood coagulation
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15
Q

When does informed consent occur?

A

before surgery is performed or sedation is administered

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16
Q

What are components of informed consent?

A

> Nature of surgery and reason for surgery
Person performing the surgery
Who will be present during surgery
Alternatives to this specific surgery
Associated risks with this surgery and alternative options
Risks of anesthesia
Correct site verification

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17
Q

Who provides informed consent for surgery?

A

Surgeon is responsible for providing detailed information about the surgery
(Anesthesiologist provides consent for anesthesia)

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18
Q

What is role of nurse in informed consent? (3)

A
  • To clarify facts presented by the surgeon during the informed consent process
  • Verify that the consent form is signed
  • Serve as a witness to the patient’s/ HCPOA’s signature
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19
Q

What do you need if someone blind is signing informed consent?

A

-need another witness for signing

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20
Q

Non/english speaking patient and informed consent?

A

need interpreter present DURING informed consent

process

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21
Q

Informed consent: if Emergency/ patient unable to sign-

A

provider signs emergency form if can’t find next of kin of designated HCPOA

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22
Q

Informed consent patient unable to sign for self and not an emergency?

A

need to get next of kin

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23
Q

Informed consent and patients are unable to write?

A

can sign an “X” with a witness

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24
Q

informed consent and physically unable to write

A

= need 2 witnesses

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25
Q

if patient refuses surgery, do you need to sign an informed consent?

A

nope,, call surgeon to clarify canceling surgery

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26
Q

What do you do if a patient is unclear on surgery and hasn’t signed the consent yet?

A

do not have them sign and get surgeon to clarify

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27
Q

Why are patients required to be NPO before surgery?

A

-do not want anything in stomach do to increase risk of vomiting or aspirating

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28
Q

If patient eats before surgery, then surgery can be_____

A

cancelled

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29
Q

How long to be NPO?

A

> 8 hours
but also
6 hours solids, >2 hours clears

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30
Q

Metoprolol and blood thinners before surgery?

A
  • Blood thinners (plavix, aspirin) = do NOT take morning of surgery
  • Beta Blockers if normally on it like Metoprolol = take it!
  • If in doubt- find out!
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31
Q

What size IV before surgery?

A
  • Intravenous Access:
    • Large Bore preferred
    • 18G-20G
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32
Q

Does everyone need to have foley or NG tube before surgery?

A

no, will depend on the surgery

33
Q

Who has to be STERILE in surgery?

A
  • Surgeon
  • Surgeon assistant:
	Resident
	Advanced Nurse Practitioner
	Physician’s Assistant
	Registered Nurse First Assistant
	Surgical Technician
*Scrub nurse or Scrub tech
34
Q

What is role of circulating nurse?

A

person makes sure things are running smoothly and documents

35
Q

When does time out occur?

A

before incision

36
Q

What are components of time out?

A

Correct Patient
Correct Site
Correct Procedure
Has Antibiotic Been Given? (w/in 60 minutes)
Is Necessary Imaging Available if needed?

37
Q

What does anyone is OR need to wear? why?

A

-Anyone working in OR must wear scrub attire
-Clean (not sterile)
FXN: Reduce risk for infection

38
Q

Who has to scrub in?

A
  • Surgeon
    • Assistant
    • Scrub Nurse/ Technician
39
Q

When do you have to scrub in?

A
  • After Mask

- Before Donning gloves and gown

40
Q

How do you scrub in?

A

1) Antimicrobial soap for hands
2) Surgical Scrub with surgical antimicrobial
- Fingertips to elbows
- 3-5 minutes
- Dry with sterile towel
- Walks with hands above waist into OR, assisted with gown, then gloves
- Only sterile on FRONT from WAIST UP

41
Q

definition of anesthesia?

A
  • Induced state of part or entire loss of sensory perception with or without loss of consciousness
  • Block nerve impulse transmission, suppress reflexes, induce muscle relaxation and to often induce loss of consciousness (controlled)
42
Q

3 types of anesthesia?

A

general, local, regional

43
Q

which anesthesia has the highest risk?

A

general

44
Q

type of anesthsia:

sometimes some loss of consciousness, put lidocaine on area before putting needle in, very small amount

A

local

45
Q

type of anesthesia: sometimes some loss of consciousness, larger- entire arm/leg

A

Regional

46
Q

What is twilight sedation?

A

sedated but able to talk

47
Q

What is malignant hyperthermia?

A

Inherited autosomal disorder
-Results in thermoregulation problems (High body temperature)
-Patho: Skeletal muscle exposure to anesthesia–> Increase in calcium levels and
muscle metabolism –>Increase in metabolic rate

48
Q

Early signs of malignant hyperthermia?

A
  • decreased O2
  • increased end tidal CO2
  • Tachycardia
49
Q

Signs of malignant hyperthermia?

A

*= early signs
*-Decreased O2 saturation/ Increased end-tidal CO2 (normal =35-45) (increase
to 55 = assess for malignant hyperthermia)
-Tachycardia
-High body temperature (108), late in game for presentation
-Dysrhythmias
-Muscle rigidity (late)
-Hypotension
-Skin Mottling
-Cola-Colored Urine- broken down muscle in urine (late)
(getting acidotic)

50
Q

treatment for malignant hyperthermia?

A

Treatment= Dantrolene , stop giving meds we are giving

  • If someone has hxs of Malignant Hyperthermia
    • change meds ahead of time
    • preemptively give Dantrolene
51
Q

When is onset of malignant hyperthermia?

A

can occur immediately or even post operatively

52
Q

Nurses role in anesthesia induction?

A

Positioning of Patient (prevent pressure ulcers, hyperextension)
Assisting anesthesia provider
Observing for breaks in sterile technique
Soothe patient

53
Q

What is on the pre-surgery checklist?

A
  • Dentures? Removable dental inserts: cannot intubate with dentures
  • Attire: hospital gown
  • Jewelry removed
  • Contacts removed
  • Hearing Aids removed
  • Glasses removed
54
Q

intraoperative assessment includes

A
  • Confirm patient identification
  • Confirm Informed Consent (form signed? Patient consented?)
  • Confirm Allergies
  • Pre-surgery checklist:
55
Q

intraoperative interventions

A
  • Position
  • Transferring
  • Gel Pads
  • Comfort
  • Warmth: prevent hyperthermia
  • Reducing interruptions
56
Q

when does postoperative period begin?

A

-Begins with completion of surgery and transfer of patient to PACU, ambulatory care or ICU

57
Q

How many phases of postoperative care?

A

3

58
Q

What is priority of Phase I postoperative care?

A

Airway management!

59
Q

What happens in phase 1 post operative care? How long does it last? priorities?

A
  • Immediately after surgery until hemodynamic stability
  • Most commonly takes place in PACU (Post anesthesia care unit)
  • May occur in the Intensive Care Unit
  • Priority is airway management
  • Frequent vital signs- every 15 mins for 1 hr, every 30 for 4 hours, etc
  • Level of consciousness assessment
60
Q

When does phase 2 postoperative care occur? how long does it last? what happens?

A
  • Begins at end at Phase I and ends when patient achieves pre-surgery level of alertness (and hemodynamic stability)
  • Can last varying lengths of time
  • Preparing patient for care in extended care environment
    • Medical-Surgical Unit
    • Step-Down Unit
    • Home
    • Skilled Nursing Facility ”SNF”
61
Q

What is phase 3 postoperative care? Where does this occur, fxn?

A

“Extended Care Environment”

  • Hospital or Home or SNF
  • Ongoing until back to initial fxn
62
Q

What happens in. PACU?

A

Ongoing evaluation and stabilization of patients in order to anticipate, prevent and manage complications after surgery
*Airway is priority!

63
Q

Who is giving handoff to pacu nurse?

A

-Verbal hand-off from/ between Circulating Nurse and Anesthesia provider to/ with PACU nurse (NPSG via Joint Commission)

64
Q

What is happening in postoperative assessment?

A
  • Level of Consciousness
  • Vital Signs
  • Surgical Site
  • “Post Anesthesia Recovery Score”
    • Discharge when score is 9-10
  • systems: resp, CV, neuro, fluid electrolyte, kidney/urinary, GI, wound
65
Q

Postoperative Respiratory assessment? what do if snoring? stridor?

A
  • ABC ☺
  • Patent Airway? Gas Exchange?
  • Snoring? - simple airway maneuver if snoring or think tongue is blocked
  • Stridor? - high pitched- upper airway closing- GET HELP! intubate and/or IV steroids
  • Continuous Pulse Oximetry (> 95%)
  • Respiratory rate& depth
  • Lung sounds- monitor for fluid overload
  • Work of Breathing- accessory muscles? = resp. distress
66
Q

postoperative CV assessment

A
  • Vital Signs (Blood pressure, Heart rate)
  • Heart sounds
  • Telemetry- continuous post op
  • Pulses
  • “CMS” (Circulation, motion & Sensation)
67
Q

Post-operative neuro assessment?

A
  • Know the baseline!
  • Level of Consciousness
  • Voice –>Touch –> progressively increase to arouse
  • Orientation
  • Motor & Sensory Function
  • PAIN LEVEL*
68
Q

Post operative:Assessment: Fluid, Electrolyte & Acid-Base

A
  • Intake & Output/ Hydration status
    • Urine
    • Vomit- common complication of anesthesia
    • Wound drainage
    • NG tube output
    • IV fluids
  • Abg’s
  • Lab Values
69
Q

post operative assessment kidney/urinary

A
  • Urinary retention
    • Bladder Scanner
    • Bladder distension
  • Assess Urine
    • Color
    • Amount
    • Clarity
    • Urinary output < 30ml/hr = BAD! report it
70
Q

post operative assessment GI

A 
Nausea & Vomiting
	MED to treat/prevent:
	-Ondansetron (zofran)
	-Dimenhydrinate (dramamine)
	-Scopolamine
Can cause: 
-*Increases risk for aspiration
-Increases intracranial & Intraocular pressure Treat: cool washcloth over neck and back of head
  • Monitor bowel sounds & gas
  • NG tube output
  • Constipation-decrease motility, chew gum/ambulation helps
71
Q

post operative wound assessment

A

-Closure
-Skin
Color
Swelling
Temperature
Sensation
*assess at site and around
-Drainage
Serous
Serosanguinous
Sanguinous
Purulent
*drainage after surgery is usually serous or serosanguinous, want to get better w/ time
-Dehiscence- wound opens
-Evisceration- contents of abdomen are poking out, cover with wet sterile dressing

-Wound Drains
Jackson Pratt - bulb , squeeze n cap to create vaccum
Hemovac (Accordian) - squeeze n cap to create vacuum
Penrose- open tube/straw type drain

72
Q

Surgical complications?

A
  • Pneumonia: PREVENTION: move, manage pain for increasing deep breath
  • DVT’s –> pulmonary emboli
  • Bleeding - if you cant see it will see: Increase HR, decrease BP = shock
  • Anxiety
  • Paralytic Ileus
  • Bowel Obstruction: passing gas important. evidenced by waves of n/v
  • Infection- post op infection = infection w/in 30 days of surgery
  • Shock- Increase HR, decrease BP
  • Delayed wound healing- as risk = diabetes, elderly, immune suppressant, malnutrition
73
Q

define post op surgical infection

A

infection w/in 30 days of surgery

74
Q

signs of shock?

A

increase HR, decrease BP

75
Q

when can you give NSAID post operatively?

A

after risk of lbeeding is reduced

76
Q

Whats up with opioids and post op pain?

A

not everyone needs an opioid post op!

77
Q

How do we manage pain post op?

A

Multimodal

78
Q

3 ways to prevent blood clots post op

A
  • TED hose
    • SCD’s
    • Lovenox
79
Q

incentive spirometer- how often? inhale or exhale?

A

10x/hour

doing it on the INhale

kol- Med Surg 320 Spring (43 decks)

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