Perioperative

Question 1

elderly considerations

Answer 1

• decrease fatty subq fat makes them more susceptible to temperature changes
• decrease body and organ functions
• may need more education
• respiratory and cardiac problems are the leading cause of post op death

Question 2

bariatric consideration

Answer 2

• increase fatty tissue increases chance of infection
• risk for dehiscence
• low reserve
• high risk of hypoventilation postop
• movement restriction
• increase cardiac and pulmonary functionality problems

Question 3

disability considerations

Answer 3

• difficulty transferring and positioning
• may need more pre-op education
• may have difficulty communicating

Question 4

main concerns during preop

Answer 4

• decreasing stress and anxiety
• education
• decreasing risk for post op complications

Question 5

preoperative assessment

Answer 5

• physical assessment
• vitals signs, temperature
• oxygenation status
• surgical hx?
• comorbidities?
• family hx?
• medications/allergies?
• smoke/etoh/drugs?
• nutritonal fluid status
• dentition
• respiratory and cv status
• risk for VTE
• hepatic/renal function
• anxiety/fears?

Question 6

how coricosteroids (dexamethasone) can affect perioperative

Answer 6

• helps with stress of surgery
• masks infection
• decreases wound healing
• increases glucose levels
• risks for bleeding

Question 7

how diuretics (hctz, furosemide) can affect perioperative

Answer 7

• electrolyte imbalance
• decrease fluid
• hypotension
• fall risk
• monitor ABCs during surgery
• monitor weight

Question 8

how BENZOs and tranquilizers (diazepam) affect perioperative

Answer 8

• effects narcotics

- hypotension

Question 9

how antihypertensives affect perioperative

Answer 9

-needed to prevent increase in BP intraoperatively

Question 10

how anticoags/salicylates/nsaids (warfarin) affect perioperative

Answer 10

increases risk for bleeding

Question 11

how opioids (morphine) affects perioperative

Answer 11

affects respiratory system and bp

Question 12

post op education

Answer 12

• deep breathing, coughing, IS
• mobility ROM
• pain management

Question 13

elderly considerations intraoperatively

Answer 13

positioning because of their bony prominences and loss of skeletal mass

Question 14

role of the circulating nurse

Answer 14

• monitors team
• delegation (legal and ethical)
• make sure informed consent is signed
• specimen tagged correctly
• aseptic practices
• time out

Question 15

scrub tech role

Answer 15

• aseptic technique
• setting up the sterile field
• handing the instruments to surgeon
• counting the instruments

Question 16

types of anesthesia

Answer 16

• general anesthesia
• regional anesthesia
• local anesthesia

Question 17

general anesthesia

Answer 17

• causes loss of sensation, reflexes, and consciousness
• can’t breathe on their own, can’t feel painful stimuli, not arousable
• assessment done by anesthesia providers
• inhalation agents or iv anesthetic agents

Question 18

inhalation agents

Answer 18

• halothane, isoflurane, nitrous oxide

- given with oxygen

Question 19

iv anesthetic agents

Answer 19

• benzo, etomidate, propofol, ketamine
• can be used to induce or maintain aesthetic
• neuromuscular blocking agent
• must have resuscitation or ventilation devices near
• don’t admin propofol if pt has egg or soybean allergy

Question 20

regional anesthesia

Answer 20

• decrease in feeling in a specific part of the body
• inject local anesthesia and block peripheral nerves
• pt is awake
• spinal anesthesia or epidural

Question 21

local anesthesia

Answer 21

injection of local anesthetic into tissues at planned incision site

Question 22

spinal anesthesia

Answer 22

• injected into subarachnoid space (between L4 & L5)

- provides autonomic, sensory, and motor blockade to lower extremities, perineum, and lower abdomen

Question 23

complications of spinal anesthesia

Answer 23

• headache from csf leakage, size of needle, or dehydation
• instruct to lay flat and stay hydrated
• n/v
• pain

Question 24

epidural anesthesia

Answer 24

• injected in epidural space in thoracic or areas of spine

- blocks sensory pathways but motor function stays intact

Question 25

intraoperative complications

Answer 25

- anesthesia awareness - respiratory - hypothermia - malignant hyperthermia

Question 26

possible respiratory problems intraoperatively

Answer 26

- intubations problems - inadequate ventilation, occluded airway (o2 stat, auscultate, skin, respirations) - esophageal intubation (distended abdomen) - unrecognized hypoventilation (can affect major organs)

Question 27

hypothermia

Answer 27

- decrease in cellular oxygen - from warm gasses - decreases in muscle activity - place warm blankets

Question 28

malignant hyperthermia

Answer 28

- medical emergency - hypermetabolic condition: alter in ca activity in skeletal muscle cells - trigger: inhalation anesthetic agents and succinylcholine combo - treat sx - early identification is key!

Question 29

sx of malignant hyperthermia

Answer 29

- early signs: tachycardia, increased co2, generalized muscle rigidity - late sign: hyperthermia - decreased o2

Question 30

initial PACU assessment

Answer 30

- airway: check for patent airway - breathing: place hand near mouth, auscultate, assess respirations, check o2 saturation, give supplemental 02 - circulation: monitor ecg, measure bp frequently, assess skin color & temp, assess tissue perfusion (peripheral pulses, capillary refill)

Question 31

how to maintain patent airway

Answer 31

- provide o2 - assess breathing - positioning: hob elevated 15-30 - tcdb - suction if cant cough - reposition to side if vomiting - stay at bedside of pt with oral airway

Question 32

maintaining cv stability

Answer 32

-monitor for hypotension, shock, hemorrhage, hypertension, dysrhythmias

Question 33

monitoring/managing hypotension, shock

Answer 33

- low bp, high hr (commonly from fluid or blood loss) - increase iv fluids - assess surgery site - monitor h&h levels

Question 34

managing/monitoring hemmorhage

Answer 34

- monitor hr - monitor surgery site - not drainage increase - restore circulating volume

Question 35

monitoring/managing htn

Answer 35

- from sympathetic stimulation from pain, anxiety, bladder distention, resp. compromise - hypothermia or pre-existing htn - possible result of revascularization

Question 36

monitoring/managing for dysrhythmias

Answer 36

- leading causes: hypokalemia, hypoxemia, change in pH balance, circulatory instability, pre-existing heart disease - other causes: hypothermia, pain, surgical stress, meds

Question 37

s/s of hypovolemic shock/hemorrhage

Answer 37

- changes in loc - pallor - cool, moist skin - tachypnea - cyanosis - rapid, weak thready pulse - hypotension - narrowed pulse pressure - concentrated urine

Question 38

what to do when pt has hypovolemic shock or hemorrhage

Answer 38

place with head down and legs elevated

Question 39

managing airway obstruction

Answer 39

- assess respiratory - head tilt/chin lift, pull tongue forward and open airway - resuscitation equipment

Question 40

managing hypoxia

Answer 40

- elevate hob - tcdb - frequent reposition - monitor o2 sat - give o2 as indicated

Question 41

managing hypovolemic shock

Answer 41

- admin o2 - supine with legs up, head down - iv fluids - vasopressors (tightens vessels and increases bp)

Question 42

managing paralytic ileus

Answer 42

- assess bowel sounds - ambulation - advance diet as tolerated - metoclopramide: stimulate peristalsis - ng tube if needed

Question 43

managing dehiscence/evisceration

Answer 43

- cover with moistened saline, reassure pt, get help | - low fowlers, knees flexed, monitor for shock, call HCP

Question 44

risk factors for dehiscence/evisceration

Answer 44

- obesity - coughing - no splinting - dm - infection - hematoma

Question 45

managing dvt

Answer 45

- ted, sed hose - heparin if needed - early ambulation - hydration - no pressure behind knees

Question 46

dvt risk factors

Answer 46

- dehydration - hypercoagulability - immobility - obesity - trauma - hormones