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MEDSURG INTRODUCTION > PERIOPERATIVE > Flashcards

PERIOPERATIVE Flashcards

1
Q

Is the art and science of treating diseases, injuries, and deformities by operation and instrumentation

A

Surgery

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2
Q

1500’s

A

Surgical Advancements by Ambroise Pare of France

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3
Q

1800’s

A

Ephraim Mcdowell pioneered abdominal surgeries

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4
Q

1865

A

Joseph Lister introduced the use of carbolic acid to prevent infection on surgical wounds

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5
Q

Surgical gloves were worn

A

1898

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6
Q

Establishment of Association of Operating Room Nurses (AORN)

A

1949

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7
Q

First open heart surgery was performed in Cape Town, SA

A

1967

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8
Q

Used to describe the care of patients in the immediate preoperative, intraoperative, and postoperative phases of the surgical experience

A

Operating Room Nursing

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9
Q

Implies the delivery of comprehensive patient care with the preoperative, intraoperative, and postoperative periods of the patient’s experiencing during operative and other invasive procedures by using the framework of the nursing process.

A

Perioperative Nursing

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10
Q

Determination of the presence and extent of a pathologic condition

A

Diagnostic

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11
Q

Elimination or repair of a pathologic condition

A

Curative

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12
Q

Alleviation of symptoms without cure

A

Palliative

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13
Q

Removal of a body part before it becomes problematic

A

Preventive

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14
Q

Surgical examination to determine the nature or extent of a disease

A

Exploratory

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15
Q

Patient requires immediate attention as the disorder may be life/limb-threatening

A

Emergent

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16
Q

Patient requires prompt attention (within 24-30 hours)

A

Urgent

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17
Q

Patient needs surgery but may be delayed up to few weeks or months

A

Required

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18
Q

Patient should have surgery but failure to do so is not catastrophic

A

Elective

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19
Q

Decisions rests with patient

A

Optional

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20
Q

Major Types of Pathologic Processes Requiring Surgery

A

Obstruction
Perforation
Erosion
Tumors

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21
Q

3 phases of perioperative care

A

Preoperative Phase
Intraoperative Phase
Postoperative Phase

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22
Q

Begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the operating room (OR) bed.

A

Preoperative Phase

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23
Q

Begins when the patient is transferred onto the OR bed and ends with admission to the PACU

A

Intraoperative Phase

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24
Q

Begins with the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or home.

A

Postoperative Phase

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25
Q

Emotional state influences stress response, and thus the surgical outcome

A

Psychosocial Assessment

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26
Q

Examples of Psychosocial Assessment

A

Fear of Death
Fear of Pain
Fear of Mutilation
Fear of the Unknown

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27
Q

The patient’s autonomous decision about wheter to undergo a surgical procedure

A

Informed Consent

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28
Q

Elements of a Valid Informed Consent

A

Element 1: Voluntary Consent
Element 2: Informed Subject
Element 3: Patient Able to Comprehend

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29
Q

Consent must be freely given, without coercion

A

Voluntary Consent

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30
Q

Individual who is not autonomous and cannot give or withhold consent

A

Legal incompetence

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31
Q

Consent must be in writing and should contain explanation, description, offer to answer questions about procedure

A

Informed Subject

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32
Q

Characterisitic of an Effective Health Teaching Plan

A

Individualized
Integrates varied strategies
Begun as soon as possible
Allows time for patient to assimilate information

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33
Q

The patient concentrates on a pleasant experience or restful scene

A

Imagery

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34
Q

Patient thinks of an enjoyable story or recites a favorite poem or song

A

Distraction

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35
Q

The patient recites optimistic thoughts

A

Optimistic self-recitation

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36
Q

The patients listens to soothing music

A

Music

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37
Q

Purpose of NPO

A

To prevent aspiration

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38
Q

The purpose of Bowel Preparation

A

To allow satisfactory visualization of the surgical site and to prevent trauma to the intestine or contamination of the peritoneum by fecal material.

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39
Q

Bowel Preparation may be achieved through:

A

Cleansing enemas
Laxatives
Antibiotics

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40
Q

Surgery indicated for Bowel Preparation

A

Abdominal surgery and Pelvic surgery

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41
Q

The goal or purpose of Skin Preparation during preoperative phase

A

The goal of preoperative skin preparation is to decrease bacteria without injuring skin

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42
Q

Principles of Skin Preparation

A

*Antiseptic skin cleansing protocols
* Hair is generally not removed unless it is expected to interfere with operation
Mark surgical site prior to procedure (done by both patient and physician)

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43
Q

Intraoperative Phase

A

*Surgical Team
*Surgical Environment
*Principles of Asepsis
*Types of Anesthesia
*Intraoperative Positiniong

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44
Q

Who are the surgical team?

A

*Patient
*Surgeon
*Anesthesiologist

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45
Q

Circulating Nurse

A

*Manages the OR
*Protect patient’s safety and health by monitoring activities of surgical team, checking OR condition, and monitoring patient for signs of injury and implementing appropriate interventions.
* Coordinates the surgical team
*Monitors strict observance of aseptic technique
* Documents specific activities throughout the operation
*Facilitates “Time out”

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46
Q

Scrub Nurse

A

*Does surgical hand scrub
* Sets up sterile field and equipment
*Prepares sutures, ligatures, and special equipment
* Assist the surgeon during procedure by anticipating the instruments and supplies that will be required.
* Does counting of all needles, sponges, and instruments with the circulating nurse
*Labels tissue and specimen obtained during surgery

47
Q

Surgical Environment where street clothes are allowed.

A

Unrestricted Zone

48
Q

Surgical Environment where scrub suit, mask, cap and OR shoes are allowed.

A

Semi-restricted Zone

49
Q

Surgical Environment where scrub suit, mask, cap, OR shoes, shoe covers, OR gown (for sterile members) and other PPEs were allowed.

A

Restricted Zone

50
Q

Is a state of narcosis (severe CNS depression produced by pharmacologic agents), analgesia, relaxation, and reflex loss

A

Anesthesia

51
Q

Anesthesia Experience

A

*Starting an IV Line
*Sedation
*Induction
*Losing consciousness
*Intubation (if required)
* Receiving combination anesthetics

52
Q

4 Types of Anesthesia

A

*General Anesthesia
* Regional Anesthesia
*Moderate Anesthesia
*Local Anesthesia

53
Q

Characteristics of patients receiving GA:

A

*Not arousable even to pain
*Loss of spontaneous ventilation
*Possible impairment of CV function

54
Q

This stages of general anesthesia experience dizzines, feeling of detachment, ringing or roaring, or buzzing in ears, exaggerated perception of noise.

A

Beginning Anesthesia

55
Q

Stage 2: Excitement

A

Bizzare behavior (struggling, shouting, talking, singing, laughing, or crying)
Dilated pupils
Rapid pulse rate
Irregular respirations

56
Q

Surgical Anesthesia

A

Unconsciousness
Small pupils but still react to light
Respirations are regular
Pulse becomes normal
Skin is pink or slightly flushed

57
Q

Surgical Anesthesia

A

Unconsciousness
Small pupils but still react to light
Respirations are regular
Pulse becomes normal
Skin is pink or slightly flushed

58
Q

Medullary Depression

A

Shallow respirations
Weak and thready pulse
Fixed, dilated pupils
Cyanosis
Death

59
Q

Methods of Induction

A

Inhalation
Intravenous

60
Q

Uses volatile liquid agents and gases

A

Inhalation

61
Q

Anesthesia is produced when patients inhale the vapor from these anesthetic agents

A

Inhalation

62
Q

Consist of introducing a soft rubber or plastic ETT into the trachea by means of laryngoscope

A

General Endotracheal Anesthesia (GETA)

63
Q

An alternative means of anesthesia induction wherein the ETT is inserted through the nose into the trachea

A

Intranasal Intubation

64
Q

A flexible tube with an inflatable silicone ring and cuff that can be inserted into the larynx

A

Laryngeal Mask Airway

65
Q

May be used to induce and/or maintain anesthesia. May be combined with inhalation anesthetics or used alone

A

Inhalation

66
Q

Characteristics of patients receiving RA (Regional Anesthesia)

A

Awake
Aware of sorroundings unless intentionally sedated

67
Q

Mechanism of Action of Regional Anesthesia

A

An Anesthetic agent is injected around nerves so that the region supplied by these nerves is anesthetized.

68
Q

Things to avoid when patient is injected with regional anesthesia

A

Health care team must avoid careless conversation, unnecessary noise, and unpleasant odors because these may be noticed by the patient in the OR and may contribute to a negative response to the surgical experience.

69
Q

Achieved by injecting a local anesthetic agent into the epidural space that surrounds the dura mater or the spinal cord.

A

Epidural Anesthesia

70
Q

An extensive conduction nerve block that is produced when a local anesthetic agent is introduced into the subarachnoid space at the lumbar level, usually between L4 and L5

A

Spinal Anesthesia

71
Q

A form of anesthesia that involves the IV administration of sedatives or analgesic medications to reduce patient anxiety and control pain during diagnostic and therapeutic procedures

A

Moderate Sedation

72
Q

Goal of Moderate Sedation

A

To reduce LOC to a moderate level to enable procedures to be performed while ensuring comfort and cooperation.

73
Q

Characteristics of patients receiving moderate sedation

A

*Able to maintain patent airway
*Retains protective airway reflexes
*Responds to verbal and physical stimuli

74
Q

A form of moderate sedation given by an anesthesiologist or CRNA who must be prepared and qualified to convert to general anesthesia if necessary

A

Monitored Anesthesia Care (MAC)

75
Q

Indications of monitored anesthesia care

A

-Minor surgical procedures
-Critically ill patients who are unable to tolerate anesthesia without invasive monitoring and pharmacological support.

76
Q

is the injection of a solution containing the anesthetic agent into the tissues at the planned incision site.

A

Local Anesthesia

77
Q

Intraoperative Complications

A

-Anesthesia Awareness
-Nausea and vomiting
-Anaphylaxis
- Malignant Hyperthermia

78
Q

Part of anesthesia awareness where it refers to a patient becoming cognizant of surgical interventions while under general anesthesia and then recalling the incident

A

Unintended intraoperative awareness

79
Q

Indications of the occurrence of Anesthesia Awareness

A

-increase in BP
-Rapid HR
-Presence of patient movements

80
Q

Occurs as a side effect of anesthetic agents

A

Nausea

81
Q

Nurse Management of N/V (Nausea and Vomiting)

A

-Antiemetics
- Turn patient to side
- Lower head of bed
-Provide basin to collect vomitus
-Suction oral cavity

82
Q

Anytime the patient comes into contact with a foreign substance, there is potential for

A

Anaphylactic reaction

83
Q

Serious, life-threatening allergic reaction

A

Anaphylaxis

84
Q

Intraoperative causes of Anaphylaxis

A

-Medications
-Lasix

85
Q

Manifestations of Anaphylaxis

A

-Periorbital swelling
-Rash
-Flushing
-Laryngeal edema
-Cyanosis

86
Q

Management of Anaphylaxis

A

Epinephrine SQ

87
Q

Indicated by a core body temperature that is lower than normal 36.6C

A

Hypothermia

88
Q

Intraoperative causes of hypothermia

A

-Low temperature in OR
-Infusion of cold fluids
-Inhalation of cold gases
-Open wounds/cavities
-Decreased muscle activity
-Advanced age
-Medications

89
Q

Management of Hypothermia

A

-Temporarily increase OR temp to 25C to 26.6 C
- Warm IV and irrigating fluids
-Warm air blankets
-Minimize exposure

90
Q

is a rare inheritied muscle disorder that is chemically induced by anesthetic agents

A

Malignant Hyperthermia

91
Q

Risk Factors of Malignant Hyperthermia

A

-People with strong and bulky muscles
-History of muscle cramps/weakness AND unexplained temperature elevation
- History of unexplained death of a family member during surgery
-Inhalation anesthetics and muscle relaxants (succinylcholine)

92
Q

Clinical Manifestations of Malignant Hyperthermia

A

-Generalized muscle rigidity- EARLIEST SIGN
-Tachycardia: HR > 150 bpm- early cardiac sign
-Hypercapnia- early respiratory sign
-Hypotension
-Oliguria (UO<30 cc/hr)
-Rapid increase in body temperature (1C to 2C every 5 minutes)- Late Sign

93
Q

Nursing Management of Malignant Hyperthermia

A

-Discontinue anesthesia
-Dantrolene sodium (Dantrium)- muscle relaxant
-Decrease body temperature
- cooling
-Lower OR temperature
-Cooled IVF

94
Q

Principles of Intraoperative Positioning

A

-The patient should be in as comfortable position as possible, whether conscious or unconscious.
-The operative field must be adequately exposed
-An awkward anatomical position, undue pressure on a body part, or the use of stirrups or traction should not obstruct the vascular supply.
-Respiration should not be impeded by pressure of arms on chest or by a gown that constricts the neck or chest.

95
Q

Goal of Care of Postoperative Phase

A

-Reestablishment of physiologic equilibrium
-Alleviating of pain
-Preventing complications
-Education on self-care

96
Q

Extend from the time patient the patient leaves the OR until the last follow-up visit with the surgeon.

A

Postoperative Phase

97
Q

Is located adjacent to the OR suite

A

Post Anesthesia Care Unit

98
Q

Patient still under anesthesia or recovering from anesthesia are places in this unit for easy access to experienced, highly skilled nurses, anesthesia providers, surgeons, advanced hemodynamic and pulmonary monitoring and support, special equipment, and medications.

A

Post Anesthesia Care Unit

99
Q

Nusing care in the PACU

A

-Provide supplemental oxygen, as ordered
-Attach monitoring equipment
-Begin initial assessment such as vital signs, LOC, surgical site for drainage tubes and monitoring lines, IV fluids and medications
-Monitor at least every 15 minutes
-Administer post operative analgesics, as ordered

100
Q

Occurs when the patient lies on their back, the lower jaw and the tongue fall backward and the air passages become obstructed

A

Hypopharyngeal Obstruction

101
Q

Signs of occlusions include

A

-Choking
-Noisy and irregular respirations
-Desaturation
-Cyanosis

102
Q

The primary cardiovascular complications seen in the PACU include

A

-hypotension
-hemorrhage
-hypertension
-arrythmias

103
Q

Hypotension causes

A

Blood loss- Most Common
Hypoventilation
Position Changes
Pooling of blood in extremities
Side effect of medications and anesthetics

104
Q

Nursing Responsibilities of Hypotension

A

-Fluid Replacement, as ordered
-Blood transfusion if blood loss > 500 ml, as ordered

105
Q

Is an uncommon yet serious complication of surgery that can result in hypovolemic shock and death

A

Hemorrhage

106
Q

Clinical Manifestations of hemorrhage

A

Hypotension
Rapid, thready pulse
disorientation
-restleness
oliguria

107
Q

Nursing Responsibilities of Hypovolemic Shock

A

-Position in modified Trendelenburg
-Fluid replacement, as ordered
-Administer supplemental oxygen, as ordered
-Administer vasopressor, as ordered if unresponsive to fluid replacement

108
Q

PAIN

A

-Determine pain score using appropriate pain assessment tools
-Give postoperative analgesics before pain gets severe

109
Q

Why IV opioids are commonly used in PACU?

A

as they provide immediate pain relief and are short- acting

110
Q

Management of Nausea and Vomiting during postoperative complications

A

-Reposition to side
-Administer antiemetics, as ordered
-Encourage DBE
Aromatherapy

111
Q

Used to determine the patient’s general condition and readiness for transfer from the PACU

A

Aldrete Score

112
Q

Score of 7-10 in aldrete is an indication for

A

DISCHARGE

113
Q

Score of <7

A

remain in PACU until condition improves

MEDSURG INTRODUCTION (4 decks)

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