Perioperative Flashcards
What is the primary focus of current trends in surgery?
Emphasis on minimally invasive techniques to reduce hospitalization.
Procedures that once required extended stays (e.g., gallbladder removal) are now often outpatient.
How does robotic surgery benefit patients?
Helps reduce infection risks.
What are the three phases of perioperative nursing?
- Preoperative Phase
- Intraoperative Phase
- Postoperative Phase
What type of surgery is performed to remove the cause of disease?
Curative Surgery.
What defines elective surgery?
Optional but may improve quality of life.
What is the role of nursing in Pre-Admission Testing (PAT)?
Gather patient history, conduct assessments, verify diagnostics, and plan for discharge.
What lab tests are commonly performed during the preoperative assessment?
- CBC
- Metabolic panel
- Coagulation tests
- Urine analysis
What factors are assessed in the preoperative assessment?
- Health History & Physical Exam
- Medications & Allergies
- Nutritional & Fluid Status
- Dental Considerations
- Substance Use
- Respiratory & Cardiovascular Assessment
- Hepatic & Renal Function
- Endocrine & Immune Function
- Psychosocial & Cultural Factors
Fill in the blank: Corticosteroids can _______ infection risk and slow healing.
increase
What are some considerations for older adults undergoing surgery?
- Declining Organ Function
- Respiratory Complications
- Skin Integrity & Temperature Regulation
- Longer Recovery & Education Needs
Who are the members of the surgical team?
- Patient
- Anesthesiologist or CRNA
- Surgeon(s)
- Circulating Nurse
- Scrub Nurse/Tech
- Registered Nurse First Assistant
What is a potential complication during surgery related to anesthesia?
Anesthesia Reactions.
What is malignant hyperthermia?
A genetic reaction to anesthesia; life-threatening.
What is the purpose of proper patient positioning during surgery?
Prevents nerve damage, ulcers, and respiratory distress.
What are the two phases of the Post Anesthesia Care Unit (PACU)?
- Phase 1: Immediate, intensive care post-anesthesia
- Phase 2: Further recovery before discharge or transfer
List the responsibilities of the PACU nurse.
- Monitor Airway & Breathing
- Assess Circulation
- Pain Management
- Manage Nausea & Vomiting
- Monitor Surgical Site & Drains
What are the signs of hypovolemic shock?
- Pale, cool, moist skin
- Rapid, weak pulse
- Decreasing blood pressure
- Concentrated urine
- Cyanosis
Fill in the blank: Postoperative nausea and vomiting (PONV) can be caused by _______ and pain medications.
anesthesia
What is a common type of surgical drain?
Jackson Pratt (JP Drain).
What is a key takeaway regarding perioperative care?
Perioperative Care Involves a Multidisciplinary Approach.
Why is preoperative assessment critical?
Identifies risks, plans for safe surgery and recovery.
True or False: Intraoperative safety and sterility are priorities in surgery.
True.
What special considerations are necessary for older adults in perioperative care?
Increased risk of complications and slower recovery.
What is the purpose of Pre-Admission Testing (PAT)?
Ensures patient readiness for outpatient or inpatient surgery, identifies potential risks such as allergies, medical conditions, or medication interactions.
Key areas of assessment include allergies, smoking history, renal & hepatic function, immunity & coagulation status.
Which allergies are linked to latex allergies?
Kiwi or banana allergies.
Important to assess during preoperative evaluations.
What risks are associated with a patient’s smoking history?
Increases respiratory complications and impairs healing.
What labs are included in assessing renal and hepatic function?
- Basic Metabolic Panel (BMP) or Comprehensive Metabolic Panel (CMP)
- BUN & Creatinine (kidney function)
- ALT & AST (liver function)
What assessments are part of evaluating immunity and coagulation status?
- CBC (Complete Blood Count)
- Coagulation Studies (PT, PTT, INR) – important for elderly patients on blood thinners.
Why is preoperative education important?
Patients remember pre-op instructions better once they’re in recovery.
What topics should be covered in preoperative education?
- Breathing Exercises
- Early Mobilization
- Pain Management
- Coping Strategies
- Postoperative Instructions
What are examples of breathing exercises to be taught preoperatively?
- Coughing
- Deep breathing
- Incentive spirometry
What is a key aspect of pain management education?
Discuss medications, expectations, and discharge pain control.
Fill in the blank: Preoperative preparations include changing into a hospital gown and wearing a _______.
[surgical cap]
Why is jewelry and piercing removal important before surgery?
Not just for sterility but to prevent electrical burns from surgical cautery.
What should be done with a patient’s belongings before surgery?
Stored safely or given to a family member.
Who is responsible for transporting the patient to surgery?
The circulating OR nurse and anesthesiologist.
What psychosocial interventions can help reduce patient anxiety?
- Simple conversations
- Active listening
- Spiritual & Cultural Support
What are signs of dehydration to monitor preoperatively?
- Dry mucous membranes
- Low blood pressure (BP)
What is the significance of blood pressure in preoperative assessments?
Blood pressure is a key indicator of fluid status.
What is a common bowel preparation for colorectal surgery?
Pre-op laxatives or enemas are given at home or in the hospital.
What is the purpose of using Chlorhexidine Gluconate (CHG) wipes preoperatively?
Reduces bacteria before surgery.
Fill in the blank: Surgical site infection (SSI) prevention is a ______ measure.
[Core]
What are common preoperative complications?
- Failure to Follow NPO Orders
- Undisclosed Alcohol or Drug Use
- Electrolyte Imbalances
What risk does failure to follow NPO orders present?
Risk of aspiration pneumonia under anesthesia.
What is the initial focus of postoperative nursing care in the PACU?
Airway management, vital signs monitoring, and pain control.
True or False: Patient education reduces anxiety and ensures compliance.
True
Why is postoperative nausea and vomiting (PONV) significant?
PONV is common and can slow recovery, leading to dehydration, aspiration, or delayed wound healing.
What is the most widely used medication for postoperative nausea?
Ondansetron (Zofran)
It has minimal side effects.
What are the side effects of Scopolamine patches?
Can cause dizziness.
What is Hydroxyzine used for?
Nausea and anxiety management.
Why is Promethazine (Phenergan) less commonly used?
Due to sedative effects and irritation of veins.
What should nurses assess regarding anti-nausea medications?
Medication interactions and patient response.
What is the purpose of surgical drains?
Prevent fluid accumulation and reduce swelling, hematomas, and infection risk.
Name a common type of surgical drain used for abdominal surgeries.
Jackson-Pratt (JP) Drain.
What is a Penrose drain?
A simple rubber tube that allows passive drainage.
What is a Hemovac drain used for?
Orthopedic surgeries or larger wounds.
What are nursing responsibilities regarding surgical drains?
Monitor drainage color, amount, and consistency.
What are the goals of postoperative dressings?
- Promote a healing environment
- Immobilization and support
- Encouraging primary and secondary healing
What is AquaCell dressing?
An advanced wound dressing with nutrients, waterproof, and can stay on for 2-3 weeks.
When should dressings be changed?
If saturated with drainage or peeling off, or if signs of infection appear.
What does sterile technique prevent during dressing changes?
Contamination and surgical site infections (SSIs).
What should be assessed if the dressing is clean, dry, and intact?
Leave it alone.
What common materials are used for post-op wound closures?
- Glue (Dermabond)
- Steri-strips
- Sutures or staples
What may be needed before dressing changes to manage pain?
Pain medication.
Who should be educated about wound care if the patient is sedated?
Their caregiver.
What is essential for documenting wound status?
Proper documentation.
True or False: Nurses play a vital role in educating patients about wound care.
True.
Fill in the blank: Postoperative nausea management is crucial for patient _______.
[comfort and recovery]
What is the role of surgical drains in postoperative care?
Help prevent fluid accumulation and infection.
What is essential for successful postoperative recovery?
Pain control and patient education.
What is the primary focus of perioperative nursing care?
Reducing hospital stays, preventing infections, ensuring patient safety, and optimizing surgical outcomes.
List the key goals of surgery.
- Minimally invasive techniques to reduce hospital stays and recovery time
- Decrease infection rates using robotic surgeries and sterile techniques
- More outpatient procedures to reduce healthcare costs and hospital congestion
- Trauma patients typically require hospitalization due to unpredictable injury extent and complex healing needs.
What is the purpose of the preoperative phase?
Prepare patients for surgery, assess risks, and prevent complications.
What are the classifications of surgery?
- Diagnostic
- Curative
- Repair
- Reconstructive
- Cosmetic
- Palliative
- Rehabilitative
What are the types of surgery based on urgency?
- Emergency
- Urgent
- Required
- Elective
- Optional
Fill in the blank: Preoperative testing includes assessments of demographics, medical history, social factors, and _______.
[lab work]
What lab tests are commonly performed preoperatively?
- CBC
- BMP/CMP
- PT/PTT/INR
- Urinalysis
What are key preoperative considerations regarding medication?
- Blood thinners & anesthesia interactions must be checked
- Nasal decongestants can increase blood pressure unexpectedly.
What is informed consent?
A document that must be signed before any sedation, explaining procedure, risks, benefits, and alternatives.
Who can sign the informed consent?
The patient or legally authorized person (spouse, child, power of attorney).
Name the members of the surgical team.
- Anesthesiologist or CRNA
- Surgeon & surgical assistants
- Scrub nurse/tech
- Circulating nurse
True or False: Anesthesia-related complications can include respiratory depression and anaphylaxis.
True
What are common surgical complications?
- Infections due to contamination
- Blood clots (DVT/PE) from immobility
- Nerve damage due to improper positioning
What are the surgical zones?
- Unrestricted
- Semi-restricted
- Restricted
What is the purpose of the aseptic technique?
To ensure sterile materials remain sterile during surgery.
What is monitored in the immediate recovery phase (PACU)?
- Vitals every 5-15 minutes
- Airway
- Circulation
What indicates possible blood loss in a patient post-surgery?
Blood pressure drop with low urine output.
Fill in the blank: Patients on chronic opioids require _______ pain management post-surgery.
[adjusted]
What criteria must be met for discharge readiness?
- Stable vitals
- Controlled pain
- Ability to swallow & move
What is the Aldretti Score used for?
To determine readiness for discharge.
What are common postoperative issues?
- Nausea & Vomiting
- Delayed Waking
What types of drains are commonly used in surgery?
- JP (Jackson Pratt) Drain
- Hemovac Drain
What dressing type is used for orthopedic wounds?
AquaCell Dressings
What is the role of the nurse in dressing changes?
Follow sterile technique for surgical wounds.
Key takeaways from perioperative nursing care include focusing on _______ techniques and outpatient procedures.
[minimally invasive]
What should be reported about blood loss during the procedure?
Estimated blood loss/fluid loss
Critical for assessing the patient’s stability and need for replacement.
What is important regarding fluid and blood management?
Fluid/blood replacement
Necessary for maintaining hemodynamic stability post-surgery.
What vital signs should be relayed in the report?
Last set of vital signs and any problems during the procedure
Includes issues like nausea and/or vomiting.
What medications should be listed?
List of allergies and medications taken at home (including pain medications, antihypertensives, and anticoagulants)
Helps in understanding the patient’s baseline health status.
What considerations should be made for the immediate postoperative period?
Considerations for immediate postoperative period (pain management, reversals, ventilator settings)
Essential for effective recovery and patient comfort.
What is hypovolemia?
Insufficient blood volume in the body.
Hypovolemia can lead to significant physiological changes, impacting various body functions.
What physiological response occurs due to hypovolemia?
Vasoconstriction.
Vasoconstriction helps to maintain blood pressure but reduces blood flow to tissues.
How does insufficient blood volume affect wound healing?
Reduces oxygen and nutrients available for wound healing.
Proper wound healing requires adequate blood supply for oxygen and nutrients.
What effect does hypothermia have on tissue oxygenation?
Causes poor tissue oxygenation.
This can lead to inadequate perfusion, which is critical for effective wound healing.
What should be monitored to assess for volume deficit?
Circulatory impairment.
Monitoring circulatory status helps in identifying hypovolemia early.
How can hypovolemia be corrected?
Fluid replacement as prescribed.
Fluid replacement therapy is essential in managing hypovolemia.
When should the patient’s temperature be assessed?
Pre-, intra-, and postoperatively.
Continuous temperature monitoring is crucial for patient safety during surgery.
What measures can be implemented for temperature management?
Warm blanket or forced air warming measures.
These interventions help maintain normothermia during surgical procedures.
What effect do corticosteroids have on infection?
May mask presence of infection by impairing normal inflammatory response.
Corticosteroids can reduce the body’s natural response to infection, making it difficult to detect underlying issues.
What should healthcare providers be aware of regarding medications?
Be aware of action and effect of medications patient is receiving.
Understanding the effects of medications is crucial for patient safety and effective care.
What risk is associated with anticoagulants?
May cause hemorrhage.
Anticoagulants are commonly prescribed to prevent blood clots but can lead to excessive bleeding.
When are broad-spectrum and specific antibiotics most effective?
Effective if given immediately before surgery for specific pathology or bacterial contamination.
Timing of antibiotic administration is critical to prevent infections during surgical procedures.
Why are antibiotics ineffective if given after a wound is closed?
Ineffective if given after wound is closed due to intravascular coagulation at the periphery of the surgical site.
Administering antibiotics post-closure does not impact existing infections due to coagulation barriers.
What should be encouraged to favor healing?
Encourage rest.
Adequate rest is essential for the body’s recovery and healing processes.
What is hemorrhagic shock?
A type of shock resulting from significant blood loss
Hemorrhagic shock can lead to inadequate perfusion of tissues.
Define acidosis.
A condition characterized by an excessive acidity of body fluids
Acidosis can disrupt various bodily functions.
What does hypoxia refer to?
A deficiency in the amount of oxygen reaching the tissues
Hypoxia can severely affect cellular metabolism.
What are the potential consequences of kidney injury?
Impaired kidney function leading to fluid and electrolyte imbalances
Kidney injury can also affect the elimination of waste products.
What is hepatic disease?
A range of diseases affecting the liver, impairing its function
Hepatic disease can lead to complications such as jaundice and coagulopathy.
What is sepsis?
A life-threatening condition caused by the body’s response to infection
Sepsis can lead to tissue damage, organ failure, and death.
How do systemic disorders affect wound healing?
They depress cell functions that directly affect wound healing
This can result in delayed recovery and increased risk of infection.
What should be done for a patient with an immunosuppressed state?
Provide maximum protection to prevent infection
This includes restricting visitors and enforcing strict hand hygiene.
True or False: Immunosuppressed patients have enhanced defense mechanisms.
False
Immunosuppressed patients are more vulnerable to infections.
What is the importance of administering prescribed treatment for systemic disorders?
To manage the specific disorder effectively
Timely treatment can prevent complications and improve outcomes.
What may be indicated to determine appropriate antibiotic therapy?
Cultures
Cultures help identify the causative organisms and their sensitivities.
What is the primary action of Metoclopramide?
Stimulating gastric emptying and increasing GI transit time.
Administration recommended at the end of procedure. Available in oral, IM, and IV forms.
What is Prochlorperazine indicated for?
Control of severe nausea and vomiting.
Available in oral, SR, rectal, IM, and IV forms.
How often should Promethazine be administered for nausea and vomiting associated with anesthesia and surgery?
Every 4–6 hours.
Available in oral, IM, and IV forms.
What is Dimenhydrinate used for?
Prevention of nausea, vomiting, or vertigo of motion sickness.
Available in oral, IM, and IV forms.
What is the role of Hydroxyzine in the context of anesthesia?
Control of nausea and vomiting and as adjunct to analgesia preoperatively and postoperatively.
Available in oral and IM forms.
What does Scopolamine prevent and control?
Nausea and vomiting associated with motion sickness and recovery from surgery.
Available in oral, transdermal SC, and IM forms.
What is Ondansetron primarily used for?
Prevention of postoperative nausea and vomiting.
Available in oral, IM, and IV forms. With few side effects, frequently the drug of choice.
Fill in the blank: Metoclopramide is available in _______ forms.
oral, IM, and IV
True or False: Prochlorperazine is available only in oral form.
False
Available in oral, SR, rectal, IM, and IV forms.
List the forms in which Promethazine is available.
- Oral
- IM
- IV
What begins the inflammatory phase of wound healing?
Formation of a blood clot and migration of phagocytic white blood cells
Neutrophils are the first cells to arrive at the wound site.
What is the role of neutrophils in the inflammatory phase?
Ingest and remove bacteria and cellular debris
Neutrophils are the first responders to the injury site.
Which cells join neutrophils after 24 hours in the inflammatory phase?
Macrophages
Macrophages continue to ingest debris and produce growth factors.
What is the primary focus of the proliferative phase?
Building new tissue to fill the wound space
This phase is crucial for restoring the integrity of the skin.
What key cell type is involved in the proliferative phase?
Fibroblast
Fibroblasts synthesize and secrete collagen and other essential molecules.
What do fibroblasts produce that is essential for wound healing?
Collagen, proteoglycans, and glycoproteins
These components are critical for the structural integrity of new tissue.
What process do fibroblasts induce during the proliferative phase?
Angiogenesis
Angiogenesis is the growth of new blood vessels necessary for supplying nutrients to the new tissue.
What occurs during the epithelialization process?
Epithelial cells at the wound edges proliferate to form a new surface layer
This process helps to restore the barrier function of the skin.
When does the wound contraction and remodeling phase begin?
Approximately 3 weeks after injury
The timeline may vary based on the severity of the wound.
What characterizes the wound contraction and remodeling phase?
Development of a fibrous scar and continued remodeling of scar tissue
This phase can last for 6 months or longer.
What happens to vascularity during the remodeling phase?
There is a decrease in vascularity
This is part of the natural healing process as the scar matures.
What two processes occur simultaneously during the remodeling phase?
Synthesis of collagen by fibroblasts and lysis by collagenase enzymes
This balance is crucial for the strength and appearance of the scar.
What is the effect of remodeling on scar tissue?
Increases tensile strength and shrinks the scar
This makes the scar less visible over time.
