Perioperative Flashcards
What are reasons for surgery?
- Diagnosis
- Cure
- Palliation
- Prevention
- Exploration
- Cosmetic
- Improvement
What are the different types of surgery?
- Elective
- Emergency
- Ambulatory (same-day outpatient)
- Inpatient
- Data Collection
- Assessment
- Outcome Identification
- Nursing Diagnosis
- Planning
Pre-Operative
- Implementation
- Ongoing Assessment
- Coordinate
- Interventions
- Evaluation
Intraoperative
- Assessment
- During Diagnosis
- Planning
- Implementation
- Evaluation
- Discharge Planning
Post Operative
What is the goal of the Pre-operative nursing assessment?
Goal: Identify risk factors and plan care to ensure safety throughout the surgical experience.
Pre-operative nursing assessment, examples of subjective data:
- Psychosocial assessment (anxiety/common fears)
- Past health history
- Medication
- ALLERGIES
- Review of systems
- Functional Health Patterns
Pre-Operative nursing assessment Objective data
Physical assessment of body systems
Ventilatory and metabolic function; oxygenation status
ABGs; pulse oximetry
metabolic status; diabetes mellitus
Blood glucose
Renal function
Blood urea nitrogen (BUN), creatine, chest X-ray
Annemia, immune status, infection
Complete blood count (CBC): RBC, Hb, Hct, WBCs, WBC differential
Cardiac disease, dsyrhethmia, electrolyte abnormality
Electrocardiogram (ECG)
Metabolic status, renal function, diuretic side effects
Electrolytes
Pregnancy
HcG
Coagulation Status
PT, PTT, INR, platelet count
Nutritional status
serum albumin
Preoperative teaching should include the following:
- sensory information
- process information (where families can wait during surgery, information about the general flow of surgery)
- procedural information
What are the types of consent usually obtained?
- surgical consent
- anesthesia
- blood products
What are considerations for elderly patients during preoperative care?
- emotional reactions to surgery
- anesthesia risks
- surgical risks
- sensory deficits
- caregiver support
Who are members of the surgical team who have to practice surgical hand asepsis?
surgeon, scrub nurse, assistant
How many pairs of gloves do you wear during surgery?
2
What is the purpose of universal protocol?
To prevent wrong site, wrong procedure, and wrong surgery
What are the components of universal protocol?
- pre-procedure verification process
- mark the procedure site
- perform a time out
What is an indication for the use of general anesthesia?
For procedures requiring:
- Significant duration
- Skeletal muscle relaxation
- Uncomfortable operative position
- Control of respiration needed
What is the method of delivery for General Anesthesia?
- IV
- Inhalation
- Combination
Interrupts the generation of nerve impulses by altering the flow of sodium into nerve cells through cell membranes.
Local Anesthesia
*results in the loss of sensation without the loss of consciousness
What are the different routes for local anesthesia?
Topical, opthalmic, nebulized, or injectable
*May be used alone or with MAC
What is something to be concerned about when using local anesthesia?
Many are mixed with epinephrine to decrease blood flow and therefore DELAY absorption of the anesthetic. If absorbed into the tissues or injected IV, can cause tachycardia, HTN, and sense of panic.
What are the two classes of local anesthetics?
- Esthers (Procaine/Novocain)
- Amides (Lidocaine/Xylocacaine)
What is another term for a regional anesthesia?
Block
- Provides loss of sensation to a region of the body without loss of consciousness
- Involves the use of a local anesthetic injected into a central nerve or group of nerves
Regional Anesthetic
*Can be used alone or with MAC
What are the two types of Regional Anesthetics?
- Spinal Anesthesia
- Epidural Anesthesia
Involves injection of a local anesthetic into the CSF found in the subarachnoid space, usually below the level of L2.
–> Local anesthesia mixes with CSF. Various levels of anesthesia are achieved depending on the extent of spread.
Spinal Anesthesia
*Causes autonomic, sensory, and motor blockade
What are some side effects of an autonomic blockage?
May cause hypotension d/t vasodilation
Involves injection of local anesthesia into the epidural space via a thoracic or lumbar approach.
–> Anesthetic does not enter the CSF; works by binding to nerve routes as they enter and exit the spinal cord.
Epidural Anesthesia
*sensory pathways are blocked but motor fibers remain intact
(Vasodilation may cause hypertension)
What is an important consideration to take when giving an epidural anesthesia?
Monitor respiratory rate and depth
- Sedatives and opioids are given, but at a lower dose
- Relives anxiety, provides analgesia and amnesia
- Patients remain conscious and breath unassisted
- can be used with local or regional anesthesia
- Procedures may be performed outside of the OR environment
MAC/ conscious sedation
such as midazolam (versed)
Uses during Anesthesia: ↓ anxiety preop & postop, induce & maintain anesth., induce amnesia, treat emergency delirium, supplement sedation
Benzodiazapines
such as fentanyl or meperidine (demerol)
Uses during Anesthesia: Induce & maintain anesth.,↓ stimuli, provide analgesia during surgery & recovery in PACU
Opioids
What are some anaphylactic reactions?
- Initial signs may be masked by anesthesia
- Can cause tachycardia, hypotension, bronchospasm
- Antibiotics and latex are common causes
- Rare; results from exposure to certain anesthetic agents (Succinylcholine/Anectine especially with volatile inhalation agents)
- Defect of hypermetabolism of skeletal muscle resulting from altered control of intracellular calcium
- Characterized by hyperthermia, rigidity of skeletal muscles, and can result in death. Can occur during surgery or in the PACU
Malignant hyperthermia
- important to assess for risk pre-operatively
- Treated with Dantrolene (Dantrium)
How do you treat malignant hyperthermia?
Dantrolene (Dantrium)
What position do they put you in in the PACU?
Recovery Position (side-position)
What are monitoring priorities in the PACU?
- Pulse oximetry
- ECG
- Frequent VS
What are priorities in the PACU?
- Respiratory
- Cardiovascular
- Pain
- Temperature
- Surgical Site
What is a potential respiratory complication for someone on anesthesia?
Hypoxemia
What are causes of hypoxemia?
May be caused by airway obstruction, atelectasis (collapse of lung), aspiration, pulmonary edema, pulmonary embolism, bronchospasm, and hypoventilation
What are nursing interventions to prevent complications from hypoxemia?
- Positioning
- coughing and deep breathing
- Incentive Spirometry
- Ambulation
- Ensure pain is well controlled
What are potential cardiovascular complications in the PACU?
Hypotension and Tachycardia:
Hypertension
Dysrythmias
What are nursing interventions for hypotension and tachycardia related to cardiovascular problems?
- Oxygen
- Assess volume status
- Assess for bleeding
- IV fluid bolus
What are nursing interventions related to hypertension as a result of cardiovascular problems in the PACU?
- Analgesics
- Assist with voiding
- If hypothermic, rewarming measures
What are nursing interventions related to dysrythmias as a result of cardiovascular problems in the PACU?
- Assess for myocardial injury
- other causes include hypoxemia, hypercapnia, electrolyte/acid base imbalances, circulatory instability, preexisting heart disease
What are cardiovascular complications on the clinical unit?
- Fluid and electrolyte imbalances
- Venous thromboembolism (VTE)
- Syncope
What are nursing interventions related to fluid and electrolyte imbalances?
- Strict I/O
- monitor hemoglobin and hematocrit
- Monitor for fluid volume deficit and excess
Nursing interventions for venous thromboembolism (VTE)
- ambulation
- anti-embolism stockings
- SECs
- Pharmacologic Prophylaxis
Nursing interventions for Syncope
- Check orthostatic BP/HR
- Have patient sit on edge of bed for a few minutes before standing
- Encourage hydration
What are pharmacological prophylaxis for VTE?
- Low molecular weight heparin (LMWH)
- Low dose unfractionated heparin
What are neurologic considerations for the PACU?
- Emergence delirium
- Restlessness
- Agitation
- disorientation
- thrashing
- shouting
- Check for HYPOXEMIA!!
- Delayed emergence
What are neurologic complications on the clinical unit?
- postoperative cognitive dysfunction (POCD)- decline in cognitive function
- delirium
- Anxiety and depression
- Alcohol withdrawal
- prevention
What are non-pharmacological techniques for pain control?
- Repositioning
- Massage
- Distraction
- Deep breathing
- Music therapy, guided imagery, aromatherapy
How do you treat pain?
Treat with IV opioids, epidural catheters, PCA pumps, or regional blocks
What is a clinical intervention to do for hypothermia?
Active rewarming
What is the main consideration for hyperthermia?
PREVENTION!!
- Aseptic technique
- Promote effective airway clearance
Diagnosis:
- Chest X-ray
- Cultures
Treatment:
- Antibiotics (if infection)
- If temperature greater than 103, antipyretics and cooling measures
What are gastrointestinal complications
- N/V
- Abdominal Distention
- Hiccups
What are nursing interventions for N/V
- Antiemetics
- Aspirational precautions
- When to resume diet
What are nursing interventions for abdominal distention
- Ambulation
- NG tube decompression
- Right-side positioning
- Bisacodyl (Dulcolax) suppositories
What are genitourinary complications?
- Oliguria
- Urinary Retention
Nursing interventions for oliguria (not enough urine)
- Urine output should be at least .5/kg/hr
- Strict I/O, monitor BUN/creatine
- IV fluids
Nursing interventions for urinary retention
- Normal positioning for urination
- Ambulate to BR or BSC
- Privacy, running water, etc.
- Bladder assessment for distention
- Bladder scan
- Catheterize if needed, per orders
*Minimize use of indwelling urinary catheters
What are integumentary complications?
- poor wound healing
- would infection
Nursing interventions for poor wound healing
-promote nutrition
Separation and disruption of previously joined wound edges
wound dehiscence
Bowel contents protruding through the abdominal wall
Wound evisceration
Treatment for wound dehiscence
- If OOB, return pt to bed
- Lower HOB to 20 degrees or less
- Have patient bend knees and avoid coughing
- Sterile gauze or towels soaked in normal saline should be placed over the wound
- Assess wound for color
- Frequent vital signs, prepare for emergency surgery
What is discharge criteria for the PACU?
- Pt awake or at baseline
- Vital signs stable or at baseline
- No excessive bleeding or drainage
- No respiratory depression
- Oxygen saturation > 90%
- Report given
What is discharge criteria for ambulatory surgery?
- All PACU criteria
- No IV opioids in past 30 minutes
- Minimal n/v
- Voided
- Able to ambulate if not contraindicated
- Responsible adult present to accompany patient
- Written discharge instructions given and understood
