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NS371—Fundamentals of Nursing > Perioperative Care > Flashcards

Perioperative Care Flashcards

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1
Q

3 phases of periop period

A

preoperative

intraoperative

postoperative

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2
Q

preop period begins and ends…

A
  • Begins with decision to have surgery
  • Ends with pt transferred to op table
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3
Q

intraop begins and ends…

A
  • Begins with pt transferred to op table
  • Ends with pt admitted to PACU
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4
Q

postop period begins and ends…

A
  • Begins with admission to PACU
  • Ends with healing completion
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5
Q

5 purposes of surgery

A
  • Diagnostic
  • Palliative - relieving pain/sx - does not cure disease
  • Ablative - removal of diseased body part
  • Constructive - restores appearance that has been lost
  • Transplant - replaces malfunctioning structures
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6
Q

2 degrees of surgical urgency

A
  • Emergency - performed immediately to save life
  • Elective - non-life-threatening situations
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7
Q

what distinguishes major vs minor surgery?

examples?

A
  • Major - high blood loss, complications, vital organ removal
    • ex heart surgery, hip surgery
  • Minor - less risk - less complications, can be performed outpatient
    • ex tonsil removal, biopsy
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8
Q

why does being >65yo increase risk in surgery

A

decreased immune system, decreased kidney function, response to anesthesia, chronic disease, obesity

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9
Q

what should nurses be sure to assess for older surgical pts?

A

respiratory function

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10
Q

resp condition that ↑ surgical risk

A

OSA

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11
Q

questionnaire that assesses OSA

what does it ask about?

A

STOP-bang

snoring, tiredness after sleep, apnea, hypertension

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12
Q

what should a nurse take note of for surgical pts with OSA?

A

BMI, age, neck circumference, sex

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13
Q

micronutrients vital for surgical wound healing (7)

A

vit A, B, C, K; iron, zinc, copper

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14
Q

meds that can interfere with anesthesia

A

anticoags

tranquilizers

steroids

diuretics

seizure meds

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15
Q

stop taking anticoags ____ days before surgery

A

5-7

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16
Q

steroids in surgical pts increase risk of…

A

inadequate wound healing

infection

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17
Q

aspects of the preop phase (5)

A

informed consent

physical assessment

pt teaching

physical prep

safety protocols

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18
Q

aspects of the preop assessment (8)

A

general health

resp & cardio

allergies (meds, tape, latex, iodine, soaps, foods, etc)

meds

screening tests

MMSE

smoking, alcohol

coping mechanisms, support

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19
Q

preop screening tests (11)

A

CBC

blood grouping

electrolytes

glucose

BUN & creatinine

liver function

albumin/protein

urinalysis

chest x-ray

EKG on all pts >40 or with cardio conditons

pregnancy test

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20
Q

preop planning

A
  • Overall goal: ensure pt is mentally & physically prepared for surgery
  • discharge planning
  • Home care
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21
Q

components of preop teaching (5)

skills training (5)

A
  • Discuss pain scale
  • Explain what will happen and when
  • Dr will most likely order pain meds
  • Explain roles of pt and support people in preop prep, during surgical procedure, & during postop period
  • Skills training
    • Moving
    • Deep breathing
    • Coughing
    • Splinting incisions (pillow on incision during movement, coughing)
    • Using incentive spirometer
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22
Q

preop nutrition rules

A

NPO after midnight (usually)

light meal 6hrs before surgery

clear liquids 2hrs before surgery

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23
Q

preop physical prep (7)

A
  • Cleansing enema
  • Antiseptic soap night before & morning of
  • Nail polish, makeup removed
  • Preop meds
  • Prostheses removed
  • Ask if they have any loose teeth
  • Check orders for special requirements
24
Q

preop meds that may be given and why

A

Versed - anxiety

morphine - sedation

Zofran - n/v

25
Q

3 preop safety protocols

A
  • Preop verifications - schedule, time of testing, time of admission
  • Mark operative site c pt initials/Dr initials OR word “yes”
  • Time out - final verification of correct pt, procedure, site
26
Q

loss of sensation & consciousness; loss of protective reflexes; blocks awareness centers; IV or inhalation

A

general anesthesia

27
Q

disadvantages of general anesthesia

A

depresses resp & circulatory systems

protective reflexes/self-care abilities compromised

28
Q

lidocaine or benzocaine

A

topical anesthetic

29
Q

lidocaine 0.1% - injected - small procedures

A

infiltration anesthesia

30
Q

nerve block example

A

facial surgery

31
Q

low (saddle, caudal), mid, or high - lumbar puncture

A

spinal/subarachnoid block

32
Q

low spinal block examples

A

surgery involving perineal or rectal areas

33
Q

mid spinal block examples

A

hernia, appendectomy - below umbilicus

34
Q

high spinal block examples

A

Caesarean births

35
Q

anesthesia inside spinal column

A

epidural

36
Q

conscious sedation

drugs used

advantages

example

A

morphine, fentanyl, Valium

minimal depression of LOC - allows pt to retain ability to maintain patent airway, respond to commands

ex endoscopies

37
Q

nurses’ responsibilities in intraop period (8)

A
  • Position pt
  • Preop skin prep
  • Assist in preparing/maintaining sterile field
  • Open & dispense sterile supplies
  • Provide meds & solutions
  • Manage caths, tubes, drains, specimens
  • Perform sponge, sharps, instrument counts
  • Document nursing care provided & pt response
38
Q

circulating nurse role (4)

A
  • Coordinates activities
  • Assess pt position
  • Monitors aseptic practice
  • Monitors temp, humidity, lighting in OR
39
Q

scrub person role (2)

A
  • Draping pt c sterile drapes
  • Handling sterile instruments & supplies
40
Q

RNFA - registered nurse first assistant role

A
  • Assists surgeon by controlling bleeding & suturing
41
Q

who is responsible for counting all sponges, needles, instruments used in surgery

A

scrub & circulating nurses

42
Q

how to position pt as they’re coming out of anesthesia

A
  • Unconscious pt positioned on side c face slightly down
  • Elevate pt’s upper arm on pillow - maximum chest expansion
43
Q

what indicates anesthesia ending?

A

return of reflexes

coughing out airway (except endotrach)

44
Q

PARS

A

post anesthesia recovery score

45
Q

ALDRETE

what is the score we want?

A

postop discharge rating

0-2 based on absent or present for each question

9-10 allows discharge from recovery room

46
Q

when is pt discharged from recovery room? (8)

A
  • Conscious & oriented
  • Clear airway & desirable O2 sat
  • Stable VS for 30 mins
  • Reflexes active
  • I/O adequate
  • n/v controlled
  • Temp between 96.8 to 100.4
  • Dressings dry & intact without overt drainage
47
Q

potential postop problems (resp, cardio, urinary, GI, wound, psych)

A

RESP — pneumonia; atelectasis; PE

CARDIO — hypovolemia; hemorrhage; hypovolemic shock; thrombophlebitis; thrombus; embolus

URINARY — retention; UTI

GI — n/v; constipation; tympanites; postop ileus

WOUND — infection; dehisence; evisceration

PSYCH — depression

48
Q

when should pain decrease postop?

A

2-3 days

49
Q

spinal surgery pts must be positioned…

for ____ hrs

A

flat/supine

8-12 hrs

50
Q

unconscious pts postop must be positioned…

A

laterally

51
Q

resp interventions postop

A

deep breathe & cough q2h

spirometer

splint incision

52
Q

leg interventions postop

A

ambulate day after (usually)

antiemboli stockings

NO pillow under knees

53
Q

measure I & O for ___ days postop until stable

A

2 days

54
Q

urinary & GI function should return ___ hrs postop

A

6-8hr

55
Q

assess bowel sounds q ___ hr postop

A

6-8 hr

56
Q

when can surgical pts resume sex

A

2-4 weeks

NS371—Fundamentals of Nursing (12 decks)

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