Perioperative Care Flashcards
3 phases of periop period
preoperative
intraoperative
postoperative
preop period begins and ends…
- Begins with decision to have surgery
- Ends with pt transferred to op table
intraop begins and ends…
- Begins with pt transferred to op table
- Ends with pt admitted to PACU
postop period begins and ends…
- Begins with admission to PACU
- Ends with healing completion
5 purposes of surgery
- 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
2 degrees of surgical urgency
- Emergency - performed immediately to save life
- Elective - non-life-threatening situations
what distinguishes major vs minor surgery?
examples?
-
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
why does being >65yo increase risk in surgery
decreased immune system, decreased kidney function, response to anesthesia, chronic disease, obesity
what should nurses be sure to assess for older surgical pts?
respiratory function
resp condition that ↑ surgical risk
OSA
questionnaire that assesses OSA
what does it ask about?
STOP-bang
snoring, tiredness after sleep, apnea, hypertension
what should a nurse take note of for surgical pts with OSA?
BMI, age, neck circumference, sex
micronutrients vital for surgical wound healing (7)
vit A, B, C, K; iron, zinc, copper
meds that can interfere with anesthesia
anticoags
tranquilizers
steroids
diuretics
seizure meds
stop taking anticoags ____ days before surgery
5-7
steroids in surgical pts increase risk of…
inadequate wound healing
infection
aspects of the preop phase (5)
informed consent
physical assessment
pt teaching
physical prep
safety protocols
aspects of the preop assessment (8)
general health
resp & cardio
allergies (meds, tape, latex, iodine, soaps, foods, etc)
meds
screening tests
MMSE
smoking, alcohol
coping mechanisms, support
preop screening tests (11)
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
preop planning
- Overall goal: ensure pt is mentally & physically prepared for surgery
- discharge planning
- Home care
components of preop teaching (5)
skills training (5)
- 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
preop nutrition rules
NPO after midnight (usually)
light meal 6hrs before surgery
clear liquids 2hrs before surgery
preop physical prep (7)
- 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
preop meds that may be given and why
Versed - anxiety
morphine - sedation
Zofran - n/v
3 preop safety protocols
- 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
loss of sensation & consciousness; loss of protective reflexes; blocks awareness centers; IV or inhalation
general anesthesia
disadvantages of general anesthesia
depresses resp & circulatory systems
protective reflexes/self-care abilities compromised
lidocaine or benzocaine
topical anesthetic
lidocaine 0.1% - injected - small procedures
infiltration anesthesia
nerve block example
facial surgery
low (saddle, caudal), mid, or high - lumbar puncture
spinal/subarachnoid block
low spinal block examples
surgery involving perineal or rectal areas
mid spinal block examples
hernia, appendectomy - below umbilicus
high spinal block examples
Caesarean births
anesthesia inside spinal column
epidural
conscious sedation
drugs used
advantages
example
morphine, fentanyl, Valium
minimal depression of LOC - allows pt to retain ability to maintain patent airway, respond to commands
ex endoscopies
nurses’ responsibilities in intraop period (8)
- 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
circulating nurse role (4)
- Coordinates activities
- Assess pt position
- Monitors aseptic practice
- Monitors temp, humidity, lighting in OR
scrub person role (2)
- Draping pt c sterile drapes
- Handling sterile instruments & supplies
RNFA - registered nurse first assistant role
- Assists surgeon by controlling bleeding & suturing
who is responsible for counting all sponges, needles, instruments used in surgery
scrub & circulating nurses
how to position pt as they’re coming out of anesthesia
- Unconscious pt positioned on side c face slightly down
- Elevate pt’s upper arm on pillow - maximum chest expansion
what indicates anesthesia ending?
return of reflexes
coughing out airway (except endotrach)
PARS
post anesthesia recovery score
ALDRETE
what is the score we want?
postop discharge rating
0-2 based on absent or present for each question
9-10 allows discharge from recovery room
when is pt discharged from recovery room? (8)
- 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
potential postop problems (resp, cardio, urinary, GI, wound, psych)
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
when should pain decrease postop?
2-3 days
spinal surgery pts must be positioned…
for ____ hrs
flat/supine
8-12 hrs
unconscious pts postop must be positioned…
laterally
resp interventions postop
deep breathe & cough q2h
spirometer
splint incision
leg interventions postop
ambulate day after (usually)
antiemboli stockings
NO pillow under knees
measure I & O for ___ days postop until stable
2 days
urinary & GI function should return ___ hrs postop
6-8hr
assess bowel sounds q ___ hr postop
6-8 hr
when can surgical pts resume sex
2-4 weeks
