Perioperative Care

Question 1

Preoperative Surgical Phase:

Answer 1

The timeframe between when the surgery is scheduled and until the patient goes to the surgical site.

Question 2

Intraoperative Surgical Phase:

Answer 2

During surgery

Question 3

Postoperative Surgical Phase:

Answer 3

Begins with completion of the surgery and transfer of the patient to the PACU, ambulatory care, or ICU.

Question 4

Postoperative Surgical Phase I:

Answer 4

Immediately after surgery until hemodynamic stability; occurs in PACU, and sometimes ICU; frequent vital signs and LOC.

#1 Priority here:
AIRWAY MANAGEMENT!

Question 5

Postoperative Surgical Phase II:

Answer 5

Begins at the end of Phase I and ends when the patient achieves pre-surgery level of alertness; occurs in MS or step-down unit, home, or skilled nursing facility; prepare patient for care in an extended care environment

Question 6

Postoperative Surgical Phase III:

Answer 6

Occurs in an extended care environment (hospital or home)

Question 7

Urgent vs Emergent surgery:

Answer 7

Surgery is needed within 24-48 hours.

Surgery is needed IMMEDIATELY (Emergency)

Question 8

Nursing priorities during the Preoperative Phase:

Answer 8

1) Patient safety (#1 priority!!)
2) Prepare patient for surgery
3) Patient education
4) Patient advocacy

Question 9

Preoperative Assessment:

Answer 9

1) Age
2) Surgical procedure planned
3) Current understanding of procedure/surgery
4) Medications, CAM, substance use
5) Medical History including allergies, prior surgeries, and experience with anesthesia
6) Family History
7) Patient’s support system
8) Risk for need of blood products

Question 10

Who determines the need for blood products?

Answer 10

Surgeon

Question 11

Who determines medication restrictions?

Answer 11

Surgeon

Question 12

Preoperative Patient Education:

Answer 12

1) preoperative routine (bowel prep, skin prep)
2) Dietary restrictions (NPO after midnight)
3) Medication restrictions
4) Postoperative expectations/activity/instructions

Question 13

Who is required to “Scrub up” prior to surgery?

Answer 13

1) Surgeon
2) Surgeon’s Assistant (resident, NP, PA, RN 1st assistant, surgical technician)
3) Scrub nurse
4) Scrub technician

Question 14

How do you “Scub up?”

Answer 14

1) Use antimicrobial soap for hands
2) Use surgical scrub with surgical antimicrobial for:
- fingertips to elbows
- 3 to 5 minutes
3) Dry with a. sterile towel

Question 15

When do you “Scub up?”

Answer 15

After putting on a mask (and cap)

Before donning gown and gloves

Question 16

Nursing Assessment before entering the surgical suite:

Answer 16

1) preoperative info/history collected? (previous experience w/ anesthesia)
2) Advanced directives
3) Medications taken?
4) NPO status?
5) Need for blood products?
6) Physical assessment

Question 17

Intraoperative Pre-surgery Checklist:

Answer 17

1) Confirm patient ID
2) Confirm Informed Consent (signed & pt consented)
3) Confirm allergies
4) Patient Item checklist (dentures, attire, jewelry, contacts, hearing aids, glasses)

Question 18

Informed Consent must include:

Answer 18

1) Nature or Reason for surgery
2) Surgeon performing the surgery
3) Who will be present during surgery
4) Alternatives to the surgery
5) Risks of surgery and anesthesia
6) Correct ID of surgical site
“WHO, WHAT, WHY, WHERE, RISKS, & ALTERNATIVES.”

Question 19

When is Informed Consent required?

Answer 19

1) Before surgery is performed
AND
2) Before sedation is administered

Question 20

What is the role of the Surgeon for Informed Consent?

Answer 20

1) Responsible for providing detailed info about the surgery (aka informed consent)
2) Must ensure the consent has been signed.

Question 21

What is the role of the RN for Informed Consent?

Answer 21

1) Verify the consent is signed.
2) Serve as a witness to the patient’s/HCPOA’s signature
3) To Clarify facts presented by the surgeon during the informed consent process

Question 22

Informed Consent + Blindness:

Answer 22

CAN SIGN FOR THEMSELVES

REQUIRES a witness signature and verification by the RN that the patient understood.

Question 23

Informed Consent + Non-English speaking patient:

Answer 23

REQUIRES AN INTERPRETER during the informed consent process

AN INTERPRETER MUST BE PRESENT TO WITNESS THE PATIENT’S SIGNATURE

Question 24

Informed Consent + EMERGENCY w/ an Obtunded Patient:

Answer 24

The surgeon (or provider) may sign an emergency form to provide care.

MUST STILL DO EVERYTHING WE CAN TO CONTACT NEXT OF KIN

Question 25

Informed Consent + Patient’s unable to write:

Answer 25

The patient may sign an “X” instead of their signature

REQUIRES A WITNESS SIGNATURE

Question 26

What do you do if the patient refuses the surgery?

Answer 26

CALL THE SURGEON

Question 27

What do you do if you suspect the patient doesn’t understand the surgery?

Answer 27

GET THE SURGEON!

If confusion is due to anxiety, the RN may reiterate what the surgeon said.

Question 28

What is the RN’s role in Anesthesia?

Answer 28

1) Patient Positioning
2) Assisting anesthesia provider
3) Observing for breaks in sterile technique
4) Soothe patient

Question 29

What are the early signs of Malignant Hyperthermia?

Answer 29

1) Decreased O2 Saturation
2) Increased End-tidal CO2
3) Tachycardia

Question 30

What are the late signs of Malignant Hyperthermia?

Answer 30

1) High body temperature
2) Dysrhythmias
3) Muscle rigidity
4) Hypotension
5) Skin mottling
6) Cola-colored urine (Kidney failure)

Question 31

What is the MOST sensitive indicator for Malignant Hyperthermia?

Answer 31

END-TIDAL CO2

Question 32

When does the “Time Out” occur?

Answer 32

Before incision

Question 33

What are the components of the “Time Out?”

Answer 33

The entire surgical team must be in agreement of:

1) Correct Patient
2) Correct Procedure
3) Correct Site

If applicable:

4) Antibiotics given (w/in last 60 min)?
5) Available imaging present/available?

Question 34

Intraoperative Nursing Interventions:

Answer 34

1) Patient positioning
2) Transferring
3) Gel pads
4) Comfort
5) Warmth
6) Reducing interruptions

Question 35

What is one of the most important events that should occur when transferring a patient from the surgical suite to the PACU?

Answer 35

Verbal hand-off from the Circulating Nurse & Anesthesiologist
-JCO requirement

Question 36

Postoperative Nursing Assessment:

Answer 36

1 Priority –> ABCs

1) LOC (know their preoperative baseline!!)
2) Vital signs (BP, HR, O2 Sat, pulses, pain, telemetry)
3) Surgical site
4) Perform a “Post-anesthesia Recovery Score.”

Question 37

What Post-anesthesia Recovery Score indicates that a patient can be discharged?

Answer 37

A score of 9 or 10.

Question 38

Postoperative Nursing Interventions:

Answer 38

1. AMBULATION!!
2. Incentive spirometer
3. Promote rest

Multimodal Pain Management:

1) Meds (opioids, Aceta, NSAIDs–after risk of bleeding)
- IV vs PO vs PCA
- Epidural
2) Positioning
3) Healing touch
4) Promote rest
5) Massage
6) Music

Question 39

What is the treatment for Malignant Hyperthermia?

Answer 39

Dantrolene