Perioperative Care

Question 1

Special considerations for gerontologic

Answer 1

• less physiological reserve (CO, sleep apnea, COPD, lung capacity)
• decrease subQ fat
• decreased mental status
• respiratory and cardiac leading cause of mortality

Question 2

Special considerations for bariatric

Answer 2

• wound dehiscence, infection
• immobility
• increased cardiac demand
• increased O2 demand
• hypoventilation
• increased risk of pulmonary complication

Question 3

Special considerations for disabled

Answer 3

• transfer and position
• mental status
• communication

Question 4

Special consideration for ambulatory surgery

Answer 4

• someone has to drive them home
• > 24hrs
• condensed

Question 5

Special considerations for emergency surgery

Answer 5

• not a lot of prep time

- not a lot of consent

Question 6

Informed consent

Answer 6

• provider: obtains (out of scope for nurse to explain procedure/risk)
• pt: give (has to be autonomous, age, right to refuse, confident answ)
• nurse: witness (pt understand, clarify, call MD if pt change mind)
• any invasive procedure needs a consent form

Question 7

Preoperative assessment

Answer 7

• baseline data
• meds/allergies (shellfish, px, OTC, supplements, herbal)
• nutritional,fluid status: always hydrate before surgery
• dentition: intubation/airway, increased infection with poor teeth
• resp and CV status
• hepatic, renal function: insufficiency increased mortality
• endocrine function
• immune function
• psychosocial: anxiety**

Question 8

Diagnostics

Answer 8

• electrolyte**
• CBC**
• Cr and BUN
• blood type
• clotting
• urinalysis
• ABG
• pregnancy

Question 9

Meds that can affect perioperative period

Answer 9

• corticosteroids (dexamethasone): help with stress, delay wound heal, mask infection, increase glucose, never DC abruptly**
• diuretics (HCTZ and furosemide): have enough electrolytes, holding before surgery
• tranquilizers (diazepam): decrease anxiety
• insulin: glycemic control = better healing
• antibiotics
• anticoagulant/salicylates/NSAIDS: stop 2wk before surgery
• anti seizure (carbamazepine)
• thyroid (levothyroxine): hypothyroidism, give before surgery
• opioids
• OTC/alcohol

Question 10

Preoperative nursing interventions

Answer 10

• pt edu: deep breathe, cough, mobility, pain mgt
• consent
• NPO
• skin prep
• warm blanket: thermo reg
• VS
• minimize anxiety
• DVT prevention

Question 11

Preoperative complications

Answer 11

• opioids: respiratory distress, decrease CNS, safety risk
• sedatives (BENZOs): safety, decreased CNS
• IV infusions: avoid fluid overload (crackles, edema)
• GI meds: antiemetic**, antacids, H2 receptor blockers

Question 12

Circulation nurse responsibilities

Answer 12

• responsible for team
• setting up OR
• counting
• specimen collection
• documents
• privacy

Question 13

General anesthesia

Answer 13

• general anesthesia: less of protective reflexes, not arousable
• assessment: type of procedure, age*, length of time, comorbidites
• inhalation agents: halothane, isoflurane, nitrous oxide (add O2)
• IV anesthetic agents: propofol (egg/soybean allergy, short half life)

Question 14

Regional anesthesia

Answer 14

• injected in certain area around the nerve
• effect depends on type of nerve
• spinal: provides autonomic, sensory, motor, no movement
• complications: headache (size of needle, fluid leak, dehydrated)
• epidural: blocks pathways but motor function intact (check for epinephrine)

Question 15

Anticholenergics

Answer 15

• atropine (increases heart rate)

- bradycardia, heart block

Question 16

Neuromuscular blocking agent

Answer 16

• AIRWAY!! They will not be able to breathe!!
• succinylcholine/vecuronium
• block impulse to nerve muscles relaxes

Question 17

Intraoperative complications

Answer 17

• anesthesia awareness: they stay asleep
• N&V: risk for aspiration (roll onto side or turn head)
• respiratory: intubation, ventilation, hypoventilation, air occlusion)
• malignant hyperthermia

Question 18

Malignant hyperthermia

Answer 18

• can happen immediately
• dantrolene
• trigger: inhalation anesthetic agents and succinylcholine**
• early signs: tachycardia, increased CO2, decreased O2, musicale rigidity
• treat by lowering room temp, ice, ventilation, cold gas

Question 19

Intraoperative nursing interventions

Answer 19

• reduce anxiety
• safety
• monitoring, managing potential complications*
• pt advocate

Question 20

Initial PACU assessment

Answer 20

• priority ABCs FIRST**
• keep them awake and breathing
• are they breathing and is it effective
• supplemental O2: meets O2 demand from blood loss or increase metabolism
• O2 sat EARLY WARNING**
• assess tissue perfusion, peripheral pulses, cap refill

Question 21

Maintaining patent airway

Answer 21

• provide supplement O2
• assess breathing
• positioning: HOB elevated 15-30 unless
• TCDB
• unable to cough?- may require suctioning
• vomiting: reposition left lateral

Question 22

When do you remove an oral airway

Answer 22

Until evidence of gag reflex returns

Question 23

Maintaining cardiovascular stability

Answer 23

• potential for hypotension, shock: common cause I replaced fluid/blood loss
• potential for hemorrhage
• potential for HTN (brain, heart, kidneys): from sympathetic stimulation from pain, anxiety, bladder distention, respiratory comp

-leading cause of dysrhythmias: hypokalemia**, hypoxemia, alteration in pH, circulatory instability, preexisting heat disease, hypothermia, pain surgical stress, medications

Question 24

Indicators of hypovolemic shock/hemorrhage

Answer 24

• changes in LOC
• pallor
• cool, moist skin
• tachypnea
• cyanosis
• rapid, weak, threads pulse
• hypotension
• narrowed pulse pressure
• concentrated urine

Question 25

Relieving pain and anxiety

Answer 25

• assess reassess
• control environment: low lights, noise level**
• nonpharmacologic approaches to pain
• anxiety: BENZOs**
• splinting
• positioning

Question 26

Response to anesthesia

Answer 26

• sedation: hepatic and renal insufficiency can cause oversedation, safety
• N/V: needs to be treated immediately

Question 27

Genitourinary- I&O

Answer 27

• monitor I&O Intraoperative and PACU (urine 30/mL)
• postop lab
• skin turgor
• admin IV fluids as indicated
• blood products
• bladder distention
• adequate UO

Question 28

Managing potential complication nursing interventions

Answer 28

• airway obstruction: resp assessment—low O2 sat, irregular resp, cyanosis; pull tongue forward and open airway; resuscitation equipment
• hypoxia: elevate HOB, TCBD, frequent repositioning, monitor O2 sat
• hypovolemic shock: decreased BP?UO, increase HR/RR, narrowing pulse pressure, slow cap refill; O2, supine with legs up, IV fluids, vasopressors
• paralytic ileus: bowel sounds, ambulating, advance diet, metoclopramide (increase GI emptying), NG tube
• wound dehiscence: cover with moist sterile saline, reassure pt, get help, low Fowler with knees flexed, monitor for shock, call HCP