Perioperative Care Flashcards
Outpatients (ambulatory or same-day surgery) are required to have a _______ _________.
Ride home
What is the number 1 risk factor in PACU?
Breathing
What is included in the patient interview before day of surgery?
- Establishing baseline data
- Identify risk factors
- Health clearance: labs, diagnostic exams, H&P**
- Decrease anxiety, decrease knowledge deficit
- Clarify procedural information/consent/advanced directive
- Ensure patient safety
H&P must be _____ days or newer for the patient to undergo surgery legally.
30
What are the primary goals of intraoperative care?
- Patient safety/verification
a. Time out - Prevent infection **
- Prevent heat loss
When does postoperative care begin?
Begins immediately after surgery and continues until the patient is discharged from medical care
ABC’s***
Care of potential/actual problems
What does the preoperative health screening or clearance consist of?
- Past Medical Hx
- Past Surgical Hx
- Social Hx
- familial history- Malignant Hyperthermia (anesthesia causes temp to go up to 107F)
- Medication Hx
- Allergies
- High risk: advanced age, diabetes, obesity** – airway complications, Sleep apnea (soft pharyngeal post palette obstructions)*
- Physical exam
What are the diagnostics in a preoperative clearance for surgery?
- EKG – to see baseline rhythm
- CXR
- Lab workup: T&C, CBC, coagulation panel, creatinine, pregnancy testing
More invasive surgeries will need cardiac clearance- cardiac angiogram or stress test, echocardiogram
What is T&C?
Type and cross: draw blood to see what blood type the patient has; “cross patch”
What is T&S?
Type and screen: draw and pull blood (blood transfusion)
Why would a patient be placed on NPO status for preop?
Avoid risk for aspiration pneumonia
Surgery would be postponed if the patient has had any recent ______, _______, or _______.
fever, flu, illness
What are the 3 consents for surgery?
anesthesia, blood transfusion, and surgical procedures.
What does the consent entail? (7)
- Adequate disclosure of the diagnosis, including the nature and purpose of the proposed treatment;
- the risks and benefits of the proposed treatment
- the probability of a successful outcome
- NO ABBREVIATIONS ON CONSENT
- Patient must demonstrate understanding
- Patient must give consent voluntarily.
- Must be within 30 days or within 24 hrs if inpatient
Patients need to engage in ______ ______ exercises and ______ post-op.
deep breathing; ambulation
Why do patients need to ambulate postop?
increases gastromotility, prevents atelectasis and pneumonia.
What is the intraoperative environment like?
- Maintain asepsis in surgical environment**
- Removed from other units
- Semi restricted/restricted areas
- OR- positive air pressure rooms, filters, temperature controlled
- OR and PACU on same floors
Everyone on the intraoperative team is responsible for a _______ _______ verification.
TIME OUT
The longer the operation, the more risk for ___________.
Complications
What are some risks when patients undergo surgery?
embolisms, clotting, coagulopathy, CVA**
What is the #1 reason for airway obstruction during surgery? How do you remedy this?
soft palate relaxation (even higher risk if obese); Use jaw thrust maneuver (tilt head) and OPA (oropharyngeal airway, keeps airway OPEN)
What is the #2 reason for airway obstruction? How do you remedy this?
Mucous plugs → SUCTION
What are some breathing risks post op? How can you treat them?
- Hypoxemia: O2 saturation < 90% (not enough O2 in blood)
- Hypoventilation (RR < 8): caused by anesthesia, meds
- Must wake pt up, instruct them to take deep breaths, use of bright lights and verbal stimuli
What are the signs and symptoms of a breathing issue post op?
RESTLESSNESS!!!!!!** –> sign of checking breathing (respiratory assessment (if diabetic, check glucose))
How do we measure circulation?
BP, HR, cap refill, pulses
What is the most common post op circulatory problem?
HYPOVOLEMIA → blood loss during surgery; *some meds are vasodilators → must monitor BP**
Which patient populations are at higher risk for circulatory compromise?
advanced age, ppl w/DM, obesity, high BMI
How do you monitor problems related to circulation?
Monitor vital signs and perform physical assessments frequently!!!! q minute, q 5 minute, q 10, q 15
What to do for hypovolemia post anesthesia?
Give IV Fluids*** or blood transfusion
Why is pain a problem?
Delays healing time, longer hospital stays;
tx: analgesics, opiates, PCA pumps
How do you treat nausea postop? (PONV)
Antiemetics IV, Nasogastric decompression (NGT)
Ondansetron (Zofran) 4 mg IVP q 4 hrs prn N/V**
Monitor ________ closely in patients postop.
temperature
Elderly and infants are more likely to experience _______ because they have less thermoregulation.
hypothermia
True or False: Mild temperature elevation (100.4), and surgical stress/inflammatory response is expected in postop patients.
True
If fever is over 100.4 within two days post-op, usually infection _____ related to surgery.
NOT
If fever after two days post op-, is it related to surgery**??
yes
What is the number one source of infection/fever in postop patients?
LUNGS → not deep breathing → atelectasis, pneumonia
When a patient is stabilized in the PACU and is transferred to the nursing unit, upon receiving the new patient, the unit nurse must: (4)
- Assess ABC***- take vital signs- AIRWAY!
- receive report
- check admission orders
- perform physical exam
What nursing management or prevention interventions should nurses implement in the med-surg/ICU? (8)
1.PreventionVenothromboembolism- DVT Prophylaxis
2. Prevention ofAtelectasis – Incentive Spirometer and walking
3. Prevention ofInfections
4. Pain Management –IV toPO
5. Management GI- N/V, PO toleration,BM
6. Manage drains and incisions: make sure you haveorders!
7. MOBILIZATION!!!!** be aware of complications ofimmobility***
8. Discharge teaching and discharge tohome
True or False: Patients cannot have fluids if they do not have bowel sounds post-op.
True
What are the signs and symptoms of Venothromboembolism?
red/discolored, warm skin
Swollen leg
Calf soreness
How do you prevent Venothromboembolism? What is a potential complication?
mobilization, sequential compression devices/ted hose; PE
Normal WBC lab range
5k-10k cells/mm^3
Normal hemoglobin lab ranges
Male: 14-18 g/dL
Female: 12-16 g/dL
Normal hematocrit lab ranges
Male: 42-52%
Female: 37-47%
Normal platelet lab range
150k-400k cells/mm^3
Normal INR range
0.8-1.1s
Normal Na+ range
135-145 mEq/L
Normal K+ range
3.5-5 mEq/L
Normal creatinine range
0.6-1.2 mg/dL
Normal glucose range
70-110 mg/dL
