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N465A: Med-Surg > Perioperative Care > Flashcards

Perioperative Care Flashcards

1
Q

Outpatients (ambulatory or same-day surgery) are required to have a _______ _________.

A

Ride home

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2
Q

What is the number 1 risk factor in PACU?

A

Breathing

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3
Q

What is included in the patient interview before day of surgery?

A
  1. Establishing baseline data
  2. Identify risk factors
  3. Health clearance: labs, diagnostic exams, H&P**
  4. Decrease anxiety, decrease knowledge deficit
  5. Clarify procedural information/consent/advanced directive
  6. Ensure patient safety
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4
Q

H&P must be _____ days or newer for the patient to undergo surgery legally.

A

30

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5
Q

What are the primary goals of intraoperative care?

A
  1. Patient safety/verification
    a. Time out
  2. Prevent infection **
  3. Prevent heat loss
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6
Q

When does postoperative care begin?

A

Begins immediately after surgery and continues until the patient is discharged from medical care
ABC’s***
Care of potential/actual problems

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7
Q

What does the preoperative health screening or clearance consist of?

A
  1. Past Medical Hx
  2. Past Surgical Hx
  3. Social Hx
  4. familial history- Malignant Hyperthermia (anesthesia causes temp to go up to 107F)
  5. Medication Hx
  6. Allergies
  7. High risk: advanced age, diabetes, obesity** – airway complications, Sleep apnea (soft pharyngeal post palette obstructions)*
  8. Physical exam
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8
Q

What are the diagnostics in a preoperative clearance for surgery?

A
  1. EKG – to see baseline rhythm
  2. CXR
  3. Lab workup: T&C, CBC, coagulation panel, creatinine, pregnancy testing
    More invasive surgeries will need cardiac clearance- cardiac angiogram or stress test, echocardiogram
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9
Q

What is T&C?

A

Type and cross: draw blood to see what blood type the patient has; “cross patch”

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10
Q

What is T&S?

A

Type and screen: draw and pull blood (blood transfusion)

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11
Q

Why would a patient be placed on NPO status for preop?

A

Avoid risk for aspiration pneumonia

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12
Q

Surgery would be postponed if the patient has had any recent ______, _______, or _______.

A

fever, flu, illness

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13
Q

What are the 3 consents for surgery?

A

anesthesia, blood transfusion, and surgical procedures.

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14
Q

What does the consent entail? (7)

A
  1. Adequate disclosure of the diagnosis, including the nature and purpose of the proposed treatment;
  2. the risks and benefits of the proposed treatment
  3. the probability of a successful outcome
  4. NO ABBREVIATIONS ON CONSENT
  5. Patient must demonstrate understanding
  6. Patient must give consent voluntarily.
  7. Must be within 30 days or within 24 hrs if inpatient
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15
Q

Patients need to engage in ______ ______ exercises and ______ post-op.

A

deep breathing; ambulation

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16
Q

Why do patients need to ambulate postop?

A

increases gastromotility, prevents atelectasis and pneumonia.

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17
Q

What is the intraoperative environment like?

A
  1. Maintain asepsis in surgical environment**
  2. Removed from other units
  3. Semi restricted/restricted areas
  4. OR- positive air pressure rooms, filters, temperature controlled
  5. OR and PACU on same floors
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18
Q

Everyone on the intraoperative team is responsible for a _______ _______ verification.

A

TIME OUT

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19
Q

The longer the operation, the more risk for ___________.

A

Complications

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20
Q

What are some risks when patients undergo surgery?

A

embolisms, clotting, coagulopathy, CVA**

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21
Q

What is the #1 reason for airway obstruction during surgery? How do you remedy this?

A

soft palate relaxation (even higher risk if obese); Use jaw thrust maneuver (tilt head) and OPA (oropharyngeal airway, keeps airway OPEN)

22
Q

What is the #2 reason for airway obstruction? How do you remedy this?

A

Mucous plugs → SUCTION

23
Q

What are some breathing risks post op? How can you treat them?

A
  1. Hypoxemia: O2 saturation < 90% (not enough O2 in blood)
  2. Hypoventilation (RR < 8): caused by anesthesia, meds
  3. Must wake pt up, instruct them to take deep breaths, use of bright lights and verbal stimuli
24
Q

What are the signs and symptoms of a breathing issue post op?

A

RESTLESSNESS!!!!!!** –> sign of checking breathing (respiratory assessment (if diabetic, check glucose))

25
Q

How do we measure circulation?

A

BP, HR, cap refill, pulses

26
Q

What is the most common post op circulatory problem?

A

HYPOVOLEMIA → blood loss during surgery; *some meds are vasodilators → must monitor BP**

27
Q

Which patient populations are at higher risk for circulatory compromise?

A

advanced age, ppl w/DM, obesity, high BMI

28
Q

How do you monitor problems related to circulation?

A

Monitor vital signs and perform physical assessments frequently!!!! q minute, q 5 minute, q 10, q 15

29
Q

What to do for hypovolemia post anesthesia?

A

Give IV Fluids*** or blood transfusion

30
Q

Why is pain a problem?

A

Delays healing time, longer hospital stays;
tx: analgesics, opiates, PCA pumps

31
Q

How do you treat nausea postop? (PONV)

A

Antiemetics IV, Nasogastric decompression (NGT)
Ondansetron (Zofran) 4 mg IVP q 4 hrs prn N/V**

32
Q

Monitor ________ closely in patients postop.

A

temperature

33
Q

Elderly and infants are more likely to experience _______ because they have less thermoregulation.

A

hypothermia

34
Q

True or False: Mild temperature elevation (100.4), and surgical stress/inflammatory response is expected in postop patients.

A

True

35
Q

If fever is over 100.4 within two days post-op, usually infection _____ related to surgery.

A

NOT

36
Q

If fever after two days post op-, is it related to surgery**??

A

yes

37
Q

What is the number one source of infection/fever in postop patients?

A

LUNGS → not deep breathing → atelectasis, pneumonia

38
Q

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)

A
  1. Assess ABC***- take vital signs- AIRWAY!
  2. receive report
  3. check admission orders
  4. perform physical exam
39
Q

What nursing management or prevention interventions should nurses implement in the med-surg/ICU? (8)

A

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

40
Q

True or False: Patients cannot have fluids if they do not have bowel sounds post-op.

A

True

41
Q

What are the signs and symptoms of Venothromboembolism?

A

red/discolored, warm skin
Swollen leg
Calf soreness

42
Q

How do you prevent Venothromboembolism? What is a potential complication?

A

mobilization, sequential compression devices/ted hose; PE

43
Q

Normal WBC lab range

A

5k-10k cells/mm^3

44
Q

Normal hemoglobin lab ranges

A

Male: 14-18 g/dL
Female: 12-16 g/dL

45
Q

Normal hematocrit lab ranges

A

Male: 42-52%
Female: 37-47%

46
Q

Normal platelet lab range

A

150k-400k cells/mm^3

47
Q

Normal INR range

A

0.8-1.1s

48
Q

Normal Na+ range

A

135-145 mEq/L

49
Q

Normal K+ range

A

3.5-5 mEq/L

50
Q

Normal creatinine range

A

0.6-1.2 mg/dL

51
Q

Normal glucose range

A

70-110 mg/dL

N465A: Med-Surg (5 decks)

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