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Adult Health 380 Exam 3 > Perioperative Care > Flashcards

Perioperative Care Flashcards

1
Q

What is surgery?

A

invasive medical procedure performed to diagnose and treat disease, repair injury, or correct deformity

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2
Q

What is the purpose of a diagnostic surgery?

A

-Obtain tissue samples;

-Make an incision;

-Use a scope to make a diagnosis

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3
Q

How can surgery cure a problem?

A

through elimination or repair of a pathologic condition

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4
Q

What is palliation surgery?

A

focuses on alleviation of symptoms without a cure to improve quality of life

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5
Q

What is an example of prevention surgery?

A

removing a mole before it becomes malignant

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6
Q

What is an example of cosmetic surgery?

A

reconstructive surgery

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7
Q

What is the purpose of exploratory surgery?

A

conformation or measurement of extent of condition
(exploratory laparotomy)

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8
Q

Elective vs emergency surgery

A

-elective: not needed to save life

-emergency: life-saving, necessary

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9
Q

Which type of surgery has an increased need for teaching and emotional support?

A

outpatient

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10
Q

What are determinants of inpatient or outpatient surgery?

A

-complexity of surgery

-recovery

-expected needed level of post op care

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11
Q

What are some benefits of outpatient surgery?

A

-decreased cost

-reduced risk for healthcare associated infections (HAIs)

-less interruption in the patient’s and family’s routine

-possible reduction in time lost from work and/ or responsibilities

-less physiologic stress to the patient and family

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12
Q

What are the 3 phases of preoperative nursing?

A
  1. Preoperative
  2. Intraoperative
  3. Postoperative
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13
Q

When does the preoperative phased begin and end?

A

-decision for surgery is made

-patient transferred to operating room

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14
Q

When does the intraoperative phase begin and end?

A

-admittance to recovery room

-complete recovery

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15
Q

What is informed consent?

A

an active, shared-decision making process between the provider and patient

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16
Q

What conditions must be met for informed consent?

A

-adequate disclosure

-p/t must demonstrate clear understanding of the info provided before receiving sedating preoperative drugs

-the patient must give voluntary consent

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17
Q

What is included in adequate disclosure?

A

-diagnosis

-nature and purpose of treatment

-probability of a successful outcome

-availability, benefits, and risks of alternative treatment

-prognosis if treatment no implemented

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18
Q

What medications are used in postoperative nursing?

A

-opioids

-antihypertensives

-diabetic meds

-antiplatelets

-immunosuppressive drugs

-herbal supplements

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19
Q

What are some common allergies in preoperative nursing assessment?

A

-medications

-food

-latex

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20
Q

What diagnostic studies should be obtained preoperatively?

A

-kidney and liver function

-electrolytes

-chest x-ray

-EKG

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21
Q

What should preoperative nurses review?

A

-all systems and do a full head to toe assessment

-fluid and electrolyte balance

-nutrition (overweight or underweight)

-presence of infection

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22
Q

What should the nurse assess in the cardiovascular system?

A

-vital signs

-heart sounds

-pulses

-presence of edema

-results of EKG

-presence of heart disease

-meds such as diuretics (alter potassium)

-valve problems that require prophylactic antibiotics

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23
Q

What should the nurses assess in the respiratory system?

A

-lung sounds

-O2 sat

-history of smoking

-presence of lung disease (COPD)

-use of oxygen or CPAP

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24
Q

What medications should be given preoperatively?

A

-antibiotics

-anticholinergics

-antidiabetics

-antiemetics

-benzodiazepines

-beta blockers

-opioids

-histamine receptor antagonists

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25
Why are antibiotics administered preoperatively?
to prevent infection
26
Why are anticholinergics administered preoperatively?
-to decrease oral and respiratory secretions -prevent nausea and vomiting
27
Why are anti diabetics administered preoperatively?
to stabilize blood glucose
28
Why are antiemetics administered preoperatively?
-increase gastric emptying -prevent nausea and vomiting
29
Why are benzodiazepines administered preoperatively?
to decrease anxiety
30
Why are beta blockers administered preoperatively?
to manage hypertension
31
Why are histamine receptor antagonists administered preoperatively?
-decrease gastric secretion and volume -increase pH
32
Why are opioids administered preoperatively?
pain control
33
What does preoperative teaching include?
-NPO status -meds -begin teaching on postoperative care -explanations of nursing -physical prep
34
What is some preoperative preparation?
skin care such as shaving and cleaning
35
What is preoperative nursing care guided by?
a preoperative checklist
36
What are some common priority NANDAs for preoperative care?
-knowledge deficit -fear -anxiety
37
What is the surgical suite?
a controlled environment designed to minimize the spread of pathogens and allow a smooth flow of patients, staff, and equipment needed to provide safe patient care
38
What are the 3 areas of the surgical suite?
-unrestricted -semi restricted -restricted
39
What is an example of a semi restricted area?
the doors and rooms surrounding the OR (authorized staff with facial hair covered)
40
What is an example of the restricted area?
inside the actual operating room
41
Who are the members of the surgical team?
-perioperative nurse -surgical tech -surgeon -surgical assistant -registered nurse first assistant -anesthesiologist or CRNA
42
What does the perioperative nurse do?
implements patients plan of care
43
What is a scrub nurse?
involved in sterile activities
44
Who is the circulating nurse?
circulates non sterile activities
45
What is surgical hand antisepsis
fingers and hands are scrubbed first then down to the elbows; always keep hands above arms
46
What type of technique is practiced in the OR to prevent infection?
aseptic
47
What are some examples of safety in the OR?
-prevention of wrong site surgery -accurate labeling and handling of specimens -prevent electrical, chemical, thermal burns -safe blood, fluid, med administration -prevention of positioning injuries
48
When does positioning usually occur?
following administration of anesthesia
49
What should positioning ensure?
-correct musculoskeletal alignment -prevent undue pressure on nerves, skin, and bony prominences -provide adequate thoracic excursion -prevent occlusion of arteries and veins -provide modesty in exposure -recognize and respect individual needs
50
How can nurses prevent hypothermia in intraoperative care?
unintended hypothermia has been liked to impaired wound healing, adverse cardiac events, altered drug metabolism, and altered blood clotting
51
How should you prepare the surgical site?
scrubbing or cleansing the surgical site in a circular motion, clean to dirty
52
Why is the OR kept cool?
to prevent growth of organisms
53
What medication can cause the body temperature to drop?
anesthesia
54
What are the different anesthesia techniques?
-moderate to deep sedation -monitored anesthesia care -general anesthesia -local anesthesia -regional anesthesia
55
What is moderate to deep sedation?
Done outside of OR (ACP not required) Ex: Reduction of dislocated joints in the emergency department Nurse can administer with the supervision of a physician
56
What is monitored anesthesia care?
Similar to general anesthesia Does not usually involve inhaled meds Patient is less responsive and and may require airway management
57
What is general anesthesia?
loss of consciousness
58
What is local anesthesia?
anesthesia of small/confined area of the body
59
What is regional anesthesia?
temporary interruption in sensation in a specific area
60
What are some intraoperative surgical risks?
-pulmonary embolism -anaphylactic reaction -adverse cardiac events -malignant hyperthermia
61
What can cause a pulmonary embolism in surgery?
thromboembolism and DVT
62
What kind of adverse cardiac reactions can surgery cause?
-myocardial infarction -cardiac ischemia
63
What are some intraoperative NANDAs?
-focus on airway, breathing, circulation -focus on temp -imbalanced fluid volume -pain -infection -injury -impaired skin integrity
64
What is priority in immediate postoperative care?
assessing airway and breathing
65
How often will vital signs be assessed post op?
every 15 minutes
66
What should the surgical site be assessed for?
bleeding
67
68
What are some possible respiratory problems postoperative?
-airway obstruction -hypoxemia -hypoventilation -respiratory infection
69
What are some possible ways airway obstruction occurs?
-blockage from the tongue -secretions from anesthesia -laryngospasm from inflammation from the EG tube
70
What are some possible ways hypoxemia could occur post op?
-atelectasis (bronchial obstruction) caused by increased secretions or decreased lung volume -pulmonary embolism (dislodged thrombus) -aspiration of gastric contents
71
What are some ways hypoventilation can occur post op?
-depression of central respiratory drive (symptom of anesthesia and pain meds) -mechanical restriction (positioning) -pain (could cause shallow breathing)
72
What are some ways respiratory infection could happen post op?
postoperative pneumonia
73
What are some general respiratory interventions?
-turn, cough deep breathe (splint abdominal incisions when coughing) -oxygen therapy -incentive spirometer 10 times every hour while awake -positioning: head up for the conscious patient and lateral recovery for the unconscious patient
74
What are some common cardiac problems post op?
-hypotension (low perfusion or fluid and blood loss) -hypertension (pain, anxiety, respiratory distress) -dysrhthymias (will happen almost immediately) -fluid retention -hypokalemia (GI and urinary losses) -DVT (immobility, positioning, constant pressure/ can lead to PE) -syncope (decreased cardiac output or fluid deficits
75
What are some cardiac interventions for the post op patient?
-oxygen therapy -medications -fluid replacement -assessment and management of bleeding surgical incision
76
What are interventions for post of DVT
-early ambulation -compression devices -feet exercises -meds to decrease clotting
77
What are some neurologic problems post op?
-postoperative cognitive dysfunction (memory or altered concentration for weeks or months after surgery) -delirium (pain, fluid and electrolyte imbalances)
78
What are some interventions for delirium post op?
-pain control -achieving fluid and electrolyte balance -oxygenation -proper sleep -proper nutrition -proper bowel and bladder function
79
How can pain be controlled postoperatively?
-pca (patient controlled analgesic, IV meds, anesthesia, oral meds) -around the clock
80
Alterations in Temp- Post Op
-hypothermia: warm blankets and fluids may be used -hyperthermia: after 48 hours an elevation greater than 100 degrees may indicate infection
81
What are some GI problems post op?
-nausea and vomiting (side effect of anesthesia/ anesthesia can cause gastric slowing) -constipation (may need meds) -ileus -hiccups
82
When can patients have solid food?
once bowel sounds return to normal
83
What are important interventions for ileus?
-slow diet progression -ambulation
84
What are urinary problems post op?
-low output (less than 0.5ml/kg/hr) -retention (more likely after pelvic surgery) -urinary infection (get catheter out asap)
85
Why would low urine output occur?
-increased aldosterone and pH secretion -fluid restriction before surgery -fluid loss during surgery -drainage and diaphoresis
86
What are techniques that can help post op patients urinate?
-encourage drinking water -put warm water on perineum -normal positioning for urinating -ambulating -in and out catheterization
87
How often should a surgical incision be assessed?
immediately after surgery with intervals increasing further into the post operative period
88
What should you assess the wound for?
-amount -type of drainage -risk for infection -dehiscence (separation of wound)
89
What is a JP drain?
A closed drainage system attached to a suction bulb
90
How does a JP drain work?
to suction you have to squeeze together the sides of the bulb and close the cap, both sides will remain squeezed together. this will suction any drainage into the bulb
91
What is proper care JP drain?
-assessing and emptying drainage bag -sometimes clots can clog the tubing
92
How can you prevent tubing clots in a JP drain?
take an alcohol swab and pull it down the tubing
93
What is a Penrose drain?
soft rubber tubing placed in a wound to prevent build up of fluid
94
What does the pin on a Penrose drain do?
keeps the drain from going into the incision
95
What are some NANDA's for postoperative care?
Risk for... -infection -falls -pain -impaired skin integrity -knowledge deficit
96
What are some increased risk for postoperative complications from presence of chronic illness and age related changes?
-slowed GI -fragile fluid/ electrolyte status -decreased cough reflex -decreased lung expansion -decreased cardiac output -altered immune response -altered circulation -body's altered ability to compensate
97
What is the surgical care improvement project (SCIP)?
aimed at preventing post operative errors and complications
98
Which of the following nursing interventions is most important in preventing postoperative complications?
early ambulation
99
Which of the following interventions should the nurse implement for prevention of pulmonary emboli during the postoperative period?
having the client perform leg exercises every hour while awake (anything with mobility)
100
The nurse is caring for four clients on a medical surgical flow. Which client should the nurse visit first?
82 year old post colonoscopy patient who has been difficult to wake
101
After complaining of discomfort from a surgical procedure, the client voiced fear of addiction with taking analgesics as prescribed, How should the nurse respond to the client's concerns?
-pain tolerance and the need for opioid analgesics are individualized -addiction to opioid analgesics is rare when used for acute pain management
102
After providing a client with preoperative sedative, the nurse notes that the surgical consent form has not been signed by the client. What action should the nurse take?
contact the surgeon
103
A client is preparing for surgery at 2000. When is the last time that the client may have a burger and fries?
1200 (no solid food 8 hours prior to surgery)

Adult Health 380 Exam 3 (4 decks)

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