Perioperative Care Flashcards
What is surgery?
invasive medical procedure performed to diagnose and treat disease, repair injury, or correct deformity
What is the purpose of a diagnostic surgery?
-Obtain tissue samples;
-Make an incision;
-Use a scope to make a diagnosis
How can surgery cure a problem?
through elimination or repair of a pathologic condition
What is palliation surgery?
focuses on alleviation of symptoms without a cure to improve quality of life
What is an example of prevention surgery?
removing a mole before it becomes malignant
What is an example of cosmetic surgery?
reconstructive surgery
What is the purpose of exploratory surgery?
conformation or measurement of extent of condition
(exploratory laparotomy)
Elective vs emergency surgery
-elective: not needed to save life
-emergency: life-saving, necessary
Which type of surgery has an increased need for teaching and emotional support?
outpatient
What are determinants of inpatient or outpatient surgery?
-complexity of surgery
-recovery
-expected needed level of post op care
What are some benefits of outpatient surgery?
-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
What are the 3 phases of preoperative nursing?
- Preoperative
- Intraoperative
- Postoperative
When does the preoperative phased begin and end?
-decision for surgery is made
-patient transferred to operating room
When does the intraoperative phase begin and end?
-admittance to recovery room
-complete recovery
What is informed consent?
an active, shared-decision making process between the provider and patient
What conditions must be met for informed consent?
-adequate disclosure
-p/t must demonstrate clear understanding of the info provided before receiving sedating preoperative drugs
-the patient must give voluntary consent
What is included in adequate disclosure?
-diagnosis
-nature and purpose of treatment
-probability of a successful outcome
-availability, benefits, and risks of alternative treatment
-prognosis if treatment no implemented
What medications are used in postoperative nursing?
-opioids
-antihypertensives
-diabetic meds
-antiplatelets
-immunosuppressive drugs
-herbal supplements
What are some common allergies in preoperative nursing assessment?
-medications
-food
-latex
What diagnostic studies should be obtained preoperatively?
-kidney and liver function
-electrolytes
-chest x-ray
-EKG
What should preoperative nurses review?
-all systems and do a full head to toe assessment
-fluid and electrolyte balance
-nutrition (overweight or underweight)
-presence of infection
What should the nurse assess in the cardiovascular system?
-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
What should the nurses assess in the respiratory system?
-lung sounds
-O2 sat
-history of smoking
-presence of lung disease (COPD)
-use of oxygen or CPAP
What medications should be given preoperatively?
-antibiotics
-anticholinergics
-antidiabetics
-antiemetics
-benzodiazepines
-beta blockers
-opioids
-histamine receptor antagonists
Why are antibiotics administered preoperatively?
to prevent infection
Why are anticholinergics administered preoperatively?
-to decrease oral and respiratory secretions
-prevent nausea and vomiting
Why are anti diabetics administered preoperatively?
to stabilize blood glucose
Why are antiemetics administered preoperatively?
-increase gastric emptying
-prevent nausea and vomiting
Why are benzodiazepines administered preoperatively?
to decrease anxiety
Why are beta blockers administered preoperatively?
to manage hypertension
Why are histamine receptor antagonists administered preoperatively?
-decrease gastric secretion and volume
-increase pH
Why are opioids administered preoperatively?
pain control
What does preoperative teaching include?
-NPO status
-meds
-begin teaching on postoperative care
-explanations of nursing
-physical prep
What is some preoperative preparation?
skin care such as shaving and cleaning
What is preoperative nursing care guided by?
a preoperative checklist
What are some common priority NANDAs for preoperative care?
-knowledge deficit
-fear
-anxiety
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
What are the 3 areas of the surgical suite?
-unrestricted
-semi restricted
-restricted
What is an example of a semi restricted area?
the doors and rooms surrounding the OR (authorized staff with facial hair covered)
What is an example of the restricted area?
inside the actual operating room
Who are the members of the surgical team?
-perioperative nurse
-surgical tech
-surgeon
-surgical assistant
-registered nurse first assistant
-anesthesiologist or CRNA
What does the perioperative nurse do?
implements patients plan of care
What is a scrub nurse?
involved in sterile activities
Who is the circulating nurse?
circulates non sterile activities
What is surgical hand antisepsis
fingers and hands are scrubbed first then down to the elbows; always keep hands above arms
What type of technique is practiced in the OR to prevent infection?
aseptic
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
When does positioning usually occur?
following administration of anesthesia
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
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
How should you prepare the surgical site?
scrubbing or cleansing the surgical site in a circular motion, clean to dirty
Why is the OR kept cool?
to prevent growth of organisms
What medication can cause the body temperature to drop?
anesthesia
What are the different anesthesia techniques?
-moderate to deep sedation
-monitored anesthesia care
-general anesthesia
-local anesthesia
-regional anesthesia
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
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
What is general anesthesia?
loss of consciousness
What is local anesthesia?
anesthesia of small/confined area of the body
What is regional anesthesia?
temporary interruption in sensation in a specific area
What are some intraoperative surgical risks?
-pulmonary embolism
-anaphylactic reaction
-adverse cardiac events
-malignant hyperthermia
What can cause a pulmonary embolism in surgery?
thromboembolism and DVT
What kind of adverse cardiac reactions can surgery cause?
-myocardial infarction
-cardiac ischemia
What are some intraoperative NANDAs?
-focus on airway, breathing, circulation
-focus on temp
-imbalanced fluid volume
-pain
-infection
-injury
-impaired skin integrity
What is priority in immediate postoperative care?
assessing airway and breathing
How often will vital signs be assessed post op?
every 15 minutes
What should the surgical site be assessed for?
bleeding
What are some possible respiratory problems postoperative?
-airway obstruction
-hypoxemia
-hypoventilation
-respiratory infection
What are some possible ways airway obstruction occurs?
-blockage from the tongue
-secretions from anesthesia
-laryngospasm from inflammation from the EG tube
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
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)
What are some ways respiratory infection could happen post op?
postoperative pneumonia
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
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
What are some cardiac interventions for the post op patient?
-oxygen therapy
-medications
-fluid replacement
-assessment and management of bleeding surgical incision
What are interventions for post of DVT
-early ambulation
-compression devices
-feet exercises
-meds to decrease clotting
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)
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
How can pain be controlled postoperatively?
-pca (patient controlled analgesic, IV meds, anesthesia, oral meds)
-around the clock
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
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
When can patients have solid food?
once bowel sounds return to normal
What are important interventions for ileus?
-slow diet progression
-ambulation
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)
Why would low urine output occur?
-increased aldosterone and pH secretion
-fluid restriction before surgery
-fluid loss during surgery
-drainage and diaphoresis
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
How often should a surgical incision be assessed?
immediately after surgery with intervals increasing further into the post operative period
What should you assess the wound for?
-amount
-type of drainage
-risk for infection
-dehiscence (separation of wound)
What is a JP drain?
A closed drainage system attached to a suction bulb
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
What is proper care JP drain?
-assessing and emptying drainage bag
-sometimes clots can clog the tubing
How can you prevent tubing clots in a JP drain?
take an alcohol swab and pull it down the tubing
What is a Penrose drain?
soft rubber tubing placed in a wound to prevent build up of fluid
What does the pin on a Penrose drain do?
keeps the drain from going into the incision
What are some NANDA’s for postoperative care?
Risk for…
-infection
-falls
-pain
-impaired skin integrity
-knowledge deficit
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
What is the surgical care improvement project (SCIP)?
aimed at preventing post operative errors and complications
Which of the following nursing interventions is most important in preventing postoperative complications?
early ambulation
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)
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
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
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
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)
