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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
Q

Why are antibiotics administered preoperatively?

A

to prevent infection

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26
Q

Why are anticholinergics administered preoperatively?

A

-to decrease oral and respiratory secretions

-prevent nausea and vomiting

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27
Q

Why are anti diabetics administered preoperatively?

A

to stabilize blood glucose

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28
Q

Why are antiemetics administered preoperatively?

A

-increase gastric emptying

-prevent nausea and vomiting

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29
Q

Why are benzodiazepines administered preoperatively?

A

to decrease anxiety

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30
Q

Why are beta blockers administered preoperatively?

A

to manage hypertension

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31
Q

Why are histamine receptor antagonists administered preoperatively?

A

-decrease gastric secretion and volume

-increase pH

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32
Q

Why are opioids administered preoperatively?

A

pain control

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33
Q

What does preoperative teaching include?

A

-NPO status

-meds

-begin teaching on postoperative care

-explanations of nursing

-physical prep

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34
Q

What is some preoperative preparation?

A

skin care such as shaving and cleaning

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35
Q

What is preoperative nursing care guided by?

A

a preoperative checklist

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36
Q

What are some common priority NANDAs for preoperative care?

A

-knowledge deficit

-fear

-anxiety

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37
Q

What is the surgical suite?

A

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

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38
Q

What are the 3 areas of the surgical suite?

A

-unrestricted

-semi restricted

-restricted

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39
Q

What is an example of a semi restricted area?

A

the doors and rooms surrounding the OR (authorized staff with facial hair covered)

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40
Q

What is an example of the restricted area?

A

inside the actual operating room

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41
Q

Who are the members of the surgical team?

A

-perioperative nurse

-surgical tech

-surgeon

-surgical assistant

-registered nurse first assistant

-anesthesiologist or CRNA

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42
Q

What does the perioperative nurse do?

A

implements patients plan of care

43
Q

What is a scrub nurse?

A

involved in sterile activities

44
Q

Who is the circulating nurse?

A

circulates non sterile activities

45
Q

What is surgical hand antisepsis

A

fingers and hands are scrubbed first then down to the elbows; always keep hands above arms

46
Q

What type of technique is practiced in the OR to prevent infection?

A

aseptic

47
Q

What are some examples of safety in the OR?

A

-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
Q

When does positioning usually occur?

A

following administration of anesthesia

49
Q

What should positioning ensure?

A

-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
Q

How can nurses prevent hypothermia in intraoperative care?

A

unintended hypothermia has been liked to impaired wound healing, adverse cardiac events, altered drug metabolism, and altered blood clotting

51
Q

How should you prepare the surgical site?

A

scrubbing or cleansing the surgical site in a circular motion, clean to dirty

52
Q

Why is the OR kept cool?

A

to prevent growth of organisms

53
Q

What medication can cause the body temperature to drop?

A

anesthesia

54
Q

What are the different anesthesia techniques?

A

-moderate to deep sedation

-monitored anesthesia care

-general anesthesia

-local anesthesia

-regional anesthesia

55
Q

What is moderate to deep sedation?

A

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
Q

What is monitored anesthesia care?

A

Similar to general anesthesia

Does not usually involve inhaled meds

Patient is less responsive and and may require airway management

57
Q

What is general anesthesia?

A

loss of consciousness

58
Q

What is local anesthesia?

A

anesthesia of small/confined area of the body

59
Q

What is regional anesthesia?

A

temporary interruption in sensation in a specific area

60
Q

What are some intraoperative surgical risks?

A

-pulmonary embolism

-anaphylactic reaction

-adverse cardiac events

-malignant hyperthermia

61
Q

What can cause a pulmonary embolism in surgery?

A

thromboembolism and DVT

62
Q

What kind of adverse cardiac reactions can surgery cause?

A

-myocardial infarction

-cardiac ischemia

63
Q

What are some intraoperative NANDAs?

A

-focus on airway, breathing, circulation

-focus on temp

-imbalanced fluid volume

-pain

-infection

-injury

-impaired skin integrity

64
Q

What is priority in immediate postoperative care?

A

assessing airway and breathing

65
Q

How often will vital signs be assessed post op?

A

every 15 minutes

66
Q

What should the surgical site be assessed for?

A

bleeding

67
Q
A
68
Q

What are some possible respiratory problems postoperative?

A

-airway obstruction
-hypoxemia
-hypoventilation
-respiratory infection

69
Q

What are some possible ways airway obstruction occurs?

A

-blockage from the tongue
-secretions from anesthesia
-laryngospasm from inflammation from the EG tube

70
Q

What are some possible ways hypoxemia could occur post op?

A

-atelectasis (bronchial obstruction) caused by increased secretions or decreased lung volume
-pulmonary embolism (dislodged thrombus)
-aspiration of gastric contents

71
Q

What are some ways hypoventilation can occur post op?

A

-depression of central respiratory drive (symptom of anesthesia and pain meds)
-mechanical restriction (positioning)
-pain (could cause shallow breathing)

72
Q

What are some ways respiratory infection could happen post op?

A

postoperative pneumonia

73
Q

What are some general respiratory interventions?

A

-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
Q

What are some common cardiac problems post op?

A

-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
Q

What are some cardiac interventions for the post op patient?

A

-oxygen therapy
-medications
-fluid replacement
-assessment and management of bleeding surgical incision

76
Q

What are interventions for post of DVT

A

-early ambulation
-compression devices
-feet exercises
-meds to decrease clotting

77
Q

What are some neurologic problems post op?

A

-postoperative cognitive dysfunction (memory or altered concentration for weeks or months after surgery)
-delirium (pain, fluid and electrolyte imbalances)

78
Q

What are some interventions for delirium post op?

A

-pain control
-achieving fluid and electrolyte balance
-oxygenation
-proper sleep
-proper nutrition
-proper bowel and bladder function

79
Q

How can pain be controlled postoperatively?

A

-pca (patient controlled analgesic, IV meds, anesthesia, oral meds)
-around the clock

80
Q

Alterations in Temp- Post Op

A

-hypothermia: warm blankets and fluids may be used
-hyperthermia: after 48 hours an elevation greater than 100 degrees may indicate infection

81
Q

What are some GI problems post op?

A

-nausea and vomiting (side effect of anesthesia/ anesthesia can cause gastric slowing)
-constipation (may need meds)
-ileus
-hiccups

82
Q

When can patients have solid food?

A

once bowel sounds return to normal

83
Q

What are important interventions for ileus?

A

-slow diet progression
-ambulation

84
Q

What are urinary problems post op?

A

-low output (less than 0.5ml/kg/hr)
-retention (more likely after pelvic surgery)
-urinary infection (get catheter out asap)

85
Q

Why would low urine output occur?

A

-increased aldosterone and pH secretion
-fluid restriction before surgery
-fluid loss during surgery
-drainage and diaphoresis

86
Q

What are techniques that can help post op patients urinate?

A

-encourage drinking water
-put warm water on perineum
-normal positioning for urinating
-ambulating
-in and out catheterization

87
Q

How often should a surgical incision be assessed?

A

immediately after surgery with intervals increasing further into the post operative period

88
Q

What should you assess the wound for?

A

-amount
-type of drainage
-risk for infection
-dehiscence (separation of wound)

89
Q

What is a JP drain?

A

A closed drainage system attached to a suction bulb

90
Q

How does a JP drain work?

A

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
Q

What is proper care JP drain?

A

-assessing and emptying drainage bag
-sometimes clots can clog the tubing

92
Q

How can you prevent tubing clots in a JP drain?

A

take an alcohol swab and pull it down the tubing

93
Q

What is a Penrose drain?

A

soft rubber tubing placed in a wound to prevent build up of fluid

94
Q

What does the pin on a Penrose drain do?

A

keeps the drain from going into the incision

95
Q

What are some NANDA’s for postoperative care?

A

Risk for…
-infection
-falls
-pain
-impaired skin integrity
-knowledge deficit

96
Q

What are some increased risk for postoperative complications from presence of chronic illness and age related changes?

A

-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
Q

What is the surgical care improvement project (SCIP)?

A

aimed at preventing post operative errors and complications

98
Q

Which of the following nursing interventions is most important in preventing postoperative complications?

A

early ambulation

99
Q

Which of the following interventions should the nurse implement for prevention of pulmonary emboli during the postoperative period?

A

having the client perform leg exercises every hour while awake (anything with mobility)

100
Q

The nurse is caring for four clients on a medical surgical flow. Which client should the nurse visit first?

A

82 year old post colonoscopy patient who has been difficult to wake

101
Q

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?

A

-pain tolerance and the need for opioid analgesics are individualized
-addiction to opioid analgesics is rare when used for acute pain management

102
Q

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?

A

contact the surgeon

103
Q

A client is preparing for surgery at 2000. When is the last time that the client may have a burger and fries?

A

1200 (no solid food 8 hours prior to surgery)

Adult Health 380 Exam 3 (4 decks)

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