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Med/Surg 1 Exam 3 > Perioperative Care > Flashcards

Perioperative Care Flashcards

1
Q

What are the purposes for surgery?

A 
Diagnosis 
Cure 
Palliation 
Prevetion 
Exploration 
Cosmetic improvemnt 
Transplant
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2
Q

What are the four distinct phases of surgery?

A

Pre- operative
Intra- operative
Post- anesthesia
Post- operative

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3
Q

What should be assess in pre- op?

A 
Data collection
Medication review (prescribed med, OTC, illegal, herbal, vitamins)
Nutritional status 
Pain 
ROM limitations
Pre- op labs and diagnostic tests
Allergies 
Baseline VS
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4
Q

What are some meds that would cause concern in pre- op assessment?

A

Anti- coagulant
- lovenox, heparin, warfarin, aspirin
Steroids
- prednisone

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5
Q

Why is height and weight important?

A

To make sure they get the required anesthesia

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6
Q

Why is ROM limitations important?

A

Positioning during surgery

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7
Q

What is involved in health history for coping/adaption?

A

Psychological
Developmental
Socio-cultural
Spiritual

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8
Q

Coping/adaption: Psychological

A

Stress and coping mechanisms

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9
Q

Coping/adaption: Developmental

A

Age and gender

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10
Q

Coping/adaption: Socio- cultural

A

Support system
Economics
Plans for convalescence

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11
Q

Coping/adaption: Spiritual

A

Consider influence of religious/philosophical beliefs on surgical risk
Non- judgemental
Pastoral care referral

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12
Q

What are some surgical risks?

A 
Age 
Nutritional 
Smoking 
ETOH/Drug use 
Chronic steroid use 
Pre-existing conditions
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13
Q

Why is age a surgical risk for the very young?

A

Poorly developed lungs: increases risk of pulmonary problems
Looses water quickly being dehydrated

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14
Q

Why is being obese a surgical risk?

A

Excess adipose tissue and poor blood supply

  • Prolonged surgery
  • Prolonged excretion of anesthetic agent
  • Reduced ventilatory function
  • Slower healing process
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15
Q

Why is being underweight a surgical risk?

A

May lack needed vitamins and proteins

  • Risk for poor wound healing and infection
  • May be at risk for skin impairment with significance of bony prominences
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16
Q

Why is smoking a surgical risk?

A

Decreases ciliary action
Nicotine constricts blood vessels
Decreased amount of functional hemoglobin

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17
Q

Why is excessive alcohol consumption a surgical risk?

A

Affects liver function
- Metabolism and detoxification of drugs may be delayed
- May have poor nutrition: delayed wound healing
At risk of alcohol withdrawal (DT)

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18
Q

What are some pre- existing conditions?

A 
Bleeding disorders 
Diabetes 
Heart disease
Fever
Upper resp. infection 
Chronic resp. disease 
Liver disease 
Immune disorders
Renal insufficiency 
Chronic steroid use
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19
Q

If steroids are being used chronically and abruptly stopped what can happen to the patient?

A

Adrenal crisis

- Hypertensive

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20
Q

What does BUN assess?

A

Hydration

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21
Q

What does creatinine assess?

A

Kidney function

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22
Q

Guidelines and safe practice recommendations are published by who?

A

AORN (American operating room nurse association)
ASPAN (American society of perianesthesia nurses)
WHO (World health organization)
Joint Commission (SCIP)

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23
Q

According to the WHO, what are the ten essential objectives to for safe surgery?

A
  • Operate on correct Pt on correct site
  • Use methods known to prevent harm from
    administration of anesthetics while protecting
    Pt from pain
  • Recognize & effectively prepare for life threatening
    loss of airway or resp function
  • Recognize & effectively prepare for risk of
    high blood loss
  • Avoid inducing an allergic or adverse drug
    reaction
  • Use methods known to minimize risk for
    surgical site infections
  • Prevent inadvertent retention of instruments
    & sponges
  • Secure & identify all surgical specimens
  • Effectively communicate & exchange critical
    information
  • Establish routine surveillance of surgical
    results
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24
Q

When should the pre- op antibiotic be given?

A

Within 1 hr before incision

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25
Q

When should antibiotics be discontinued?

With what exception?

A

Within 24hrs of anesthesia end time

48hrs for cardiac surgery

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26
Q

What antibiotics should they be given 2hrs before incision?

A

Vancomycin

Levaquin

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27
Q

What should be remembered about blood glucose and cardiac surgery patients?

A

Controlled 6am post-op serum glucose (less than 200 mg/dl post-op day 1 and 2)

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28
Q

Why is maintaining a normal blood glucose important post-op?

A

Risk of infections higher if blood glucose levels are elevated

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29
Q

What should be used for hair removal?

A

Clippers (preferable)

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30
Q

Why shouldn’t you shave with a razor?

A

It causes skin abrasions which may lead to infections

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31
Q

When should a foley be removed and why?

A

Post op day 2

Risk of UTI

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32
Q

What should be remembered about beta blockers and pre-op patients?

A
  • Continue if patient on home beta blocker therapy
  • Beta blocker may be given 24 hrs. prior to op or day of
    procedure
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33
Q

What are the parameters to give a beta blocker?

A

Heart rate must be ≥ 50 and systolic blood pressure ≥ 100

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34
Q

Why is giving a beta blocker important with a pre-op patient?

A
  • Perioperative myocardial ischemia has been identified as
    the #1 risk factor for mortality after non-cardiac
    surgery.
  • Attributed to the exaggerated sympathetic response leading to persistently elevated heart rate.
  • Has the potential to significantly reduce cardiac deaths for up to 2 years postoperatively
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35
Q

Why is timing of VTE prophylaxis important?

A

Reduces the risk of development of pulmonary embolism and DVT

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36
Q

What can happen to blood vessels if fluids are warmed up too much?

A

Burns to the blood vessels

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37
Q

What is temperature you want your patient to be at/above and within what time?

A

At least ≥ 96.8°F/36°C within 15 minutes of anesthesia end time or warmer used in OR

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38
Q

Why is temperature management important?

A
  • 3 times greater incidence of surgical site infections with hypothermia
  • Delayed wound closure which results in prolonged hospitalization
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39
Q

How can the nurse help in alleviating anxiety with a patient?

A
  • Therapeutic communication
  • Determine source of anxiety
  • Knowledge of the surgery, anesthesia, and their role
  • Educate & clear up misconceptions
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40
Q

What may be some of the causes for fear for a patient?

A
  • Unknown: may be first surgery
  • Pain and pain management
  • Concern with body image/ change in image
  • Death
  • Anesthesia
  • Disruption of life: having to be
    dependent on others
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41
Q

What is the nurse’s role with an informed consent for surgery?

A
  • Verify that the healthcare provider has discussed
    risks and benefits with patient and has obtained the persons signature
  • Usually witnessed by the RN
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42
Q

What is involved in pre0op teaching?

A
  • Cough & Deep Breathing
  • Leg exercises
  • ROM
  • Patient movement (amblation, compression devices, splinting)
  • Prevention of constipation
  • Surgical incision care
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43
Q

What is the most beneficial mechanism to enhance breathing post-op?

A

Incentive spirometer

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44
Q

What are some ways to reduce the risk of infection?

A
  • Chlorohexidine bath
  • Use of clippers to shave hair from surgical area immediately prior to surgery
  • Insertion and dressing of IV using aseptic technique
  • Bowel prep if indicated
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45
Q

What is involved in pre-op diagnostic testing?

A 
Labs (electrolytes, H/H, Cr, Type and cross, coagulation studies, blood sugar, ABG, total protein)
CXR/other XR 
EKG 
Pulmonary studies 
Pregnancy test
46
Q

What is the purpose of pre-op pharmacology?

A
  • Facilitate effective anesthetics
  • Minimize respiratory tract secretions
  • Induce relaxation
  • Reduce anxiety
47
Q

Examples of opiates: narcotic analgesic?

A

Morphine Sulfate
Hydromorphone (x10)
Fentanyl (x100)
(increasing in level of strength)

48
Q

What are opiates used for?

A

Control moderate to severe

pain during intraoperative and postoperative phase and can also be used for patient sedation

49
Q

What are the nursing considerations for opiates?

A
  • Monitor for decreased LOC, eventually leads to respiratory depression
  • Monitor for decreased B/P (tissue perfusion)
  • Opiate overdose can be treated with Naloxone
50
Q

What is the difference between Ondanestron and promethazine?

A

Ondanestron (Zofran) DOESN’T cause drowsiness

Promethazine (Phenergan) DOES cause drowsiness

51
Q

Examples of antiemetics?

A

Ondansetron Hydrochloride
(Zofran)
Promethazine (Phenergan)

52
Q

What are antiemetics used for?

A

Decrease N/V when

given during pre-op phase, from anesthesia during post-op phase

53
Q

What are the nursing considerations of antiemetics?

A
  • Monitor fluid and electrolytes
  • Monitor for diarrhea
  • Monitor for tachycardia and angina
54
Q

Examples of H2 Receptor antagonists?

A

Cimetidine (Tagamet)
Famatidine (Pepcid)
Rantitidine (Zantac)

55
Q

What can happen if promethazine is given to quickly through IV?

A

Necrosis of vein

56
Q

Where should the IV be placed for a patient to receive promethazine IV?

A

Forearm and above

Not hands

57
Q

What are H2 receptor antagonists used for?

A

Decreases risk of stress ulcers

58
Q

Why is acetaminophen usually given in pre-op?

A

Adjunct to narcotics to enhance effects

59
Q

Examples of anti-anxiety meds?

A

Midazolam (Versed)

Diazepam (Valium)

60
Q

What special effect does Midazolam (Versed) have?

A

Amnesia

61
Q

Examples of anticholinergics?

A 
Atropine sulfate (Atropine)
Hyoscine hydrobromide (Scopolamine) (patch behind ear)
Glycopyrrolate bromide (Robinul)
62
Q

What do anticholinergic increase?

A

HR (use cautiously in pts with cardiac issues)

63
Q

Examples of antibiotics?

A 
Cefazolin (Ancef)
Cefoxitin (Mefoxin)
Ampicillin/sulbactram (Unasyn)
Vancomycin
Clindamycin
Levofloxacin
64
Q

What is the role of the circulating nurse?

A
  • Plans & coordinates care in OR
  • Assists in setting up OR room
  • Gathers supplies & equipment
  • Opens instruments & supplies
  • Brings the patient to & from the pre-op area
  • Collects and verifies patient information
  • Verifies consent
  • Supports the patient & acts as the patient advocate
  • Anticipates & meets the needs of the surgeon, anesthesia & scrub nurse
  • Monitors & controls the OR environment
  • Monitors blood loss with anesthesia
  • Documents nursing care and all equipment counts
65
Q

When is equipment counted?

A

Before (once)
After (Twice)
Anytime circulating nurse feels the need equipment needs to be counted (During)

66
Q

What is electrosurgery and how is it used?

A

Electrical current to cut & coagulate fat, fascia, muscle, internal organs & small blood
vessels
Decreases the amount of diffuse bleeding

67
Q

What is the biggest hazard of electrosurgery?

A

Electrical burns through the patient’s skin

68
Q

How is the patient grounded?

A

With a pad

69
Q

What are some ways of maintaining safety and decreasing risk of infection?

A
  • Hand washing (5-10 hand &
    arm scrub)
  • Laminar air flow to reduce air currents
  • HEPA filters in air ducts
  • Sterile field is created & maintained throughout surgical procedure
70
Q

What are the types of anesthesia?

A

Local
Regional
General

71
Q

What is local anesthesia?

A 
- Numbs a small area on the
body
- Patient is awake and conscious
- The surgical site is injected
with a anesthetic, such as
lidocaine, into the SQ tissue in
order to depress the superficial
peripheral nerves
72
Q

What is regional anesthesia?

A
  • Blocks the feeling to a large part of the body
  • Includes epidural and nerve blocks
  • Regional- reversible loss of sensation &/or movement when a local anesthetic is injected to block or anesthetize nerve fibers (Spinals, Epidurals, Caudals or Major peripheral blocks such as a brachial nerve block)
73
Q

What is general anesthesia?

A 
Reversible, unconscious state
◦ Amnesia
◦ Analgesia
◦ Depression/loss of reflexes
◦ Muscle relaxation
◦ Homeostasis or manipulation of physiological functions
74
Q

What is conscious sedation?

A
  • State of reduced consciousness which allows performance of unpleasant
    procedures while preserving protective airway, reflexes, & the ability to respond to verbal commands`
75
Q

What type of meds are given for conscious sedation?

A

Amnesic
Analgesic
Sedative

Morphine & Midazolam (Versed)

76
Q

What is balanced anesthesia?

A

Use of combining IV anesthetics, analgesics, amnesics & inhalation drugs to
achieve unconsciousness, skeletal muscle relaxation, pain relief & physiological homeostasis

77
Q

What are some complications of anesthesia?

A
  • N/V
  • Anaphylactic reaction
  • Malignant hyperthermia
  • Hypotension
  • Fluid imbalance
  • Electrolyte imbalance
  • Hypothermia
  • Hypoventilation
  • Airway obstruction
  • Loss of sensation &/or movement from regional
  • Hematoma, infection, tissue trauma from regional/local
  • Inability to void from regional
  • Drug toxicity
78
Q

What does the PACU focus on?

A
  • Respiratory status
  • CV status
  • Pain level
  • Type of anesthesia given
  • Temperature
  • Control of N/V
  • Operative site assessment
79
Q

What is a sign for low temperature?

A

Bradycardia

80
Q

What are some S/S of ineffective airway clearance?

A
  • Snoring
  • Nasal flaring
  • Accessory muscle use
  • Intercostal retractions
81
Q

What are some S/S of ineffective breathing pattern?

A
  • CO2>45 mmHg
  • Extreme sedation
  • Decreased RR
  • Shallow respirations
  • HR & BP ↑ or ↓
82
Q

Cause of ineffective airway clearance?

A

Tongue occlusion

83
Q

Treatment for ineffective airway clearance?

A
  • Chin lift / jaw thrust
  • Stimulate the patient
  • Insert oral airway
  • Intubation
84
Q

Causes of ineffective breathing pattern?

A
  • Residual effects of anesthesia
  • Pain
  • Obesity
  • Supine positioning
85
Q

Treatment for ineffective breathing pattern?

A
  • Stimulate the patient to take deep breathes
  • Supplemental O2
  • Elevate HOB
  • Place in lateral position
  • Provide pain relief
86
Q

What is atelectasis?

A

Partial or complete collapse of the lung

87
Q

Causes of atelectasis?

A 
- Hypoventilation/mechanical
ventilation
- Mucous plugs
- Decreased surfactant production
- Constant recumbent position
- Ineffective coughing
- History of smoking
- Can lead to the development of Pneumonia
88
Q

What are some interventions to prevent atelectasis?

A
  • HOB elevated 30 degrees
  • O2 therapy as ordered
  • Coughing & Deep breathing Q1hr
  • Incentive spirometer Q1hr
  • Incisional splinting
  • Changing position Q1-2hr
  • Early ambulation
  • Adequate hydration
89
Q

What can cause altered tissue perfusion?

A

Hypotension ( 160/90)

90
Q

Causes of hypotension?

A

Hemorrhage
Hypovolemia
MI
Embolism or drugs

91
Q

Causes of hypertension?

A 
Pain 
Anxiety,
Full bladder
Pulmonary emboli Hypervolemia
Hypothermia
Hypoxemia
92
Q

Treatment for hypotension?

A

Fluid replacement
Vasoconstriction meds
Elevate the pts legs
Monitor VS & I&O

93
Q

Treatment for hypertension?

A

Treat the cause & give quick

acting antihypertensives

94
Q

What are post-op patients most at risk for?

A

VTE

95
Q

What are some interventions for

A
  • Prophylaxis for VTE (Heparin or LMWH, SCD’s)
  • Accurate I&O
  • Monitoring of electrolyte levels
  • Close monitoring of IV therapy
    replacement
  • Promote early, progressive ambulation
96
Q

Risk factors for pulmonary emboli?

A
  • Childbirth
  • Pregnancy
  • Birth control pills
  • Older adults with hx of A-fib or heart valve disease
  • Trauma/Surgery
  • Cancer
  • Sedentary lifestyle
  • Overweight
  • Smoking
  • Drug abuse
  • Dehydration
  • Hypertension
97
Q

S/S of pulmonary emboli

A
  • Sudden onset of dyspnea
  • Increase in HR & RR
  • Chest pain
  • Hemoptysis
  • Crackles
  • Fever
  • Accentuation of pulmonic heart sounds
  • Sudden change in mental status
98
Q

Diagnosis of pulmonary emboli

A
  • Pulse Oximetry
  • ABGs
  • Blood Coagulation studies
  • EKG
  • CT (spiral) Scan
  • Pulmonary angiogram
  • V/Q scan
99
Q

Treatment for pulmonary emboli?

A
  • Stay with patient
  • Thorough assessment
  • Call Doctor
  • Provide pain relief measures
  • Prepare patient for diagnostic tests as ordered
  • Bedrest
100
Q

What should be done for decreased CO and altered tissue perfusion?

A
  • Assess for S/S right sided heart failure (Cor Pulmonale)
  • Digoxin
  • Diuretics
  • Vasopressors if in shock
101
Q

How should heparin be administered?

A

Given continuous IV infusion after initial bolus dose, given for up to 7 days until Coumadin PO has been given for a few days & the PT is 1 1/2 to 2 times the control

102
Q

Heparin Drip Protocol:

less than 35

A

↑ drip by 4u/kg/h, give 80u/kg bolus

103
Q

Heparin Drip Protocol:

35 - 49

A

↑ drip by 2u/kg/h, give 40u/kg bolus

104
Q

Heparin Drip Protocol:

50 - 80

A

No change

105
Q

Heparin Drip Protocol:

81 - 100

A

↓ infusion by 2u/kg/h

106
Q

Heparin Drip Protocol:

100 - 120

A

↓ infusion by 3u/kg/h

107
Q

Heparin Drip Protocol:

>120

A

Stop infusion, call doctor immediately

108
Q

Heparin Drip Protocol:

After any change in drip, what should you do?

A

Repeat PPT in 6hrs

109
Q

Heparin Drip Protocol:

Heparin antidote?

A

Protamine sulfate

110
Q

What should be avoided while taking anticoagulants?

A

Trauma

Green leafy veggies

111
Q

What interventions are used for pain?

A
  • IV opioids provide most rapid pain relief
  • Sustained relief (Epidurals, PCA pumps, Regional anesthesia blockade)
  • First 48 hours (Opioids)
  • Thereafter: Non-opioids (NSAID’s)
  • Times prior to activity
112
Q

What significant findings should be reported?

A
  • Prolonged unresponsiveness
  • Changes in LOC
  • O2 saturation 120 BPM
  • Hyper or hypotension
  • Absence of peripheral pulses
  • UO

Med/Surg 1 Exam 3 (5 decks)

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