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Nursing 105 > Perioperative Care- Exam 2 > Flashcards

Perioperative Care- Exam 2 Flashcards

1
Q

What are the 3 phases of perioperative care?

A

-Preoperative phase
-Intraoperative phase
-Postoperative phase

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2
Q

When does the preoperative phase begin and end?

A

Begins when the decision to proceed w/ surgical intervention is made, ends w/ transfer of pt. onto the OR bed

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3
Q

When does the intraoperative phase begin and end?

A

Begins when the pt. is transferred onto the OR bed, ends w/ admission to PACU

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4
Q

When does the postoperative phase begin and end?

A

Begins w/ admission of pt. to PACU, ends w/ f/u evaluation in clinical setting or home. Can be up to 1 year.

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5
Q

What are reasons surgery is performed?

A

-Facilitate a dx, cure, or repair
-Reconstructive, cosmetic, or palliative
-Rehabilitative

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6
Q

What does STOP BANG mean, and what is it used for?

A

S-snoring
T-tired during day
O-observed apnea
P-pressure
B-BMI
A-age
N-neck >16 in.
G-gender

Assesses for OSA

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7
Q

What are some surgical settings?

A

-Elective surgery: planned in advance
-Emergency sx: unexpected urgency
-Inpatient: hospitalized for acute or chronic conditions or same-day admission
-Ambulatory: same day or outpatient- stand alone facilities (<24 hrs)

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8
Q

When does discharge planning begin?

A

During preadmission testing

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9
Q

What are important preoperative assessments?

A

-H&P
-Medications & allergies
-Drug & alcohol use
-Resp. & CV status
-Hepatic & renal function
-Immune function
-Last food/drink
-Meds the day of
-Spiritual/cultural beliefs

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10
Q

Whose responsibility is it to ensure there is a signed informed consent prior to sx?

A

Nurse

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11
Q

Whose responsibility is it to explain the procedure, benefits, risks, complications, and what happens if no sx?

A

Surgeon & anaesthesiologist

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12
Q

Can a nurse obtain an informed consent following the administration of Lorazepam for anxiety?

A

No

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13
Q

Where does the signed consent go when the patient goes to OR?

A

With the pt. to OR

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14
Q

Is informed consent a hospital policy or legal mandate?

A

Legal mandate

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15
Q

When is it okay to not obtain an informed consent?

A

Emergent sx

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16
Q

What pt. education does the nurse provide pre-op?

A

-TCDB, coughing, IS, splinting
-Early mobility, active body movements
-Pain mgmt (establish pain goal)
-Cognitive coping strategies
-Instruction for pts undergoing ambulatory sx (ride home, when/why to call surgeon or 911)

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17
Q

What are immediate preoperative nursing interventions?

A

-Remove all jewelry!
-Verify NPO status
-Administer pre-anesthetic meds (ex: abx for GI)
-New VS & complete chart
-Pt. transported to pre-surgical area
-Attend to family needs (tell/show them where to wait, what to expect)

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18
Q

Who are the members of the surgical team?

A

-Patient
-Anesthesiologist or CRNA
-Surgeon
-Nurses
-Surgical technicians
-RN first assistants (RNFAs) or certified surgical technologists

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19
Q

What is the role of the circulating nurse during sx?

A

Initial pt. position on table, advocate, verify consents, monitor asepsis, time out

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20
Q

Who is responsible for performing equipment counts before (x1) and after (x2) sx?

A

Surgical tech & circulating nurse

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21
Q

What is a time out?

A

-Right pt.
-Right procedure
-Right appendage/limb

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22
Q

What is the role of the anesthesiologist during sx?

A

Sleeps pt
Intubates
Monitors condition

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23
Q

What are some intraoperative complications?

A

-Anaesthesia awareness
-N/V
-Anaphylaxis
-Hypoxia, respiratory complications
-Hypothermia
-Malignant Hyperthermia
-Infection

24
Q

What are some adverse effects of sx & anesthesia?

A

-Allergic rxn’s
-Cardiac dysrhythmias
-CNS changes, over sedation, undersedation
-Trauma: laryngeal, oral, nerve, skin, including burns
-Hypotension
-Thrombosis

25
Q

If electrocautery is being used on a pt., what is an essential step?

A

Ground pad

26
Q

Typically older pt’s will need more or less anesthetic agents?

A

Less

27
Q

What are some gerontologic considerations r/t sx?

A

Higher risk for complications r/t
-age related CV & pulmonary changes
-decreased tissue elasticity
-decreased rate liver can inactivate anesthetic agents
-decreased kidney function slows elimination of waste products & anesthetic agents
-impaired ability to ^ metabolic rate & impaired thermoregulatory mechanism

28
Q

Why are surgical environmental zones important?

A

Prevention of infection

29
Q

What are the 3 surgical environmental zones?

A
  1. Unrestricted zone
  2. Semi-restricted zone
  3. Restricted zone
30
Q

Which surgical environmental zone is aseptic?

A

Restricted zone

31
Q

What PPE is required in the restricted zone?

A

scrub clothes
shoe covers
caps
maska

32
Q

What PPE is required in the semi-restricted zone?

A

scrub clothes
caps

33
Q

Are IV or inhalation anesthetic agents first?

A

IV

34
Q

Name inhalation anesthetic agents.

A

-Halothane
-Isoflurane
-Sevofluranea

35
Q

Name IV anesthetic agents.

A

-Succinylcholine
-Rocuronium
-Etomidate
-Ketamine

36
Q

What is the advantage of moderate sedation?

A

Pt. can respond to stimuli

37
Q

What are specific ways to protect pts from injury r/t to sx?

A

-Pt. ID
-Correct informed consent
-Verify site marked
-Allergies
-Safety measures (grounding, restraints, not leaving a sedated pt.)

38
Q

What should a PACU nurse due upon admission to the unit?

A

Baseline assessment

39
Q

What assessments will the PACU nurse perform?

A

Assess airway
LOC
Cardiac
Respiratory
Wound
Pain
Check drainage tubes
Monitor lines
IV fluids
Medications

40
Q

Depending on facility, how often should a PACU nurse assess VS?

A

q5min or q15min

41
Q

What level should HOB be unless contraindicated in PACU?

A

15-30 degrees

42
Q

What discharge information should be provided to pt./responsible adult for outpatient sx?

A

-WRITTEN instructions regarding f/u care
-S/S to call surgeon or 911
-Prescriptions (your contact info. in case issues)

43
Q

Can a pt. drive themselves home if they are only having an outpatient surgery performed?

A

No

44
Q

What is the most common electrolyte imbalance after sx? & what does it cause?

A

K+, arrhythmias

45
Q

What are clinical indicators of hypovolemic shock/hemorrhage?

A

-Tachycardia w/ weak, thready pulse
-Tachypnea
-Hypotension
-Pallor, cool, moist skin
-Cyanosis
-Concentrated urine (late sign)

46
Q

What are common medications used to control N/V after sx?

A

GI stimulants:
-Metoclopramide
Antiemetic:
-Promethazine, hydroxyzine, ondansetron
Antimotion:
-Dimenhydrinate, scopolamine

47
Q

How should a room be prepared prior to receiving a pt. in the clinical unit after sx?

A

-Clean linens
-Bed zeroed
-Suction available
-Emesis basin
-Thermometer
-IV pump

48
Q

What should occur upon receiving a pt. in the clinical unit post sx?

A

-VS upon arrival
-Cardiac & resp. status
-Assess dressing & drains
-LOC
-Pain control

49
Q

What are collaborative problems r/t sx?

A

-Pulmonary infections/hypoxia
-DVT/PE
-Hematoma/hemorrhage
-Infection
-Wound dehiscence or evisceration

50
Q

How can wound dehiscence be prevented?

A

Splinting during coughing

51
Q

How can most collaborative problems be prevented after sx?

A

Early ambulation

52
Q

What are some factors that affect healing?

A

-Age
-DM
-Smoker
-Nutrition
-Obesity
-Immunocompromised

53
Q

What are some reasons for postoperative dressings?

A

-Provide healing environment (clean)
-Absorb drainage
-Splint or immobilize
-Protect
-Promote homeostasis
-Promote pts physical & mental comfort

54
Q

Is removal of postoperative dressing clean or sterile?

A

Clean

55
Q

Is attachment of new dressing postoperative clean or sterile?

A

Sterile

56
Q

During postoperative dressing change, what is the nurse assessing for?

A

-Redness
-Warmth
-Drainage
-Pus
-Foul Odor

Report to surgeon

Nursing 105 (11 decks)

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