Perioperative Care- Exam 2 Flashcards
What are the 3 phases of perioperative care?
-Preoperative phase
-Intraoperative phase
-Postoperative phase
When does the preoperative phase begin and end?
Begins when the decision to proceed w/ surgical intervention is made, ends w/ transfer of pt. onto the OR bed
When does the intraoperative phase begin and end?
Begins when the pt. is transferred onto the OR bed, ends w/ admission to PACU
When does the postoperative phase begin and end?
Begins w/ admission of pt. to PACU, ends w/ f/u evaluation in clinical setting or home. Can be up to 1 year.
What are reasons surgery is performed?
-Facilitate a dx, cure, or repair
-Reconstructive, cosmetic, or palliative
-Rehabilitative
What does STOP BANG mean, and what is it used for?
S-snoring
T-tired during day
O-observed apnea
P-pressure
B-BMI
A-age
N-neck >16 in.
G-gender
Assesses for OSA
What are some surgical settings?
-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)
When does discharge planning begin?
During preadmission testing
What are important preoperative assessments?
-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
Whose responsibility is it to ensure there is a signed informed consent prior to sx?
Nurse
Whose responsibility is it to explain the procedure, benefits, risks, complications, and what happens if no sx?
Surgeon & anaesthesiologist
Can a nurse obtain an informed consent following the administration of Lorazepam for anxiety?
No
Where does the signed consent go when the patient goes to OR?
With the pt. to OR
Is informed consent a hospital policy or legal mandate?
Legal mandate
When is it okay to not obtain an informed consent?
Emergent sx
What pt. education does the nurse provide pre-op?
-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)
What are immediate preoperative nursing interventions?
-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)
Who are the members of the surgical team?
-Patient
-Anesthesiologist or CRNA
-Surgeon
-Nurses
-Surgical technicians
-RN first assistants (RNFAs) or certified surgical technologists
What is the role of the circulating nurse during sx?
Initial pt. position on table, advocate, verify consents, monitor asepsis, time out
Who is responsible for performing equipment counts before (x1) and after (x2) sx?
Surgical tech & circulating nurse
What is a time out?
-Right pt.
-Right procedure
-Right appendage/limb
What is the role of the anesthesiologist during sx?
Sleeps pt
Intubates
Monitors condition
What are some intraoperative complications?
-Anaesthesia awareness
-N/V
-Anaphylaxis
-Hypoxia, respiratory complications
-Hypothermia
-Malignant Hyperthermia
-Infection
What are some adverse effects of sx & anesthesia?
-Allergic rxn’s
-Cardiac dysrhythmias
-CNS changes, over sedation, undersedation
-Trauma: laryngeal, oral, nerve, skin, including burns
-Hypotension
-Thrombosis
If electrocautery is being used on a pt., what is an essential step?
Ground pad
Typically older pt’s will need more or less anesthetic agents?
Less
What are some gerontologic considerations r/t sx?
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
Why are surgical environmental zones important?
Prevention of infection
What are the 3 surgical environmental zones?
- Unrestricted zone
- Semi-restricted zone
- Restricted zone
Which surgical environmental zone is aseptic?
Restricted zone
What PPE is required in the restricted zone?
scrub clothes
shoe covers
caps
maska
What PPE is required in the semi-restricted zone?
scrub clothes
caps
Are IV or inhalation anesthetic agents first?
IV
Name inhalation anesthetic agents.
-Halothane
-Isoflurane
-Sevofluranea
Name IV anesthetic agents.
-Succinylcholine
-Rocuronium
-Etomidate
-Ketamine
What is the advantage of moderate sedation?
Pt. can respond to stimuli
What are specific ways to protect pts from injury r/t to sx?
-Pt. ID
-Correct informed consent
-Verify site marked
-Allergies
-Safety measures (grounding, restraints, not leaving a sedated pt.)
What should a PACU nurse due upon admission to the unit?
Baseline assessment
What assessments will the PACU nurse perform?
Assess airway
LOC
Cardiac
Respiratory
Wound
Pain
Check drainage tubes
Monitor lines
IV fluids
Medications
Depending on facility, how often should a PACU nurse assess VS?
q5min or q15min
What level should HOB be unless contraindicated in PACU?
15-30 degrees
What discharge information should be provided to pt./responsible adult for outpatient sx?
-WRITTEN instructions regarding f/u care
-S/S to call surgeon or 911
-Prescriptions (your contact info. in case issues)
Can a pt. drive themselves home if they are only having an outpatient surgery performed?
No
What is the most common electrolyte imbalance after sx? & what does it cause?
K+, arrhythmias
What are clinical indicators of hypovolemic shock/hemorrhage?
-Tachycardia w/ weak, thready pulse
-Tachypnea
-Hypotension
-Pallor, cool, moist skin
-Cyanosis
-Concentrated urine (late sign)
What are common medications used to control N/V after sx?
GI stimulants:
-Metoclopramide
Antiemetic:
-Promethazine, hydroxyzine, ondansetron
Antimotion:
-Dimenhydrinate, scopolamine
How should a room be prepared prior to receiving a pt. in the clinical unit after sx?
-Clean linens
-Bed zeroed
-Suction available
-Emesis basin
-Thermometer
-IV pump
What should occur upon receiving a pt. in the clinical unit post sx?
-VS upon arrival
-Cardiac & resp. status
-Assess dressing & drains
-LOC
-Pain control
What are collaborative problems r/t sx?
-Pulmonary infections/hypoxia
-DVT/PE
-Hematoma/hemorrhage
-Infection
-Wound dehiscence or evisceration
How can wound dehiscence be prevented?
Splinting during coughing
How can most collaborative problems be prevented after sx?
Early ambulation
What are some factors that affect healing?
-Age
-DM
-Smoker
-Nutrition
-Obesity
-Immunocompromised
What are some reasons for postoperative dressings?
-Provide healing environment (clean)
-Absorb drainage
-Splint or immobilize
-Protect
-Promote homeostasis
-Promote pts physical & mental comfort
Is removal of postoperative dressing clean or sterile?
Clean
Is attachment of new dressing postoperative clean or sterile?
Sterile
During postoperative dressing change, what is the nurse assessing for?
-Redness
-Warmth
-Drainage
-Pus
-Foul Odor
Report to surgeon
