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
