Perioperative care - things in red Flashcards
Suffix meaning: Excision or removal
Ectomy
Suffix meaning: Destruction of
lysis
Suffix meaning: repair or suture of
orrhaphy
Suffix meaning: looking into
oscopy
Suffix meaning: creation of opening into
ostomy
Suffix meaning: cutting into or incision of
otomy
Suffix meaning: repair or reconstruction of
plasty
During the preoperative assessment, it is vital to take note of any prescription and OTC medications, and ______ used.
herbs
Describe the preoperative rating.
Rating from I to V - done by anesthesiologist
I - healthy
II - mild risk
III - severe risk
III - severe threat to life
V - unlikely to survive 24 hours with or without surgery
Done to protect surgeon
There are three patient information types, what are they? Describe them.
Sensory information - what patient will see, hear, smell, taste, feel during surgery
Process information: patient wants general flow of what will happen, but not specific details
Procedural information: specific details - want to know everything
Consent:
- Anyone undergoing invasive procedure must sign an _________ consent
Pt. or legal designate must receive full explanation of the operation, including reasons for the surgery, alternatives available, _____ and ______, and probability of a successful outcome from the “_______”
informed
risks, benefits
surgeon
What is an important consideration in preoperative care when preparing the GI tract to receive GA?
Remove the water jug from the patient’s bedside
Although we generally remove everything from the patient and put their belongings in a safe area, what can they have on their person?
A wedding band taped in place
Immediate care prior to OR:
- Ensure patient has done this
- Complete this.
Ensure patient has voided
Complete and sign preoperative checklist
Immediate care prior to OR - preoperative medications.
What is important?
Check written preoperative Dr’s orders for which medications are to be given the DAY OR SURGERY
What is one of the more important meds to be given prior to surgery?
Insulin - up to doctor to determine, but best to ask; dose often elevated due to insult to body
What are the most important roles of the circulating nurse?
Ensures pt safety
Advocates for the patient
Admitting client to OR
- Done by?
- Pt identified by arm band, and ID number as well as asked to state name, surgeon’s name, operation and _______ (verified against consent)
circulating nurse
location
What do we use to report in between transfers?
SBAR Situation Background Assessment Recommendation
What is the MOST important part of post-operative care on the unit?
Reunite the family!
Post-operative assessment: Assess respiratory status: - \_\_\_\_\_\_\_ airway - \_\_\_\_\_\_\_ all lobes of the lungs - \_\_\_\_\_, \_\_\_\_\_ and \_\_\_\_\_\_ of respirations - Chest \_\_\_\_\_\_\_ - Body temperature > \_\_\_\_C in the first 24 hours or oxygen saturation \_\_\_ indicates this. What do we do?
patent auscultate rate, rhythm, depth symmetry 37.7C; 92% atelectasis Encourage DB and C
Post-operative assessment:
- Assess Circulatory status:
- thrombus can form in any blood vessel - be aware for _____, unilateral _______ or warmth in the _____
- Encourage ______ and leg ______, apply _______
- check ___, skin ____, and ______
pain, edema, calf
turning, exercises, stockings
VS, temperature, colour
Post-operative assessment:
Monitor the IV, PICC lines:
- Patency, type of solution and rate of infusion
- Check insertion sites for?
- Intake and output monitoring - ?
- Can be switched to _____ _____ once the pt is stable
reptiles
I&O - 0.5mL/kg/hr or 30mL/hr or urine
saline lock
Post-operative assessment:
Assess neurological status
- _______ first sense to return
- ______ more prone to confusion which can last for days to weeks - remember to observe for ______
- Anesthetics are ____ soluble so ______ patients require more anesthetic and take longer to clear drugs
- LOC, PERRLA, A&Ox3 - lingering effects of anesthesia for 24 hours
hearing
seniors - delirium
fat, obese
Post-operative assessment:
Surgical wound status:
- wound infections tend to develop __-___ days post-op
- What do we assess?
Signs and symptoms of infection?
- What are the important ones to look out for?
3-4
dressing, amount and character of dressing
SnS
- INCREASING pain
- INCREASED drainage
Post-operative assessment:
Monitor drainage tubes:
- Note whether they should be attached to _______ or ______
- is the drainage tube _____, if not irrigate with ____ _____ - this requires what?
- NG tubes inserted for decompression remain in place until _____ begins - how do we know it has begun?
suction or gravity
patent - irrigate with NS but with physician order
persistalsis - know when BS present, flatus or hunger present
Small collapsible piece of tubing that removes drainage from inside the wound
Penrose drain
Describe removal of a penrose drain.
MD will order for drain to be shortened by 1” per day (check order)
- Clean wound, pull drain out 1”, reattach safety pin and snip the drainage tube above the pin with sterile scissors and cover with a dry sterile dressing (DSD)
Document and keep doing this until drain is removed/falls out
Inserted into the wound, stabilized with a suture on top, drainage collects via a vacuum into collection chamber
Ensures skin is dry. Drainage is emptied periodically from the reservoir and the vacuum is reestablished
vacuum drain
Small balloon collection device; vacuum established by squeezing all the air out of the balloon then closing it.
Jackson-Pratt
Flat circular collection device; vacuum established by pushing top down until chamber is flat then close device.
Hemovac
Drain removal
- most important thing?
- often removed when there is _____ drainage in 24 hrs
- Painful - what do we do?
check orders for removing the drain
often removed when there is <30mL drainage in 24 hr
Painful - pre-medicate pt, when removing having patient take a deep breath in and blow it out, remove drain while they are exhaling - quick and do not hesitate
Post-operative assessment
- How do we control nausea and vomiting?
Give fluids, clear and flat
anti-emetics
k-basin near
position on side to prevent aspiration, etc.
Post-operative assessment - Control pain
- Analgesics should be given when needed and ______ pain becomes severe
- Document the date and time of medication, amount given, pain location and the _________ of medication
before
effectiveness
