Perioperative Client Flashcards
Oscopy?
An action or activity involving the use of an instrument for viewing
Ostomy?
An artificial opening in an organ created during surgery
Ex. Colostomy, ileostomy
Otomy?
Means to cut into a part of the body
Ex. Gastronomy cuts into stomach but not remove
Plasty?
Molding or shaping of a defect to restore form and function to a body part
Anastomosis?
A connection made surgically between adjacent channels of the body
Ex. Blood vessels
Dermatome?
An area of the skin that is supplied with the nerve fibres of a single, posterior, spinal root
Preoperative phase?
The time period between the decision to have surgery until the patient enters operating room
Intraoperative phase?
Starts when patient enters operating room until the patient enters recovery/PACU
-includes anesthesia admin and surgical procedure
Postoperative phase?
Begins when patient enters recovery/PACU and continues until healing is complete
-includes follow up/rehab
Pneumatic compression device?
A device that prevents thrombosis in bedridden patients
-it uses an inflatable device that squeezes the calves to prevent pooling of blood from forming mimicking the effects of walking
Atelectasis?
Collapse of alveoli
-partial or complete
Thrombophlebitis?
Inflammation of the wall of a vein with associated thrombosis
Paralytic ileus?
Small bowel obstruction when peristalsis stops
Conscious sedation?
A combination of medications to help you relax and block pain
General anesthesia?
Anesthesia that affects the whole body and induces a loss of consciousness
Regional anesthesia?
Only numbs the area of the body that requires surgery
Spinal anesthesia?
A form of regional anaesthesia involving injection of local anaesthesia into the subarachnoid space
Loss of feeling below perineum
Epidural anaesthesia?
Injection of anaesthesia into the epidural space of the spine which eliminates sensation from the point of insertion and downward
Ex. C-section
Things that determine type of surgery?
Purpose
Degree of urgency
Level of invasiveness
Body part
Equipment used
Degree of risk
Purposes of surgery?
Diagnostic (exploratory): confirms or establishes
Palliative: relieves or reduces pain but does not cure
Ablative or curative: removes diseased body part
Constructive: restores function or appearance
Transplantation: replaces malfunctioning structures
Levels of invasiveness?
Invasive (open): involves large incisions made to visualize and provide direct access
Minimally invasive: involves small incisions through telescopic equipment to provide indirect visualization and manipulation
Degree of urgency?
Emergency: performed immediately to preserve function or life
Urgent: within 24-48hrs
Elective: treatment for something that is not life threatening or to improve clients own life
Degree of risk: major?
Involves a high degree of risk
- complicated
- large loss of blood may occur
- vital organs involved
- post op complications
Degree of risk: minor?
Involves little risk
Few complications
Often day surgery
What may affect degree of risk?
Age: neonates/infants & older adults
General health
Nutritional status: malnutrition/obesity
Medical hx: medications, surgeries
Mental health status: ability to cope
What’s covered in preoperative phase?
Consent Assessment Physical assessment Psychological assessment Planning -discharge
What are some things covered in informed consent?
Nature and reason Name and qualifications of surgeon Risks and potential outcomes Possible alternatives Right to refuse or withdrawal consent
Preoperative assessment?
Collecting and reviewing client data Nursing hx Allergies Previous surgeries Mental status Medications Current health status Understanding of procedure/anaesthesia Coping Cultural/spiritual considerations
Why is previous surgeries an important part of assessment?
How did they respond to their previous surgery
Response to anaesthesia
Any complications
What is the perioperative period?
Entire operative period
Starting when doctor says you need surgery and includes rehab/restorative care at home/follow up
Why can the postoperative phase last a long time?
Because surgical wounds are primary intention healing which can take up to a year or longer
Why might someone need an urgent surgery?
Preserve clients life
Preserve a body part
Preserve function of the body
What are some physical assessments done in preoperative phase?
Head to toe -mini mental -resp assessment -cardiovascular assessment -other systems --> GI, GU Preop labs and diagnostics Vitals
Ectomy?
Surgical removal of a specified part of the body
What are some preoperative planning?
Teaching pre and post op Physical prep -NPO, enema, skin prep, meds Psychological prep -providing comfort, reducing fears Planning pick up/drive home Discharge planning -home care Continuum of care -coordination throughout transfers -care of patients belongings -contact with physician and fam
True or false.
It’s the nurses role to gain informed consent?
False.
It’s the physicians responsibility to gain informed consent from patient
Nurses can answer questions about procedure but cannot gain informed consent from patient
Consent must be documented
Planning in intraoperative phase?
Maintain clients safety Maintain homeostasis Preserve patients life Maintaining sterile environment Promote psychological comfort Updating family Ensuring right patient, right procedure, right body part, etc. Managing tubes Documentation Advocating for clients dignity Sponge and instrument counts Assisting with positioning
Preoperative teaching topics?
Info. about what will happen to client -sensations/discomfort Providing accurate info that decrease fears/misbeliefs Skill training -coughing, splinting incisions Explaining need for preoperative tests Educate about anaesthesia
Medications given in preop period?
Antibiotic -prophylactic Analgesic -additive to anaesthetic, decrease post op discomfort Antiemetic -decrease post op discomfort Anticholinergic -decrease secretions Benzos -decrease anxiety, sedative effect, increase amnesia
Postoperative phase?
Promoting wellness/healing Multidisciplinary communication Preventing associated risks Head to toe assessments Assess drains/wounds Med admin Psychosocial support Documentation Continue discharge planning
Health problems that increase surgical risks/post op complications?
Malnutrition Obesity Cardiac conditions Blood coagulation disorders Resp tract infections Renal disease Diabetes Liver disease Uncontrolled neurological disease
Purpose of moving a client?
Promote venous return
Mobilize secretions
Stimulate GI mobility
Facilitate early ambulation
Purpose of leg exercises?
Promote venous return
Prevent thrombophlebitis and thrombus formation
Purpose of deep breathing and coughing?
Enhance lung expansion
Mobilize secretions
Prevent atelectasis and pneumonia
Types of anaesthesia?
General
Regional
Local
Characteristics of general anaesthesia?
Loss of sensation and consciousness Loss of protective reflexes Ex. Cough and gag Blocks awareness centres in the brain -amnesia, analgesia effects
Given through IV or inhalation
Narcosis?
A state of severe CNS depression produced by pharmacological agents
Regional anaesthesia characteristics?
Temporary interruption of transmission of nerve impulses
Loss of sensation in an area of the body
Concurrent meds may be given for mild sedation or to relieve anxiety
-less risky than general
-not given by IV because you cannot target one area
Techniques to give regional anaesthesia?
Nerve block: injected into a nerve group
IV block: tourniquet used to prevent absorption beyond extremity
Spinal or subarachnoid block: numb below perineum
Epidural
Conscious sedation: depression on consciousness but patient retains control of airway
True or false.
LPNs can assess dermatome return?
False.
RN job
Local anaesthesia?
Interrupts transmission of nerve impulses Used on specific small areas Used in minor procedures Clients remain conscious Ex. Dentist
Given by local infiltration (injected) or topical
Do LPNs care for patients in PACU?
No.
PACU is a specialty to care for patients recovering from anaesthesia and surgery
Once patients are stabilized they are returned to the surgical unit where RNs do assessment and depending on stability LPNs may care for them
Potential post op problems?
Pneumonia Atelectasis Pulmonary embolism Hypovolemia Hemorrhage Thrombophlebitis UTI Constipation Postoperative ileus Wound infection Depression
Postoperative assessment?
LOC Vitals Skin colony and temp Comfort Fluid balance Dressing abs bedding Drains and tubes
Epidural vs. Subarachnoid anaesthesia?
Different locations of the spinal cord Narcosis in different locations Used for different types of surgery Different risk factors Different assessments post op
What are some key assessments of a patient coming off anaesthesia?
ABCs Vitals Level of sedation Autonomic return Side effects -headache, nausea Assessing dressing for leaking or bleeding
Lifespan considerations for anaesthesia: young children?
At higher risk for complications due to immature physical status
- need extra help maintain temp
- dosing and oxygenation
- more susceptible to dehydration
- pain assessments
- smaller equipment
- safety
Lifespan considerations for anaesthesia: pregnant women?
2 physiological systems to consider
- Influences mom and baby
- monitoring vitals for both
- hormone levels affect dosages
- tetragenic effect to fetus
- increase risk venous stasis/DVT
- lab values and oxygenation might be different
- anxiety
- stimulation of premature labour
Lifespan considerations for anaesthesia: older adults?
Delayed healing/recovery from anaesthetic Rigidity of vascular system Decrease cardiac output Increase risk of skin breakdown Increase risk of clots/DVT Stiffening of alveoli, decreased gas exchange Increased risk of atelectasis Increased risk of shock
What type of data should you review on a patients chart prior to receiving patient on surgical unit?
OR report Preop checklist PACU charting Meds given Baseline assessment Orders for dressing changes and post surgical diagnostics Sedation scale Drains, catheter? Teaching that's been given Safety concerns
When a patient comes to the surgical unit what should you do?
Head to toe
- all systems
- vitals
- IV
- catheter
- pain
- safety
- comfort
- mood
Possible anaesthesia complications?
Spinal headache N/V High block DVT Hypovolemic bleeding
Importance of preop lab values/diagnostics?
Establishes baseline and potential for complications
-identifies high risk patients
Common labs/diagnostics?
CBC & diff Coagulation Serum Cr BUN LFT Blood glucose Electrolytes
Why do a CBC before surgery?
Establish baseline
Determine oxygenation status/carrying capacity (RBC)
Why check coagulation before surgery?
INR, PTT, PT
-how much time it takes for clotting to occur
-increased INR = blood taking longer to clot
Warfarin= anticoagulant
What does serum Cr and BUN evaluate?
Kidney function
Poor kidney function affects fluid balance (excrete and filter)
Post op head to toe?
Safety Neurological Mood/psychosocial Pain/sedation Respiratory Cardiovascular Nutrition/hydration Hygiene/oral care Incisions/drains Skin integrity GI/GU Mobility
