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Medical-Surgical Nursing 1 > Perioperative Nursing > Flashcards

Perioperative Nursing Flashcards

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1
Q

It is a term used to describe the nursing care provided in the total surgical experience of the patient

A

PERIOPERATIVE NURSING

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2
Q

consists of three phase that begin and end at a particular point in the sequence of events in the surgical experience.

A

perioperative period

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3
Q

begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the operating room (OR) table.

A

Preoperative phase

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4
Q

begins when the patient is transferred onto the OR table and ends with admission to the PACU (Post Anesthesia Care Unit)

A

Intraoperative phase

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5
Q

begins with the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or home

A

Postoperative phase

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6
Q

What are the surgical classifications

A

Diagnostic (eg, biopsy, exploratory laparotomy)

Curative (eg, excision of a tumor or an inflamed appendix)

Reparative (eg, multiple wound repair)

Reconstructive or cosmetic (eg, mammoplasty or a facelift)

Palliative (eg, to relieve pain or correct a problem-for instance, a gastrostomy tube may be inserted to compensate for the inability to swallow food)

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7
Q

What are the Degrees of Urgency?

A

Optional – Surgery is scheduled completely at the preference of the patient (eg, cosmetic surgery)

Elective – The approximate time for surgery is at the convenience of the patient; failure to have surgery is not catastrophic (eg, a superficial syst)

Required – The condition requires surgery within a few weeks (eg, eye cataract)

Urgent – The surgical problem requires attention within 24 to 48 hours (eg, cancer)

Emergency – The situation requires immediate surgical attention without delay (eg, intestinal obstruction)

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8
Q

It is the patient’s autonomous decision about whether to undergo a surgical procedure. It is the process of informing the patient about the surgical procedure; that is risks and possible complications of surgery and anesthesia. Consent is obtained by the surgeon. This is a legal requirement.

A

Informed Consent

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9
Q

Part of the surgical team where their main responsibilities include:

  • Verifying consent
  • Coordinating the team
  • Ensuring cleanliness
  • Proper temperature and humidity
  • Lighting and safe function of equipment and the availability of supplies and materials.
A

Circulating Nurse

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10
Q

Member of the surgical team that:

  • Performs surgical hand scrub
  • Setting up the sterile tables
  • Preparing sutures, ligatures, and special equipment (eg, laparoscope)
  • Assisting the surgeon and the surgical assistants during the procedure by anticipating the instruments and supplies that will be required, such as sponges, drains, and other equipment
  • Scrub nurse and the circulator count all needles, sponges, and instruments to be sure they are accounted for and not retained as a foreign body in the patient
A

Scrub Nurse

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11
Q

Part of the Surgical Team that:
• Performs the surgical procedure, heads the surgical team and is specially trained and qualified
• Has the ultimate responsibility for performing the surgery in an effective and safe manner

A

Surgeon

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12
Q

Part of the surgical team that:
• Assesses the patient before surgery, selects anesthesia, administers it, intubates patient if necessary, manages any technical problems related to the administration of the anesthetic agents, and supervises the patient’s condition throughout the surgical procedure
• During surgery, the anesthesiologist monitors the patient’s blood pressure, pulse, and respirations as well as the electrocardiogram (ECG), blood oxygen saturation level, tidal volume, blood gas level, blood pH, alveolar gas concentrations, and body temperature

A

Anesthesiologist

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13
Q
  • The surgical suite is behind double doors, and access is limited to authorized personnel. External precautions include adherence to principles of surgical asepsis; strict control of the OR environment is required, including traffic pattern
    restriction
  • To provide the best possible conditions for surgery, the OR is situated in a location that is central to all supporting services
A

Surgical Environment

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14
Q

To help decrease microbes, the surgical area is divided into three zones:

A

o Unrestricted zone: where street clothes are allowed; area in the operating room that interfaces with other departments; includes a patient reception area and holding area

o Semi-restricted zone: area in the operating room where scrub attire (scrub clothes and caps) is required; may include areas where surgical instruments are processed

o Restricted zone: scrub clothes, shoe cover caps, and masks are worn; includes operating room and sterile core area

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15
Q

What is included in the surgical attire?

A
  • Scrub suit
  • Head cover
  • Shoes and shoe cover
  • Surgical Mask
  • Eye wear
  • Laser eyeware
  • Gloves
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16
Q

True or False:

Only sterile surfaces/articles may touch other sterile surfaces/articles.

A

True

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17
Q

True or False:

Gowns of the surgical team are considered sterile in front from the chest to the level of the sterile field. The sleeves are also considered sterile form 2 inches above the elbow to the stockinette cuff.

A

True

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18
Q

True or False:

The top surface and bottom of a draped table is considered sterile.

A

False, only the top surface is sterile.

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19
Q

True or False:

The movements of the surgical team can be sterile to unsterile, unsterile to sterile.

A

False, the movements of the surgical team are from sterile to sterile areas and from unsterile to unsterile areas.

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20
Q

True or False:

Items of doubtful sterility are considered unsterile.

A

True

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21
Q

Removal of foreign material from the instrument by a combination of mechanical means (scrubbing) and chemical means (Enzyme and detergents)

A

Cleaning

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22
Q

Uses 100°C boiling water to destroy most pathogens except spores

A

PHYSICAL DISINFECTION BY BOILING

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23
Q
  • Used for items such as reusable respiratory devices and anesthesia breathing circuit
  • Exposure to hot water with temperature of 60°C-80°C for 30 mins.
A

PASTEURIZATION

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24
Q
  • Items are soaked in a disinfectant
  • Choice depends on compatibility and effectiveness on the instruments
  • Used for heat labile instruments that cannot be boiled or sterilized
A

CHEMICAL DISINFECTION

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25
Q
  • Process in which all pathogens are destroyed including spores
  • Highest level of decontamination
A

STERILIZATION

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26
Q

What are the methods of Sterilization?

A

Chemical, autoclaving, and dry heat sterilization

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27
Q

True or False:

Shelf life depends on
• Amount of handling
• The quality of packaging materials used
• Storage condition

A

True

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28
Q

3 Categories under Spaulding’s Classification

A
  • Non-critical - Items that come in contact with INTACT SKIN (BP cuffs, stethoscope, tourniquet)
  • Semi-critical - Items that come in contact with MUCOUS MEMBRANES and NON-INTACT SKIN (Speculum, anesthesia equipment, thermometer, laryngoscope)
  • Critical - Items that come in penetrate sterile tissues such as BODY CAVITY and VASCULAR SYSTEM (implants, urinary catheter, needles, surgical instruments)
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29
Q

A reversible consisting of complete loss of consciousness that provides analgesia, muscle relaxation, and sedation, Protective reflexes are lost.

A

General Anesthesia

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30
Q

What are the 2 methods of administering general anesthesia?

A
  • INHALATION

- INTRAVENOUS

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31
Q

4 Stages of General Anesthesia

A

STAGE 1 (BEGINNING ANESTHESIA/INDUCTION)

STAGE 2 (EXCITEMENT/DELIRIUM)

STAGE 3 (SURGICAL ANESTHESIA)

STAGE 4 (MEDULLARY DEPRESSION/DANGER)

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32
Q

Anesthetic agents are injected around nerves so that the region supplied by these nerves is anesthetized

A

REGIONAL ANESTHESIA

33
Q

Achieved by injecting a local anesthetic agent into the epidural space that surrounds the dura mater of the spinal cord

A

Epidural anesthesia

34
Q

• Extensive conduction nerve block that is produced when a local anesthetic agent is introduced into the
subarachnoid space at the lumbar level, usually between L4 and L5.
• It produces anesthesia of the lower extremities, perineum, and lower abdomen

A

Spinal anesthesia

35
Q

• Previously referred to as conscious sedation, is form of anesthesia that involves the IV administration of sedative or analgesic medications to reduce patient’s anxiety and to control pain during diagnostic or therapeutic procedures

A

Moderate Sedation

36
Q

Also referred to as monitored sedation, is moderate sedation administered by an anesthesiologist or anesthetist who must be prepared and qualified to convert to general anesthesia if necessary

A

Monitored Anesthesia Care (MAC)

37
Q

Injection of a solution containing the anesthetic agent into the tissues at the planned incision site

A

Local Anesthesia

38
Q

Patient teaching: Deep Breathing, Coughing and Incentive

A
  • Demonstrates how to take deep, slow breath and how to exhale slowly
  • Instruct the patient to breathe deeply, exhale through the mouth, take a short breath, and cough from deep in the lungs
  • Demonstrates how to use an incentive spirometer
39
Q

Patient teaching: Mobility and Active Body Movement

A

Patient should be taught that early and frequent ambulation, exercise of the extremities and frequent change of position immediately postoperative as tolerated will help to prevent complications

40
Q

Patient Teaching: Pain Management

A

Patient is instructed to take the medication as frequently as prescribed during the initial postoperative period for pain relief

41
Q

Patient Teaching: Reducing Anxiety and Decreasing Fear

A

Assists the patient to identify coping strategies that he or she has previously used to decrease fear

42
Q

Patient Teaching: Managing Nutrition and Fluids

A

• NPO overnight or longer to prevent aspiration
• Specific recommendations depend on the age of the patient and the type of food eaten (ex. Adult is advised to
fast for 8hours after eating fatty food)

43
Q

True or False:

Enemas are not commonly prescribed preoperatively unless the patient is undergoing abdominal or pelvic surgery

A

True

44
Q

Perioperative Nursing Intervention: SKIN PREPARATION

A
  • Goal is to decrease bacteria without injuring the skin
  • Cleanse the skin with soap containing detergent-germicide
  • If hair must be removed, electric clippers are used
45
Q

Patient is flat on the back, both arms are positioned at the side of the table, one with the hand placed palm down; the other is carefully positioned on an armboard to facilitate IV infusion of fluids, blood, or medications

A

Supine Position

46
Q

Surgical position for vaginal or perineal procedures

A

Dorsal Recumbent

47
Q

Usually is used for surgery on the lower abdomen and pelvis to obtain good exposure by displacing the intestines into the upper abdomen

A

Trendelenburg’s Position

48
Q

Surgical position used for thyroidectomy, laparoscopic gallbladder, biliary tract or stomach procedure

A

Reverse Trendelenburg’s Position

49
Q

Surgical position where the hips are positioned over the center break of the operating table between the body and leg section.

A

Kraske (Jack-Knife) Position

50
Q

What are the potential intraoperative complications?

A
  • Nausea and vomiting
  • Respiratory complications
  • Hypothermia
51
Q

What are the Classifications of Instruments:

A
  • Cutting and Dissecting
  • Grasping and Holding
  • Clamping and occluding
  • Exposing and retracting
  • Sutures
  • Non-absorbable sutures
  • Surgical needles
52
Q

Used to dissect, incise, separate or excise tissues

A

Scalpels

53
Q

Scissors used to cut sutures

A

Suture Scissor

54
Q

Scissor used to cut wires

A

Wire scissors

55
Q

Scissors used to cut drains and dressing and to open items such as plastic packets

A

Bandage Scissors

56
Q

Scissors with short jaws used for vascular surgery

A

Sharp-tipped angled scissors

57
Q

Scissors used for cutting heavy fascia and sutures

A

Mayo Scissors

58
Q

Scissors that are more delicate than mayo scissors and are used to cut delicate tissues

A

Metzenbaum Scissors

59
Q

Cutting and Dissecting Instrument: tissue from bone is removed by scraping with the sharp edge of the loop or scoop on the end of the curette

A

Curettes

60
Q

Forceps used to hold fine tissues such as eye tissues

A

Delicate forceps

61
Q

Forcep used to pick up or hold soft tissues during closure

A

Adson forceps

62
Q

Forceps used to prevent injury to the suture

A

Smooth forceps or thumb forceps

63
Q

The instrument used to hold on tough tissue

A

Toothed Forceps

64
Q

Instrument where end of each jaw is rounded to grasp tissue without injury

A

Babcock Forceps

65
Q

Forcep used for occluding blood vessels

A

Hemostatic Forceps

66
Q

Clamp used to crushed tissues or clamp blood vessels

A

Crushing Clamps

67
Q

Retractor that may be bent to the desired angle and depth for retraction

A

Malleable retractor

68
Q

Commonly used to retract skin edges during a wide-flap dissection such as mastectomy

A

Hooks

69
Q

Clamp instrument inserted to spread the edges of an incision and hold them apart. eg: Balfour

A

Self-retraining

70
Q

Also called the recovery room or post-anesthesia recovery room, is located adjacent to the operating rooms suite

A

Post-Anesthesia Care Unit (PACU)

71
Q

What are the 3 phases of Post-Anesthesia Care?

A
  • Phase I PACU: care of surgical patients immediately after surgery and for the patient whose condition warrants close monitoring and intensive care is provided
  • Phase II PACU: surgical patient’s condition no longer requires close monitoring provided in a phase I PACU. Patient is prepared for self-care or care in the hospital or in extended care setting.
  • Phase III PACU: setting in which the patient is cared for in the immediate postoperative period and then prepared for discharge from the facility
72
Q

What are the areas of assessment in Aldrete Score include?

A 
activity
respiration
circulation
consciousness
oxygen saturation
73
Q

What are the nursing managements in PACU?

A
  • Maintaining Patent airway
  • Maintaining Cardiovascular Activity
  • Shock
  • Hemorrhage
74
Q

What are the classifications of Hemorrhage?

A
  • Primary - Hemorrhage occurs at the time of surgery.
  • Intermediary - Hemorrhage occurs during the few hours after surgery when the rise of blood pressure to its normal level dislodges insecure clots from untied vessels.
  • Secondary - Hemorrhage may occur sometime after surgery if a suture slips because of blood vessel was not securely tied, became infected, or was eroded by a drainage tube.
75
Q

What are the types of vessels under classifications of hemorrhage?

A
  • Capillary - Hemorrhage is characterized by a slow, general ooze.
  • Venous - Darkly colored blood bubbles out quickly.
  • Arterial - Blood is bright red and appears in spurts with each heartbeat.
76
Q

What are the types of visibility under the classifications of hemorrhage?

A
  • Evident - Hemorrhage is on the surface and can be seen.

- Concealed - Hemorrhage is in a body cavity and cannot be seen.

77
Q

What are the clinical signs for Hemorrhage?

A
  • Patient presents with hypotension, rapid, thready pulse, disorientation, restlessness, oliguria, cold and pale skin.
  • Feeling of apprehension, decreased cardiac output and vascular resistance and signifies that the patient is in the early phase of shock
78
Q

True or False:

Opioid analgesics are administered mostly in the IV in the PACU, it immediately relieve pain and are short-acting

A

True

79
Q

True or False:

Early ambulation has a significant effect on the recovery and the prevention of complications

A

True

Medical-Surgical Nursing 1 (2 decks)

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