Perioperative Nursing Flashcards by sha flores

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

PERIOPERATIVE NURSING

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

perioperative period

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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.

Preoperative phase

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

Intraoperative phase

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

Postoperative phase

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What are the surgical classifications

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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What are the Degrees of Urgency?

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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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.

Informed Consent

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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.

Circulating Nurse

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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

Scrub Nurse

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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

Surgeon

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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

Anesthesiologist

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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

Surgical Environment

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

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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What is included in the surgical attire?

Scrub suit
Head cover
Shoes and shoe cover
Surgical Mask
Eye wear
Laser eyeware
Gloves

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True or False:

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

True

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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.

True

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True or False:

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

False, only the top surface is sterile.

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True or False:

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

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

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True or False:

Items of doubtful sterility are considered unsterile.

True

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

Cleaning

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

PHYSICAL DISINFECTION BY BOILING

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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.

PASTEURIZATION

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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

CHEMICAL DISINFECTION

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* Process in which all pathogens are destroyed including spores * Highest level of decontamination

STERILIZATION

What are the methods of Sterilization?

Chemical, autoclaving, and dry heat sterilization

True or False: Shelf life depends on • Amount of handling • The quality of packaging materials used • Storage condition

True

3 Categories under Spaulding's Classification

- 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)

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

General Anesthesia

What are the 2 methods of administering general anesthesia?

- INHALATION | - INTRAVENOUS

4 Stages of General Anesthesia

STAGE 1 (BEGINNING ANESTHESIA/INDUCTION) STAGE 2 (EXCITEMENT/DELIRIUM) STAGE 3 (SURGICAL ANESTHESIA) STAGE 4 (MEDULLARY DEPRESSION/DANGER)

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

REGIONAL ANESTHESIA

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

Epidural anesthesia

• 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

Spinal anesthesia

• 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

Moderate Sedation

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

Monitored Anesthesia Care (MAC)

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

Local Anesthesia

Patient teaching: Deep Breathing, Coughing and Incentive

- 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

Patient teaching: Mobility and Active Body Movement

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

Patient Teaching: Pain Management

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

Patient Teaching: Reducing Anxiety and Decreasing Fear

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

Patient Teaching: Managing Nutrition and Fluids

• 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)

True or False: | Enemas are not commonly prescribed preoperatively unless the patient is undergoing abdominal or pelvic surgery

True

Perioperative Nursing Intervention: SKIN PREPARATION

* 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

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

Supine Position

Surgical position for vaginal or perineal procedures

Dorsal Recumbent

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

Trendelenburg's Position

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

Reverse Trendelenburg's Position

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

Kraske (Jack-Knife) Position

What are the potential intraoperative complications?

- Nausea and vomiting - Respiratory complications - Hypothermia

What are the Classifications of Instruments:

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

Used to dissect, incise, separate or excise tissues

Scalpels

Scissors used to cut sutures

Suture Scissor

Scissor used to cut wires

Wire scissors

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

Bandage Scissors

Scissors with short jaws used for vascular surgery

Sharp-tipped angled scissors

Scissors used for cutting heavy fascia and sutures

Mayo Scissors

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

Metzenbaum Scissors

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

Curettes

Forceps used to hold fine tissues such as eye tissues

Delicate forceps

Forcep used to pick up or hold soft tissues during closure

Adson forceps

Forceps used to prevent injury to the suture

Smooth forceps or thumb forceps

The instrument used to hold on tough tissue

Toothed Forceps

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

Babcock Forceps

Forcep used for occluding blood vessels

Hemostatic Forceps

Clamp used to crushed tissues or clamp blood vessels

Crushing Clamps

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

Malleable retractor

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

Hooks

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

Self-retraining

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

Post-Anesthesia Care Unit (PACU)

What are the 3 phases of Post-Anesthesia Care?

* 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

What are the areas of assessment in Aldrete Score include?

``` activity respiration circulation consciousness oxygen saturation ```

What are the nursing managements in PACU?

- Maintaining Patent airway - Maintaining Cardiovascular Activity - Shock - Hemorrhage

What are the classifications of Hemorrhage?

- 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.

What are the types of vessels under classifications of hemorrhage?

- 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.

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

- Evident - Hemorrhage is on the surface and can be seen. | - Concealed - Hemorrhage is in a body cavity and cannot be seen.

What are the clinical signs for Hemorrhage?

* 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

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

True

True or False: Early ambulation has a significant effect on the recovery and the prevention of complications

True