Perioperative Nursing Flashcards
1
Q
3 phases
A
pre
intra
post
2
Q
what phases are completed by the generalist nurse
A
pre and post
3
Q
what phase does the OR nurse do
A
intra
4
Q
pre
A
time patient decides to have surgery to OR table
5
Q
intra
A
OR to PACU
6
Q
PACU
A
post anesthetic care unit
7
Q
Post
A
PACU to complete recovery
8
Q
3 types of urgencies
A
elective, urgent, emergency
9
Q
elective
A
scheduled, no urgency
10
Q
urgent
A
perform soon
11
Q
emergency
A
STAT
12
Q
risk is minor or major, what contributes
A
hours under for surgery
under longer=greater risk
13
Q
5 purposes
A
diagnostic
ablative
palliative
reconstructive
transplantation
14
Q
what 2 are not curative
A
diagnostic and palliative
15
Q
diagnostic
A
to diagnose
16
Q
ablative
A
removed an organ
17
Q
palliative
A
reduce intensity
18
Q
reconstructive
A
restore function
19
Q
transplantation
A
organs
20
Q
what is breast biopsy
A
diagnostic
21
Q
what is hip replacement
A
recontructive
22
Q
what is debridement of pressure injury
A
palliative
23
Q
what is hysterectomy
A
ablative
24
Q
ambulatory surgery
A
stay at home night before and come in for same day surgery
25
why is ambulatory surgery good
reduces length of stay
reduces stress for patient
*since surgery is breaking integrity of the skin we limit stay at hospital so decreased chance of nosocomial infections
26
why might ambulatory surgery require additional teaching
because patient will be monitoring themself
27
who might not be a good candit for ambulatory surgery
elderly
unable to follow directions, no support, respond to anesthetics differently
28
for an ambulatory surgery we want to make sure we have the right
patient and type of surgery
29
what is the main priority for preop
SCREENING AND TEACHING
30
what is screening
identify all risks so they do not occur in OR
31
what are some examples of stuff we need to know during screening
risk factors
allergies (esp to anethtics)
lab results
abnormal results
consent is signed
32
why do nurses need to sign the consent
as a witness
33
who goes over the complications and procedures with the patient for consent form
surgeon and anesthisologist
34
if the patient signs the consent and then says they don't understand what is your job
get the surgeon back down to explain it again
35
when is teaching performed
pre
36
when is teaching reinforced
post op
37
what do we want to teach
pain management
coughing and deep breahting
incentive spirometry
medications
38
what does coughing and deep breathing do
prevent pneumonia and atelectasis
how? anesthetics decrease cillary movement which cause secretions to sit and lead to pneumonia
39
what do we want to do for a patient who has a midline abdominal surgery
splint
40
SMILE
sustained maximum inspiratory lung expanded
41
where do we want the incentive spirometry at
bedside
42
what meds do we want to discontinue
blood thinner
43
what meds do we want to continue
blood pressure and beta blockers
44
what does a chest x ray tell us
infection, heart failure, lungs
45
what does a EKG tell us
arrthymias
46
what does a complete blood count tell us
WBC
HC
HB
*infection, anemia, platelets
47
electrolyte levels
NA, K, CA, CL
48
what does K tell us
heart
49
what does Na tell us
dehydrated
50
urinalysis is
gross/global/broad
51
previous surgery and how did you tolerate
possible allergies
52
nutrition such as
protein, vit c, a, d, zinc, copper, iron
*wound healing
53
who does poorly in nutrition category
obesity and thin
54
why are obesity poor wound healers
hypoventilators which leads to atelectasis and pneumonia and difficulty taking narcotics because of hypoventilator, increase subq which has no blood flow
55
why are thin poor wound healers
no protein
56
atelectasis turns into
pneumonia
57
what do we want to know about illicit drugs
what type and last use so no WITHDRAWL
58
what do we want to know about nicotine
pack year
(pack/day x years smoking)
59
what is included in informed consent
- procedure
- alternative therapies
- name and qualifications performing procedures
- risks and how often
- expected outcomes
- recovery
- rehabilitation plan
- refuse treatment
- withdraw consent
60
what is an advance directive
legal document for patient specific instructors post op
61
AND
allow natural death
62
what do sedatives do
relax patient
63
what do anticholinergics and histamine receptor antihistamines do
decrease secretions and decrease aspiration
64
when are antibiotics hung
1 hour prior to first cut
65
what do we do for hygiene and skin prep
CHG baths
66
what type of affect do CHG have
cumulative
67
CHG decreases
bacterial load on skin
68
why do we not shave the skin
can lead to micro cuts which breaks skin intergity
69
since we don't shave what do we do now
electric razor in OR
70
clear liquids up to ___ hours before elective surgery
2
71
light breakfast __ hours prior to surgery
6
72
heavier meal allowed __ hours prior to surgery
8
73
what is the main goal intraop
safety and monitoring
74
increased hydration decreases
PONV
75
what is PONV
postop nausea and vomiting
76
what do we do before surgery
universal protocal
77
what is a universal protocol
a timeout,
right patient, prodecure
78
what does universal protocol decrease
senital events and adverse events
79
what is included for safety
aspiration
positioning
body temp
80
how do we prevent aspiration
fluids and positioning
81
what is the time and pressure for capillary breakdown
30 mmHg for 2 hours
82
we do not want hypothermia because what does that lead to
decrease blood flow which results in less o2 to site and less nutrients
83
what vital signs show bleeding/shock
increase HR and decrease BP
84
we want I&O
equal
85
what do equipment counts limit
surgical souvenirs
86
what does general anesthesia affect
LOC, analgesia, relaxation, loss of all reflexes, amnesia
87
what is analgesia
pain relief
88
what relaxes are included under loss of all relfexes
gag, airway, cough
89
what does amnesia mean
don't remember
90
what does regional affect
analgesia, relaxation, and loss of all reflexes below sight of injection
91
what does conscious sedation affect
analgesia, relaxation, amnesia
92
what does topical/local anesthesia affecy
analgesia
93
what is an example of regional
spinal block, epidural
94
what is an example of conscious sedation
wisdom teeth
95
what anesthesia has the greatest risk
general
96
malignant hyperthermia inherited
autosomal dominat trait
97
malignant hyperthermia is a reaction to
general anesthesia gases and neuromuscular blocking agents
98
how will malignant hyperthermia react
increase in HR, RR, which leads to hyperthermia, disrhytmias and respiratory/metabolic acidosis
99
what is the treatment for malignant hyperthermia
dantrolene
100
what does malignant hyperthermia result in
death
101
when should we pick up malignant hyperthermia
screening
102
what is the main priority in PACU
assessment and prevention of complications
103
how long do we normally stay in PACU
1 hour
104
what do we want to see in vital signs
stable
105
what do we want to see in LOC
waking up
106
what is included in reversal of anesthesia
feeling back, gag and cough
107
vital signs post op
Q15mins x4
Q30mins x4
Q1HR x4
Q4hrx4
108
why do we check vital signs frequently on a post op patient
catch complication early
complications occur earlier
109
what do we want to see in color and skin temp
warm so there is circulation and no hypothermia
110
what reflexes do we want to see
cough and gag (protect the airway)
111
how do we have the head of the bed on a patient with general anethstia
HOB up
112
who do we want the HOB down and why
regional anesthetics, because if they are up they have a shift if cerebral spinal fluid which causes bad headaches so we want flat with head to side and suction in mouth
113
what are some tubes and drains seen post op
JP/Hemovac/-Pressure/woundvac
penrose
trach
feeding (for decompress the stomach)
chest
ostomy
foley
114
do we expect a patient with a ostomy to have output
no
- NPO and anesthetics
115
how do we know if a patient has active drainage
draw a circle around the drainage on the dressing
116
who removes the first dressing
surgeon
117
what are some complications of the heart
hemorrhage and shock
118
why will we see an increase HR
because CO=HRxSV and we cannot change stroke volume so we compensate by increasing HR
119
what are some nursing interventions for hemorrhage and shock
monitor BP and HR
monitor I&O
assess dressing and drainage
monitor Hgb and Hct
120
what are some complications with the lungs
thrombophlebitis
pulmonary embolus
121
what are some nursing interventions for pulmonary embolism
SCD stockings and prophylactic low does heparin/lovenox
assess for sudden onset of chest pain, tachycardia, tachypnea, O2 and desat
122
what is a saddle embolism
goes into both pulmonary arteries/veins
123
what are some post op respiratory complications
atelectasis
aspiration
pnuemonia
respiratory arrest
124
what are some interventions for respiratry complications
monitoring vital signs
implement coughing and deep breathing
SMILE
ambulating (expands chest and reserves anesthetics)
HOB 30 or higher
maintaining hydration (looses secretions)
avoid flat positioning that decreases ventilation
monitor response to narcotics (decreases reps)
125
why would an obese person be high risk post op for respiratory
they are a hypo ventilator and they are receiving narcotics which slows resps
126
lungs on an XRAY
costrophrenic angle
127
black on XRAY
air
128
what does early ambulation do
improve convalesce and decrease LOS, increase GI motility and decrease analgeisic use
129
why is it important to get GI motility back
patient can drink and eat which leads to decrease PONV
decreases small bowel obstruction
130
CABG
coronary artery bypass and graft
131
early ambulation decreases
length of stay = decrease nosocomial ifection
132
early ambulation
decreases NPO
low analgesic use
increase energy
decrease LOS
return to baseline function faster
133
who's going to have delayed wound healing
obesity
smoker
nutritionally deprived
134
dehiscence and eviseration
splint
135
monitor wounds by
drainage and WBC
136
complications of PONV
pain and anxiety
delayed recovery
surgical site stress
dehydration
aspiration pnumonia
delayed resumption of eating
increase health care cost
137
PONV risk
female
history of PONV
motion sickness
nonsmokers
post op use of opiods (prolong GI emptying)
surgery lasting longer than 60 min (more anesthetic)
obesity (longer time to remove anesthics, anesthetic love lipids)
pain
138
prevention and treatment of PONV
asses for risk factors
500mL infused prior to OR
antiemetics given at first sign
cool cloth
GINGER ALE
change position slowly
deep slow breaths
139
how do we remove sutures
cut on non knot side so not exposing outside thread to inside
140
SCIP
surgical care intervention plan
141
does aspirin only for DVT work
no
142
does walking to bathroom work for DVT
no
143
what surgery puts patients at greater risk for DVT
ortho
144
how early do we hang antibiotic
1 hour before incision
145
what is the exception to hanging antibiotics 1 hour before
vancomycin or clindamycin because they are aminoglycosides and they are nephroTOXIC
146
when do we discontinue all antibiotics
within 24 hours after surgery
48 for cardiac patient
147
when do beta blockers need to be taken
24 hour prior to surgery
148
when do beta blockers start back up
post op day 1
149
when does the foley get removed
on or before post op day 2
150
what do we want glucose post op 18-24 hours after surgery
less than 180
151
we need to document what
SCDS were placed during surgery for all procedures
152
we ned to administer what before 24 hours of surgery end
DVT prophylaxis
