Perioperative Nursing Flashcards
3 phases
pre
intra
post
what phases are completed by the generalist nurse
pre and post
what phase does the OR nurse do
intra
pre
time patient decides to have surgery to OR table
intra
OR to PACU
PACU
post anesthetic care unit
Post
PACU to complete recovery
3 types of urgencies
elective, urgent, emergency
elective
scheduled, no urgency
urgent
perform soon
emergency
STAT
risk is minor or major, what contributes
hours under for surgery
under longer=greater risk
5 purposes
diagnostic
ablative
palliative
reconstructive
transplantation
what 2 are not curative
diagnostic and palliative
diagnostic
to diagnose
ablative
removed an organ
palliative
reduce intensity
reconstructive
restore function
transplantation
organs
what is breast biopsy
diagnostic
what is hip replacement
recontructive
what is debridement of pressure injury
palliative
what is hysterectomy
ablative
ambulatory surgery
stay at home night before and come in for same day surgery
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
why might ambulatory surgery require additional teaching
because patient will be monitoring themself
who might not be a good candit for ambulatory surgery
elderly
unable to follow directions, no support, respond to anesthetics differently
for an ambulatory surgery we want to make sure we have the right
patient and type of surgery
what is the main priority for preop
SCREENING AND TEACHING
what is screening
identify all risks so they do not occur in OR
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
why do nurses need to sign the consent
as a witness
who goes over the complications and procedures with the patient for consent form
surgeon and anesthisologist
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
when is teaching performed
pre
when is teaching reinforced
post op
what do we want to teach
pain management
coughing and deep breahting
incentive spirometry
medications
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
what do we want to do for a patient who has a midline abdominal surgery
splint
SMILE
sustained maximum inspiratory lung expanded
where do we want the incentive spirometry at
bedside
what meds do we want to discontinue
blood thinner
what meds do we want to continue
blood pressure and beta blockers
what does a chest x ray tell us
infection, heart failure, lungs
what does a EKG tell us
arrthymias
what does a complete blood count tell us
WBC
HC
HB
*infection, anemia, platelets
electrolyte levels
NA, K, CA, CL
what does K tell us
heart
what does Na tell us
dehydrated
urinalysis is
gross/global/broad
previous surgery and how did you tolerate
possible allergies
nutrition such as
protein, vit c, a, d, zinc, copper, iron
*wound healing
who does poorly in nutrition category
obesity and thin
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
why are thin poor wound healers
no protein
atelectasis turns into
pneumonia
what do we want to know about illicit drugs
what type and last use so no WITHDRAWL
what do we want to know about nicotine
pack year
(pack/day x years smoking)
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
what is an advance directive
legal document for patient specific instructors post op
AND
allow natural death
what do sedatives do
relax patient
what do anticholinergics and histamine receptor antihistamines do
decrease secretions and decrease aspiration
when are antibiotics hung
1 hour prior to first cut
what do we do for hygiene and skin prep
CHG baths
what type of affect do CHG have
cumulative
CHG decreases
bacterial load on skin
why do we not shave the skin
can lead to micro cuts which breaks skin intergity
since we don’t shave what do we do now
electric razor in OR
clear liquids up to ___ hours before elective surgery
2
light breakfast __ hours prior to surgery
6
heavier meal allowed __ hours prior to surgery
8
what is the main goal intraop
safety and monitoring
increased hydration decreases
PONV
what is PONV
postop nausea and vomiting
what do we do before surgery
universal protocal
what is a universal protocol
a timeout,
right patient, prodecure
what does universal protocol decrease
senital events and adverse events
what is included for safety
aspiration
positioning
body temp
how do we prevent aspiration
fluids and positioning
what is the time and pressure for capillary breakdown
30 mmHg for 2 hours
we do not want hypothermia because what does that lead to
decrease blood flow which results in less o2 to site and less nutrients
what vital signs show bleeding/shock
increase HR and decrease BP
we want I&O
equal
what do equipment counts limit
surgical souvenirs
what does general anesthesia affect
LOC, analgesia, relaxation, loss of all reflexes, amnesia
what is analgesia
pain relief
what relaxes are included under loss of all relfexes
gag, airway, cough
what does amnesia mean
don’t remember
what does regional affect
analgesia, relaxation, and loss of all reflexes below sight of injection
what does conscious sedation affect
analgesia, relaxation, amnesia
what does topical/local anesthesia affecy
analgesia
what is an example of regional
spinal block, epidural
what is an example of conscious sedation
wisdom teeth
what anesthesia has the greatest risk
general
malignant hyperthermia inherited
autosomal dominat trait
malignant hyperthermia is a reaction to
general anesthesia gases and neuromuscular blocking agents
how will malignant hyperthermia react
increase in HR, RR, which leads to hyperthermia, disrhytmias and respiratory/metabolic acidosis
what is the treatment for malignant hyperthermia
dantrolene
what does malignant hyperthermia result in
death
when should we pick up malignant hyperthermia
screening
what is the main priority in PACU
assessment and prevention of complications
how long do we normally stay in PACU
1 hour
what do we want to see in vital signs
stable
what do we want to see in LOC
waking up
what is included in reversal of anesthesia
feeling back, gag and cough
vital signs post op
Q15mins x4
Q30mins x4
Q1HR x4
Q4hrx4
why do we check vital signs frequently on a post op patient
catch complication early
complications occur earlier
what do we want to see in color and skin temp
warm so there is circulation and no hypothermia
what reflexes do we want to see
cough and gag (protect the airway)
how do we have the head of the bed on a patient with general anethstia
HOB up
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
what are some tubes and drains seen post op
JP/Hemovac/-Pressure/woundvac
penrose
trach
feeding (for decompress the stomach)
chest
ostomy
foley
do we expect a patient with a ostomy to have output
no
- NPO and anesthetics
how do we know if a patient has active drainage
draw a circle around the drainage on the dressing
who removes the first dressing
surgeon
what are some complications of the heart
hemorrhage and shock
why will we see an increase HR
because CO=HRxSV and we cannot change stroke volume so we compensate by increasing HR
what are some nursing interventions for hemorrhage and shock
monitor BP and HR
monitor I&O
assess dressing and drainage
monitor Hgb and Hct
what are some complications with the lungs
thrombophlebitis
pulmonary embolus
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
what is a saddle embolism
goes into both pulmonary arteries/veins
what are some post op respiratory complications
atelectasis
aspiration
pnuemonia
respiratory arrest
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)
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
lungs on an XRAY
costrophrenic angle
black on XRAY
air
what does early ambulation do
improve convalesce and decrease LOS, increase GI motility and decrease analgeisic use
why is it important to get GI motility back
patient can drink and eat which leads to decrease PONV
decreases small bowel obstruction
CABG
coronary artery bypass and graft
early ambulation decreases
length of stay = decrease nosocomial ifection
early ambulation
decreases NPO
low analgesic use
increase energy
decrease LOS
return to baseline function faster
who’s going to have delayed wound healing
obesity
smoker
nutritionally deprived
dehiscence and eviseration
splint
monitor wounds by
drainage and WBC
complications of PONV
pain and anxiety
delayed recovery
surgical site stress
dehydration
aspiration pnumonia
delayed resumption of eating
increase health care cost
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
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
how do we remove sutures
cut on non knot side so not exposing outside thread to inside
SCIP
surgical care intervention plan
does aspirin only for DVT work
no
does walking to bathroom work for DVT
no
what surgery puts patients at greater risk for DVT
ortho
how early do we hang antibiotic
1 hour before incision
what is the exception to hanging antibiotics 1 hour before
vancomycin or clindamycin because they are aminoglycosides and they are nephroTOXIC
when do we discontinue all antibiotics
within 24 hours after surgery
48 for cardiac patient
when do beta blockers need to be taken
24 hour prior to surgery
when do beta blockers start back up
post op day 1
when does the foley get removed
on or before post op day 2
what do we want glucose post op 18-24 hours after surgery
less than 180
we need to document what
SCDS were placed during surgery for all procedures
we ned to administer what before 24 hours of surgery end
DVT prophylaxis
