Perioperative Nursing Flashcards
Surgery performed to resolve a health problem by repairing or removing the cause
Curative
Surgery performed to determine the origin and cause of a disorder or the cell type for cancer
Dagnositc
Surgery performed to improve a patient’s functional ability
Restoritive
Surgery performed to relieve the symptoms of a disease process, but not to cure the disease
Palliative
Surgery performed primarily to alter or enhance personal appearance
Cosmetic
Surgery planned for correction of a nonacute problem
Elective
Surgery that requires prompt intervention; may be life threatening if treatment is delayed more than 24-48 hours
Urgent
Surgery requiring immediate intervention because of life-threatening consequences
Emergent
Type of procedure where only the most overtly affected areas are involved in the surgery
Simple
Extensive surgery beyond the area obviously involved
Radical
What is the purpose of radical surgery?
Finding a rot cause of the problem
Surgery performed in a body cavity or body area through one or more endoscopes; can correct the problems, remove organs, take tissue for biopsy, reroute blood vessels and drainage systems
Minimally invasive surgery
What are the benefits for the patient of ambulatory surgery?
Less anesthesia, less healing time, smaller scars, less hospital stay, less opioid medications
Why are older patients at an increased risk for complications in surgery?
The normal aging process decreases immune system functioning and delays wound healing
When anesthetizing a patient, what do you specifically have to ask them about?
Cardiac disease and problems
What kinds of complications are more likely to occur in older patients?
Pulmonary
What should the preoperative nurse be assessing her patients for?
Current health problems, potential complications related to anesthesia, and potential complications that may occur after surgery
Which electrolyte imbalance is absolutely critical to correct before surgery?
Potassium
What does anesthesia do?
Blocks nerve impulses, suppresses reflexes, promotes muscle relaxation
When and where does the induction phase of anesthesia occur?
In the waiting room before the surgery
What is done during the induction stage of anesthesia?
Prep, put in the IV, consent must be done, pre-medications
What occurs during the maintenance phase of anesthesia?
Positioning of patient, prepping the skin, surgical procedure
What occurs during the emergence phase of anesthesia?
Reversal or decrease of drugs causes patient to awaken
Loss of sensation in an area of the body due to a nerve block of multiple peripheral nerves
Regional anesthesia
Loss of sensation at application site only
Local anesthesia
In a patient with spinal anesthesia, what do you have to watch especially for?
Respiratory paralysis, drop in blood pressure, and loss of sensation in fingers and toes
How can respiratory paralysis be prevented in patients with spinal anesthesia?
Elevation of the upper body
Why does spinal anesthesia cause a drop in blood pressure?
Vasodilation associated with the block
Anesthesia that depresses the level of consciousness while allowing maintenance of reflexes
Conscious Sedation
What is the nurse’s responsibilities for a patient in conscious sedation?
Monitor and check the airway, LOC, O2 saturation and ECG
What increases the risks of anesthesia?
Fluid and electrolyte imbalance, respiratory complications, cardiovascular disease, obesity, diabetes, renal disease, and sleep apnea
Why does sleep apnea increase the risk of anesthesia?
Can’t metabolize anesthesia well
Why does obesity increase the risk of anesthesia?
Patients are often malnourished and the meds are desponsited in the fatty tissue
What happens during surgery to mess up fluid and electrolyte balances?
Increase in ADH and aldosterone, stress hormones are released, and platelet aggregation increases
Why are malnourished patients at a higher risk of surgical complications?
Negative nitrogen balance can cause impaired healing
Why does diabetes increase surgical risk for complication?
Increased susceptibility to infection, impaired wound healing
Why do respiratory problems increase the risk for surgical complications?
Difficulty clearing secretions, reduces means to compensate for acid/base alterations
Why does liver disease increase the risk for surgical complications?
Alters drug metabolism, impairs wound healing, impaired clotting times
What preoperative diagnostic tests should be run on patients?
CBC with diff, coagulation studies, BUN, creatinine, ECG, pulmonary function tests, and type and cross match
What is the duty of the physician in obtaining informed consent?
Explain the nature and reason for the surgery, who will be performing it, all available options and risks
What is the nurse’s responsibility in obtaining informed consent?
Witness the explanation and the signature
Minimally, what must be verified by all members of the surgical team?
Patient’s identity, correct site and side, correct patient position, and agreement on the proposed procedure
Why are patients made NPO before surgical procedures?
To ensure that the stomach contains a limited volume of gastric secretions to decrease the risk of aspiration
Which types of drugs are commonly allowed on the day of a surgical procedure, despite NPO status?
Drugs for cardiac disease, respiratory disease, seizures, and hypertension
What teachings should a nurse do for the preoperative patient?
Diaphragmatic breathing, splinting, leg exercises, turning and mobility, equipment, medications
How can the nurse monitor fluid and electrolyte balance in a preoperative patient?
Weigh them
What is the most important way to prevent surgical infection?
Antibiotics before surgery
What must be in the patient’s chart before surgery?
Signed and witnessed consents for the procedure and for blood transfusions, history and physical completed, diagnostic test results, baseline vitals and nurse’s notes
When do the 3 surgical time outs occur?
Before anesthesia, before surgery starts, and before the patient leaves the OR
Registered nurses who coordinate, oversee, and are involved in the patient’s nursing care in the OR
Circulating nurses
Prepares supplies and equipment on the sterile field, maintains safety, does a sharps count
Scrub nurse
When are counts of the equipment performed?
Before the procedure, during the procedure as items are added, at the closure of the first layer of the surgical wound, and immediately before the complete skin closure
Which members of the surgical team are not scrubbed in?
Anesthesia provider and the circulating nurse
What adverse reactions to anesthesia may the patient display during emergence?
Retching, vomiting, and restlessness
When a patient is experiencing malignant hypothermia, what electrolyte imbalances will he display?
Hypercalemia and hyperkalemia
How often should the vital signs of a postoperative patient be taken?
Every 5 minutes
What is the best way to minimize skin breakdown during surgery?
Pad bony prominences
What is the most sensitive indication of malignant hypothermia?
An unexpected rise in the end-tidal carbon dioxide level, along with a decrease in the oxygen saturation
Once discharged from the PACU, how often should vitals be taken?
q15 minutes x 4, q30 minutes x 4, q1 hour x four, q4 hours
What are the postoperative risks for all patients?
Pneumonia, shock, cardiac arrest, respiratory arrest, venous thromboembolism, and GI bleeding
What is the priority assessment of a postoperative patient upon admission to the PACU?
Patent airway and adequate gas exchange
What are the “4 W’s” of postoperative complications?
Wind, wound, water, walk
What is the treatment for malignant hypothermia?
Dantrolene
What can cause a postoperative patient to have hypotension?
Supine positioning and hypometabolism
What are the nurse’s priority focuses for a postoperative patient?
Maintain airway and body temperature
If left untreated, what does atelectasis turn into?
Hypostatic pneumonia
How often should the lungs of a postoperative patient be checked?
q4 hours x 6, then q8 hours
How much of a difference in systolic or diastolic blood pressure is reportable to the surgeon?
15-20 point difference or 25%
How often should the level of consciousness of a postoperative patient be assessed?
q4-8 hours
What type of vein distention can indicate fluid overload?
Carotid
What types of IV fluids are generally used for fluid replacement in the PACU?
Isotonic solutions
What is the best indicator of intestinal activity?
Passage of flatus or stool
What fluid and electrolyte imbalances can occur with NG tubes?
Fluid volume deficit, hypokalemia, hyponatremia, hypochloremia, and metabolic alkalosis
What is the minimum expected urine output for postoperative patients?
30mL/hr
At what point does serosanguineous drainage indicate dehiscence?
Beyond day 5
In what patients is wound separtation more likely to occur?
Diabetic, immune deficient, malnourished, or steroid using patients
How often should a postoperative patient’s dressings be checked?
q8 horus
When does surgical pain usually reach its peak?
Post op day 2
At what point should patients be voiding after surgery?
6-8 hours postoperative
At what point can a patient eat after surgery?
When the gag reflex has returned
In what types of surgeries is nausea and vomiting most seen?
Abdominal, eye, ear, intracranial, and testicular surgeries
What are the effects of early ambulation?
Increases smooth muscle tone, improves GI/GU function, stimulates circulation/prevents venous stasis, and increases vital capacity to increase respiratory functions
At what point would a wound infection start to become evident?
3-4 days postoperative
What type of dressing should be used on a infected surgical wound?
Wet to dry
How often should a wet to dry dressing be changed on an infected surgical wound?
1 to 3 times/day
Why are wet to dry dressings used on infected surgical wounds?
They promote healing from within and debridement
What should a postoperative patient’s diet be high in?
Protein, calories, and vitamin C
What do snoring sounds when inhaling indicate in a postoperative patient?
Respiratory depression
How should a postoperative patient with respiratory depression be positioned?
Side-lying with the head in a neutral position
