Perioperative Nursing

Question 1

What is the AORN and their goals

Answer 1

organization for perioperative nurses
- patient-centered
safety, physiological, and behavioral

Question 2

What are the three phases of perioperative nursing

Answer 2

preoperative
intraoperative
postoperative

Question 3

define preoperative nursing

Answer 3

-inpatient or outpatient
-varying amount of planning time
-begins with the decision to have surgery
-lasts until pt is transferred to the operating room

Question 4

define intraoperative nursing

Answer 4

begins when pt is transferred to OR until pt goes to PACU

Question 5

What is the PACU

Answer 5

post anesthesia care unit

Question 6

define postoperative nursing

Answer 6

-can be in ICU, same-day surgery suite, outpatient, rehab
-can be a day or months
-lasts from admission to recovery room to last follow-up visit

Question 7

what is perioperative nursing

Answer 7

surgical nursing
-before, during, and after

Question 8

define major surgery

Answer 8

inside a body cavity, has a longer/more complicated recovery

Question 9

define minor surgery

Answer 9

does not expose the body cavity, has an easier recovery

Question 10

define elective surgery

Answer 10

choosing to have done, may not preserve life/function

Question 11

what kind of surgery is a joint replacement

Answer 11

elective

Question 12

define urgent surgery

Answer 12

has to be done promptly, within two days
-is done to preserve life and function

Question 13

what kind of surgery is a fracture repair

Answer 13

urgent

Question 14

define emergent surgery

Answer 14

done immediately, life-saving, do not need consent

Question 15

what kind of surgery is the removal of an aneurysm

Answer 15

emergent

Question 16

give an example of diagnostic surgery

Answer 16

exploratory surgery

Question 17

what is ablative surgery

Answer 17

the removal of a diseased body part

Question 18

what is a palliative surgery

Answer 18

eliminating symptoms, promoting improvement

Question 19

define reconstructive surgery

Answer 19

repair a deformity

Question 20

define transplantation surgery

Answer 20

replacement by a donor or artificial source

Question 21

what is a common constructive surgery

Answer 21

cleft lip surgery, normally birth defects

Question 22

what is the main goal of a preoperative nurse

Answer 22

identify and minimize risks

Question 23

What are the assessments of a pre-op nurse

Answer 23

-history and physical (normally done by a physician)
-identification of risk factors and allergies
-medication and treatment assessment
-facilitating/reviewing diagnostic tests
-identification of teaching and psychosocial needs (what will happen after?)
assessing for postsurgical support and referral needs

Question 24

What are some things to ask about in an H&P

Answer 24

-development
-medical history and comorbidities
-surgical history and complications
-allergies and medications taken
-nutritional status
-ADLs and occupation
-sociocultural needs
-support system

Question 25

why is nutritional status important for surgery

Answer 25

can affect albumin levels

Question 26

what are examples of sociocultural needs?

Answer 26

may need a translator -be aware of things that could be culturally important to them

Question 27

how can nicotine affect surgery

Answer 27

it is a vasoconstrictor, raising bp and can decrease hemoglobin function -surgeons may refuse to operate

Question 28

what are things important to a physical exam

Answer 28

-height and weight (for dosing) --can use wingspan if unsure -vital sign baseline -integumentary system and skin integrity -respiratory health, infections are a cause for cancelation -cardiovascular health -neurological health (can they make their own decisions) -GI/GU -musculoskeletal (what are their abilities, important for post-op assessment)

Question 29

biggest concern/comorbidity for surgery

Answer 29

-heart health, may not be able to handle surgery -diabetes, impacts the vascular system, electrolytes, CV health and infection risk

Question 30

common comorbidities for surgery

Answer 30

-HTN, MI, HR, arrhythmias, CVA, thrombocytopenia, anemia -COPD, asthma, pneumonia, bronchitis, URI -renal and hepatic health -diabetes -medication (warfarin)

Question 31

risk factors for surgery

Answer 31

-age (very old and young) -nutritional status (underweight and obese) -malnutrition=more dangerous, may not have enough resources -obese=increased operation time and smaller lung capacity -fluid and electrolyte balance, can shift during surgery -A pregnancy, test needs to be done -previous complications with surgery

Question 32

what is a part of a BMP or CMP

Answer 32

-electrolytes -BUN and creatinine -glucose -liver function

Question 33

what is tested for a coagulation study

Answer 33

PT/INR PTT

Question 34

Other than BMP & CMP & coagulation needs to be done for blood work

Answer 34

Blood type, HCG, complete blood count

Question 35

what are the parts of a complete blood count

Answer 35

-RBC -Hemoglobin Hgb -Hematocrit Hct -WBC Platelets

Question 36

what should RBC be

Answer 36

men: 4.6-6.2 women: 4.2-5.4

Question 37

what should hemoglobin be

Answer 37

men: 13-18 women: 12-16

Question 38

why is hemoglobin important

Answer 38

carries oxygen and CO2, is important for healing

Question 39

what should hematocrit be

Answer 39

men: 42-52% women: 35-47%

Question 40

how is hematocrit measured

Answer 40

amount of blood that is RBC, a high level means dehydration -should be 3x the amount of hemoglobin

Question 41

what should WBC be

Answer 41

4.5-11

Question 42

what should platelets be

Answer 42

150-450

Question 43

why are platelets important

Answer 43

ability to bleed/clot

Question 44

what are the electrolytes

Answer 44

- sodium Na - potassium K - Chloride Cl - bicarbonate HCO3 -Glucose

Question 45

what should sodium level be

Answer 45

135-145

Question 46

what should potassium level be

Answer 46

3.5-5

Question 47

what should chloride be

Answer 47

95-105

Question 48

what should bicarbonate levels be

Answer 48

22-26

Question 49

what should glucose levels be

Answer 49

70-110

Question 50

what do glucose levels do after surgery

Answer 50

spike

Question 51

what should kidney levels be

Answer 51

creatinine: 0.7-1.4 (more specific) BUN (blood urea nitrogen): 10-20 MONITORS WASTE LEVELS

Question 52

explain how coagulation numbers work

Answer 52

the higher the number the longer it takes for a clot to form

Question 53

Prothrombin levels PT

Answer 53

9.5-12 rarely used

Question 54

international normalized ratio INR levels

Answer 54

0.76-1.27 when not on meds 2-3 when on meds -established by the World Health Organization for accuracy

Question 55

activated partial thromboplastin time aPTT and when is it used

Answer 55

20-39 -used when taking heparin

Question 56

anti-factor Xa assay levels and when is it used

Answer 56

0.3-0.7 -used when taking heparin, more accurate than aPTT

Question 57

Imaging that may be done before surgery

Answer 57

chest x-ray joint/bone x-ray CT MRI

Question 58

Cardiac workup done before surgery

Answer 58

EKG --electrical conduction cardiac stress test sleep study -- sleep apnea

Question 59

when should teaching be done

Answer 59

before surgery

Question 60

rules of informed consent for nurses

Answer 60

can verify consent and sign over the phone advocate for pt education

Question 61

important interventions for the day of

Answer 61

-NPO -IV placement -bowel/bladder emptying -taking preoperative meds on time -skin prep -removal of items -finish documentation -provide direction and emotional support

Question 62

what does the preoperative checklist cover

Answer 62

-consent -advanced directives -preoperative checklist