Perioperative Nursing Flashcards
What is the AORN and their goals
organization for perioperative nurses
- patient-centered
safety, physiological, and behavioral
What are the three phases of perioperative nursing
preoperative
intraoperative
postoperative
define preoperative nursing
-inpatient or outpatient
-varying amount of planning time
-begins with the decision to have surgery
-lasts until pt is transferred to the operating room
define intraoperative nursing
begins when pt is transferred to OR until pt goes to PACU
What is the PACU
post anesthesia care unit
define postoperative nursing
-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
what is perioperative nursing
surgical nursing
-before, during, and after
define major surgery
inside a body cavity, has a longer/more complicated recovery
define minor surgery
does not expose the body cavity, has an easier recovery
define elective surgery
choosing to have done, may not preserve life/function
what kind of surgery is a joint replacement
elective
define urgent surgery
has to be done promptly, within two days
-is done to preserve life and function
what kind of surgery is a fracture repair
urgent
define emergent surgery
done immediately, life-saving, do not need consent
what kind of surgery is the removal of an aneurysm
emergent
give an example of diagnostic surgery
exploratory surgery
what is ablative surgery
the removal of a diseased body part
what is a palliative surgery
eliminating symptoms, promoting improvement
define reconstructive surgery
repair a deformity
define transplantation surgery
replacement by a donor or artificial source
what is a common constructive surgery
cleft lip surgery, normally birth defects
what is the main goal of a preoperative nurse
identify and minimize risks
What are the assessments of a pre-op nurse
-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
What are some things to ask about in an H&P
-development
-medical history and comorbidities
-surgical history and complications
-allergies and medications taken
-nutritional status
-ADLs and occupation
-sociocultural needs
-support system
why is nutritional status important for surgery
can affect albumin levels
what are examples of sociocultural needs?
may need a translator
-be aware of things that could be culturally important to them
how can nicotine affect surgery
it is a vasoconstrictor, raising bp and can decrease hemoglobin function
-surgeons may refuse to operate
what are things important to a physical exam
-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)
biggest concern/comorbidity for surgery
-heart health, may not be able to handle surgery
-diabetes, impacts the vascular system, electrolytes, CV health and infection risk
common comorbidities for surgery
-HTN, MI, HR, arrhythmias, CVA, thrombocytopenia, anemia
-COPD, asthma, pneumonia, bronchitis, URI
-renal and hepatic health
-diabetes
-medication (warfarin)
risk factors for surgery
-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
what is a part of a BMP or CMP
-electrolytes
-BUN and creatinine
-glucose
-liver function
what is tested for a coagulation study
PT/INR
PTT
Other than BMP & CMP & coagulation needs to be done for blood work
Blood type, HCG, complete blood count
what are the parts of a complete blood count
-RBC
-Hemoglobin Hgb
-Hematocrit Hct
-WBC
Platelets
what should RBC be
men: 4.6-6.2
women: 4.2-5.4
what should hemoglobin be
men: 13-18
women: 12-16
why is hemoglobin important
carries oxygen and CO2, is important for healing
what should hematocrit be
men: 42-52%
women: 35-47%
how is hematocrit measured
amount of blood that is RBC, a high level means dehydration
-should be 3x the amount of hemoglobin
what should WBC be
4.5-11
what should platelets be
150-450
why are platelets important
ability to bleed/clot
what are the electrolytes
- sodium Na
- potassium K
- Chloride Cl
- bicarbonate HCO3
-Glucose
what should sodium level be
135-145
what should potassium level be
3.5-5
what should chloride be
95-105
what should bicarbonate levels be
22-26
what should glucose levels be
70-110
what do glucose levels do after surgery
spike
what should kidney levels be
creatinine: 0.7-1.4 (more specific)
BUN (blood urea nitrogen): 10-20
MONITORS WASTE LEVELS
explain how coagulation numbers work
the higher the number the longer it takes for a clot to form
Prothrombin levels PT
9.5-12
rarely used
international normalized ratio INR levels
0.76-1.27 when not on meds
2-3 when on meds
-established by the World Health Organization for accuracy
activated partial thromboplastin time aPTT and when is it used
20-39
-used when taking heparin
anti-factor Xa assay levels and when is it used
0.3-0.7
-used when taking heparin, more accurate than aPTT
Imaging that may be done before surgery
chest x-ray
joint/bone x-ray
CT
MRI
Cardiac workup done before surgery
EKG –electrical conduction
cardiac stress test
sleep study – sleep apnea
when should teaching be done
before surgery
rules of informed consent for nurses
can verify consent and sign over the phone
advocate for pt education
important interventions for the day of
-NPO
-IV placement
-bowel/bladder emptying
-taking preoperative meds on time
-skin prep
-removal of items
-finish documentation
-provide direction and emotional support
what does the preoperative checklist cover
-consent
-advanced directives
-preoperative checklist
