Perioperative Nursing Flashcards
Three phases of Perioperative care
Perioperative, Intraoperative, postoperative
Classification of Surgical procedures: Purpose
diagnostic, ablative, palliative, reconstructive, transplantation, constructive
Intraoperative
begins when the patient is transferred to the OR bed until transfer to the postanesthesia care unit (PACU)
Perioperative
begins with decision to have surgery, lasts until patient is transferred to operating room or procedural bed
Postoperative
lasts from admission to the PACU or other recovery area to complete recovery from surgery and last follow-up health care provider visit
Classification of Surgical procedures
Urgency, Risk, Purpose
Classification of Surgical procedures: Risk
Minor or major
Classification of Surgical procedures: Urgency
elective, urgent, emergency
Ablative surgery
Ablative surgery is performed to remove a diseased part.
Diagnostic surgery
Diagnostic surgery is performed to make or confirm a diagnosis.
Palliative surgery
Palliative surgery is performed to relieve or reduce intensity of an illness.
Reconstructive Surgery
performed to restore function to tissue.
Types of Anesthesia
General, Moderate sedation/Analgesia, Regional, Topical/local
General Anesthesia
administration of drugs by inhalation or intravenous route
Moderate sedation/Analgesia
(conscious sedation/analgesia): used for short-term, minimally invasive procedures
Regional Anesthesia
anesthetic agent injected near a nerve or nerve pathway or around operative site
*abdominal surgery
Topical/local anesthesia
used on mucous membranes, open skin, wounds, burns
Three phases of General anesthesia:
Induction, Maintenance, Emergence
Three phases of General anesthesia: Induction
from administration of anesthesia to ready for incision
Three phases of General anesthesia: Maintenance
from incision to near completion of procedure
Three phases of General anesthesia: Emergence
starts when patient emerges from anesthesia and is ready to leave operating room
Types of Regional anesthesia
Nerve blocks
Spinal anesthesia
Epidural anesthesia
Intravenous anesthesia with pneumatic tourniquet-ing
Informed Consent
Description of procedure and alternative therapies
Underlying disease process and its natural course
Name and qualifications of person performing procedure
Explanation of risks and how often they occur
Explanation that the patient has the right to refuse treatment or withdraw consent
Explanation of expected outcome, recovery, rehabilitation plan, and course of treatment
Outpatient/Same-day surgery
Reduces length of hospital stay and cuts costs
Reduces stress for the patient
May require additional teaching and home care services for certain patients
-Older patients, chronically ill patients, patients with no support system
Outcomes for the Surgical Patient
Receive respectful and developmentally and culturally appropriate care
Be free from injury and adverse effects
Be free from surgical site infection
Maintain fluid and electrolyte balance; skin integrity, normal temperature
Collaborate in management of pain
Demonstrate understanding of physiologic and psychological responses to surgery
Participate in rehabilitation process
Patient Risk Factors and Strengths (8)
Developmental level
Medical and surgical history
Medication history
Nutritional status
Use of alcohol, illicit drugs, or other drugs
Activities of daily living and occupation
Coping patterns and support systems
Sociocultural needs
Surgical Risks of Medications
-Anticoagulants: precipitate hemorrhage
-Diuretics: electrolyte imbalances, respiratory depression from anesthesia
-Tranquilizers: increase hypotensive effects of anesthetic agents
-Adrenal steroids: abrupt withdrawal may cause cardiovascular collapse
-Antibiotics in mycin group: respiratory paralysis when combined with certain muscle relaxants
Usual Presurgical Screening Tests
Chest x-ray
Electrocardiography
Complete blood count (CBC)
Basic (BMP) or complete (CMP) metabolic profile
Urinalysis
Nurse’s Role in Presurgical Testing
-Ensure that tests are explained to the patient
-Ensure that appropriate specimens are collected
-Ensure that results are recorded in patient records before surgery
-Ensure that abnormal results are reported
Preparing the Patient Through Teaching
Surgical events and sensations
Pain management
Physical activities
Deep breathing
Coughing
Incentive spirometry
Leg exercises
Turning in bed
Early ambulation
Nursing Interventions for Surgical Patients (5)
Hygiene and skin preparation
Elimination
Nutrition and fluids
Rest and sleep
Preparation and safety the day of surgery
Typical Preoperative Medications (3)
-Benzodiazepines to alleviate anxiety and produce sedation
-Opioids to facilitate sedation and relaxation
-Alpha 2-adrenergic receptor agonist to reduce anesthesia requirements
Error Prevention
-Preoperative patient identification verification process
-Marking the operative site
-Final verification just prior to beginning the procedure, referred to as the time-out
Postoperative Assessments and Interventions (Every 10 to 15 Minutes) (8)
Respiratory status (airway, pulse oximetry)
Cardiovascular status (blood pressure)
Temperature
Central nervous system status (level of alertness, movement, shivering)
Fluid status
Wound status
Pain management
General condition
Cardiovascular Complications
Hemorrhage
Shock
Thrombophlebitis
Thromboembolism
Deep vein thrombosis
Pulmonary embolus
Respiratory Complications
Atelectasis
Pneumonia
Pulmonary embolism
Additional Postoperative Considerations
Preventing surgical site complications
Promoting a return to health
Elimination needs
Fluid and nutrition needs
Comfort and rest needs
Helping the patient cope
Interventions to Prevent Respiratory Complications
Monitoring vital signs
Implementing deep breathing
Coughing
Incentive spirometry
Turning in bed every 2 hours
Ambulating
Maintaining hydration
Avoiding positioning that decreases ventilation
Monitoring responses to narcotic analgesics
