Perioperative Nursing Flashcards
What is perioperative nursing?
Care provided immediately before, during, and after surgery
Specialized area of practice requiring knowledge of surgical anatomy, physiologic disruptions, injuries, and risk factors.
What are the three phases of the surgical experience in perioperative nursing?
- Preoperative
- Intraoperative
- Postoperative
What does the preoperative phase begin and end with?
Begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the operating room (OR) bed.
What is the intraoperative phase?
Begins when the patient is transferred onto the OR bed and ends with admission to the PACU (postanesthesia care unit).
What does the postoperative phase encompass?
Begins with the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or home.
How are surgeries classified?
- Purpose
- Risk
- Technique
- Urgency
What are the classifications of surgical procedures by purpose?
- Diagnostic
- Curative
- Reconstructive/Constructive
- Palliative
- Transplant
What are the risk classifications of surgical procedures?
- Minor
- Major
What are the urgency classifications of surgical procedures?
- Emergent
- Urgent
- Elective
What are the determinants of inpatient or outpatient surgery?
- Complexity of surgery
- Recovery
- Expected needed level of postoperative care
What are the advantages of outpatient surgery?
- Decreased cost
- Reduced risk of hospital-acquired infection
- Less interruption in patient’s routine
- Reduction in time lost from work
- Less physiologic stress
What is included in the preoperative assessment?
- Health history and physical exam
- Medications and allergies
- Nutritional, fluid status
- Dentition
- Drug or alcohol use
- Respiratory and cardiovascular status
- Hepatic, renal function
- Endocrine function
- Immune function
- Previous medication use
- Psychosocial factors
- Spiritual, cultural beliefs
Which medications potentially affect the surgical experience?
- Anticoagulants
- Antiplatelets
- Antihypertensives
- Opioids
- Herbal Supplements
- Corticosteroids
- Diuretics
- Insulin
- Antibiotics
- NSAIDs
What are required preoperative documents?
- Informed consent
- History & Physical
What is the purpose of informed consent?
Legal mandate; surgeon must explain the procedure, benefits, risks, complications, etc.
When is consent valid?
Only when signed before administering psychoactive premedication.
What should preoperative patient education include?
- General information on what to expect after surgery
- Wound care
- Deep breathing, coughing, incentive spirometry
- Mobility, active body movement
- Pain management
- Coping strategies
What are immediate preoperative nursing interventions?
- Confirms patient’s identity
- Changes into hospital gown
- Inspects mouth and removes dentures/plates
- Removes jewelry
- Void immediately before going to the OR
- Administers presurgical medications
What are the expected outcomes of preoperative nursing?
- Relief of anxiety
- Decreased fear
- Understanding of the surgical intervention
Who are the members of the surgical team?
- Patient
- Anesthesiologist or CRNA
- Surgeon
- First assist
- Nurses (Circulating nurse, Scrub nurse)
What are the zones in the surgical environment?
- Unrestricted zone: street clothes allowed
- Semirestricted zone: scrub clothes and caps
- Restricted zone: scrub clothes, shoe covers, caps, and masks
What are common intraoperative complications?
- Anesthesia awareness
- Nausea, vomiting
- Anaphylaxis
- Hypoxia or respiratory complications
- Hypothermia
- Malignant hyperthermia
- Infection
What is the purpose of the surgical/Pre procedure time out?
To verify patient identification, correct informed consent, and review medical records.
What are the phases of post-anesthesia care?
- Phase I: Immediate recovery in PACU
- Phase II: Preparation for transfer or discharge
What are the responsibilities of the PACU nurse?
- Review pertinent information
- Assess airway, level of consciousness, cardiac, respiratory, wound, and pain
- Check drainage tubes, monitoring lines, IV fluids
- Assess vital signs
- Administer postoperative analgesia
What are common postoperative complications?
- Pulmonary infection/hypoxia
- Deep vein thrombosis/PE
- Hematoma/hemorrhage
- Elimination issues
- Infection
- Wound dehiscence or evisceration
What is hypovolemic shock?
A life-threatening complication resulting from insufficient blood flow, commonly due to loss of blood volume.
What are the manifestations of pneumonia?
- Chills and fever
- Tachycardia and tachypnea
- Dyspnea
- Chest pain
- Crackles
What is the purpose of postoperative dressing?
- Provide healing environment
- Absorb drainage
- Splint or immobilize
- Protect
- Promote homeostasis
- Promote patient’s physical and mental comfort
True or False: Wounds heal by primary intention when they are large, gaping, or irregular.
False
Primary intention occurs with uncomplicated, clean wounds.
What are the phases of tissue healing?
- Inflammatory phase
- Proliferative phase
- Remodeling phase
What factors can affect healing time?
What is the risk factor for pulmonary embolism (PE)?
Deep vein thrombosis (DVT) is the major risk factor for PE.
What are potential causes of urinary retention and altered bowel elimination postoperatively?
- Narcotics
- Recumbent position
- Altered fluid balance
- Nervous tension
- Inactivity
