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Adult Health Nursing I > Perioperative Nursing > Flashcards

Perioperative Nursing Flashcards

1
Q

What are some reasons why surgery is performed?

A 
Diagnostics; 
Cure; 
Palliation; 
Prevention; 
Cosmetic; 
Exploration
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2
Q

Two times surgery is performed…

A

Elective;

Emergency

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3
Q

Diagnostic surgery

A

Determine the extent of a condition

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4
Q

Diagnostic Surgery

Example

A

Biopsy

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5
Q

Surgery for Palliation

A

Done to alleviate symptoms without curing the disease to increase the quality of life of a patient

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6
Q

Surgery for Prevention

A

To remove a growth before (or to prevent) malignancy

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7
Q

Surgery done in which the client has time to prepare and plan.

A

Elective Surgery

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8
Q

To have surgery quickly would be

A

Emergency Surgery

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9
Q

What determines whether or not a surgery will be inpatient or outpatient?

A

Complexity of Surgery;
Recovery;
Needed level of post op care

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10
Q

Benefits of Outpatient Surgery

A

Decreased Cost; Reduced HA-infections;
Less interruption in daily routine; less time missed at work;
Less physiologic stress to patient and family

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11
Q

3 Phases of Perioperative Care

A
  1. Preoperative
  2. Intraoperative
  3. Postoperative
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12
Q

When does pre-op begin?

A

Begins when decision is made to have surgery until transfer to the OR

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13
Q

When does intraoperative phase begin?

A

From Entry into the OR to Transfer to recovery

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14
Q

When does post-op phase begin?

A

From Admittance to recovery to complete recovery of the patient

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15
Q

Definition of Informed Consent

A

Active, shared decision-making process between the provider and the patient

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16
Q

3 Conditions of Informed Consent

A
  1. Adequate Disclosure
  2. Clear understanding of the information by the patient BEFORE the administration of sedating drugs.
  3. Patient must give voluntary consent
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17
Q

What does it mean to give Adequate Disclosure in Informed Consent?

A

The surgeon must discuss:

  1. Diagnosis. 2. Nature and purpose of treatment
  2. Probability of a successful outcome
  3. Availability, benefits, risks of alt treatment
  4. Prognosis if not implemented
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18
Q

Who must give the person Adequate Disclosure to meet the condition of Informed Consent?

A

The surgeon is responsible for adequate disclosure

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19
Q

What is the nurse’s role in obtaining informed consent?

A

Verify the identity of the patient;
Witness patient signature;
Make sure all the conditions are met

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20
Q

5 Steps in Preoperative Nursing Assessment

A
  1. Past Medical History
  2. Document Current Medications
  3. Allergies
  4. Diagnostic Studies
  5. Review of Systems
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21
Q

PreOp Nsg Assessment:

Parts of PMH

A

Medical History: Previous Surgeries & Complications

Family History

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22
Q

Medications that should be especially paid attention to for documentation during pre-op.

A 
Opioids,
Antihypertensives,
Diabetic Medications,
Antiplatelets,
Immunosuppressive,
Herbal Supplements
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23
Q

Diagnostic Studies to include in Pre-Op Assessment

A

CBC, Coag,
Electrolytes, Chest X-ray; EKG;
Liver and Kidney function`

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24
Q

Types of Medications given in PreOp setting:

A

Antibiotics; Anticholinergics; Antidiabetics;
Antiemetics; Benzodiazapines; beta blockers;
Histamine receptor antagonists;
Opioids

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25
Q

Priority NANDA Diagnoses:

Preoperative

A

Fear
Anxiety
Knowledge Deficit

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26
Q

A controlled environment to minimize the spread of pathogens and allows for the smooth flow of patients, staff and equipment needed to provide safe patient care.

A

Surgical suite

27
Q

3 Areas of a surgical suite

A
  1. Unrestricted Area
  2. Semi-Restricted Area
  3. Restricted Area
28
Q

What is the unrestricted area of the surgical suite?

A

People in street clothes can interact w/ those in surgical attire;
Ex. Holding area where caregivers can wait with the patient

29
Q

What is the semi-restricted area of the surgical suite?

A

Area outside of the OR for those in surgical attire w/ head and facial hair covered

30
Q

What is the restricted area of the surgical suite?

A

Inside the OR;

Masks must also be worn in addition to the head and facial hair coverings

31
Q

Members of the Perioperative team

7 Members

A
  1. Scrub Nurse 2. Circulating Nurse
  2. Surgeon 4. Surgical Tech
  3. Surgical Assistant 6. RN 1st Assistant
  4. Anesthesiologist or CRNA
32
Q

What is the role of the perioperative nurse?

A

RN who implements plan of care

33
Q

What types of perioperative nurses are there?

A

Scrub Nurse

Circulating Nurse

34
Q

Whit is the role of the scrub nurse?

A

Perform sterile procedures using sterile technique

35
Q

What is the role of the circulating nurse?

A

Perform activities and documentation that require non-sterile technique.

36
Q

What does Safety in the OR entail?

A

Prevention of wrong site surgery and retention of foreign objects;
Accurate labeling and handling of specimens; Prevent thermal, electrical, and chemical burns; Safe blood, fluid, med admin.; Prevention of positioning injuries

37
Q

What are some things that you should ensure when positioning a client after the administration of anesthesia?

A

Provide correct musculoskeletal alignment, Adequate thoracic excursion, and modesty of exposure.
Prevent undue exposure on nerves, skin, bony prominences, earlobes and eyes; occlusion of arteries and veins.
Recognize and respect individual needs such as previously assessed pain and physical deformities.

38
Q

Why is it important to monitor the patient for hypothermia during surgery?

A

Patient is at increased risk of hypothermia because of altered temperature control of the body because of anesthesia and the cool temperature of the OR

39
Q

Why is the OR kept cool?

A

Prevention of growth of microorganisms

Comfort of the surgical team who is dressed in layers of surgical attire

40
Q

What has unintended hypothermia been linked to?

A

Impaired wound healing
Adverse cardiac events
Altered drug metabolism
Altered blood clotting

41
Q

How to clean incision site?

A

Scrub in circular motion, clean to dirty (or incision site and moving outward)

42
Q 
Anesthesia Techniques
(5 types)
A 
Moderate -> Deep Sedation
Monitored Anesthesia Care
General Anesthesia
Local Anesthesia
Regional Anesthesia
43
Q

Who can perform moderate to deep sedation?

A

Trained RN can administer

44
Q

Where is moderate to deep sedation usually done? What is an example?

A

Outside the OR

Ex. Colonoscopy

45
Q

Where is monitored anesthesia care done? Who can administer and why?

A

In or outside the OR;

Administered by anesthesiologist or CRNA because of a possible conversion to general anesthesia.

46
Q

What is general anesthesia?

A

Can be through IV or inhaled meds. Patient is intubated and airway is managed by the surgical team.

47
Q

What is local anesthesia?

A

Interrupts nerve impulses by altering the flow of sodium into nerve cells; Does not require sedation or loss of consciousness

48
Q

What are some ways local anesthetics can be administered?

A

Topical; ophthalmic;

nebulized or injected

49
Q

What is a regional anesthetic? How is it administered? What is an example?

A

Regional anesthetic involves a central or group of nerves that supply an area remote to injection.
Always Injected
Ex. Epidural

50
Q

Intraoperative surgical risks:

A

Thromboembolism and DVT —> PE;
Anaphylactic reactions;
Adverse cardiac reactions r/t ischemia;
Malignant Hyperthermia

51
Q

What are some NANDA diagnoses for intraoperative care?

A

Ones that focus on:
Airway, breathing, circulation, temperature, pain;
Risk for: imbalanced fluid volume, infection, injury, impaired skin integrity

52
Q

Immediate actions during postoperative care?

A

Monitor vital signs and surgical site
Assess: Airway, breathing, mental status, LOC, hydration status, pain level
Provide emotional support

53
Q

Respiratory Problems during Post-Op Care?

A

Airway obstruction
Hypoxemia
Hypoventilation

54
Q

Cardiac Problems seen in PostOp care

A

Hypo/Hypertension;
Dysrhythmias; Fluid Retention;
Hypokalemia; DVT;
Syncope

55
Q

Neurological problems during PostOp recovery?

A

PostOperative cognitive dysfunction

Delirium

56
Q

What is postoperative cognitive dysfunction?

A

When patient experiences memory problems after surgery; especially after multiple surgeries; related to anesthesia

57
Q

What is the most important thing to teach about the PCA pump and something that the nurse should be checking on?

A

The PCA pump should be controlled by the patient and not the family. It would be easy to oversedate the patient and possibly lead to a negative outcome.

58
Q

During the postoperative period immediately following surgery, how often should pain be assessed and medications be administered.

A

Around the clock; to achieve therapeutic pain management level.

59
Q

Gastrointestinal problems related to surgery

A

Nausea & Vomiting
Ileus
Constipation
Hiccups

60
Q

What is the standard value for urinary output

A

0.5 ml/kg/hr

61
Q

NANDA Diagnoses during PostOperative Phase

A

Risk for: Infection, Falls
Pain
Impaired skin integrity
Knowledge Deficit

62
Q

Surgical Risk and Safety Protocols

A

Surgical Care Improvement Project (SCIP);
National Patient Safety Goals;
Handoff (Handover);
Medication Reconciliation

63
Q

What is handoff/handover communication?

A

Documentation for each area;

Increases communication between all units and the providers

64
Q

What is medication reconciliation?

A

Lets the providers/caregivers know what medications should be continued in each area

Adult Health Nursing I (3 decks)

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