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Perioperative Nursing Flashcards

1
Q

What are the earliest recorded surgical procedures?

A

Circumcision and trepanation

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2
Q

Preoperative Phase

A

begins w/ the decision to proceed w/ surgical intervention and ends with the transfer of the patient onto the operating room table

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3
Q

What are the 4 categories of surgical procedures?

A
  1. Diagnostic
  2. Exploratory
  3. Curative
  4. Palliative
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4
Q

Diagnostic Surgery

A

used to confirm a diagnosis (biopsy)

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5
Q

Exploratory Surgery

A

to determine the extent of the disease

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6
Q

Curative Surgery

A

to remove or repair damaged or diseased tissue (ectomy)

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7
Q

Palliative Surgery

A

relieves symptoms to make patient comfortable, but does NOT cure

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8
Q

Emergent Surgery

A

patient requires IMMEDIATE surgery

-performed to maintain life, organ/limb function, remove a damaged organ, stop hemorrhage

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9
Q

Urgent Surgery

A

Surgery is imperative

  • patient requires prompt attention
  • performed within 24-30 hours
    ex: acute gallbladder infection, kidney or urethral stones
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10
Q

What would prompt a legal case?

A

Physician delayed decision to perform surgery and the patient died

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11
Q

Required/Planned Surgery

A

Patient needs to have surgery, but timing is not immediate

  • scheduled several weeks/months in advance
    ex: prostatic hyperplasia, thyroid disorders, cataracts
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12
Q

Elective Surgery

A

Patient should have surgery, but failure to have surgery is not catastrophic
ex: repair of scars, simple hernia, vaginal repair (cosmetics)

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13
Q

What does a nurse look at for a preoperative nursing assessment?

A

Nutritional and Fluid Status
Drug/Alcohol use
Psychosocial Factors
Spiritual/Cultural Beliefs

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14
Q

Alcohol Withdrawal Syndrome or Delirium Tremens

A
  • anticipated b/t 48-72 hours after alcohol withdrawal
  • increased mortality rate postop
  • contributed to cardiac dysrhythmias and bleeding tendencies
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15
Q

What are the 5 fears associated with Psychosocial Factors?

A 
Fear of unknown
Fear of death/pain
Fear of anesthesia 
Fear of cancer
Fear of loss of job
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16
Q

Informed Consent

A

the patient’s autonomous decision about whether to undergo a surgical procedure
-consent is a legal mandate

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17
Q

What are 3 rules for informed consent?

A
  1. Consent must be given voluntarily
  2. Refusing to undergo a surgical procedure is a person’s legal right and privilege
  3. Required for invasive procedures, any procedure requiring sedation, and nonsurgical procedures such as a heart cath
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18
Q

Who is responsible for explaining the procedure, the risks, and the benefits?

A

the physician

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19
Q

What is the nurses job with informed consent?

A

to make sure the consent form is signed, in a prominent place on the patients chart, and accompanies the patient to the OR

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20
Q

What is part of the preoperative checklist?

A 
Bloodwork
Vital signs 
Hospital gown
Dentures removed
Voided
Consent Sign
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21
Q

How recently should vital signs have been checked for preop checklist?

A

within 15 minutes of departure

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22
Q

What blood work should be completed for preop checklist?

A

CBC-total hematocrit, WBC, platelets
MBP-electrolytes
Chest X-ray

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23
Q

What body systems are important to assess preop?

A

respiratory, cardiovascular, renal, and endocrine systems

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24
Q

What should the nurse include in patient teaching preop?

A
  • Deep breathing, coughing, incentive spirometry
  • Mobility
  • Pain management
  • Nutrition and fluids
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25
What is the progression of the patients diet postop?
NPO--Clear liquids-- Full liquids-- soft-- diet prior to surgery
26
What should the nurse discuss with the patient's family?
- inform about the "waiting area" - Never judge the seriousness of an operation by the length of time a patient is in the OR - Discuss Post Anesthesia Care Unit (PACU)
27
Postoperative Period
begins after surgery and continues until the patient is discharged
28
Post anesthesia care is divided into 2 segments
Phase I PACU and Phase II PACU
29
Phase I PACU
includes the immediate recovery phase
30
Phase II PACU
Patient is prepared for self-care or care in the hospital, an extended care setting or discharge
31
What are the objectives for postanesthesia care?
to provide care until the patient has recovered from the affects of anesthesia, is oriented or returns to baseline cognition, has stable vital signs, adequate pain control, and no signs of hemorrhage or other complications
32
RN's responsibility in PACU
- Determine physiological status at time of admission and every 15 minutes - Allow periodic re-evaluation of the patient's trends - Establish baseline parameters - Assess ongoing status of surgical site - Assess recovery from anesthesia and residual affects
33
What criteria must a patient reach to be discharged from PACU?
- Awake or at baseline - Stable vitals - No excessive bleeding or drainage - No respiratory depression
34
To maintain a patent airway postop the RN should?
- Check for oxygen order - Assess respiratory rate and depth - Check oxygen saturation rate - Check breath sounds
35
Respiratory Difficulty
- Can result from excessive secretion of mucus or aspiration of vomit - Elevate head of bed to 15-30 degrees - Suction prn
36
What is the most common cause of postop hypoxemia?
Atelectasis or alveolar collapse resulting from bronchial obstruction caused by retained secretions
37
How can you prevent atelectasis and pneumonia?
- Deep breathing q 1-2 hours - Coughing - Ambulation
38
When is coughing contraindicated?
- head injuries - undergone intracranial surgery - had eye surgery - plastic surgery
39
What does the nurse have to watch for in postop cardiovascular care?
Fluid and Electrolyte Balance: - Fluid Over load - Fluid Deficit
40
How can Fluid overload occur?
- IV fluids administered too rapidly | - patient has concurrent cardiac and renal disease
41
How can fluid deficit occur?
- slow or inadequate fluid replacement | - losses from vomiting, bleeding, wound drainage, suctioning
42
Blood Transfusions
- Hemoglobin levels of 7-9 g/dL may be tolerated by most asymptomatic patients - Transfusion may occur with any hgb < 8 g/dL - Transfusion of 1 unit of packed RBCs should increase the hemoglobin level by 1 g/dL
43
What are the 3 classifications of a hemorrhage?
Primary, intermediary, secondary
44
Primary Hemorrhage
occurs at the time of surgery
45
Intermediary Hemorrhage
occurs during the first few hours after OR when increase in BP to its normal level dislodges insecure clots
46
Secondary
occurs some time after surgery if blood vessel was insecurely tied or became infected
47
What are the 3 types of hemorrhage?
Capillary, Venous, Arterial
48
Capillary Hemorrhage
slow, general hemorrhage
49
Venous Hemorrhage
bubbles out quickly and is dark in color
50
Arterial Hemorrhage
bright red and appears in spurts
51
S/S of Hemorrhage
Can be evident or concealed | -apprehension, restless, thirsty, cold skin, moist skin, increased pulse, increased respirations, decreased B/P
52
RN Care for Shock
- position patient flat w/ feet elevated 20 degrees - Monitor VS and signs of shock - Administer IV fluid per physicians orders - Oxygen - Meds to improve cardiac function
53
S/S of shock
pallor, cool moist skin, increased pulse, low BP, concentrated urine
54
Postop Urinary Expectations
- low urinary output is expected 1st 24 hours - by 2-3 day patient will diuresis after fluid has been mobilized - AVOID catheterization if possible
55
Postop Urinary Care
Assess urine for quantity and quality Monitor I&O Use measures to facilitate urination Catheterization in 8 hours post op if voiding has not occurred
56
Nursing Interventions Postop
- circle any drainage on the dressing mark time and date - No drainage after 24-48 hrs, incision may be open to air - Be careful with drains when changing dressing - Check incision after every shift - Nonsterile gloves to change dressing, sterile to apply
57
Who has to remove the first dressing?
the surgeon
58
When does a wound infection become apparent postop?
the 3rd-5th day
59
Postop Gastrointestinal Affects
- N/V caused by narcotics/anesthesia, delayed gastric emptying, slowed peristalsis - Bowel mobility reduced for 3-5 days - Flatulence/Gas pain - Hiccups
60
RN Care for Gastrointestinal
- Check frequency of bowel sounds - NPO status - NG tube decompress stomach - Liquid diet - Encourage to expel flatus - Constipation treatment
61
Wound Dehiscence
opening of wound edges
62
Wound Evisceration
protrusion of internal organs through the incision
63
Why does wound dehiscence/evisceration happen? When does it often occur?
wound infection, faulty closure, or severe stretching of abdominal wall -6-7th day after surgery
64
What are prophylactic measures to prevent dehiscence/evisceration?
abdominal binder used with the primary dressing
65
What are the three types of wound drains?
- Penrose - Jackson-Pratt - Hemovac

Nursing (21 decks)

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