perioperative nursing Flashcards
what are the purposes of surgery
diagnosis cure palliation: alleviate symptoms preventions exploration cosmetic
why is it important to know the surgical patients prescribed and OTC meds
some vitamins/herbs can increase/decrease effectiveness of anesthetics
-allergies
ask about hay fever, asthma, allergy to bananas, kiwi, guava, avocados
what are the preoperative interview purposes
patient health history patient expectations provide and clarify info assess emotional state verify that consent is signed
Discuss effective preoperative teaching with an older adult that has difficulty seeing and hearing.
Allow additional time for teaching, ensure adequate lighting and quiet environment for teaching, ensure safety if patient experiences balance, thought or cognitive deficits
Why is deep breathing/incentive spirometer and coughing important for surgical patients? What would be appropriate to do for an abdominal surgical patient prior to coughing and deep breathing?
Prevention of complications – pneumonia, atelectasis, pulmonary embolism. Pt with abd
What would be an appropriate intervention when the surgical patient refuses to take off their wedding ring?
tape it to their finger
Why is the bedpan the only option for patients that have received preoperative IV medications?
After preop meds are given pt is at a higher risk for falls. Safety first!
Review principles of basic aseptic technique.
All materials entering sterile field must be sterile
• Front from chest to table level and the sleeves to 2 inches above the elbow are sterile
• If sterile item comes in contact with an unsterile item, it is contaminated
• Tables sterile on tabletop only
• Edges of sterile packages are not sterile
• Bacteria harbor on the skin
• Must maintain margin of safety between sterile and non-sterile (1 inch)
• Bacteria travels on airborne particles
What is general anesthesia
General anesthesia- the loss of sensation, with loss of consciousness, skeletal muscle relaxation, analgesia, and elimination of the somatic, autonomic and endocrine responses, including coughing, gagging, vomiting, and sympathetic nervous system responsiveness.
Two types of General Anesthetic Agents:
Intravenous induction agents- usually start with this IV induces pleasant sleep lasts a few mins. ET tube and inhalant started
2. Inhalation- Foundation of general anesthesia enters body through alveoli in lungs via mask or ET-Tube can irritating and produce laryngospasms
Patient risks- damage to teeth, irritation of vocal cords
what are adjunct to general anestheia
are added to the anesthetic regimen to achieve unconsciousness, analgesia, amnesia, muscle relaxation, or autonomic nervous system control.
what is dissociatvie anesthesia
interrupts associative brain pathways, pt appears catatonic is amnesic and experiences profound analgesia into post-op period. Ketamine used promotes bronchodilation (used for asthmatic patients), however can produce hallucinations
what is local anesthesia
allows op procedure to be performed on a part of body without loss of consciousness or sedation. Topical, ophthalmic, nebulized, or injectable.
what is topical anesthesia
Applied directly to skin (EMLA 30-60 minutes before procedure)
what is local infiltration
inject into tissues through which incision will pass- lidocaine.
what is regional
(peripheral) nerve block
what are the types of regional
Spinal- injection of local anesthesia in CSF usually below L2. Mixes with CSF. Has faster onset, increased H/A with leakage @ injection site.
o Epidural- injection into epidural space. Does not enter CSF, binds to nerve roots entering and exiting spinal cord.
Define malignant hyperthermia. What is the treatment?
A rare metabolic disease characterized by hyperthermia with rigidity of skeletal muscles that can result in death. Defect is hypermetabolism of skeletal muscle resulting from altered control of intracellular calcium. This causes muscle contractures, hyperthermia, hypoxemia, lactic acidosis, and hemodynamic and cardiac alterations. Can be prevented by obtaining a thorough family history and alert to MH s/s during the perioperative period.
what is the definition of surgery
the art and science of treating disease injuries and deformities by operation and instrumentation
what are the preoperative medications
antibiotics- precent postoperative infection
benzodiazepines- sedative and amnesic effect, decrease anxiety
anticholinergics- decrease oral and respiratory secretions
opiods- decrease pain
antimetics- increase gastic emptying, prevent nausea and vomiting
what are the routes of Preop meds
oral- 60-90 mins before
IM,SC 30-60 mins before
IV admiinist in OR
in the unrestricted surgical suite what is the attire
those in street cloths can interact with those in scrubs
int he semi restricted area in the surgical suite whats the attire
peripheral support areas and corridors- only authorized and must wear scrubs
in the restricted area in the surgical suite what is the attire
must weak masks and scrub sink area
what does the circulating nurse do
Prepares room, ID pt, check chart, admits pt to OR, monitoring devices in place, monitors asepsis, labels monitors and measures blood and fluid loss, assists ACP,(Anesthesia care provider) records med used, counts sponges, coordinates activities (students), reports to PACU, goes with patient.
what does the scrub nurse do
Assists with prepping room, scrubs, gowns & gloves self and others, prepares instruments on table, counts sponges, and needles, assists with draping, keeps track of irrigation solution, reports amount of anesthesia used ACP. Keeps hands above operating table level.
what does the LPN or surgical tech do
scrub function, passes instruments, supervised by RN
what does the surgeon and assistant do
perform surgical procedure
what does the registered nurse first assist do
works collaboratively with surgeon, may provide/require formal education
what does the nurse anesthetist do
administers anesthesia, assess pt preop- P-rating scale, prescribe preop meds, monitors cardio and resp function, VS’s, fluid and blood.
what are the 4 levels of sedation
Mild- pt responds normal
Moderate (conscious sedation) - airway and C-V function are maintained, maintains his/her own airway with emotional and physical acceptance of painful stimuli, used for diagnostic procedures, monitor closely
Deep- pt not easily aroused
Anesthesia- pt requires assisted ventilation
what are the phases of general anesthesia
Phases:
o Preinduction-Pre-op meds to start of IV, monitors, etc..
o Induction- Start of med sequence rendering pt unconscious
o Maintenance-During procedure, pt unconscious
o Emergence- Surgery complete, pt prepared for return to consciousness, removal of airway
what are the patient risk with general anesthetic
damage to teeth
irritation of vocal cords
what are the two types of local anesthesia
topical
local infiltration
what are catastrophic events in the OR
anaphylactic reactions
malignant hyperthermia
what is an anaphylactic reaction
Most severe form of allergic reaction characterized by decreased BP, tachycardia, bronchospasm, pulmonary edema (ABX or latex?) Reaction may be masked by anesthesia
what is the treatment for malignant hyperthermia
Rapid administration of Dantrolene (slows metabolism) is a skeletal muscle relaxant along with cardiac support and iced saline lavage to body cavities
what is the primary trigger of a malignant hyperthermia
succinlycholine
hypventialtion is caused by
opioids
when should post op patent do deep breathing
10 times every hour while awake
when should you change patients position
every 1-2 hours
when should you notify the surgeon
systolic BP less than 90 or greater than 160 pulse less than 60 or greater than 120 pulse pressure narrows BP trends up or down Change in heart rhythm
deep breathing is encouraged to
aid in gas exchange
what are petition cardiovascular risk problems
hypotension
hypertension
dysrhymia
early ambulation associated with walking
increase muscle tone
stimulate ciruclation
increases vital capacity
maintain normal respiratory function
what is DVT prevention
Administering LMWH (low molecular weight heparin) in combination with antiembolism stocking
how to prevent syncope
by making changes slowly in the patient’s position. Raise patient’s head of bed first and then assist patient to sit on the side of the bed. If faintness occurs the nurse can help the patient to a nearby chair or ease the patient to the floor
emergence delirium can include what behaviors
restlessness agitation disorientation thrashing shouting
what is delayed emergence
-the most common cause is prolonged drug action- particularly opioids, sedatives, and inhalation anesthetics
the most common cause of post op aviation is
hypoxemia
what is the most reliable indicator of pain
patients self report
during the first 48 hours of post op
opioid are used and then after that nonopioid are used
what are non pharmacologic approach of helping with acute pain
music
imagery
relaxation
aromatherphy
when should you take the temperature
every 4 hours for the first 24 hours
what are hiccups in the GI problems
irritation by the phrenic nerve
what is low output caused by
increase aldosterone and ADH
what is wound dehiscence
separation and disruption of previously joined wound edges
what are gerontologic considers
Decreased respiratory function, Decreased ability to cough and
Decreased thoracic compliance - increases work of breathing and decreases ability to eliminate drugs – need to monitor reaction to drugs.
Pneumonia – common complication
Altered vascular function due to atherosclerosis and decreased elasticity in blood vessels.
Compromised cardia function – decreased circulating blood volume, HTN common.
Drug toxicity due to decreased renal perfusion – decreased ability to excrete drugs.
Changes in mental status due to age, history of alcohol abuse, poor baseline cognition, hypoxia, severe metabolic derangement, hypotension, polypharmacy.
Pain control – do not want to ask for medications.
