Perioperative Nursing

Question 1

230 - Surgery:
+ Phases of Anesthesia (3)
+ Medications provided during surgery

Answer 1

SURGERY

PHASES OF ANESTHESIA:
+ INDUCTION: IV line inserted, pre-op meds given, airway secured.
+ MAINTENANCE: Surgery performed, maintenance of airway.
+ EMERGENCE: Completion of surgery, airway removed.

SURGERY MEDS:
+ Anesthetics (ex: benzodiazepines, propofol)
+ Opioid analgesics (ex: fentanyl)
+ Antiemetics (ex: ondansetron, metoclopramide)
+ Neuromuscular blocking agents (ex: succinylcholine)
+ Anticholinergics (ex: atropine)

Question 2

231 - Informed Consent
+ Provider responsibilities
+ RN responsibilities

Answer 2

INFORMED CONSENT

PROVIDER RESPONSIBILITIES:
+ Communicate purpose of procedure, and complete description of procedure in the patient’s primary language (use medical interpreter if needed).
+ Explain risks vs. benefits.
+ Describe other options to treat the condition.

RN RESPONSIBILITIES:
+ Make sure provider gave the patient the above information.
+ Ensure patient is competent to give informed consent (i.e. patient is an adult or emancipated minor, not impaired).
+ Have patient sign consent document.
+ Notify provider if patient has more questions or doesn’t understand any information provided.

Question 3

232 - Malignant Hyperthermia:
+ What is it?
+ Symptoms
+ Treatment

Answer 3

MALIGNANT HYPERTHERMIA: Hypermtabolic condition induced by anesthetic agents in surgery.

SYMPTOMS: FEVER, TACHYCARDIA, hypotension, tachypnea, dysrhythmias, MUSCLE RIGIDITY, mottled skin, cyanosis.

TREATMENT:
+ Discontinue surgery.
+ Administer dantrolene (muscle relaxant) as ordered.
+ Administer 100% oxygen, obtain ABGs.
+ Administer iced NaCl IV fluids, apply cooling blanket.

Question 4

233 - Post-op Nursing Care: PACU assessment

Answer 4

POST-OP NURSING CARE: PACU ASSESSMENT

+ Assess airway. Check SpO2 (should be > 95% or at pre-op level), respirations, lung sounds. Suction secretions if needed.
+ Assess Circulation. Assess for signs of hemorrhaging (hypotension, tachycardia), skin color/temp, peripheral pulses, ECG readings.
+ Assess vital signs (stable for d/c from PACU).
+ Monitor I&Os. Ensure urine output >= 30 ml/hr.
+ Assess surgical wounds, incisions, dressings.
+ ENSURE RETURN OF GAG AND SWALLOW REFLEXES.

Question 5

234 - Post-op Nursing Care:

+ Nursing care after d/c from PACU

Answer 5

POST-OP NURSING CARE: NURSING CARE AFTER PACU

+ Encourage early ambulation.
+ Prevent DVTs: apply SCDs, reposition frequency, administer anticoagulants,
+ Treat pain, nausea.
+ Monitor for S/S of infection at surgical site (redness, extreme tenderness, purulent drainage)
–> EXPECTED FINDINGS: PINK WOUND EDGES, SLIGHT EDEMA, SLIGHT CRUSTING AT INCISION LINE.
+ Teach patient to splint w/coughing and deep breathing.