Perioperative nursing Flashcards
perioperative period
total surgical episode
preoperative period
time before surgery
intraoperative period
actual time of surgery
postoperative period
time after surgery completed
role of nurse in periop care
- Preparing the patient for surgery
- Assisting and observing the patient during operation
- Preventing and treating postoperative complications
- Preparing the patient for discharge
importance of nrsg assessment?
- Identify risk factors
- Assess ALL systems, no matter where surgery is being done (Lungs to handle intubation, kidney to be able to rid the body and continue urination, etc)
- Correct, minimize, or prevent potential problems
- Develop preoperative and postoperative teaching plans (Teaching begins before the pt ever goes to surgery. Teaching will be based generally on surgery but also what is the pt most at risk for)
- Provides baseline of physical/functional ability
nrsg responsibilities preop
-Good phys assess
-Obtain baseline VS
-focus on body system for surgery, but look at ALL systems
-Assess lab values, diagnostic tests: Report abnormal findings to surgeon AND anesthesiologist (even if u think they might already know, still tell them! don’t risk)
-Pt teaching (cause after they might not be able to focus), and then prepping pt (NPO, skin prep, etc)
-Witness signing of informed consent (must be obtained by surgeon): Needs to be a competent adult; if not, can be a power of attorney
-clarify facts presented by the physician/ dispel myths
-Implement NPO status 6-8hrs before surgery
If they need PO meds for their HTN, DM, etc → give with small sip of water and let surgeon and anesthesiologist know
-Intestinal prep: enema or laxative as ordered
-Skin prep: shower using antiseptic solution, use clippers for shaving
-Preop chart/checklist (allergies, NPO, height, weight, medications, lab results, special considerations, surgical consent)
whatre you look for when reviewing labs/diagnostics?
Look at things that will help pt have best intraop course. Ie anemia would affect oxygenation. Infection presence or problem with WBC might disqualify them from surgery.
Every single pt going to surgery gets chest x ray and EKG so heart can handle anesthesia and so their lungs can oxygenate. Sometimes itll be done outpatient if theyre getting a knee surgery or something but still wanna look for it in chart if possible. Even emergency surgery they get it.
preop teaching to prevent complications:
Teach about complications and how to decrease the risk. Clarify questions of pt or family.
Procedural information–tell them what to expect, what its going to feel like, etc
Sensation and discomfort information
Breathing exercises, IS
Splinting the incision (abdominal)
Coughing
Leg exercises/ leg squeezers
Ambulation and mobility (pt is expected to be OOB within 24hrs of surgery. EVERYBODY no matter what surgery gets up within 24 hrs of the surgery and walk even if just a few feet. Let them know ahead of time this will be expected.)
informed consent
Consent is responsibility of SURGEON before sedation/surgery. They must talk to patient before consent is signed. Nurse can be a witness ONLY if they know pt knows everything about the surgery that the surgeon is supposed to tell them. For EVERY invasive OR procedure. Patient MUST understand what’s going on. Nurse can clarify questions but if patient is not fully informed after talking to doc and about to sign consent, must call surgeon back to talk to pt again.
-it’s voluntary, always revocable
-Includes full disclosure of:
Condition requiring surgery
Surgical procedure to be performed
Risks and benefits of procedure
Treatment options and prognosis
dietary restrictions for surgery:
Client is given nothing by mouth (NPO 6-8 hours before surgery. Usually start it the night before. For ppl needing emergency surgery after car accident or something, probably will give them an IV drug to move things along faster. Take pitcher, glass, food, everything out of their room to prevent them eating something by accident or something too.
reason for npo before surg?
decreases risk for aspiration.
Failure to adhere can result in cancellation of surgery or increase the risk for aspiration during or after surgery.
intestinal prep for pt prior to surg
Intestinal Prep (particularly for GI surgery) • Bowel or intestinal preparations are performed to prevent injury to the colon and to reduce the number of intestinal bacteria. • Enema or laxative may be ordered by the physician
Golytely: Gallon jug that must be drank by patient within a certain time period. Very hard for some pts which may mean they might not be completely clean which may affect the surgery.
skin prep prior to surg
shower using antiseptic soln. Usually we use the wipes, bathe them with wipe ALL over and then use special treatment on their surgical area.
shaving before is controversial: Shaving is now old fashioned. Scrapes skin and puts pt at risk. Now we use clippers, just get hair as short as possible.
preop checklist: nurses responsibility
OUR JOB to make sure all these checklist things get done. don’t need to know all the elements of checklist, but know that it’s our job and it’s a lot of stuff
Ensure all documentation, preoperative procedure orders are complete.
Check the surgical consent form and others for completeness.
Document allergies.
Note medications taken before surgery
Document height and weight.
Ensure results of allf laboratory and diagnostic tests are on the chart; report any abnormal results.
report special needs/concerns(religious/cultural)
NPO status
members of surgical team
surgeon, RNFA, anesthesia care provider (anesthesiologist or CRNA), circulating nurse, scrub nurse (Usually a scrub tech not scrub nurse), surgical nurse or OR technician
circulating nurse
Very impt role: make sure everything goes right. They double check checklist in preop area. They are not sterile. They stay around the field, but tech is the one handing tools. Circ. Nurse just protects pt and makes sure everything goes correctly. Overlook things.
RNFA
registered nurse first assistant
Get OR experience, take short course, then can help surgeon close wounds or suction etc.
general anesthesia is? must do what?
Complete loss of consciousness → must support breathing – always have an ET tube.
what is the biggest deal / danger point with gen anesthesia
airway
Norm with gen anesthesia can’t give water food anything until gag reflex returns.
gen anesthesia meds?
Cocktail of meds, variety → balanced anesthesia: less of each- something for hypnosis, amnesia, muscle relaxer
potential complications of gen anesthesia
Malignant hyperthermia–treat with dantrolene
Overdose = oversedation
Unrecognized hypoventilation due to breathing support → keep an eye on O2
Complications of specific anesthetic agents (allergies)
Complications of intubation
malignant hyperthermia: why is it concerning?
This is a concern because it causes stiffness in the chest, preventing expansion, so gases are not being exchanged: life threatening. That’s why dantrolene (muscle relaxant)
why is there a such thing as unrecognized hypoventilation?
Unrecognized because they’re getting supported ventilation. Must watch o2 sat. sometimes it’s not found until tube is taken out.
local (regional) anesthesia
Epidural block or spinal block.
No total LOC, no ET tube.
Sensory nerve impulse from a specific body area is briefly disrupted.
Motor function may be affected
Pt remains conscious and able to follow instructions
Not total loss = don’t need ET tube
Gag and cough reflexes remain intact = no airway issues
epidural block v spinal block for local anesthesia
Epidural: going thru relatively thick membrane, there’s a pop. Common for pregnancy.
Spinal: keep going until another pop. More dangerous, closer to core.
what is used as supplement with local anesthesia
Sedatives, opioid analgesics or hypnotics are often used as supplements to reduce anxiety
benefit of local anesthesia?
Usually does not depress respirations, less post op vomiting and nausea
prevent wrong site surg
Visibly mark intended site.
Purpose: identify unambiguously intended site.
Method and type of marking should be consistent throughout the organization
Person doing the marking should be the one doing the procedure .
Person who’s having surgery needs to be involved. Ideally if they can, u want them to sign their arm or leg too or whatever.
surgical time out
Adopted from the aviation industry model
Requires surgical team members to cease all other activities
Actively, verbally, and mutually verify information
post op period: focus is on what?
PACU assessment
Think of pACU period separate from total post op period.
immediately after surgery focus in PACU?
Focus of nurse’s assessment and intervention:
- Patient safety
- Hemodynamic stability
- Recognition and prevention of postoperative complications
