Perioperative Nursing Flashcards
What are the 3 phases of the perioperative period?
preoperative- before going into the OR
intraoperative- in the OR
postoperative- from admission to PACU until discharge
What are the 3 classifications of surgical procedures?
Urgency
Risk
Purpose
What are the types of urgency? (3)
Elective- Procedures that patients need, but they don’t have to be done right away.
Urgent- Can wait until the patient is medically stable, but should generally be done within 2 days.
Emergency- Immediate surgery due to life-threatening factors. Can’t wait.
What are the types of purpose in surgical procedures?
8
Diagnostic Curative Preventive Ablative Palliative Reconstructive Transplantation Constructive
What surgery is performed to remove a diseased part?
Ablative
What surgery is performed to relieve or reduce intensity of an illness?
Palliative
What surgery is performed to restore function to tissue?
Reconstructive
What are the types of anesthesia?
General
Moderate sedation/analgesia
Regional
Topical and local anesthesia
What are the three phases of general anesthesia?
Induction- starts from administration of anesthesia to ready for incision. (inducting the drug)
Maintenance: from incision to near completion of surgery. (keeping them asleep)
Emergence- starts from when the patient emerges from anesthesia and is ready to leave the OR. (patient is EMERGING out of anesthesia).
What are the states of anesthesia?
5
Loss of consciousness Amnesia- not remembering Analgesia- inability to feel pain Relaxed skeletal muscles Depressed reflexes
What are the types of regional anesthesia?
Nerve blocks
Spinal anesthesia
Epidural anesthesia
What are the 6 things a doctor must inform the patient on for an informed consent?
- Explanation of the procedure and alternative therapies
- Underlying disease process and its natural course
- Name & qualifications of people performing the procedure
- The risks and how often they occur
- Explanation that the patient has the right to refuse treatment or withdrawn consent
- Explanation of outcome, recovery, rehab, and course of treatment.
What are 2 types of advance directives?
- Living wills
2. Durable power of attorney for health care (you choose someone to represent your wishes for you).
What are the 7 outcomes for the surgical patient?
- receive respectful and culturally/age-appropriate care
- be free form injury and adverse effects
- free from infection & DVT
- Maintain fluid and electrolyte balance
- Have pain managed
- Have an understanding of physiologic and psychological responses to surgery
- Participate in rehab process
What are 5 surgical risks for medications?
- Anticoagulants: precipitates hemorrhage
- Diuretics: electrolyte imbalances, respiratory depression
- Tranquilizers: increase hypotensive effects of anesthetic agents
- Adrenal steroids: abrupt withdrawal may cause cardiovascular collapse
- Antibiotics in mycin group: respiratory paralysis when combined with certain muscle relaxants
What are the usual presurgical screening tests?
chest x-ray electrocardiography complete WBC count electrolyte levels urinalysis
What is the Nurses role in Presurgical Testing?
4
Ensure that:
- tests are explained to the patient
- appropriate specimens are collected
- results are recorded in patient records before surgery
- abnormal results are reported
What are the Nursing Interventions to meet psychological needs of surgical patients? (4)
- establish therapeutic relationships and allows patients to verbalize fears/concerns
- use active listening skills to identify anxiety/fear
- use touch to demonstrate genuine empathy and caring
- be prepared to respond to common patient questions about surgery.
What can you prepare the patient for through teaching?
surgical events & sensations
pain management
physical activities
What physical activities can you teach a patient?
deep breathing coughing incentive spirometry leg exercises turning in bed early ambulation
What are the 5 nursing interventions for surgical patients?
- hygiene & skin preparation
- elimination
- nutrition and fluids
- rest and sleep
- preparation and safety the day of surgery
What are typical preoperative medications? (5)
- sedatives
- anticholinergics
- narcotic analgesics
- neuroleptanalgesic agents
- histamine-2-receptor antihistamines
TJC Protocol to prevent wrong site, procedure, and surgery.
- Preoperative patient identification verification (prior to surgery make sure its the right person)
- mark the operative site
- TIME-OUT PERIOD: final verification just before beginning the procedure.
What are the postoperative assessments and interventions (every 10-15 min)? (8)
- Respiratory status (O2)
- Cardiovascular status (BP)
- Temperature
- CNS status: level of alertness, movement, shivering
- Fluid status
- Wound status
- GI status (nausea/vomiting)
- General condition
Levels of the return of consciousness:
Unconscious Response to touch/sounds Drowsiness Awake but not oriented Awake and oriented
What are some cardiovascular complications? (4)
Hemorrhage- an escape of blood from a ruptured blood vessel
Shock- lack of blood flow, life-threatening
Thrombophlebitis- Inflammation that causes a blood clot to form and block one or more veins
Pulmonary embolus- A blockage in one of the pulmonary arteries in the lungs.
How can you prevent respiratory complications?
- Monitoring vital signs
- Implementing deep breathing
- Coughing
- Incentive spirometry
- Turning in bed every 2 hours
- Ambulating
- Maintaining hydration
- Avoiding positioning that decreases ventilation
- Monitoring responses to narcotic analgesics
