Perioperative Nursing Part 2 Flashcards by Madison Gibbons

what is the goal of intraoperative and postoperative nurses

get pts through the surgical experience the same or better than before

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which nurse adds and verifies the preoperative checklist

everyone

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who created the surgical safety universal protocol

the joint commission

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what are the main goals of the universal protocol

prevent
-wrong person
-wrong procedure
-wrong site
-foreign objects left behind
-intra/postoperative death

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what are the three main steps for a universal protocol

-patient identification
-marking the operative sight (Dr. does)
-Time out, involving the care team and pt

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what are the types of anesthesia

-general
-moderate/analgesia
-regional
-topical and local

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rules of general anesthesia

-given through IV or inhalation
-have to be intubated
-NPO
-given by the anesthesiologist or certified nurse
-causes analgesia, muscle relaxation, diminished reflexes, CNS depression

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steps for general anesthesia

-induction – administration
-maintenance – maintain throughout
-emergence – waking up

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key facts of moderate sedation/analgesia

-conscious sedation
-nurses can administer
-pt can respond with purpose with stimulation, maintain airway
-doesn’t have to be NPO but normally is
-can give something to wipe memory

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types of regional/codal sedation

-nerve block
-spinal
-epidural

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Key facts on topical and local anesthesia

-loss of sensation
-can be used for pain control
-the main side-effect is lowered BP
- doesn’t have to be NPO but normally is
-can be used alone or together

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what type of anesthesia ends with -caine

local

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what are tropars used for

to make puncture holes, fill abdomen with air and remove objects

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benefits of laparoscopic surgery

less complications and shorter recovery

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if only one nurse can be in the OR what is their job

circulator

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key points of circulator nurse

-not sterile
-insures pt rights
-coordinate care –radiology, lab, etc
-control environment, and monitor asepsis
-sets up table with scrub

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key points of scrub nurse

-can be RN, LPN, or tech
-hands equipment to the surgeon
-needs to know the procedure, equipment, and anatomy

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key points of RNFA

-the first assist
-has to have 2 years OR experience
-certified
-participates in surgery

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key points of CRNA

-anesthesia nurse
-has additional schooling and testing

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jobs of surgical nursing

-safety
-communication
-positioning –discussed with multiple roles
-prep
-draping
-observation and assessment
-documentation –done by circulator
-device placement (foley, SCD, grounding pad, suction)
-runner –getting new equipment
-counting equipment
-prep for transfer

what is malignant hypothermia

the increase of skeletal muscle metabolism, causing increased oxygen need, increased temp, and can cause circulatory collapse, can also cause kidney failure
-it is autosomal dominant, seen more in males

signs of MH

-muscle rigidity –seen in jaw first
-increased CO2 –hypercapnia
-tachycardia and dysrhythmias
-tachypnea and cyanosis
-increased temp – 2 Celsius per hour
-mottled skin
-sweating
-DIC – decimated idiopathic coagulation

interventions for MH

-ice packs
-cooling blanket
-dantrolene — med
-reversal of anesthesia
-monitor UOP

signs of MH-related kidney failure

cola urine and muscle aches

What does SBAR stand for

Situation, background, assessment, recommendations

give an example on an SBAR from OR to PACU

name, procedure, past medical history anesthesia type, neds, intraoperative events, complications Vitals, surgical sight, EBL, IV, fluids, pain, foley, skin issues plan of care, family

what does EBL stand for

estimated blood loss

respiratory concerns in pacu

awake enough to breathe

CV concerns in pacu

vitals every 5-15 minutes

temperature concerns in pacu

hypothermic response is common

CNS concerns in pacu

are they waking up, what is the level of sedation

fluid concerns in pacu

maintaining their BP and urine output

wound concerns in pacu

bleeding internal and external, make sure to roll pts for observation

pain concerns in pacu

management

GI and GU concerns in pacu

complications, NV, urine output needs to be 30ml per hr

list postoperative complications

-hemorrhage -shock -temperature regulation -DVT -PE -aspiration -atelectasis- collapsed alveoli -pneumonia -site complications -Fluid and electrolyte imbalance -bowel and bladder dysfunction -infection psychosocial -nutrition

assessments and interventions to do for respiratory complications

ASSESS: lung sounds, respirations, WOB (work of breathing), Sp02, respiratory depression, sputum INTERVENE: elevate HOB, 02, C &DB coughing and deep breaths q2h, IS spirometer 10hr, ambulation, hydration, pain control

assessments and interventions for CV complications

ASSESS: VS, UOP, skin, calves, peripheral pulses INTERVENE: leg exercise, TED/SCD, ambulation, anticoagulants, hydration, positioning

assessments and interventions for hydration complications

ASSESS: I&O, weight, electrolytes, skin, mucus membranes, lung sounds (crackles), time since voided, bladder scan INTERVENE: IV fluids, encourage void, catheterize, progressive fluid intake

assessments and interventions for GI complications

ASSESS: bowel sounds, ABD assessment, nutrition, flatus (gas), stool INTERVENE: ambulation, antiemetics (nausea), stool softener, NPO, NGT, IVF, progressive diet

what is an ileus

bowel not waking up for days, will need bowel rest

when does constipation become a concern

late post-op

what are skin complications to be aware of

infection, dehiscence (wound edges separate), evisceration (organ protrudes)

Assessments and interventions for skin complications

ASSESS: skin, incision, temperature, WBC INTERVENE: turning/movement, ambulation, splinting (comfort measure for coughing), hydration/nutrition, handwashing, wound care, teaching

how is skin closed after surgery and what reasons for each

sutures staples (cause less damage than sutures) BOTH REMOVED 7-10 days steri-strips (maybe used after suture/staples) Glue (most commonly used, no foreign body)

evisceration interventions

semi-fowlers notify physician cover the intestine with sterile gauze and saline monitor vs prepare for OR

assessments and interventions for psychosocial complications

ASSESS: pain, sleep, ability to do ADLS, assess for image disturbances INTERVENE: emulation, quiet environment, hygiene, managing drainage, social support, self-care, pain meds, nonpharm interventions, providing preferences

what to go over before discharge

activity restrictions, incision care, dietary restrictions, when to notify physicians, medications, arrange for home care if needed