Perioperative Nursing Part 2 Flashcards
what is the goal of intraoperative and postoperative nurses
get pts through the surgical experience the same or better than before
which nurse adds and verifies the preoperative checklist
everyone
who created the surgical safety universal protocol
the joint commission
what are the main goals of the universal protocol
prevent
-wrong person
-wrong procedure
-wrong site
-foreign objects left behind
-intra/postoperative death
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
what are the types of anesthesia
-general
-moderate/analgesia
-regional
-topical and local
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
steps for general anesthesia
-induction – administration
-maintenance – maintain throughout
-emergence – waking up
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
types of regional/codal sedation
-nerve block
-spinal
-epidural
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
what type of anesthesia ends with -caine
local
what are tropars used for
to make puncture holes, fill abdomen with air and remove objects
benefits of laparoscopic surgery
less complications and shorter recovery
if only one nurse can be in the OR what is their job
circulator
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
key points of scrub nurse
-can be RN, LPN, or tech
-hands equipment to the surgeon
-needs to know the procedure, equipment, and anatomy
key points of RNFA
-the first assist
-has to have 2 years OR experience
-certified
-participates in surgery
key points of CRNA
-anesthesia nurse
-has additional schooling and testing
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
