Perioperative Patient Review Flashcards
Preoperative(before surgery); Preop: Prior to surgery
Postoperative (after surgery)
Together, these time periods are know as the perioperative period
Regardless where at sending pats to surgery and getting pats in recovery phase (may not be immediate recovery phase)
Together known as perioperative period - all encompassing of those
Perioperative nursing
starts with completion of surgery and transfer of the patient to a specialized area for monitoring such as the postanesthesia care unit (PACU) and may continue after discharge from the hospital until all activity restrictions have been lifted
Postop/PACU: After surgery - completion of surgery and transfering to PACU and sometimes may go ICU; may have activity restrictions; send pats home quickly and continue postop care at home
Postoperative (after surgery)
You know that nursing care in PACU is multifaceted and involves: (select all that apply)
A. Monitoring the patient’s physiological status
B. Intervening to ensure uneventful recovery from anesthesia and surgery
C. Providing a safe environment for the patient experiencing limitations in physical, mental, and emotional function
D. Preventing or promptly treating complications in the immediate post-anesthesia period
E. Upholding the patient’s rights to dignity, privacy, and confidentiality
F. Utilizing high tech equipment so health care costs will be justified
Answer: A, B, C, D, E
Physiological status - includes: VS, LOC, (not mobility at this point - could be asleep and intubated depending on surgery - further down road for sure), resp status, what type anesthesia have, have airway and make sure maintaining airway, ABCs thinking about those in PACU period - did have anesthesia and that can depress resp period - may have airway in place and that is imp
Intervening - not want lot events happening after anesthesia and surgery - want wake up and not want in excurciating pain; want maintaining pain level and be uneventful
Safety - big thing - how keep pat safe; provide safe environment; when wake up might not know where are so should have rails up and make sure monitoring them closely so are safe with all these limitations; have a ride home
Two-way verbal interaction
Report between two health care professionals is required to communicate the patient’s condition and needs
Done to ensure SAFETY of patients
Also really big part pat going from preop to intraop to PACU - not seen pat before; not know type surgery had and drastically change how care for them depending on type surgery; care very diff and type anesthesia changes how cared for; verbal interaction and is required and need think about what report to nurse so best care for pat to provide everything they need; also to ensure their safety
Hand off report
The nurse anesthetist gives you Mr. Potter’s record, and prepares to give you a verbal report. You know that her verbal report should include: (Select all that apply)
A. Mr. Potter’s height and weight
B. The name of the surgical procedure Mr. Potter had
C. Mr. Potter’s relevant health history
D. Anesthetic agents and other drugs that were administered to Mr. Potter
E. Mr. Potter’s estimated blood loss during surgery
F. Mr. Potter’s religious preference
G.Mr. Potter’s fluid status and IV therapy
Answer: A, B, C, D, E, G
Height and weight - weight based drugs, meds are imp
Name surgical procedure - affects recovery
Relevant health history - could affect recovery
Drugs - sedation had, how much fentanyl/whatever med given because tell when wake up and what might look like
Blood loss - based on surgery: some areas more vascular and somethings happen in surgery where might lose more blood than others; lost lot blood monitoring labs and know what expect; might need give blood products; affect recovery
Religious preference - no; do ask on admission; not know if certain religion that prac certain things is personal thing; in PACU
Fluid status and IV therapy - need good IV access going to any procedure and after because probably giving IV meds
In providing care for Mr. Potter, your first step is to:
A. Assess your patient
B. Analyze patient data
C. Plan care
D. Intervene
E. Evaluate care
Answer: A
Cannot do anything until assess pat
Cannot do further in process until assess pat
See type airway, how breathing, conscious/not
In PACU, many assessments and interventions are done simultaneously. However, the most critical, high-priority assessment to be done with Mr. Potter is his:
A. Operative site
B. Skin integrity
C. Pulse
D. Airway
E. Blood Pressure
Answer: D
High-priority
Airway
ABCs
Not maintaining airway then big problem; airway is imp
Which TWO assessments are your next priorities?
A. Operative site
B. Skin color
C. Skin integrity
D. Pulse
E. Blood pressure
F. Orientation
Answer: D, E
Pulse and BP
ABCs - both represent circulation
Orientation - change in mental status indicates hypoxia but that is general overall how look and learning-oriented
Since Mr. Potter is a smoker, he has increased risk associated with surgery and anesthesia. You are aware that smoking can be responsible for which of the following in the immediate postop period? SATA
A. dehydration
B. difficulty in clearing secretions
C. cardiac dysrhythmias
D. increased drowsiness
Answer: B, C
Immediate postop period
Difficulty in clearing secretions - can be
Cardiac dysrhythmias - smoking has a strong effect on heart
Increase in CO2 - see increased drowsiness
Why is it important to measure arterial oxygen saturation (SpO2) levels in PACU?
A. Levels indicate how much oxygen is available for use by tissues
B. Levels reflect the effectiveness of intraoperative sedation
C. Levels reflect the ability to absorb medications from the bloodstream
D. Levels reflect how much oxygen has been used by tissues
Answer: A
O2 available for use - decrease in O2 sat indicates tissue death - imp, easy, noninvasive assessment that we can take
Given Mr. Potter’s SpO2 of 97%, what intervention is indicated?
A. Continue to monitor SpO2
B. Increase oxygen to 100%
C. Increase liter flow to 15 liters per minute
D. Remove Mr. Potter from the ventilator
Answer: A
Continue to monitor at this point
Normal
Want some more info before remove from ventihilator; levels are good; can cont to monitor and may be able to remove soon but not quite there yet; SpO2 not entire pic because would need to pass NIF (negative inspiratory forst - RT and anesthesiologist does) where can show how much can exhale and if at certain number then can remove them from it; also depends on how awake is
You know that Mr. Potter’s shivering is a physiological effort to do which of the following?
A. avoid seizure
B. generate heat
C. reset the body’s internal “thermostat” setting
D. eliminate heat
Answer: B
Shivering helps with muscle activity and increases metabolic rate
You recognize that a number of conditions may be responsible for Mr. Potter’s low body temperature. These include which of the following? (Select all that apply)
A. Surgical wound infection
B. The anesthetics Mr. Potter received
C. The environmental temperature in the OR
D. Mr. Potter’s preoperative skin prep
E. The common use of cooled irrigation solutions during surgery
Answer: B, C, D
Wound infection - high body temp: fever - s/s of infection
Anesthetics received: with body processes everything slows down; not want move/be awake
Environmental temp in the OR - very cold
Preop skin prep - to preop the skin can do chlorhexidine/iodine: depending on type of surgery prep larger area of skin and making sure everything is clean; involves a liquid and that can cool the body
Do use fluids during surgery - NS, lactated ringers but not common that cooled will be at room temp
Ice packs have been ordered for application to Mr. Potter’s scrotum. As you apply an ice pack, he asks the reason why. You correctly advise Mr. Potter that the ice pack will:
A. Promote healing at the operative site
B. Prevent inflammation and swelling of the scrotum
C. Encourage blood flow to the surgical site
D. Help to prevent postoperative wound infection
Answer: B
Promote vasoconstriction to decrease inflammation as much as possible
generic; pain control in PACU; for IV
Hydromorphone -
