Perioperative Patients Flashcards
When does the peroperative period begin? When does it end?
– begins when pt is scheduled for surgery
– ends at the time of transfer to surgical suite
What are the 5 reasons for surgery? Describe each.
- diagnostic: determining cause of disorder
- curative: resolving health issues
- restorative: improving functional ability
- palliative: relieving symptoms for pt comfort
- cosmetic: altering appearance
What are the 3 ways to describe surgery based on urgency?
- elective: planned
- urgent: requires prompt intervention
- emergent: requires immediate intervention
What are the 3 ways to describe surgery based on extent?
- simple: only most affected areas involved
-
radical: extensive surgery beyond area obviously involved
- attempts to find root causes
- minimally invasive: performed through an endoscope
What is the nurse’s role in preoperation?
- clarification of the facts presented by the physician/surgeon
- acting as a witness for signed consent
- SIGNED consent, not INFORMED consent
What are the dietary restrictions for preoperative pts? Why?
– NPO for 6 - 8 hours prior to surgery
– decreases risk for aspiration
- surgery will be cancelled if pt is noncompliant
- written and oral directions provided
Which medications are permitted with a sip of water prior to surgery? Outside of these medications, how should a pt’s regularly scheduled medications be handled?
– meds permitted with sip of water prior to surgery:
- cardiac
- respiratory
- seizure
- HTN
– physician and anesthesia providers should be consulted on how to handle regularly scheduled medications other than the above
How is the GI tract prepared for surgery? Why?
– enemas or laxatives may be ordered
– preparations prevent injury to colon and reduce number of intestinal bacteria
How is the skin prepped for surgery? Why?
– washed with antiseptic solution and hair may be removed using clippers (razors may nick the skin)
– a break in the skin increases the risk for infection
What are 4 interventions that are used post-operatively to prevent respiratory complications?
- breathing exercises
- incentive spirometry
- cough and deep breath
- splinting of incision
What are the 2 purposes of pre- and post-operative pt teaching?
- decrease anxiety
- increase compliance
What are 3 interventions that are used post-operatively to prevent circulatory complications?
- leg exercises and ROM
- early ambulation
- support stockings (TEDs) or sequential compression devices (SCDs)
What 4 things can be taught to pts pre- and post-operatively regarding pain management?
- pain scale
- requesting/taking pain meds PRN
- PCA
- other mechanisms of pain control
What are 5 pre-operative anxiety interventions?
- pre-operative teaching
- encouraging communication
- promoting rest
- using distraction
- teaching family members
What are the 7 items the nurse should review in the pt’s chart pre-operatively?
- ensure documentation, pre-operative procedures, and orders are completed
- check surgical consent form for completion
- document allergies
- document height and weight
- ensure results of all labs and diagnostic tests are in chart
- document and report any abnormal results
- report special needs and concerns
What are the 6 things that the nurse must do to prepare the pt for surgery?
- ensure pt has removed most clothing and is wearing a hospital gown
- valuables locked up or with family
- tape rings in place that cannot be removed
- remove all pierced jewelry
- ensure pt has an ID band
- remove dentures, prosthetics, hearing aids, contact lenses, nail polish, and artificial nails
What are the 7 functions of pre-operative drugs?
- reduce anxiety
- promote relaxation
- reduce nasal/oral secretions
- prevent laryngospasm
- reduce vagal-induced bradycardia
- inhibit gastric secretion
- decrease amount of anesthetic needed
What is the intra-operative period?
begins once the pt enters the surgical suite and ends when the pt enters the recovery room
What is the purpose of universal protocol? What are the 3 items that comprise universal protocol?
– purpose – the Joint Commission protocol for prevention of wrong site surgery
– 3 items:
- verify pt using 2 identifiers
- mark surgical site
- time-out – verify pt, procedure, and site
What is anesthesia? What is it used for?
– anesthesia: induced state of partial or total loss of sensation, with or without loss of consciousness
– used to block nerve impulses, suppress reflexes, relax muscles, and control level of unconsciousness
What regions of the body does general anesthesia affect? What is the effect of general anesthesia?
– regions:
- head
- neck
- upper torso
- abdominal procedures
– effect – reversible loss of consciousness by use of a single agent or a combination of agents
What are the 5 stages of general anesthesia?
-
stage 1 – analgesia, sedation, relaxation
- pt can hear everything
-
stage 2 – excitement, delirium
- involuntary movement of extremities
-
stage 3 – operative anesthesia, surgical anesthesia
- loss of reflexes, depression of vital functions, surgery is ready to move forward
-
stage 4 – danger
- more pronounced depression of vital functions
- if not addressed, can result in respiratory failure or cardiac arrest
-
emergence – recovery from anesthesia
- pts will sometimes get sick as they come back – N/V, restlessness, shivering, rigidity, cyanotic
What is balanced anesthesia?
combination of IV drugs and inhalation agents used to obtain specific effects
What are 5 possible complications of general anesthesia?
- malignant hyperthermia
- could result as a complication from certain agents
- causes electrolyte disturbance
- high calcium
- increased muscle metabolism
- acidosis
- high potassium
- can treat with dantrolene
- overdose
- especially of concern in the elderly and pts with comorbidities
- unrecognized hypoventilation
- hypoxia – need to check perfusion before and after procedure
- complications of specific anesthetic agents
- complications of intubation
What is local anesthesia? How is it delivered?
– local anesthesia: briefly disrupts sensory nerve impulse transmission from a specific area or region; pt remains conscious
– delivered topically and by local infiltration
What is regional anesthesia? What are the 4 types of blocks?
– regional anesthesia: local anesthesia that blocks multiple nerves in a specific body region
– 4 blocks:
- field block: blocks nerves around operative field
- nerve block: blocks nerves in or around one nerve or a group of nerves
- spinal block: blocks nerves in the CSF and subarachnoid space
- epidural block: blocks nerves in the epidural space
What are the 5 possible complications of local/regional anesthesia?
- anaphylaxis
- incorrect delivery technique
- systemic absorption – can be lethal
- overdose – important to obtain proper H & W
- local complications
What are the 5 ways to treat complications of anesthesia?
- establish an open airway
- give oxygen
- notify surgeon
- fast-acting barbiturate – usual treatment
- epinephrine – for unexplained bradycardia
What is moderate sedation? Name some common examples of moderate sedation drugs.
– moderate sedation (conscious sedation): IV delivery of sedative, hypnotic, and opioid drugs to reduce LOC
- pt maintains a patent airway
- pt can respond to verbal commands
- amnesia action is short
- rapid return to ADLs
– common examples:
- etomidate
- diazepam
- midazolam
- meperidine
- fentanyl
- alfentanil
- morphine sulfate
What 4 things are monitored to prevent hypoventilation during surgery?
- breathing
- circulation
- cardiac rhythms
- BP and HR
What is the PACU?
– postanesthesia care unit
– allows for ongoing evaluation and stabilization of pts after surgery
What are the 4 priorities of PACU nurses when caring for pts post-operatively?
- respiratory status
- vitals Q15 minutes– LOC, temp, SpO2, BP
- examination of surgical area
- discharge from PACU
What is an important neurological assessment to make for pts post-operatively?
motor and sensory – movement of extremities and return of SNS (gradual elevation of head and monitoring for hypotension)
How long after surgery could peristalsis be delayed?
24 hours
What are the 6 reasons for NG tube insertion during surgery?
- decompress and drain stomach
- rest GI system
- heal lower GI tract
- enteral feeding route
- monitor gastric bleeding
- prevent intestinal obstruction
Differentiate between dehiscence and evisceration.
– dehiscence: partial or complete separation of outer wound layers
– evisceration: total separation of all wound layers and protrusion of internal organs through wound
How long after surgery yields the highest incidence of hypoxia?
2nd day after surgery
What is pneumonia, and how does it occur? What are 3 preventions for pneumonia?
– pneumonia: inflammation of alveoli
– results from accumulation of fluid, aspiration, infection, decreased cough reflex, and immobility
– 3 preventions:
- CDB
- incentive spirometry
- splinting of incision
What is atelectasis? Why is it dangerous? What are some signs and symptoms?
– atelectasis: incomplete expansion or collapse of alveoli
– impairs gas exchange
– s/s:
- diminished lung sounds
- crackles
- dyspnea
- cyanosis
- restlessness
- apprehension
What are 5 treatments for atelectasis?
- position in semi-Fowler’s
- oxygen
- CDB
- ambulation
- hydration
What is hypovolemic shock, and what are the 2 ways it can result?
– hypovolemic shock: decreased circulatory blood volume
– 2 ways it can result:
- dehydration
- blood loss
- trauma – blunt or penetrating
- bleeding
What is thrombophlebitis?
inflammation of vein associated with thrombus formation; AKA DVT
What are treatments for thrombophlebitis?
- anticoagulants
- antiembolic stockings – only after anticoagulants are given
- elevation of extremities to level of heart
- measurement of calf circumference
- NO MASSAGE – can dislodge clot and cause PE
