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Medsurg Review > PERIOPERATIVE PERIOD > Flashcards

PERIOPERATIVE PERIOD Flashcards

1
Q

Branch of medicine concerned with the (purposes of surgery) treatment of diseases, repair of
injuries and deformity, establishment of medical diagnosis

A

Surgery

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2
Q

purposes of surgery

A

treatment of diseases
repair of injuries and deformity
establishment of medical diagnosis

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3
Q

Refer to any procedure that involves entry into the human body usually
performed through the use of instruments.

A

surgery

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4
Q

When does surgery emerged as medical specialty?

A

Mid 19th century

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5
Q

When does OR nursing began?

A

late 19th century

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6
Q

early pioneer of antiseptic procedures

A

Ignaz Philip Semmelweis

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7
Q

founder of antiseptic medicine

A

Joseph Lister

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8
Q

Who is the father of surgery?

A

Hippocrates

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9
Q

Surgery came from the Greek word “. ” which means working by hand.

A

kheirurgos

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10
Q

The activities performed by the professional nurse during the pre-, intra- and post-operative phases of
the patient’s surgical experience

A

PERIOPERATIVE NURSING PRACTICE

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11
Q

What are the Phases of surgery?

A

Pre, intra, post operative phase

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12
Q

Begins when the decision for surgery is made
and ends when the patient is transferred to
the operating room bed.

A

PreOperative Phase

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13
Q

Begins when the patient is transferred to the
OR table and ends upon admission to the post
anesthesia care unit.

A

Intra-Operative Phase

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14
Q

Begins when the patient is transferred to PACU or Recovery Room onwards

A

Postoperative phase

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15
Q

This phase usually ends with resolution of surgical sequela

A

Postoperative Phase

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16
Q

Preoperative “Period”

A

Period used for patient’s
physical and psychological
preparation for surgery

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17
Q

Intraoperative “Period”

A

Period when the patient is
monitored , sedated, prepped,
draped and operated

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18
Q

Post operative “Period”

A

Commonly ends outside the facility
where surgery is
performed

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19
Q

Scope of Preoperative

A

Informed consent Nursing
activities are directed
towards patient support,
teaching and preparation
for the procedure

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20
Q

Scope of Intraoperative

A

Nursing activities focus on
patient safety, facilitation of
the procedure, prevention of
infection and satisfactory
physiologic response to
anesthesia and surgery

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21
Q

Scope of Postoperative phase

A

Nursing activities include support of
patient’s physiologic
responses and patient discharge
education Postop nursing care
including positioning, monitoring,
addressing psychological body image
disturbances

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22
Q

Rupture of an organ, artery or bleb (blister)

A

Perforation

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23
Q

Impairment of the flow of vital body fluids (tubes, arteries, ventricles, sinuses, ducts)

A

Obstruction

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24
Q

What are the common causes of obstruction?

A

▪ Vasoconstriction
▪ Tumor
▪ Foreign bodies
▪ Asphyxia

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25
Q

Wearing off of a surface of membrane or surface of a tissue as a result of:

A

Erosion

▪ Continuous physical irritation
▪ Infection
▪ Inflammation/ ulceration

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26
Q

Refers to abnormal growth of tissue that form mass without physiological function within the body
which may either be benign or malignant.

A

Tumor

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27
Q

removal of an organ/ gland (e.g. nephrectomy)

A

ectomy

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28
Q

repair or suture of a body part (e.g. colporrhaphy) — focused on suturing

A

Orrhaphy

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29
Q

creation of temporary or permanent opening (e.g. tracheostomy)

A

Ostomy

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30
Q

cutting into a tissue (e.g. rhizotomy)

A

otomy

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31
Q

repair or reconstruction (e.g.etoplasty)

A

plasty

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32
Q

looking into/to visualize (e.g. esophagoscopy)

A

oscopy

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33
Q

to loosen, separate, breakdown (e.g.entweolysis)

A

lysis

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34
Q

FACTORS AFFECTING THE DEGREE OF SURGICAL RISK OF PATIENTS

A

Physical and mental condition
extent of disease
Extent of surgical procedure
caliber of the professional staff

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35
Q

Factors affecting the degree of surgical procedure under “physical and mental condition”

A

Age
Nutritional Status
Fluid & Electrolyte Balance
General Heath status
General history of the patient
use of drugs
occupational status
mental outlook

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36
Q

Factors affecting the degree of surgical procedure under “extend of disease”

A

nature of the disease
location
duration of the disease

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37
Q

One’s mental condition greatly affects one’s response to stress.

A

Physical & mental health

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38
Q

What age generally tolerate surgey well

A

older children & middle aged

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39
Q

what age poorly tolerated surgery

A

extremes of age

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40
Q

why do extremes of age poorly tolerate surgery ?

A

o They generally have increased sensitivity to stress, effects of anesthesia and other drugs.
o Often dehydrate/malnourished
o Frequently have other degenerative disorders
o More prone to fluid and electrolyte imbalance

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41
Q

Essential factor in promoting healing and resisting infection and other surgical complications

A

Nutritional Status

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42
Q

are needed to promote wound healing and recovery

A

Nutrients

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43
Q

Major nutritional considerations:

A

▪ Obesity
▪ Undernourishment

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44
Q

what factor affecting the degree of surgical risk of patients increases risk for complications (hyponatremia, dehydration)

A

Fluid & electrolyte balance

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45
Q

increases the risk of delayed recovery of GI function, acute kidney injury & adverse
cardiovascular events

A

Hypokalemia

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46
Q

can lead to shock & multi organ failure

A

Hypovolemia

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47
Q

General Heath status refers to:

A

o Presence of infection
o Inadequacy of function of certain organ

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48
Q

▪ Optimal function of the liver and urinary systems so that medications, anesthetic agents, body
wastes, and toxins are adequately processed and removed from the body

A

Inadequacy of function of certain organ

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49
Q

Generally assessed to help the physician determine whether or not the patient is capable of enduring
the surgical procedure.

A

General health history of the patient

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50
Q

what drugs increase vulnerability to bleeding

A

NSAIDS, anticoagulants, anti platelet agent

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51
Q

what drugs increase vulnerability to infection

A

corticosteroids, antineoplastic drugs

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52
Q

What drugs lower BP

A

anti hypertensive drugs

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53
Q

this factor affecting the degree of surgical risk of patients determine the patient’s ability to sustain expenses needed for the surgery, medication, etc.

A

Occupational status

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54
Q

Patients will to live, cooperation

A

mental outlook

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55
Q

related to the severity of the disease

A

nature of disease

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56
Q

refers to the organ or body parts that is involved

A

location

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57
Q

the longer the duration of the disease, the lower the resistance of the patient, the
higher the risk of surgery.

A

duration

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58
Q

What FACTOR AFFECTING THE DEGREE OF SURGICAL RISK OF PATIENTS whether major or minor?

A

extent of surgical procedure

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59
Q

what factor affecting the degree of surgical risk of patients refer to adequacy of staff, training, equipment; highly competent staff.

A

caliber of the professional staff

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60
Q

What are the major effects of surgery?

A

stress response
disruption of vascular system
lowered defense against infection
disruption of organ function
body image disturbances
lifestyle change

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61
Q

A collective term for the many physiologic factors that cause neuro-chemical change within the body

A

Stress response

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62
Q

True or false: As soon as the patient is set for operation, the patient will “not” be experiencing constant stress at varying levels

A

False

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63
Q

True or false: Stress response differs among individuals and the type of surgery performed, general health status and other factors.

A

True

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64
Q

Stress levels could be addressed by:

A
  1. allaying the anxiety of the patient
  2. meeting the patient’s needs
  3. helping the patient reestablish optimum functioning after the surgery
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65
Q

stress responses include:

A

▪ Peripheral vasoconstriction with increased coagulability
▪ Tachycardia with increased CO, BP & coronary artery dilation
▪ Na and water retention
▪ Increased gastric acidity and decreased peristalsis
▪ Bronchial dilatation
▪ CHON metabolism
▪ Proliferation of granulation and connective tissue
▪ Increased blood sugar and mobilization of fat stores
▪ Increased cortisol and increased inflammatory response
▪ Increased metabolic rate

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66
Q

True or false: Disruption vascular systems occurs when blood vessels are ligated and served which disturbs the vascular system hence bleeding occurs.

A

True

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67
Q

In this event, hemostasis must be done to prevent excessive blood loss.

A

Disruption of vascular system

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68
Q

When there is disruption of vascular system, what are the Approaches to stop bleeding:

A

▪ Use of hemostats/clamps
▪ Sutures
▪ Free ties
▪ Cautery
▪ Gel foams
▪ Pressure

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69
Q

A side from disruption of the vascular system as a reason for lowered biologic defense, the impairment of
the integrity of the skin could also contribute to this condition.

A

Lowered defense against infection

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70
Q

Disruption of organ function which could be associated with:

A

▪ The effect of anesthesia
▪ Manipulation of the organs

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71
Q

This occurs when an operation involves the manipulation of a certain organ in a body, this may lead to the disruption of
organs function.

A

Disruption of organ function

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72
Q

This occurs when Some surgical procedures may involve removal of some body parts (amputation) or incision in areas of the
body that are exposed (face, legs, neck) which may lead to the development of self-esteem issues

A

body image disturbances

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73
Q

TRYE OR FALSE: Extensive surgeries (i.e. amputation, heart transplant, kidney transplant) may require changes in the
patient’s lifestyle.

A

True

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74
Q

What are the major categories of surgical procedures according to purpose?

A

Diagnostic
Exploratory
Curative
Palliative
Restorative/reconstructive
constructive
preventive
ablative
procurement of transplant
cosmetic improvement

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75
Q

What are the major categories of surgical procedures according to urgency?

A

emergency (planned)
imperative/urgent (planned)
planned required surgery (unplanned)
optional (unplanned)
elective (unplanned)

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76
Q

What are the major categories of surgical procedures according to extent/seriousness?

A

Minor surgery
Major surgery

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77
Q

Surgical exploration that
allows physician to confirm
diagnosis; may involve
removal of tissue for
further diagnostic testing

A

diagnostic

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78
Q

performed to help the
physician in determining
the cause of the symptom
experience of a particular
patient (i.e. biopsy)

A

diagnostic

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79
Q

example of diagnostic surgery

A

o Exploratory laparotomy
o Breast mass biopsy

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80
Q

performed to estimate the extent of disease and
confirm the diagnosis of a particular patient.

A

exploratory

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81
Q

Elimination of repair of pathology or performed to
remove diseased, damage, or congenitally malformed body organ/ part.

A

curative

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82
Q

what is the example of curative surgery?

A

Removal of ruptured appendix or ovarian cyst

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83
Q

• Relieves or reduces intensity of disease symptoms;
will not produce cure
• performed not to cure a patient from a disease but
to alleviate signs and symptoms

A

palliative

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84
Q

What are the examples of palliative surgery?

A

o Colostomy
o Debridement of necrotic tissue
o Resection of nerve tissues
o Nerve block procedure

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85
Q

Restores function or
appearance of
traumatized or
malfunctioning tissues

A

Restorative/reconstructive

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86
Q

refers to partial or
complete restoration of a
damaged organ or body
part.
o Strengthening a
weakened area
o Rejoining
disconnected or
injured area
o Correcting deformity

A

Restorative/reconstructive

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87
Q

example of restorative/reconstructive surgery

A

o Internal fixation of fracture
o Scar revision

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88
Q

Restores function lost or
reduced as a result of
congenital anomalies

A

constructive

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89
Q

performed to repair a
congenitally defective
structure or to improve
function and appearance

A

constructive

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90
Q

example of constructive surgery

A

o Repair of cleft palate
o Closure of arterial
septal defection heart

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91
Q

used to remove
tissue that
does not
contain
cancerous cells,
but may
develop into a
malignant
tumor.

A

preventive

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92
Q

Excision or removal of diseased body part / performed to remove diseased program

A

Ablative

93
Q

example of ablative surgery

A

o Amputation
o Removal of
appendix
o cholecystectomy

94
Q

Removal of organs and/or tissues from a person
pronounced to be brain dead for transplantation

A

Procurement of transplant

95
Q

example of Procurement of transplant

A

o Kidney transplant
o Heart transplant
o Liver transplant

96
Q

Performed to improve personal appearance / performed for aesthetic purposes.

A

cosmetic improvement

97
Q

examples of Cosmetic improvement surgery

A

o Blepharoplasty
o rhinoplasty

98
Q

• Less than 1 hour
• performed immediately, stat
surgery, to:
o save life
o save function of a limb or
organ
o remove damaged organ

A

emergency

99
Q

examples of emergency surgery

A

o Repair of perforated
appendix
o Repair of traumatic
amputation
o Control of internal
haemorrhaging

100
Q

Necessary for client’s health, may prevent
additional problems from developing; not
necessarily emergency

A

imperative/urgent

101
Q

imperative/urgent must be performed for how many hours?

A

within 24-48 hours

102
Q

examples of imperative/urgent surgery

A

o Excision of cancerous tumor
o removal of gallbladder for stones
o vascular repair of obstructed
surgery

103
Q

necessary for the
patient’s wellbeing but
not urgent.

A

Planned Required Surgery

104
Q

examples of Planned Required Surgery

A

cleft lip repair,
tonsillectomy,
removing the tonsils
and/or adenoids to
treat obstructive
sleep apnea

105
Q

Surgery requested
by patient
• Not necessary for
physical health but
for aesthetic or
psychological
reason

A

optional

106
Q

Performed on basis of
client’s choice; is not
essential and may not
be necessary for
health
• performed for
patients’ wellbeing.

A

elective

107
Q

examples of elective surgery

A

o Facial plastic
surgery
o Hernia repair
o Breast
reconstruction

108
Q

Involves intensive reconstruction or alterations in body parts; poses great risks to wellbeing

A

minor surgery

109
Q

what anesthesia is common used during minor surgery?

A

local anesthesia

110
Q

what are the characteristics of minor surgery?

A

• Present little risk to life
• Generally not prolonged
• No-vital organs involved
• Leads to few serious complication

111
Q

examples of minor surgery

A

o Coronary artery bypass
o Colon resection
o Removal of larynx
o Resection of lung lobe

112
Q

Involves minimal alterations in body parts; often designed to correct
deformities; involves minimal risks compared with major procedures

A

major surgery

113
Q

what anesthesia is commonly used during major surgery?

A

spinal anesthesia

114
Q

what are the characteristics of major surgery?

A

• Involves high risk for patients
• Prolonged period of time in OR table
• Large amount of blood may be lost
• Higher risk of post- operative complications

115
Q

examples of major surgery

A

o Cataract extraction
o Facial surgery
o Tooth extraction

116
Q

what are the activities during pre-operative phase?

A

• Assessment
• Pre-operative Teaching
• Psychological Preparation
• Physiological Preparation
• Physical Preparation
• Spiritual Preparation
• Securing appropriate documents for legal purposes

117
Q

is done to identify and correct problems to decrease patient’s risk of complications
during and after surgery.

A

Pre-operative assessment

118
Q

It is also performed to obtain baseline data for post-operative comparison.

A

assessment

119
Q

what are the possible pre-operative assessments?

A

• Allergies
• Medication and substances
• Herbs and nutritional supplements use
• Cultural and religious preferences
• Functional assessment – ability to do ADLS
• Level of anxiety
• Medical history

120
Q

what are the importance of assessment?

A

• Identify & correct complications
• Decrease risk of patient
• Baseline data

121
Q

it is a process of action embracing perception, thought, feelings and performance.

A

teaching/pre-operative teaching

122
Q

Instruction of teachings is best given during this phase of the perioperative procedure.

A

preoperative teaching

123
Q

It helps patients in coping with psychological stress of surgery.

A

Pre-operative Teaching

124
Q

True or false: The nurse teaches patient how to participate in their own postoperative recovery.

A

true

125
Q

pre-operative teaching includes the following:

A

o Assess learning needs of the patients, consider expectations, level of understanding, age and cultural
background
o Preparing patient for recovery
o information, psychosocial support, skill training Should take place

126
Q

this should take place during preoperative teaching that involves explanations of procedures, patient care activities and physical feelings
that the patient may encounter during the perioperative experience.

A

information

127
Q

this should take place during preoperative teaching when the nurse assists the patient in identifying effective coping mechanisms
in dealing with anxiety and fear; provision of emotional support

A

psychosocial support

128
Q

this should take place during preoperative teaching that involves guiding the patient in practicing the patient in the postoperative period.
Doing this may decrease anxiety, hasten patient’s recovery and prevent the occurrence of
complications

A

skill training

129
Q

Teaching Children for OR

A

• Use simple languages, supplement with pictures, books and films
• Show pictures of doctors and nurses in surgical dress
• May use puppet show
• Allow patient to have a hands-on play with the surgical instruments (with close
supervision)

130
Q

What are the pre-operative teachings?

A

DBCE
incentive spirometry
leg & foot exercises
splinting the incision
turning exercises
extremity exercises
ambulation
deep breathing
coughing
extremity exercise

131
Q

promotes faster clearance of inhaled anesthesia’s, done 5-10 times every hour; teach
patient how to splint surgical incision

A

DBCE

132
Q

turning and reposition every 2 hours; turning team

A

turning exercises

133
Q

how does extremity exercises be performed?

A

flex and extend each joint while lying

134
Q

(1) turn to sides; (2) sit up on bed and dangle feet; (3) transfer to bedside chair; (4)
walk around bed then corridor

A

ambulation

135
Q

(1) sit on edge of bed or lie supine with knees flexed to relax abdominal muscle;
(2) place hand on abdomen; (3) inhale through nose until abdomen balloons outwards; (4) exhale
thru pursed lips while contracting abdominal muscles

A

deep breathing

136
Q

(1) on sitting or lying position, lace fingers and hold them tightly across incision before
coughing [small pillow or folded towel over incision site may do]; (2) seconds then cough deep
from the lungs once or twice; (3) encourage patient to perform DBE before coughing.

A

coughing

137
Q

(1) alternate dorsiflexion and plantar flexion of feet; (2) flex, extend the
knees and press back of knees into bed while dorsiflexing the feet; (3) raise and lower legs
alternately from the surface of the bed

A

extremity exercises

138
Q

why does sitting position is the best position for DBCE?

A

it gives the best lung expansion for coughing and deep
breathing exercises

139
Q

client should perform DBCE every?

A

every 1-2 hours

140
Q

In incentive spirometry, Instruct the client to inhale slowly to raise and maintain the flow rate indicator, usually between…

A

600 and 900 marks on the device

141
Q

Incentive spirometry is repeated for how many times

A

10 times every hour

142
Q

in the leg and foot exercise, what do you call the procedure when you Instruct the client to
move both ankles by pointing the toes up and then
down?

A

Gastrocnemius (calf) pumping

143
Q

in the leg and foot exercise, what do you call the procedure when you Instruct the client to
press the back of the knees against the bed and then
to relax the knees; this contracts and relaxes the
thigh and calf muscles to prevent thrombus
formation.

A

Quadriceps (thigh) setting

144
Q

in the leg and foot exercise, what do you call the procedure when you Instruct the client to rotate each foot in a circle.

A

foot circles

145
Q

in the leg and foot exercise, what do you call the procedure when you Instruct the client to flex
the knee and thigh and to straighten the leg, holding
the position for 5 seconds before lowering (not
performed if the client is having abdominal surgery
or if the client has a back problem).

A

hip and knee movements

146
Q

TRYE OR FALSE: In splinting the incision, If the surgical incision is abdominal or thoracic,
instruct the client to place a pillow, or one hand with
the other hand on top, over the incisional area.
• During deep breathing and coughing, the client
presses gently against the incisional area to splint or
support it.

A

TRUE

147
Q

What are the psychological preparation during preoperative phase?

A

• Reinforce surgeon’s teachings
• Identify anxieties of the patient’s
• Listen to patient’s verbalization of fear
o fear of destruction of body image
o fear of permanent disability
o fear of pain
o fear of dying

148
Q

Involves a thorough physical assessment to identify whether or not the patient is capable
of enduring the surgery

A

physiologic preparation

149
Q

May involve diagnostic procedures such as ECG, chest x-ray, spirometry and other tests (cardio
pulmonary clearance)

A

physiologic preparation

150
Q

In contrast to physiologic preparation, physical preparation refers to interventions that would
directly prepare a patient for surgery.

A

physical preparation

151
Q

what should be done in the eve of surgery?

A

skin prep
bowel prep
prep for anesthesia
promoting rest and sleep

152
Q

what should be done on the day of surgery?

A

o Early morning care
o Pre- operative medication
o Recording
o Transportation to OR
o Care of patient’s family

153
Q

what will you do during skin preparation?

A

▪ Shave the area to be operated (area of preparation should always be wider
and longer than proposed incision)
▪ Use adequate lighting and sterile razor.
▪ Shave against or in the direction of hair growth
▪ Check potential sites for infection

154
Q

what will you do during bowel preparation?

A

Generally, patients indicated for surgery should have light dinner, should
take nothing per orem, post-midnight, have an enema (as ordered)

155
Q

what is being done during the preparation for anesthesia?

A

▪ The anesthesiologist visit’s the patient for appropriate assessment
▪ The anesthesiologist may ask about previous experiences that necessitated the
use of anesthetic agents, assess for the cardiac reserve, explain to the patient the
nature of anesthesia

156
Q

what will you do during early morning care?

A

▪ Involves bathing the patient, helping the patient change into hospital gown or OR gown and other bedside care

157
Q

what is being done during pre-operative medication?

A
  1. nurse must ascertain that the
    consent form has been completed, signed and placed in the chart.
  2. medications are given at least 45 mins before the induction of anesthesia, however pre-medication may be omitted altogether
158
Q

what are the purposes of giving medication during pre-operative phase?

A

• Decrease amount of anesthesia needed.
• Decrease secretion of saliva gastric juices
• To prevent nausea and vomiting
• Decrease anxiety and provide sedation

159
Q

what are the medications that are given pre-operatively?

A

• Anticholinergics (scopolamine, atrophine sulfate)
• Antianxiety (diazepam, midazolam)
• H2 Receptor antagonist ( cimetidine, ranitidine)
• Narcotics ( meperidine, morphine)
• Sedatives ( Pentobarbital, sodium)
• Tranquilizer ( promethaxine, HCL)

160
Q

this will serve as a concise evaluation of the care given
during the entire pre-operative phase.

A

nurse’s report

161
Q

this will communicate all the pertinent data to the OR nurse

A

nurse’s report

162
Q

what contains the record during pre-operative phase

A

Contains records of pre- operative teaching content and the patient’s (as well
as patient’s family) responses; vital sign, pre- operative medications given,
laboratory and diagnostic results

163
Q

When transporting a patient to the OR, the nurse should:

A

• Check the identity of the patient
• Verify surgical procedure, site and surgeon (if the patient is heavily
sedated, the surgeon may be asked to identify the patient)
• Check IV infusion, indwelling catheters and other gadgets attached
to the patient
• Check for consent
• Accomplish the OR checklist

164
Q

True or False: In caring for a patient for surgery, the nurse should also consider the
patient’s family.

A

true

165
Q

true or false: The nurse is to provide information on how to assist the patient in going about the
procedure as well as how they could assist the patient in going about the
procedure as well as how they could assist the patient in his/ her recovery.

A

true

166
Q

when does emergency situations start?

A

In emergency situations, preparation may start as early as in the ER and may be
continued until the patient is transported to the OR (holding room)

167
Q

this preparation could give rise to several issue hence, it is vital to seek the preference of the parents regarding this matter.

A

spiritual preparation

168
Q

what are the purposes of legal aspects?

A

o Ensure patient understanding to the nature of the treatment
o Indicate patients, decision
o Protect patient from unauthorized procedure
o Protect the surgeon and hospital against legal action

169
Q

what are the purposes of legal aspects?

A

o Ensure patient understanding to the nature of the treatment
o Indicate patients, decision
o Protect patient from unauthorized procedure
o Protect the surgeon and hospital against legal action

170
Q

what are the two types of consent?

A

general consent
informed consent

171
Q

this consent authorizes the attending physician and staff to render standard day-to- day
treatment or to perform generalized treatment and care as the physician deemed advisable

A

general consent

172
Q

this consent process (not mere documentation) explanations of the procedures, risks,
benefits and alternative therapy made verbally to the patient’s level of understanding.

A

informed consent

173
Q

True or false: In the case of surgical procedures, an informed consent is required

A

true

174
Q

what are the components of consent?

A

o Patient’s full legal name
o Surgeon’s name
o Specific procedures to be performed
o Signature of the patient, next of kin, legal guardian
o Witnesses
o Date

175
Q

Who are qualified to give consent?

A

o Those of legal age
o Those of sound mind (during their lucid interval)

176
Q

In the event that the patient is not capable of giving consent such as in cases where the patient is minor,
unconscious or mentally unsound, the following may give consent (arranged according to legal interstate
succession):

A

o Spouse
o Adult child
o Parent
o Sibling
o For minors: legal guardian

177
Q

In case of emergency, the surgeon may operate without the written permission of the patient or family
although every effort is made to contact a family member if time permits:

A

o Consent in the form of a telephone call is permissible in such situations provided that there
should be two persons to witness the call
o If no family or legal guardian can be contacted, two physicians who are not associated with the
procedure may take the decision for surgical intervention. In this circumstance a relative must
sign an operative consent as soon as possible

178
Q

what is the role of the nurse?

A

patient’s advocate

179
Q

Who assesses the patient’s decision-making capacity, confirms that patient has been
given the necessary information to give informed consent and clarifies any misconception?

A

nurse

180
Q

Who should be the one to provide information about the procedure, its nature and known
possible consequences

A

surgeon

181
Q

Who has the obligation to provide the patient or legal guardian full disclosure
regarding the risk and benefits of anesthetic agents that are to be used to the patient?

A

anesthesiologist

182
Q

Nursing Diagnoses for Pre-operative Nursing

A

• Anxiety related to the surgical experience (anesthesia, pain) and the outcome of surgery
• Fear related to perceived threat of the surgical procedure and separation from support system
• Knowledge deficit of preoperative procedures and protocols and postoperative expectations

183
Q

In intra-operative phase, who are the sterile surgical team?

A

• Primary surgeon
• Assistant to the surgeon (other
surgeon residents)
• Registered nurse first attendant
• Scrub nurse

184
Q

In intra-operative phase, who are the non-sterile surgical team?

A

• Anesthesiologist
• Nurse anesthetist
• Circulating nurse

185
Q

What are the responsibilities of Surgeon?

A

• Determining the pre-operative diagnosis
• Identifying and performing the appropriate surgical
procedure
• Explaining the risks and benefits of the surgical
procedure to the patient/legal guardian
• Obtaining informed consent for the surgical
procedure
• Identifying and making the surgical procedure
• Managing post-operative care

186
Q

Refers to a physician who specializes in administering agents and monitoring the patient’s response to
the agents

A

anesthesiologist

187
Q

what are the responsibilities of anesthesiologist?

A

• Evaluates the patient to determine the appropriate anesthetic to administer
• Anesthetizing the patient, provide appropriate levels of pain relief
• Monitoring patients’ physiologic status
• In the immediate postoperative period, the anesthesiologist assumes medical responsibility for the patient

188
Q

what are the responsibilities of anesthesiologist?

A

• Evaluates the patient to determine the appropriate anesthetic to administer
• Anesthetizing the patient, provide appropriate levels of pain relief
• Monitoring patients’ physiologic status
• In the immediate postoperative period, the anesthesiologist assumes medical responsibility for the patient

189
Q

this May be performed by an RN, licensed Practical Nurse (LPN), or OR scrub technologist

A

scrub nurse

190
Q

Must have a thorough knowledge and understanding on the specific surgical procedure and the
anatomy and physiology of the involved system.

A

scrub nurse

191
Q

what are the responsibilities of scrub nurse?

A

• Preparing supplies and equipment in the sterile field
• Monitoring the scrubbed team members for breaks in the sterile technique
• Providing appropriate sterile instrumentation, sutures, and supplies to the operating surgeon.

192
Q

Refers to an RN whose responsibility is to serve as the patient’s advocate while coordinating events
before, during and after a surgical procedure

A

circulating nurse

193
Q

what are the responsibilities of circulating nurse?

A

• Creating a safe environment for the patient
• Managing the activities outside the sterile field
• Providing nursing care to the patient
• Before and during the induction of anesthetic, provides emotional support to the patient and
assists the anesthesia team during the induction period
• Obtains supplies and equipment for the sterile team members
• Ensures that sponge, instruments and sharp counts are completed and appropriately
documented
• Communicate relevant information to individuals outside the OR
• Documenting intraoperative nursing care and ensuring surgical specimens are identified and
placed in the appropriate media

194
Q

partial or total loss of sensation with or without loss of consciousness deliberately
induced to prevent pain perception and promote relaxation during surgery

A

anesthesia

195
Q

what are the 4 main types of anesthesia?

A

general
sedation
regional
local

196
Q

what are the 4 main types of anesthesia?

A

general
sedation
regional
local

197
Q

What type of anesthesia refers to Reversible state of unconsciousness with loss of sensation of the entire body?

A

general anesthesia

198
Q

what type of anesthesia can Decreased level of consciousness or relaxed state, but not fully unconscious?

A

sedation anesthesia

199
Q

what type of anesthesia Blocks sensation in a large region or portion of the body?

A

regional anesthesia

200
Q

what type of anesthesia Blocks sensation in a specific area of the body?

A

local anesthesia

201
Q

what type of anesthesia refers to the depression of the central nervous system by administration of
drugs or inhalation agents; patients under this usually require ventilator assistance?

A

general anesthesia

202
Q

What are the three ways in administering general anesthesia?

A

inhalation
intravenous anesthesia
rectal anesthesia

203
Q

it is a way of administering general anesthesia that is given through (1)
open drop [anesthesia is roped directly into layers of gauze that is held on the
patients’ mouth

A

inhalation

204
Q

what are the examples of general inhalation anesthesia?

A

halothane, ether, nitrous oxide, cyclopropane

205
Q

what way of administering anesthesia is commonly employed as induction agent prior to inhalation anesthesia?

A

general: intravenous anesthesia

206
Q

what are the examples of IV anesthesia?

A

pentothal, ketalar

207
Q

this anesthesia is rarely used today; indicated for anesthetizing a child when facial
surgery makes it difficult to maintain airway

A

rectal anesthesia

208
Q

what are the 4 phases that the general anesthesia is accomplished?

A

pre-induction
induction
maintenance
reversal/extubation

209
Q

This phase where general anesthesia is accomplished Begins as soon as the patient is brought to the procedure room and ends immediately before the induction of the anesthesia

A

pre-induction

210
Q

this phase where general anesthesia is accomplished Begins with the induction of anesthetic agents and ends with stabilization
of the patient. Involves putting the patient safely to sleep. A patent airway and
adequate ventilation must be ensured

A

induction

211
Q

this phase where general anesthesia is accomplished Starts when stabilization is accomplished and ends when reversal of anesthesia is initiated near the procedure’s end.

A

maintenance

212
Q

this phase where general anesthesia is accomplished Begins with closure of the wound and ends before patient transport to PACU

A

reversal/extubation

213
Q

stages of anesthesia

A
  1. analgesia
  2. Excitement
  3. Surgical Anesthesia
  4. Medullary depression
214
Q

what stage of anesthesia when there is analgesia without amnesia?

A

stage 1 : analgesia

215
Q

what stage of anesthesia when there is nausea, vomitting, hyperactivity, & irregular respiration ?

A

stage 2: excitement

216
Q

what stage of anesthesia when there the patients have sleep and normal respiration and blood pressure?

A

stage 3: surgical anethesia

217
Q

what stage of anesthesia when there the patients have sleep and normal respiration and blood pressure?

A

stage 3: surgical anethesia

218
Q

what stage of anesthesia when there is depression of vasomotor and respiratory centers — coma and death

A

stage 4: medullary depression

219
Q

what type of anesthesia refers to suspension of sensation on affected site of the body; temporarily prevents
generation and conduction of nerve impulses and may not affect motor functions; used for patients
whom general anesthesia is contra indicated

A

regional anesthesia

220
Q

what are the different ways to administer regional anesthesia?

A

topical surface
local
peripheral nerve block (tetracaine)
spinal anesthesia
epidural block
acuounture
cryothermia

221
Q

this anesthesia blocks sensory receptor by penetrating thru sensory nerve endings reducing responses to stimuli

A

topical surface

222
Q

this anesthesia is administered through injection into the surgical area making the receptor unresponsive to
stimuli

A

local anesthesia

223
Q

this anesthesia is administered through injection of an agent into the large trunk or nerve plexus

A

peripheral nerve block (tetracaine)

224
Q

this anesthesia is administered through injection of certain local anesthesia into subarachnoid space
between l3 and l4 using a lumbar interspace, usually employed for almost any type of major operation below the level of diaphragm

A

spinal anesthesia

225
Q

this anesthesia is administered through introducing anesthetic agent into the epidural space (through
the intervertebral space into the space surrounding the dura matter in the
spinal column)

A

epidural block

226
Q

this anesthesia is administered through insertion of long needles into acupuncture points

A

acupuncture

227
Q

this anesthesia is administered through use of cols to induce anesthesia

A

cryothermia

228
Q

what are the major complications of anesthesia?

A

▪ Respiratory arrest
▪ Cardiac arrest

Medsurg Review (3 decks)

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