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fundamentals exam 5 > perioperative/ pre & post > Flashcards

perioperative/ pre & post Flashcards

1
Q

three phases of perioperative nursing

A

preoperative, intraoperative, postoperative

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2
Q

what is preoperative

A

begins with decision to have surgery, lasts until the patient is transferred to operating room or procedural bed

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3
Q

what is intraoperative

A

begins when the patient is transferred to the OR bed until transfer to the post anesthesia care unit (PACU)

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4
Q

what is postoperative

A

lasts from admission to recovery room to complete recovery from surgery and last follow up physician visit

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5
Q

assessments for preoperative nursing

A

history & physical, identification of risk factors and allergies, medication & tx assessment, facilitating/ reviewing diagnostic tests, teaching and psychosocial needs, assessing for post surgical support and referral needs

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6
Q

what are some post surgical support and referral Needs

A

driving restrictions, lifting restrictions, home health care

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7
Q

what history of the patient should you gather before surgery

A

developmental considerations (for children), PMH, surgical history, allergies & medications(OCT, alcohol), nutritional status(albumin level drawn, wound healing), ADLs & occupation(activity restrictions after surgery), sociocultural needs, support system

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8
Q

what things should check in physical exam before surgery

A

general surgery: height, weight, VS, mobility; integumentary: scars, wounds, Braden score; respiratory: cough, lungs sounds, recent URI; cardiovascular: rate, rhythm, MI; neurological: mental status, A x O x ?; GI/GU: constipation, N/V/D; musculoskeletal: mobilize after surgery, able to walk around

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9
Q

what are key considerations for other conditions going into surgery

A

CV: HTN, MI, HF, arrhythmias, CVA, thrombocytopenia, anemia; resp: COPD, asthma, pneumonia, bronchitis, URI; renal or hepatic disease; diabetes (insulin regiment may change before or after surgery); medications: drugs that increase the risks of surgery

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10
Q

risk factors related to surgery

A

age (elderly & very young), nutritional status (malnutrition: wound healing complications, obesity: stress on heart, wound healing complications, more time in OR), fluid & electrolyte imbalance (fluid loss, low Na+/K+), pregnancy (caring for 2, every girl will have a pregnancy test if older than 10/11), previous surgical or anesthesia complications

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11
Q

blood work done with surgery

A

CBC(hbg, hct), BMP(electrolytes, BUN & creatinine, glucose), coagulation studies (PT/INR, PTT), blood type, HCG (pregnancy test)

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12
Q

red blood cells in women

A

4.2-5.4 million

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13
Q

red blood cells in men

A

4.6-6.2 milion

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14
Q

hgb in men

A

13-18 g/dL

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15
Q

hgb in women

A

12-16g/dL

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16
Q

hct in men

A

42-52%

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17
Q

hct in women

A

35-47%

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18
Q

normal WBC count

A

4500-11,000

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19
Q

normal platelet count

A

150-450 x 10^9/L

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20
Q

normal Na+ (serum electrolytes)

A

135-145mmol/L

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21
Q

normal K+ (serum electrolytes)

A

3.5-5mmol/L

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22
Q

normal Cl- (serum electrolytes)

A

95-105 mEq/L

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23
Q

normal HCO3- (serum electrolytes)

A

22-26mEq/L

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24
Q

normal glucose (serum electrolytes)

A

70-110mg/dL

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25
normal creatinine (renal function)
0.7-1.4 mg/dL
26
normal blood urea nitrogen BUN (renal function)
10-20mg/dL
27
prothrombin time (PT)
9.5-12 secs
28
international normalized ratio (INR)
0.76-1.27 when not anti coagulated, 2-3 when anticoagulated
29
activated partial thromboplastin time (aPTT)
20-39 secs
30
antifactor Xa assay
0.3-0.7 units/ mL (when anti coagulated)
31
diagnostic tests for preoperative
CXR (respiratory complications/ any infection), Joint/ bone X-rays (ortho surgery), CT or MRI (location to focus on during surgery), EKG (electrical conduction thru heart, any dysrhythmias), cardiac stress test , sleep study (sleep apnea, need O2)
32
preoperative nursing diagnoses
knowledge deficit, anxiety, pain, risk for infection, impaired physical mobility, disturbed body image, disturbed sleep pattern
33
perioperative care planning: planning
set goals with the patient that are realistic and will help lead to a successful and complication free surgical experience/ involve setting expectations and providing info (physical therapy coming up/)
34
perioperative care planning: implementation
teaching: general info(time, who & what to bring), communicating expectations (why need for CXR), provide anticipatory guidance (what to expect), verify informed consent (before surgery), postoperative referrals (case management, DME medical equipment, homecare, prescriptions, post appts)
35
day of surgery interventions to be aware of
NPO status, IVs, bowel preparation/ empty bowel & bladder, pre op meds, hygiene & skin prep, removal of jewelry/ dentures/ hearing aids, documentation review and complete, provide directions and emotional support
36
surgical safety: universal protocol, intraoperative goal and components
prevent: wrong person, wrong procedure, wrong site, foreign object left behind, death; main components: preop patient identification, marking operative site, time out
37
types of anesthesia
general (systemic), moderate sedation/ analgesic, regional, topical
38
general anesthesias
works on whole body; induction, maintenance, emergence
39
regional anesthesia
work on parts of the body; nerve blocks, spinal, epidural
40
intraoperative nursing roles
circulator, scrub, RNFA, CRNA
41
circulator nurse
responsible for the delivery and documentation of patient care during intraoperative period; assess patients needs, plan nursing care
42
scrub nurse
do a surgical scrub and go into the surgery with the surgical patient and doctor; ensure tools are sterile, hand tools to doctor
43
RNFA, registered nurse first assistant
monitor patients VS during procedures, if complications arise nurse helps surgeon to stabilize patient
44
CRNA, certified registered nurse anesthetist
administers and provides anesthesia- related care to patients before, during and after surgery
45
intraoperative nursing responsibilities
safety, communication, positioning, site prep, draping, observation/ assessment, documentation, device placement (foleys, SCDs, grounding pad, suction), "runner", counts, prep for transfer to PACU
46
intraoperative complication: malignant hyperthermia (MH)
muscle rigidity (jaw), increased end tidal CO2, tachycardia/ dsyrhythmias, tachypnea, increased temp, mottled skin, sweating, DIC
47
what is at risk for with malignant hyperthermia
rhabdomyolysis
48
in postop, transfer from OR to PACU, you need
situation (pt name, procedure, significant PMH), background (type of anesthesia, meds given, significant intraop events, complications), assessment (VS, site assessment, IV site, fluids, pain, foley, skin issue), recommendations (plan of care, family update/ location)
49
PACU assessment priorities
resp: airway, rate, depth, breath sounds; cardiac: BP/ HR q 15 mins; neuro: pupillary response, muscle strength; dressings: monitor drainage, observe for hemorrhaging; pain management: subjective & objective manifestations of pain, administer meds; renal function: I & Os; Temperature
50
postoperative complications
hemorrhage, shock, poor temp regulation, DVT, PE, aspiration, atelectasis, pneumonia, surgical site complications, F/E imbalances, bowel/bladder dysfunction, infection, psychosocial, nutrition
51
post op respiratory complications
aspiration, atelectasis, respiratory depression, pneumonia, PE, stridor
52
post op respiratory key assessments
lungs sounds, RR, SpO2, signs of respiratory depression, sputum
53
post op respiratory interventions
elevate HOB, O2 as ordered, C & DB, IS, early ambulation, hydration, adequate pain control
54
postop cardiovascular complications
hemorrhage, shock, DVT, thrombophlebitis
55
postop cardiovascular key assessments
VS, UOP, skin, calf warmth/ tenderness, peripheral pulses
56
postop cardiovascular interventions
leg exercises, TEDs/SCDs, early ambulation, anticoagulation, hydration, positioning
57
postop hydration complications
dehydration, fluid overload, urinary retention
58
postop hydration key assessments
I&Os, Wt, serum electrolytes, skin, mucous membranes, lung sounds, time of last void, bladder scan
59
postop hydration interventions
IV fluids, encourage voiding, catheterize if needed, profess fluid intake (ice, sips, clear, full liquid)
60
postop GI and nutritional complication
N/V, constipation, ileus, abd distention, inability to progress diet
61
postop GI and nutritional key assessments
bowel sounds, and assessment, nutritional intake, flatus, BM/ stool assessment
62
postop GI and nutritional interventions
early ambulation, antiemetics, stool softeners, NPO, NGT, IVF, progress diet
63
postop skin and wound complications
infection, dehiscence, evisceration
64
postop skin and wound key assessments
skin, incision, temperature, WBCs
65
postop skin and wound interventions
turning/ movement, early ambulation, splinting/ and binder, hydration/ nutrition, hand washing, wound care
66
evisceration interventions
semi-fowlers, notify MD, cover intestine with sterile gauze and NS, monitor VS, prepare for OR
67
postop comfort and psychosocial complications
pain, altered sleep/rest, altered self image, altered self care
68
postop comfort and psychosocial key assessments
pain, sleep, ability to complete ADLs, assess for image disturbances
69
postop comfort and psychosocial intervention
early ambulation, quiet environment/ rest/ support, promote hygiene, encourage social support, share feelings, pain meds, non-pharm interventions (back rubs, meditation)
70
what to do when preparing for discharge
activity restrictions, incisional care, dietary restrictions, when to call physician, medication instruction, arrange home care PRN

fundamentals exam 5 (9 decks)

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