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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
Q

normal creatinine (renal function)

A

0.7-1.4 mg/dL

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26
Q

normal blood urea nitrogen BUN (renal function)

A

10-20mg/dL

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27
Q

prothrombin time (PT)

A

9.5-12 secs

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28
Q

international normalized ratio (INR)

A

0.76-1.27 when not anti coagulated, 2-3 when anticoagulated

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29
Q

activated partial thromboplastin time (aPTT)

A

20-39 secs

30
Q

antifactor Xa assay

A

0.3-0.7 units/ mL (when anti coagulated)

31
Q

diagnostic tests for preoperative

A

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
Q

preoperative nursing diagnoses

A

knowledge deficit, anxiety, pain, risk for infection, impaired physical mobility, disturbed body image, disturbed sleep pattern

33
Q

perioperative care planning: planning

A

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
Q

perioperative care planning: implementation

A

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
Q

day of surgery interventions to be aware of

A

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
Q

surgical safety: universal protocol, intraoperative goal and components

A

prevent: wrong person, wrong procedure, wrong site, foreign object left behind, death; main components: preop patient identification, marking operative site, time out

37
Q

types of anesthesia

A

general (systemic), moderate sedation/ analgesic, regional, topical

38
Q

general anesthesias

A

works on whole body; induction, maintenance, emergence

39
Q

regional anesthesia

A

work on parts of the body; nerve blocks, spinal, epidural

40
Q

intraoperative nursing roles

A

circulator, scrub, RNFA, CRNA

41
Q

circulator nurse

A

responsible for the delivery and documentation of patient care during intraoperative period; assess patients needs, plan nursing care

42
Q

scrub nurse

A

do a surgical scrub and go into the surgery with the surgical patient and doctor; ensure tools are sterile, hand tools to doctor

43
Q

RNFA, registered nurse first assistant

A

monitor patients VS during procedures, if complications arise nurse helps surgeon to stabilize patient

44
Q

CRNA, certified registered nurse anesthetist

A

administers and provides anesthesia- related care to patients before, during and after surgery

45
Q

intraoperative nursing responsibilities

A

safety, communication, positioning, site prep, draping, observation/ assessment, documentation, device placement (foleys, SCDs, grounding pad, suction), “runner”, counts, prep for transfer to PACU

46
Q

intraoperative complication: malignant hyperthermia (MH)

A

muscle rigidity (jaw), increased end tidal CO2, tachycardia/ dsyrhythmias, tachypnea, increased temp, mottled skin, sweating, DIC

47
Q

what is at risk for with malignant hyperthermia

A

rhabdomyolysis

48
Q

in postop, transfer from OR to PACU, you need

A

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
Q

PACU assessment priorities

A

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
Q

postoperative complications

A

hemorrhage, shock, poor temp regulation, DVT, PE, aspiration, atelectasis, pneumonia, surgical site complications, F/E imbalances, bowel/bladder dysfunction, infection, psychosocial, nutrition

51
Q

post op respiratory complications

A

aspiration, atelectasis, respiratory depression, pneumonia, PE, stridor

52
Q

post op respiratory key assessments

A

lungs sounds, RR, SpO2, signs of respiratory depression, sputum

53
Q

post op respiratory interventions

A

elevate HOB, O2 as ordered, C & DB, IS, early ambulation, hydration, adequate pain control

54
Q

postop cardiovascular complications

A

hemorrhage, shock, DVT, thrombophlebitis

55
Q

postop cardiovascular key assessments

A

VS, UOP, skin, calf warmth/ tenderness, peripheral pulses

56
Q

postop cardiovascular interventions

A

leg exercises, TEDs/SCDs, early ambulation, anticoagulation, hydration, positioning

57
Q

postop hydration complications

A

dehydration, fluid overload, urinary retention

58
Q

postop hydration key assessments

A

I&Os, Wt, serum electrolytes, skin, mucous membranes, lung sounds, time of last void, bladder scan

59
Q

postop hydration interventions

A

IV fluids, encourage voiding, catheterize if needed, profess fluid intake (ice, sips, clear, full liquid)

60
Q

postop GI and nutritional complication

A

N/V, constipation, ileus, abd distention, inability to progress diet

61
Q

postop GI and nutritional key assessments

A

bowel sounds, and assessment, nutritional intake, flatus, BM/ stool assessment

62
Q

postop GI and nutritional interventions

A

early ambulation, antiemetics, stool softeners, NPO, NGT, IVF, progress diet

63
Q

postop skin and wound complications

A

infection, dehiscence, evisceration

64
Q

postop skin and wound key assessments

A

skin, incision, temperature, WBCs

65
Q

postop skin and wound interventions

A

turning/ movement, early ambulation, splinting/ and binder, hydration/ nutrition, hand washing, wound care

66
Q

evisceration interventions

A

semi-fowlers, notify MD, cover intestine with sterile gauze and NS, monitor VS, prepare for OR

67
Q

postop comfort and psychosocial complications

A

pain, altered sleep/rest, altered self image, altered self care

68
Q

postop comfort and psychosocial key assessments

A

pain, sleep, ability to complete ADLs, assess for image disturbances

69
Q

postop comfort and psychosocial intervention

A

early ambulation, quiet environment/ rest/ support, promote hygiene, encourage social support, share feelings, pain meds, non-pharm interventions (back rubs, meditation)

70
Q

what to do when preparing for discharge

A

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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