perioperative/ pre & post Flashcards
three phases of perioperative nursing
preoperative, intraoperative, postoperative
what is preoperative
begins with decision to have surgery, lasts until the patient is transferred to operating room or procedural bed
what is intraoperative
begins when the patient is transferred to the OR bed until transfer to the post anesthesia care unit (PACU)
what is postoperative
lasts from admission to recovery room to complete recovery from surgery and last follow up physician visit
assessments for preoperative nursing
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
what are some post surgical support and referral Needs
driving restrictions, lifting restrictions, home health care
what history of the patient should you gather before surgery
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
what things should check in physical exam before surgery
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
what are key considerations for other conditions going into surgery
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
risk factors related to surgery
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
blood work done with surgery
CBC(hbg, hct), BMP(electrolytes, BUN & creatinine, glucose), coagulation studies (PT/INR, PTT), blood type, HCG (pregnancy test)
red blood cells in women
4.2-5.4 million
red blood cells in men
4.6-6.2 milion
hgb in men
13-18 g/dL
hgb in women
12-16g/dL
hct in men
42-52%
hct in women
35-47%
normal WBC count
4500-11,000
normal platelet count
150-450 x 10^9/L
normal Na+ (serum electrolytes)
135-145mmol/L
normal K+ (serum electrolytes)
3.5-5mmol/L
normal Cl- (serum electrolytes)
95-105 mEq/L
normal HCO3- (serum electrolytes)
22-26mEq/L
normal glucose (serum electrolytes)
70-110mg/dL
normal creatinine (renal function)
0.7-1.4 mg/dL
normal blood urea nitrogen BUN (renal function)
10-20mg/dL
prothrombin time (PT)
9.5-12 secs
international normalized ratio (INR)
0.76-1.27 when not anti coagulated, 2-3 when anticoagulated
activated partial thromboplastin time (aPTT)
20-39 secs
antifactor Xa assay
0.3-0.7 units/ mL (when anti coagulated)
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)
preoperative nursing diagnoses
knowledge deficit, anxiety, pain, risk for infection, impaired physical mobility, disturbed body image, disturbed sleep pattern
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/)
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)
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
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
types of anesthesia
general (systemic), moderate sedation/ analgesic, regional, topical
general anesthesias
works on whole body; induction, maintenance, emergence
regional anesthesia
work on parts of the body; nerve blocks, spinal, epidural
intraoperative nursing roles
circulator, scrub, RNFA, CRNA
circulator nurse
responsible for the delivery and documentation of patient care during intraoperative period; assess patients needs, plan nursing care
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
RNFA, registered nurse first assistant
monitor patients VS during procedures, if complications arise nurse helps surgeon to stabilize patient
CRNA, certified registered nurse anesthetist
administers and provides anesthesia- related care to patients before, during and after surgery
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
intraoperative complication: malignant hyperthermia (MH)
muscle rigidity (jaw), increased end tidal CO2, tachycardia/ dsyrhythmias, tachypnea, increased temp, mottled skin, sweating, DIC
what is at risk for with malignant hyperthermia
rhabdomyolysis
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)
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
postoperative complications
hemorrhage, shock, poor temp regulation, DVT, PE, aspiration, atelectasis, pneumonia, surgical site complications, F/E imbalances, bowel/bladder dysfunction, infection, psychosocial, nutrition
post op respiratory complications
aspiration, atelectasis, respiratory depression, pneumonia, PE, stridor
post op respiratory key assessments
lungs sounds, RR, SpO2, signs of respiratory depression, sputum
post op respiratory interventions
elevate HOB, O2 as ordered, C & DB, IS, early ambulation, hydration, adequate pain control
postop cardiovascular complications
hemorrhage, shock, DVT, thrombophlebitis
postop cardiovascular key assessments
VS, UOP, skin, calf warmth/ tenderness, peripheral pulses
postop cardiovascular interventions
leg exercises, TEDs/SCDs, early ambulation, anticoagulation, hydration, positioning
postop hydration complications
dehydration, fluid overload, urinary retention
postop hydration key assessments
I&Os, Wt, serum electrolytes, skin, mucous membranes, lung sounds, time of last void, bladder scan
postop hydration interventions
IV fluids, encourage voiding, catheterize if needed, profess fluid intake (ice, sips, clear, full liquid)
postop GI and nutritional complication
N/V, constipation, ileus, abd distention, inability to progress diet
postop GI and nutritional key assessments
bowel sounds, and assessment, nutritional intake, flatus, BM/ stool assessment
postop GI and nutritional interventions
early ambulation, antiemetics, stool softeners, NPO, NGT, IVF, progress diet
postop skin and wound complications
infection, dehiscence, evisceration
postop skin and wound key assessments
skin, incision, temperature, WBCs
postop skin and wound interventions
turning/ movement, early ambulation, splinting/ and binder, hydration/ nutrition, hand washing, wound care
evisceration interventions
semi-fowlers, notify MD, cover intestine with sterile gauze and NS, monitor VS, prepare for OR
postop comfort and psychosocial complications
pain, altered sleep/rest, altered self image, altered self care
postop comfort and psychosocial key assessments
pain, sleep, ability to complete ADLs, assess for image disturbances
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)
what to do when preparing for discharge
activity restrictions, incisional care, dietary restrictions, when to call physician, medication instruction, arrange home care PRN
