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1008 Acute Care Nursing practice > Perioperative roles, post op and Pain > Flashcards

Perioperative roles, post op and Pain Flashcards

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1
Q

Perioperative nursing

A
  • patient advocacy
  • scientific nursing interventions
  • critical thinking
  • clinical reasoning
  • caring
  • comfort
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2
Q

What does a role of pre operative nurse?

A
  • alterations and consequences for the patient
  • identifies intraoperative risk factors and the potential for the prevention of patient injury
  • understand the psychosocial implications of surgery for the patient family and caregiver
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3
Q

Design of the operating theater?

A

= restricted area accessed through semi restricted area with marks and PPE required

  • Lighting - UV radiation reduces number of organisms in ai
  • temp - 20-22 degrees to inhibit bacterial growth
  • humidity - 50-60% inhibits bacterial growth
  • positive air pressure
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4
Q

Role of anaesthetic nurse?

A
  • prepares and chest the anaesthetic machines, equipment, intravenous and arterial lines
  • participates in time out
  • assists the anaesthetist in the. induction and maintenance of the anaesthetic
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5
Q

Role of the scrub nurse?

A
  • reviews anatomy and physiology and surgical procedure
  • completes surgical hand and arm scrub gowns/gloves self
  • prepares instrument table and organises sterile equipment
  • assists with skin prep
  • passes instrument to surgeon
  • reports medications used by surgeon and monitors irrigation fluids for calculation of blood loss
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6
Q

Role of the circulating nurse?

A
  • plans and coordinates intraoperative nursing care
  • assists in preparing the OT
  • monitors aseptic technique
  • identifies and admits the patient to the operating room
  • maintains an accurate count of sponges, needles, instruments and other medical devices that may be retained in the patient
  • document intraoperative care
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7
Q

Hand over in operating room?

A

ISOBAR

  • identification
  • situation
  • obs
  • background
  • assessment and action to establish an agreed management plan
  • responsibility and risk management
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8
Q

Post anaesthesia care PACU nurse role

A

Stage 1: patient recovery unconscious

- one on one nursing care 
- Close monitoring of vital signs and A-G
- assessment of complications 
- medications for pain

Stage 2: pt transferred to postsurgical ward to meet requirements for dischargee
- 1:4 nurse ratio

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9
Q

Initial PACU assessment

A
  • Airway
  • Breathing – (including oxygen)
  • Circulation-ECG
  • Neurological- level of consciousness/ orientation
  • Gastrointestinal –nausea/ vomiting/intake/ fluids/ irrigations
  • Genitourinary –output/ urine/ drains
  • Surgical site -dressings and drainage/ per vagina loss/ fundal height/ pain/ incision
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10
Q

What does post operative care include?

A
  • care in recovery
  • care in the ward
  • care on discharge
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11
Q

Post anaesthetic recovery unit

A
  • close observations, evaluation and stabiles condition

- anticipate and prevent complications

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12
Q

Care in recovery

A
  • anaesthetist gives report to admitting recovery nurse
  • monitoring and management of vital functions
  • assessing whether the patient is safe to return to ward
  • report any concerns
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13
Q

Post op complications immediately

A
  • Respiratory function
  • Cardiovascular function
  • Neurological function
  • Pain & discomfort
  • Thermoregulation
  • Nausea & Vomiting
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14
Q

Discharge criteria from PACU

A

= if they score above an 8 to be discharged and no 0 in any categories

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15
Q

Transfer from recovery

A
  • ISBAR handover
  • A-G
  • check medical records
  • make patient comfortable
    • N and V
    • thermoregulation
    • pain
    • re-orientation to surroundings
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16
Q

respiratory complications post op and nursing interventions?

A
  • atelectasis and pneumonia
  • absence of deep breathing due to pain or reclined position
  • lack of coughing leads to development of mucus plugs in lungs

Nurse: respiratory assessment

  • encourage deep breathing and coughing
  • mobilisation
  • splining to reduce pain
  • regular repositioning
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17
Q

Cardiovascular complications post op and nursing interventions?

A
  • arrythmias
  • reduction in cardiac output –> bleeding or systemic infection

CO= stroke volume X HR

  • preload
    • hypovolaemia (haemorrhage)
      - vasodilation (septic shock, anaesthetic)
  • contractility
    • cardia condution, ventricular failure, hypertension

Fluid electrolyte imbalance

  • fluid retention
  • fluid overload
  • fluid defict
  • hypokalaemia (low potassium

Intevention

  • Early mobilisation
  • Lower leg exercises
  • Anti-embolism stockings
  • Anti-coagulants
  • Repositing
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18
Q

Thermoregulation complications post op and nursing interventions?

A
  • Temp below 36
  • Cold operating theatre
  • Anaesthesia can lead to vasodilation
  • Monitor temp
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19
Q

gastrointestinal complications post op and nursing interventions?

A
  • Nausea and vomiting
  • Imbalance nutrition (NBM)
  • Assess for active bowel sounds
  • Constipation
20
Q

pressure injury complications post op and nursing interventions?

A
  • Prolonged sedentary positions put pressure on the skin and reduce blood flow to that area
  • Post-operative patients are at particular risk of pressure sores due to aesthetic, nutrition, pain, immobility
  • Graded in terms of severity
  • Common sites
    o Occiput
    o Elbows
    o Ischial tuberosity
    o Heels
21
Q

Urinary retention complications post op and nursing interventions?

A

• Low urine output may be expected in first 24 hours, min/hour 0.5mls/Kg

 - Increased aldosterone & ADH from stress of surgery 
 - Fluid restriction pre-surgery 
 - Fluid loss during surgery
  • Patient may have a urinary catheter insitu
  • Retention
    • Loss of sensation e.g. epidural
    • Anaesthetic medications may interfere with ability to initiate voiding
    • Pain may inhibit bladder emptying
    • Recumbent position
    • Renal ischaemia
22
Q

Signs and symptoms of a local infection

A

• Redness (vasodilation & increased blood flow)
• Heat (vasodilation)
• Swelling (vasodilation)
• Loss of function (pain & swelling)
- Pain (nociceptor stimulation)

23
Q

Signs and symptoms of a systemic infection

A 
Signs 
•	Raised temperature (>37.5 C)
•	 Increased HR 
•	Reduction in BP & hypotension 
•	Increased respiratory rate 
Febrile convulsions (common in paediatrics ) 
•	Sweaty (diaphoretic)	Symptoms
  • Feeling hot
  • Achy joints
  • Restlessness
  • Pain
24
Q

Nursing interventions of infection

A
  • If signs of infection, either local or systemic arise, alert surgical team
  • Antipyretic medication (paracetamol, ibuprofen)
  • Antibiotics (if prescribed)
  • Adequate hydration (IV therapy or oral intake)
  • Regular monitoring of vital signs according to severity of condition
25
Q

Define pain

A

= an unpleasant sensory and emotional experience associated with actual or potential tissue damage (subjective)

  • pain is an early identification and recognition of people experiencing pain leads to improved health outcomes and greater patient satisfaction
26
Q

Types of pain

A
  • acute
  • chronic
  • neuropathic pain
27
Q

Pain assessment

A

PQRST

P - provoking factors (what caused the pain)

Q - quality (what does the pain feel like)

R - radiation (where is the pain)

S - severity (0-10 scale)

T - timing (when did the pain start)

28
Q

What is the importance of pain assessment?

A
  • First step to providing effective pain management
  • Provides a baseline for ongoing assessment
  • Nurses are unable to prescribe analgesic medications, however through a comprehensive pain assessment (and documentation) we can assist medical staff in selecting the appropriate class of analgesia, dose, frequency and route
29
Q

When do you assess pain

A
  • pain assessment
  • on all admissions
    • baseline
    • standard obs
    • every time analgesia is required
    • before analgesia
    • document
30
Q

What is treatment for acute pain ?

A

Acute pain = aggressive treatment often involving a multimodal analgesia management including opioids

  • Theoretical pain – an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of damage
  • Practical pain – is what the patient says hurts, existing wherever he/she says it does WHEN ASKED
31
Q

What is treatment for chronic pain

A

= treatment is non medicated based normally

32
Q

Pathophysiology of pain?

A
  • When tissue damage occurs a range of chemical mediators, proinflammatory cytokinesis are released
  • These substances stimulate the nociceptors which then transmit pain signals via afferent nerves to the CNS
  • The signal ascends the spinal cord along the ascending pathways (primarily the spinothalamic tract)
  • It is then projected into the medulla, thalamus and cerebral cortex of the brain for higher interpretation
  • It is at this point that the signal is greatly influenced by emotion, cognition and behaviour
33
Q

psychological aspect of pain

A

= Pain is an individual, multi-factorial experience influenced by culture, previous pain events, beliefs, mood and ability to cope

  • Pain can be escalated by psychological/spiritual distress
34
Q

What are the effects of acute pain on psychological aspect?

A

= stress response - mediated by metabolic and neuro hormonal mechanisms

35
Q

Clinical manifestations of stress response

A
  • Hypertension
  • Tachycardia
  • Splinting
  • Ventilation perfusion mismatch
  • DVT and PE
  • Decreased gastrointestinal motility
  • Water and salt retention
36
Q

Effect of stress response on respiratory system

A
  • Atelectasis
  • Decreased cough
  • Sputum retention
  • Infection
  • hypoxemia
37
Q

Effect of stress response on cardiovascular system

A
  • Tachycardia
  • Hypertension
  • Increased myocardial oxygen consumption
  • Myocardial ischaemia
  • DVT
38
Q

Effect of stress response on gastrointestinal

A
  • decreased gastric and bowel motility
39
Q

Effect of stress response on genitourinary system

A
  • urinary retention
40
Q

Effect of stress response on neuroendocrine system

A
  • increased catecholamines, cortisol, glucagon, growth hormone, vasopressin, aldosterone and insulin
41
Q

What is a PCA?

A

= patient controled analgesia

= programmable syringe pump, which delivers the opioid infusion according to individualised settings

  • Bolus dose, lockout time, dose duration, background infusion
42
Q

Drugs used in PCA

A

Drugs used in PCA

  • Opioid e.g. morphine, pethidine, fentanyl
43
Q

What is lockout time?

A
  • Usually 5 mins
  • PCA will not deliver a dose during lockout time even if the patient presses the button
  • Allows each bolus to reach peak effect before the patient has another bolus
  • Reduces risk of overdose\

Good tries = when the PCA delivers the bolus dose of analgesia

Bad tries = when the patient presses the button during lockout time and no bolus is delivered

44
Q

What are the benefits of PCA?

A
  • Patients control own pain relief
  • Less anxiety
  • Better pain relief
  • Better patient satisfaction
  • Less analgesic side effects
45
Q

Side effects of PCA?

A
  • Sedation
  • Respiratory depression
  • N and V
  • Purities
  • Urinary retention

1008 Acute Care Nursing practice (10 decks)

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