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CNOR > Pre and Post operative patient assessment and diagnosis pt.2 > Flashcards

Pre and Post operative patient assessment and diagnosis pt.2 Flashcards

1
Q

in addition to medical staff, who is important to the perioperative team?

A

patient’s desired family, members, significant others, or caregivers.

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2
Q

Why are patient’s desired family, members, significant others, or caregivers so important?

A

they are excellent sources of health care information

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3
Q

What does cultural competence look like when assessing an infant or small child?

A

the RN would call the child by his or her first name and ask any pertinent history questions of the parents and caregivers rather than the patient

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4
Q

What does cultural competence look like when assessing adolescents?

A

questions can often be asked of the patient themselves, but it is important to provide confidentiality and privacy

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5
Q

What does cultural competence look like when assessing older adults?

A

acknowledging sensory and/or physical limitations, but knowing that advancing age should not be associated with decreased levels of intelligence

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6
Q

What 4 things should the preoperative assessment look at?

A
  1. medical history, especially the presence of comorbidites
  2. results of diagnostic and lab tests
  3. medication history
  4. patient’s knowledge and planned procedure
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7
Q

information gathered during the assessment facilitates what? reveals what?

A
  1. facilitates prioritization of care
  2. reveals information that should be shared with other health care providers participating in the care of the patient
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8
Q

Are the suggested fasting periods intended for all ages?

A

yes

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9
Q

What populations are not considered in the recommendations for fasting?

A
  1. trauma patients
  2. women in labor
  3. patients with conditions that delay gastric emptying
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10
Q

What can be drank 2 hours prior to procedure?

A

clear liquids - water, black coffee or tea, carbonated beverages, and fruit juices with no pulp, does not include alcohol

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11
Q

What can be drank up to 4 hours prior to procedure?

A

breast milk

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12
Q

What can be drank up to 6 hours prior to procedure?

A

infant milk

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13
Q

true or false: a light meal can be consumed up to 8 hours prior to procedure

A

false; 6 hours prior to procedure

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14
Q

What can be consumed up to 8 hours prior to procedure?

A

fried foods, fatty foods, meat

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15
Q

If a patient is wearing jewelry that cannot be removed and the surgeon would like to use cautery what is a good way to mitigate this?

A

use bipolar cautery

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16
Q

What are things that should be addressed in the preoperative assessment?

A
  1. allergies
  2. dentition
  3. jewelry and piercings
  4. prosthetics - implants, dentures, contact lenses, hearing aids
  5. patient and family history
  6. pain assessment
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17
Q

what does a comprehensive pain assessment include?

A
  1. is consistent with the patient’s age, condition, and ability to understand the caregiver
  2. identifies interventions for pain relief
  3. reassess the pain
  4. documents results of the intervention
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18
Q

What characteristics of pain should be included?

A
  1. location
  2. pattern
  3. intensity
  4. duration
  5. effect on personal life
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19
Q

What pain scale should be used in children aged 3 years or older?

A

Wong-baker faces pain rating scale

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20
Q

What is the Wong-baker faces pain rating scale

A

combines pictures and numbers for pain ratings

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21
Q

what pain scale should be used in young children and adults who are unable to communicate?

A

the FLACC scale

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22
Q

What does the FLACC scale stand for?

A

face, legs, activity, crying, consolability

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23
Q

true or false; ratings on a pain scale alone should be used as the sole indicator for identifying the severity of the pain or the need for medicating a patient

A

FALSE; NOT SOLE INDICATOR

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24
Q

What does the PEG scale stand for?

A

pain intensity, interference with enjoyment, interference with general activity

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25
Q

What does the PEG scale measure?

A

not only the intensity of the pain but also its effect on daily activities

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26
Q

What are the 3 questions asked for the pain assessment?

A
  1. What number best describes our pain on average in the past week?
  2. What number best describes how, during the past week, pain has interfered with your enjoyment of life?
  3. What number best describes how, during he past week pain has interfered with your general activity?
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27
Q

What 2 methods should be used to help mitigate pain? which is called?

A

pharmacologic and nonpharmacologic interventions; multimodel approach

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28
Q

what is important to address in pain management of children?

A

behavioral techniques (i.e. distraction, play-acting, storytelling) that address the emotional component of pain

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29
Q

What can happen with older adults and benzos?

A

paradoxical reactions to benzos i.e. increased talkativeness, emotional release, excitement, excessive movement

30
Q

What can make it harder fro drugs to be metabolized and excreted?

A

alterations in liver and kidney function

31
Q

According to the centers for medicare and medicaid services, an H&P must be conducted within…

A

30 calendar days of the procedure

32
Q

A presurgical assessment is completed by who? H&P

A

a physician or other qualified practitioner upon admission.

33
Q

If admitting physician is different from the person performing the procedure, what needs to happen with the H&P?

A

an additional note by the physician

34
Q

What are the universally required for a medical record review?

A
  1. surgical consent. Consent for anesthesia, administration of blood products, photography, intraoperative lab testing, presence of additional people in the OR
  2. current H&P
  3. a pre-anesthesia assessment
  4. baseline admission vital signs
  5. lab results
  6. radiographic reports
  7. other diagnostic reports
  8. Height and weight in kg and pounds
35
Q

Who is responsible for obtaining informed consent?

A

the surgeon, NOT THE RN

36
Q

What does the RN do for the consent?

A

makes sure it is signed and dated

37
Q

What does witnessing the patient’s signature for the consent do? Not what?

A

attests to the validity of the person signing the consent, not to the extent of patient understanding of the surgical procedure

38
Q

According to the Federal Patient Self-Determination Act, all facilities receiving reimbursement through CMS are required to ask patients about a what?

A

an advance directive, or LIVING WILL

39
Q

TRUE OR FALSE; DNR orders are automatically waived during the intraop period?

A

are not automatically waived

40
Q

define advanced directive and living will

A

legal documents designed to control certain future health care decisions when a person becomes unable to make decisions and choices on his or her own

41
Q

define durable power of attorney

A

a legal document in which a person names someone to be his or her proxy to make all health care decisions if he or she becomes unable to do so

42
Q

define DNR order

A

a written physician order instructing health care providers not to perform cardiopulmonary resuscitation

43
Q

define Allow-natural-death order (AND)

A

the provision of comfort measures only for an actively dying patient

44
Q

define provider orders for life-sustaining treatment (POLST)

A

a plan for end-of-life care incorporating both patient preferences and physician judgement

45
Q

define patient self-determination act

A

a federal law that requires health care institutions to provide information on advanced directives to the patient at the time of admission

46
Q

What is medication reconciliation?

A

the process of comparing the medications that a patient is currently using with the medications are ordered for him or her by a physician or physician’s delegate

47
Q

When does medication reconciliation begin?

A

with the preoperative assessment

48
Q

What is poly pharmacy?

A

the use of multiple drugs by a single patient for one or more complications

49
Q

What increases the likelihood of poly pharmacy?

A

comorbidities and having to increase the number of medications older adults may be taking

50
Q

What 2 herbs may cause premature labor or miscarriage?

A
  1. black cohosh
  2. Dong quai
51
Q

What are nursing implications for black cohosh and dong quai?

A

avoid use in pregnant women

52
Q

What 6 herbs may increase bleeding?

A
  1. garlic
  2. vitamin E
    3.ginger
  3. feverfew
  4. gingko biloba
  5. ginseng
53
Q

What are 2 nursing implications if a patient is taking garlic, vitamin E, ginger, feverfew, gingko biloba, ginseng?

A
  1. avoid preoperative use
  2. have hemostatic supplies available
54
Q

What are 2 effects of goldenseal?

A
  1. aids digestion
  2. regulates menses
55
Q

What are 4 nursing implications of goldenseal?

A
  1. may exacerbate hypertension or edema
  2. may potentiate effects of insulin
  3. may cause electrolyte imbalances, seizures, respiratory paralysis
  4. avoid preoperative use
56
Q

What is the effect of kava kava?

A

has sedative effect on motor reflexes and judgement

57
Q

What are 2 nursing implications of kava kava?

A
  1. potentiates sedatives and hypnotics
  2. discontinue use at least 24 hours preoperatively
58
Q

What are 2 effects of valerian?

A
  1. may cause headaches, excitability, nausea, visual disturbance
59
Q

what can long term use of valerian cause?

A

anesthesia tolerance

60
Q

What are 3 nursing implications for valerian?

A
  1. may prolong anesthesia recovery time
  2. potentiates sedatives/hypnotics
  3. sudden cessation may cause withdrawal symptoms
61
Q

What are 3 steps to avoid withdrawal symptoms in patients taking valerian?

A
  1. taper dose over 1 to 2 weeks
  2. if not possible, continue use until surgery
  3. treat withdrawal symptoms with benzos
62
Q

Why was the universal protocol created?

A

Was created to prevent wrong person, wrong procedure, and wrong site surgeries in hospitals and outpatient settings

63
Q

What 3 steps does the universal protocol consist of?

A
  1. a preoperative or preprocedural verification process that includes confirming the patient’s identity and verifying the scheduled surgical procedure
  2. marking of the operative or procedure site
  3. a time out performed immediately before starting the operation or procedure
64
Q

When should a timeout be done?

A

before any invasive procedure

65
Q

The surgical safety checklist does what 2 things?

A
  1. standardize patient care
  2. decreases the risk of error
66
Q

What are the most universal identifiers to use for patients?

A

name and date of birth

67
Q

In addition to the identification of a patient, what 4 things are included in the universal protocol?

A
  1. the procedure
  2. informed consent
  3. the operative site
  4. the side or site marking
68
Q

What are the 5 steps to procedure verification?

A
  1. confirm the patient’s identity
  2. Ask the patient (or legal representative) what procedure is being performed?
  3. Compare the patient’s (or legal representative’s) stated procedure with the information documented on the surgical consent.
  4. verify the surgical site (and side if applicable ) with the patient (or legal representative)
  5. verify the presence of site marking as performed by the surgeon
69
Q

What are the 2 sets of nursing diagnoses?

A
  1. NANDA nursing diagnosis list
  2. Perioperative nursing data set (PNDS)
70
Q

The 4 types of NANDA nursing diagnoses:

A
  1. actual (problem focused)
  2. risk
  3. health promotion
  4. syndrome
71
Q

The nursing diagnoses formulated in the perioperative area are stated as what? because?

A

“at risk” because the goal is to prevent a problem from occurring

71
Q

What is a set of perioperative-specific nursing diagnoses, interventions, and outcomes developed by AORN

A

PNDS

CNOR (12 decks)

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