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CNOR > Pre- and Postoperative Patient Assessment and Diagnosis > Flashcards

Pre- and Postoperative Patient Assessment and Diagnosis Flashcards

1
Q

What is the goal of preoperative patient assessment and diagnosis?

A

to evaluate issues that pose a significant risk to the patient in the perioperative phase

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2
Q

What is the goal of postoperative patient assessment and diagnosis?

A

to evaluate the patient’s overall condition and to assess the integrity of the skin and bony prominences immediately following surgical intervention

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3
Q

When does the preoperative phase of the patient’s surgical experience begin?

A

upon the decision to have surgery

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4
Q

the preoperative assessment is part of what process?

A

preprocedure verification process

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5
Q

what does a preprocedure verification process is performed to prevent what?

A

wrong person, wrong site, and wrong procudure

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6
Q

What function does the preoperative assessment serve?
Hint: 3 things

A
  1. identifying patients who are higher risk for surgical complication
  2. providing the surgical team with the necessary information concerning the patient’s baseline health status
  3. uncovering comorbidities and other health risks that might contribute to intra-op complications
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7
Q

what are some of the primary comorbidities that contribute to complications?

A
  1. cardiovascular disease
  2. obstructive sleep apnea
  3. reactive airway disease (asthma, COPD)
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8
Q

What are things you assess for in the preoperative phase?

A
  1. patient record review
  2. past medical history
  3. past surgical history
  4. medication review
  5. family history
  6. social history
  7. cultural assessment
  8. functional assessment
  9. review of systems
  10. physical exam
  11. laboratory and diagnostic tests
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9
Q

What 4 things are in a patient record review?

A
  1. accurate heigh and weight
  2. allergies and adverse drug reactions
  3. chief complaint
  4. history of present illness
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10
Q

What are we looking with past medical history?

A
  1. comorbidities
  2. presence of existing implants
  3. hearing impairment
  4. visual impairment
  5. cognitive function impairment
  6. preexisting medical conditions that can increase the risk of fluid and electrolyte imbalance
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11
Q

true or false: beta blockers can be taken within 24 hours of the surgery

A

true

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12
Q

what 2 things are the most important things to look at when we are doing a physical exam in preoperative phase?

A
  1. pain level
  2. patient’s skin
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13
Q

What are things we want to CONFIRM in the preoperative assessment?

A
  1. informed consent
  2. patient identification
  3. code status
  4. correct procedure and site marking
  5. surgical environment
  6. specimens management needs
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14
Q

what 4 things should a nurse ensure in the preoperative assessment?

A
  1. ensure there are no barriers to completing a perioperative assessment (NPO status, language barriers, cultural barriers, cognitive barriers)
  2. Ensure the patient has received adequate education
  3. ensure family/contact presence (up to date number in the chart)
  4. Ensure last minute considerations are made
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15
Q

What are last minute considerations?

A
  1. type and screen
  2. blood products have been type and crossed and are available
  3. personal article have been removed
  4. any diagnostic tests/lab results are available
  5. normothermia measures are in place
  6. patient has been NPO since midnight
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16
Q

When does the intraoperative phase begin?

A

when the patient is transferred onto the OR bed

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17
Q

What 3 things does the universal protocol include?

A
  1. a preprocedure verification process
  2. marking the surgical site as appropriate
  3. performing the time out
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18
Q

What are 4 things we assess in the intraoperative assessment?

A
  1. preprocedure verification process
  2. patient setup
  3. type of wound closure to be performed
  4. wound management
  5. risk factors
  6. assess the placement of dispersive electrode grounding pad or bovie pad
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19
Q

What 3 things happen during the preprocedure verification process?

A
  1. verify the correct procedure, patient, site
  2. identify the items needed for the procedure
  3. utilize a standardized list to verify the availability of items needed for the procedure
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20
Q

define primary intention wound closure?

A

characterized by wounds created under sterile conditions, with minimal tissue destruction present with edges of wounds approximated

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21
Q

what are secondary intention wound closure?

A

characterized by chronic, dirty, or infected wounds not closed and allowed to heal through granulation

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22
Q

what are delayed primary closure or tertiary intention wound closures?

A

characterized by wounds requiring debridement and delayed healing of 3 days or more after injury or surgical intervention

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23
Q

What kind of wound management approach is debridement?

A

removal of devitalized tissue from the wound through sharp excision, mechanical irrigation, enzymatic agents, or biological methods

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24
Q

What kind of wound management approach is hydrotherapy?

A

used int eh OR and is referred to as pulsatile lavage

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25
Q

What kind of wound management approach is hydro surgery ?

A

performed using pressurized irrigation and localized vacuum to remove devitalized tissue

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26
Q

What kind of wound management approach is hyperbaric oxygenation?

A

use of hyperbaric chamber to increase oxygenation to the wound.

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27
Q

What can a hyperbaric chamber encourage?

A

can encourage cellular regeneration for chronic wounds

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28
Q

What kind of wound management approach is negative pressure wound therapy?

A

use of vacuum-assisted closure device, drainage sponge, and occlusive dressing for the long-term management of chronic or non healing wounds.

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29
Q

What are some important risk factors to consider with surgery?

A
  1. blood loss
30
Q

What kind of risks come with abdominal surgery involving the bowel or pancreas?

A

third spacing

31
Q

What kind of risks come with neurosurgery?

A

causes dysregulation of antidiuretic hormone and hyponatremia

32
Q

What kind of risks come with vaginal hysteroscopy?

A

fluids can leech into the surrounding tissues and vasculature

33
Q

Where should you avoid BOVIE pad placement?

A

on hair, bony prominences, dry skin, adipose tissue

34
Q

true or false: place the BOVIE pad as close to an implanted pacemaker or implantable cardioverter-defibrillator as possible

A

false; as far away

35
Q

do not place BOVIE pads over what?

A

metal implants or prosthesis

36
Q

what should the area where the BOVIE pad is placed have a lot of?

A

muscle mass and vascularity

37
Q

what should the BOVIE pad be opposite of?

A

the surgical site

38
Q

where should the ESU be placed?

A

on the same side as the primary surgeon where the settings can be visualized

39
Q

what are pediatric patient intraoperative special considerations?

A

airway and lungs, cardiovascular, fluid management, metabolism, temperature regulation, and skin prep solutions

40
Q

what are trauma surgery and advanced trauma life support intraoperative special considerations?

A

upon transfer of the pt. from ED to OR, the provider should assess the patient’s airway, respiratory function, and circulation; assess the level of neurologic disability, and examine the extent of injuries and thermoregulation of the patient. once first assessment is completed, secondary assessment is made

41
Q

When is a timeout conducted?

A

immediately before the invasive procedure or before the incision is made

42
Q

what must all team members agree on before surgery can start?

A
  1. correct patient identity
  2. correct site
  3. procedure to be done
  4. administration of antibiotics
  5. confirmation that all items needed for surgery are present in the surgical suite
43
Q

what 2 roles does the perioperative nurse play in the OR?

A
  1. patient advocate
  2. communicates with all members of the surgical team and other nursing personnel to ensure that all the components of the universal protocol have been addressed
44
Q

What do we want to confirm following the timeout?

A

verify correct site marking

45
Q

What is another big thing we want to confirm when positioning?

A

safety strap

46
Q

What do you want to do about any contamination encountered during the procedure?

A

has been confined and contained

47
Q

When do we perform surgical counts?

A

at the beginning and end of the case, as well as any time a count is called for during the procedure

48
Q

What do you want to make sure of once a surgical count has happened?

A

that all surgical team members are aware that a surgical count has taken place and the result of said count is communcated

49
Q

What do we want to evaluate and ensure with intraoperative assessment?

A
  1. instrument sterility using Spaulding classification system
  2. Surgical environment safety check preventing slips and falls
  3. intraoperative complication evaluation
50
Q

What is critical according to the Spaulding classification system

A

must be sterile and will enter tissue or vascular system (instruments, cutting endoscopic accessories, needles)

51
Q

What is semi-critical according to the Spaulding classification system?

A

should be sterile but high-level disinfection acceptable according to manufacturer’s IFUs

52
Q

What is an example of things that are critical in regards to sterility

A

(instruments, cutting endoscopic accessories, needles)

53
Q

What are examples of things that are semi-critical in regards to sterility?

A
  1. anesthesia equipment
  2. endoscopes
54
Q

What is non-critical according to the Spaulding classification system?

A

intermediate-to low level disinfection or cleaning required

55
Q

What are examples of things that are non-critical in regards to sterility?

A
  1. OR beds and linens.
  2. patient care items
56
Q

true or false: the postoperative assessment is performed, in varying degrees, by the entire surgical team

A

true

57
Q

What are the 2 types of hazards in the OR environment?

A
  1. biologic
  2. chemical
  3. physical
58
Q

What is a biologic hazard?

A

pathogenic organisms, infectious waste, needle sticks or cuts, latex sensitivity

59
Q

What is a chemical hazard?

A

Anesthesia gas exposure, toxic fumes or electrocautery plume, cytotoxic drugs, and cleaning agents

60
Q

What is a physical hazard?

A

falls, noise, irradiation, and fire

61
Q

What are the 5 things included in a post op assessment?

A
  1. vital signs
  2. patient’s pain level
  3. assess skin integrity
  4. if wound is uncovered, assess the wound closure
  5. evaluate for wound healing complications
62
Q

what may some facilities use during frequent assessments post-op?

A

aldrete scoring system

63
Q

What are 4 things we want to confirm at the end of the procedure?

A
  1. actions - help to anesthesia, ensure dressings are applied, ensure pt. is safely repositioned to supine position, ensure transfer of patient to the stretcher or bed is performed by at least 4 people
  2. specimen procurement and confirmation
  3. surgical counts
  4. cleaning with food and drug administration (FDA) approved disinfectant at the end of the procedure
64
Q

When we ENSURE, what actions do nurses need to make sure have occurred at the end of the procedure?

A
  1. all contaminated items are removed
  2. drains are appropriately secured, draining, and patent
  3. patient is positioned back on bed safely
  4. family has been updated
  5. nonradiopaque sponges are removed
  6. normothermia is maintained
65
Q

When we EVALUATE, what actions do nurses need to make sure have occurred at the end of the procedure?

A

evaluate the patient’s clinical status: extubation readiness based on patient’s clinical status and recommendations of surgery and anesthesia machine

66
Q

What are the 3 wound healing phases?

A
  1. inflammatory
  2. proliferation
  3. maturation
67
Q

what is the inflammatory wound healing phase?

A

this phase lasts 0 to 3 days with redness, edema, and phagocytosis

68
Q

What is the proliferation wound healing phase?

A

this phase lasts 4 to 24 days with granulation and epithelial tissue forming

69
Q

What is the maturation wound healing phase?

A

this phase lasts 24 days to 1 year with scar formation and contracture of tissue forming

70
Q
A

CNOR (12 decks)

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