Pre-Op Flashcards
3 phases of perioperative nursing
1) preoperative
2) intraoperative
3) postoperative
goal?
assisst pt, understand whats going to happen, what meds taking, when last time they took meds, sedation method
preop begins when
when you decide to get surgery, ends the moment you are in OR
postop first thing
return set of vitals
classifications of surgery (6)
1) diagnostic (we want to confirm something is wrong)
ex/ biopsy, colonoscopy (usually outpatient)
2) explorative (same as 1)
3) reconstructive (repair physical deformity; medical or elective)
ex/ cleft palette, breast reconstruction
4) curative (diseased/damaged)
ex/ apendectomy, hysterectomy
5) palliative (alleviates pain or disease symptoms doesn’t fix)
ex/ tumor depunking (shave down tumor)
types of urgency (4)
1) emergent (PRIORITY!)
ex/ AAA repair
2) urgent (require prompt attention w/ in 24-48 hours)
ex/ surgical wound infection
3) required (indicated for health, not immediately important)
4) elective (satisfies clients desire)
ex/ tummy tuck, chin reconstruction
preop nursing:
assessment
- history and physical exam
- general assessment
- thorax & lungs
- heart & vascular system
- abdomen / neuro status
- allergies*
- learning & discharge needs
- preop pain assessment
- get informed consent from person doing the procedure (before anything)
- current weight & height accurate from administering meds
preop nursing:
risk factors
- age; very young and very old
- nutrition; better nutrition the better
- obesity; increase surgical risk (larger surface)
- fluid & electrolyte imbalance
- pregnancy
dehisance
surgical incision opening
eviseration
organ popping out of incision
preop assessment:
continued
-previous surgeries (preconceived conceptions)
ex/ fear, anxiety
-medication history (current meds including herbals)
-smoking habits
-alcohol & substance abuse (look @ liver function panels (takes 72 hours for withdrawal)
-family support (holistic)
-job concerns
ex/ full time dad w/ 3 kids & stay at home mom
-cultural & religious concerns
preop assessment:
continued
- complete blood count (CBC)
- electrolytes
- coagulation studies
- BUN & Creatinine (kidney fx)
- glucose
- chest xray & EKG (make sure no existing pneumonia)
- scans & MRIs
Complete Blood Count (CBC)
-make up of what 5 things
1) RBC
2) Hgb
3) Hct
4) WBC
5) Platelets
range for RBC
- carry oxygen via hemoglobin
- produced by bone marrow
men: 4.6-6.2
women: 4.2-5.4
range for Hgb
hemoglobin & oxygen carry
men: 13.5-18
women: 12-16
range for Hct
% of total blood volume that consists of RBC
- men: 40-54%
- women: 12-16
range for WBC
increase in WBC = infection
-5,000-10,000
Platelets
-major fx in blood clotting
150-450
range for sodium (Na)
-level of Na reflects fluid status of the body (volume deficiency)
135-145
range for Potassium (K)
- normal cardiac fx, controls neuro & muscular
3. 5-5.0 - hypokaltremia = decrease K muscle weakness/cramping
- hyperkaltremia - increase K causes weakness/paralysis
range for Chloride (Cl)
95-105
-assoc with acid/base balance; muscle activity
bicarbonate range
19-25
-Buffer ex/ Tums
ALT*** & ranges
LIVER ENZYME
male: 10-40 u/mL
female: 8-35 u/mL
AST*** & ranges
LIVER ENZYME
male: 10-40
female: 15-30
when ____ and ____ are _____, something is wrong with liver
-usually in alcoholics
AST & ALT elevated
magnesium ranges
- usually with K deficiency
1. 4-7.5
calcium ranges
- produced in bone
8. 9-10.1
sub Q bubble needed for what med
Lovanox
PT (prothrombin time)
men: 9.6-11.8 seconds
female: 9.5-11.3 secs
INR (International normalized ratio)
in controls: .76-1.27
for anticoagulation: 2.0-3.0
APTT (Activated Partial Thromboplastin Time)
35-45 seconds
Platelets
150-450 L
(lower than 150 = risk for bleeding)**
which tests used for coumadin
PT & INR
which test used for IV Heprin
APTT
renal function labs:
-creatinine
shows how well kidneys are working
male: 0.6-1.3
female: 0.5-1.0
renal function labs:
-BUN (Blood Urea Nitrogen)
5-20mg
fasting serum glucose
70-110 mg
conditions that increase risks of surgery (7)
1) bleeding disorders
2) diabetes mellitus
3) heart disease
4) URI/Chronic Respiratory Disease
5) Liver disease
6) fever
7) kidney disease
drugs that increase risks of surgery (first 5)
- certain antibiotics
- antidysrhythmics
- anticoagulants
- anticonvulsants
- antihypertensives
drugs that increase risks of surgery (last 4)
- corticosteroids (used for respiratory issues)
- insulin
- diuretics
- some OTC
preop nursing diagnoses
- deficient knowledge
- anxiety/FEAR
- pain
- risk for infection
- impaired physical mobility
- disturbed body image
- disturbed sleep pattern
preop goals
- client will verbalize the importance of early postop ambulation before surgery
- client will demonstrate coughing & deep breathing exercises in preop period
preop interventions
-client teaching: breathing & leg exercises
informed consent whose responsibility?
- doctor/surgeon: explains procedure risks & complications
- takes 2 signatures for nurses
