Pre-Op

Question 1

Peri-op

Answer 1

Pre/Intra/post

Question 2

Why surgery

Answer 2

Diagnosis, cure, palliative (alleviate sx) , prevention, cosmetic (cut in face), exploration.

Question 3

Ambulatory setting

Answer 3

Same day outpatient…popping up everywhere, regional anesthetics versus general, in and out same day, pts recover at home versus hospital, cost is less.

Question 4

Elective surgery

Answer 4

Knee replacement

Question 5

Emergency

Answer 5

From trauma or need comes up abruptly

Question 6

Nurse needs to know what?

Answer 6

Risks, co-morbidities, why are they having surgery, identify pts response to stress, be aware of post-op risks, positioning.

Question 7

Nursing Process is

Answer 7

ESSENTIAL

Question 8

Assessment Priority

Answer 8

• *Interview**
• TO identify risk in order to ensure safety.
• Provide info, clarify info, assess emotional status, allergy.
• Baseline vitals and values.
• identify surgical site!!
• all medical history
• review pre-op lab/dx testing
• Familial/cultural factors
• informed consent!! (includes adequate education and info)

Question 9

If nurse identifies risks, what to do??

Answer 9

Notify surgical team!

Question 10

Subjective Data pre-op includes

Answer 10

Psychosocial
Anxiety (to unknown)
Fear (religious, death, disability, informed consent, pain, discomfort, altered body image, scarring)
Hope (with no hope = anxiety…“you’ll be able to eat after, less pain!”)

Question 11

What happens to body in stress??

Answer 11

Tachycardia and htn.

Question 12

What other things impact body during surgery?

Answer 12

Age, past experience with surgery and hospitalization, current health, socioeconomic status.

Question 13

Health Hx

Answer 13

Previous surgeries, medical hx, previous hospitalizations, issues, drug reactions, wounds, women (cycle and OB and current), family HX!!

Question 14

Shock!

Answer 14

End of day- bp PLUMMETS and death. Anesthesia causes vasodilation- dropping BP, **ask if they are taking htn meds

Question 15

Diabetes patients are a risk

Answer 15

Insulin intake… they lower BG and surgery is a stressor but before surgery they are NPO

Question 16

Aspirin has an effect on

Answer 16

Bleeding….

Question 17

Long-term anticoagulation therapy risk

Answer 17

procedure = taking off anticoagulant…but then stroke? what to do. Doctor decides this decision but nurse has to identify the problem

Question 18

Herbal Meds and Substance use

Answer 18

Marijauan, opioid, all herbals….nonjudgmental and matter of fact. Alcohol poises risk to liver and malnourishment and seizing during surgery.

Question 19

Latex food

Answer 19

Banana/avocado/egg/potato/peach

Question 20

Cardiovascular

Answer 20

-Valve /dysrhythmia /CAD/htn/HF/nmi/ pacemaker/icd.
-Peripheral edema, pulses, bilateral bp.
-And if they have any of these, which treatment are they on? (meds)
-Labs?? coagulation studies?? @ risk for bleeding?
Lasix? @ risk for losing potassium…. check labs…check K…
-Dyspnea??
-Asthma?? Do they take daily inhalers? Well controlled? Triggers? How freq. suffer?
-COPD!! @ risk for post-op atelectasis
-Smoking? “stop smoking 6 months prior” Determine pack years.
-Sleep Apnea? CPAP?
-Obesity?
-Spinal or chest deformities?
-GI- when did they last eat/bowel movement/dentures…
-Pt. weight!
-Active bowel sounds??

Question 21

Cardiologist Needed

Answer 21

Anticipate 12 lead ECG, anyone with cardio disease is @ risk for VTE (venous thromboembolism).

Question 22

Neurology

Answer 22

• Cognitive Ability to sign consent?
• Hearing! (aids?)
• Hx of stroke?
• Spinal cord injury
• multiplesclorosis

Question 23

Renal Insufficiency

Answer 23

• @ risk for not excreting well
• check ABGS… K and NA
• coagulation disorders due to low hgb
• @ risk for infection and wound healing
• BUN, Creat, GFR
• incontinent??

Question 24

Prego

Answer 24

All women should have a test prior

Question 25

Hepatic Function

Answer 25

- Monitor ALT/AST and bili - Check coagulation and platelets (ptINR) - Ask about hepatitis and obesity and - Glucose/homeostasis - Ask about alcohol use!! - JAUNDICED

Question 26

Integumentary

Answer 26

-Older pt...bony prominences? Cushions! -Identify wounds, pressure spots, rashes, bruises, scars, skin color, temperature of skin, pallor?? -Cool/clammy? dec. perfusion = shock! Want patient to be warm and dry

Question 27

Skeletal

Answer 27

- Neck issues - Assistive device to ambulate? - special positioning

Question 28

Endocrine

Answer 28

``` Diabetes...High risk for low and high blood sugar. Low bg-hypoglycemia, High bg-hyperglycemia. -delayed wound healing/infecton... KNOW proper amt of glucose Monitor levels during surgery -Hyperthyroidism. -Addison disease...need steroids. ```

Question 29

Thyroid

Answer 29

- Metabolism - hypo vs hyper...slows down or speeds up - TSH

Question 30

Immune

Answer 30

- Immunosuppressants = @ risk for slower wound healing. - Corticosteroids... give during or taper before. - WATCH Temperature and WBCs. - HIV/Sickle Cell...

Question 31

Fluids

Answer 31

low- bp low | Someone who is vomiting...electrolytes are low but would need supplements before going into surgery.

Question 32

NPO status

Answer 32

Impacts pre-op. If they weren't eating well and then they're NPO, @ risk for electrolyte deficiency...

Question 33

Nutritional status

Answer 33

Obesity...extra adipose tissue puts pressure on surgical site and holds on to anesthesia and @ risk for atelectasis. Thin...look at albumin levels and supplement before or after surgery. Coffee- withdrawal. (nutritional status)

Question 34

LABS

Answer 34

``` Respiratory - ABG, O2, chest Xray Diabetes - bg, bun, creat, GFR Kidney function Pulmonary function test CBC - Hgb (blood loss) ...hct...RBC...WBC (infection) ECG Electrolytes AST/ALT Bili Platelet count Serum Albumin (nutritional status) ```

Question 35

Teaching pre-op?

Answer 35

Decreases stress/fear Most SIG intervention we can do. Want them to feel prepared, not scared. -Teach Sensory (cold/...) Process ( Procedure (IV/intubate /shaved/diet preop and postop) Activities (spirometry and ambulation, turning/coughing) Pain Expectations after (cords/button/meds/pain rating scale) NPO - Informed CONSENT (disclosure, nature, risks, likelihood of oucome, alternatives, prognosis w/out surgery, voluntary) - surgeon is responsible but we witness signature. -Day of (allergy band, site marked, HAND OFF COMM sbar)