pre peri post op Flashcards
types of surgery: classification by purpose
diagnostic, ablative, constructive, reconstructive, transplantation, palliative and cosmetic
types of surgery: classification by degree of urgency
elective, urgent, emergency
types of surgery: degree of risk
Minor and major
preoperative period begin when
patient is scheduled for surgery and ends at the time of transfer to the surgical suite
it make start days or weeks before admission
during preoperative period you are responsible for
education and teaching
anxiety management
medication/pain management
teaching about drains
teaching about dressings
pre operative assessment
obtain history
conduct physical exam
draw and review results of labs
verify consent is signed
provide education to prevent post op complications: tcdp, is, scds
what to expect in the surgical suite and recovery
preop medications
follow surgeons orders on when to stop certain medications like
blood thinners
anticoagulants
aspirin
nsaids
vitamin E
herbs
pre-op testing
CBC
BMP
PT = 11-13
INR= ~1
aPTT = 22-35
type and screen
EKG
chest x-ray
pregnancy test
pre operative teaching
explain what tests may be done
dietary restriction- npo requirements
what families should expect
pre op assessing
ability to take care of self upon discharge
home safety- entrances, stairs, railings, showers
discharge need
pre op teaching to prevent post operative compliation include
preventing deep vein thrombosis
preventing surgical site infection
preventing raspatory complication
components the enhanced recovery after surgery (ERAS) protocol: preoperative
nutrition
habilitation
education and counseling
smoking and alcohol cessation
cardiopulmonary assessment
venous thrombo-prophylaxis
preoperative fasting and carbs rich loading
components the enhanced recovery after surgery (ERAS) protocol: intaoprative
surgical approach
anesthesia management
perioprative flid management
prevention of hypothermia
components the enhanced recovery after surgery (ERAS) protocol: postoperative
early mobilization
early removal of drains
early enteral feeding
perioperative pain control
postoperative nausea and vomiting
post operative glycemic control
member of the surgical team are
surgeon
PA/APRN
surgical/ scrub nurse and circulating nurse- they monitor patient sterile field iv vs output- urine blood and count what goes in and out sponges and equipment included
anesthesiologist or nurse anesthetist
scrub tech- create sterile field, preparing equipment,counting( sponges, sharps, etc)
surgical patients risks
anesthesia complications
patient unable to speak and protect themselves
risk for having incorrect procedure done
risk for infection
esnuring patient safty
consent and doctor explain the risk and benefits of surgery
presonal belongings get sent home or lock up somewhere
the chart is checked to be certain the correct site is listed
the site is marked by the surgon and rechecked by two nurses
types of anesthsia
general
regional
local anesthisa
moderate sedation
general anesthesia may require and may cause
advance airway
produces CNS depression, amnesia, and unconsciousness with loss of muscle tone and reflexes
intra-oprative period begins when
patient enter OR and ends when he leave
intra-operative period important points
check equipment prior to surgery to ensure that equipment is functioning properly
lock bed and surgical table
anesthesia: continouisly check vital on monitor
position patient as required
sterility: prevent infection by maintaining sterile technique
intraoperative nursing diagnoses
risk for wrong site procedure
risk for injury
risk for imbalanced body temperature: hypo or hyperthermia
risk for fluid volume deficit
post op period you must check
did patent regain consciousness
is airway patent
is patient oriented
are vs stable
can patient move extermities
is dressing dry and intact
postoperative nursing diagnoses
impaired skin integrity
impaired gas exchange
risk for infection
risk for aspiration
risk for imbalance fluids and electrolytes
risk for deep vein therombosis
report or to pacu
surgical procedure and length
medication and last time pain med was given
IV fluids
blood loss
drains
urine/ catherter
incision/dressing/packing
concerns
unusual position that may affect patent
unsusual events in surgery
questions
general immediate post op assessment
level of cosciousness
airway
tempreture VS, pulse
pain
surgical site
overall skin intergrity
iv lines and other drains or tubes
nause/ patient comfort
I&O’s
MD orders
general post op nursing care
maintain: opioids, non opioids, PCA pump
close monitoring of VS: watch for S&S hemorrhage- low BP with increased pulse rate
must urinate within a certain time period after surgery or after catheter is removed
TCDB, IS, SCDs, early ambulation
post operative nursing care
nutrition
asess for nausea and obtain order for antemetics and administer prn
education and teaching
encorage to perform IS, TCDB, foot wiggles, early ambulation
prepare for dicharge if applicable
family involvement
