Prei Op Flashcards
Exam 1
before surgery - decisions are made in this stage until moving to the surgical suite; can be days before; labs/xrays are completed in this time
assesses for various conditions and risk factors, and prepares the patient for surgery
preoperative
during surgery - occurs when pt is wheeled back to surgery until pt is in post op
preventing patient injury and complications and protecting the patient’s privacy and dignity
intraoperative
after surgery - occurs until pt is discharged from care of surgeon
monitors the patient following surgery, assesses complications, and provides teaching
postoperative
Determine the origin of the presenting symptoms and extent of a disease process ie: Breast Biopsy
diagnostic
to repair or removal of diseased organ or _____ normal physiological functioning ie: amputation of GREAT toe or removal of gallbladder
curative, restore
_________ surgery decreases the spread of the disease process to prolong life or to alleviate pain. ie: partial tumor removal
palliative
Correct a disease process or improve _______ appearance ____accident ie: rhinoplasty (hit in nose)
reconstructive, cosmetic, after
Improve cosmetic appearance ie: Face lifts, Breast Implants, Collagen Lips
cosmetic
_____________ remove disease tissue or organ and replace with ________ tissue ie: a few are kidney, heart, eyes, large bone
transplant, functioning
Diagnostic
Curative
Palliative
Reconstructive
Cosmetic
Transplant
Emergent
Urgent
Elective
Inpatient
Outpatient
types of surgeries
_______ surgery requiring immediate intervention to sustain life. Ie: gun shot, stabbing appendix
emergent, emergency
________ surgery dictates the necessity to maintain health situations that are ____ life threatening. ie: bladder obstruction, intestinal obstruction
urgent, not
__________ is usually performed at a ______ time with the client ie: Carpal tunnel, breast biopsies.
elective, convenient time
Client that has been in hospital prior to surgery, and begins recovery as inpatient ____ surgery.
inpatient, after
what are the three categories of surgical produres based on degree of urgency
elective, urgent, and emergency
Client enters hospital or free standing outpatient center has surgery and is discharged _______ after ______ and stable from Anesthesia and the surgical procedure.
Outpatient, home after recovering
what are the degrees of risk for surgery
major or minor
minor surgeries are mostly _______
elective
is usually brief, carries a low risk and results in few complications. ______ surgeries are mostly elective. e.i. Teeth extraction
Minor is low risk
removal of major organs- requires hospitalization and may require specialized care e.i. removel or organ
Major: higher risk
provides pertinent information relative to factors that can increase the client’s risk or influence the expected surgical outcomes.
ie: medical HX, medications, allergies, age-related factors, social, cultural, spiritual concerns and psychological status.
health history
testing is done when?
during pre-admission
coping ability
anxiety level
support system
common fears
what are the psychosocial aspects of preop assessment?
is a feeling of dread related to an identifiable source that the client validates. Grandparent died from Anesthesia
Common fears
do they have friends or family with them
support system
do they feel uneasy or a worry of the unknown
anxiety
how are they handling the upcoming surgery
coping ability
Patients who smoke are at _________ risk for ____________ complications due to decreased lung ciliary activity.
increased risk for anesthesia
how many weeks prior should a pt stop smoking?
4 to 8 weeks
why should a pt stop smoking before surgery?
reduce pulmonary issues and healing complication
Patients who ingest _________ or _____ _____ are at risk for adverse reactions to anesthetics and intraoperative medications
alcohol or illegal drugs
a pt will seize 48 to 72 hours after surgery if they are…
addicted to alcohol cuz they are having withdrawals
when should a pt d/c aspirin
7-10 days prior
when should herbal meds be d/c
2-3 weeks
a diabetic blood sugar may ____ during or shorty after surgery
drop
after surgery stress can cause an increase in blood surgar and ___ healing of the wounds
delay
the more involved the surgery….
the more involved the diagnostic testing
what is the purpose of preop assessment?
to determine the pt present health status and ability to tolerate the surgical procedure and anesthesia
separation of layers of incision wound
Dehiscence
an ________ would need surgical closure
Evisceration
protrusion of body organs through area where incision cam apart (with the abdomen the intestines may protrude)
total separation
Evisceration
what is the intervention you would need to preform for evisceration?
An intervention would be to cover with sterile dressing soaked in sterile saline then call Dr. for surgical closure.
what are the different types of drainage?
serous
sanguineous
purulent
clear or slightly yellow (serum plasma of blood)
Serous
thick reddish, contains red blood cells and serum
Sanguineous
which drainage envoles an infection?
Purulent
result of infection, contains white blood cell, tissue debris, bacteria, thick, color varies with causative organisms
Purulent
what are the three tention of would healing?
Primary Intention
Secondary Intention
Tertiary Intention
not sutured, tissue heals by granulation process usually a large scar.
Tertiary Intention
wound is gaping, irregular granulation tissue fills in, some scaring
Secondary Intention
surgical wound pulled shut with sutures
incision edges are well-approximated
Primary Intention
drain is placed under your skin during surgery
hemovac
what should you document when empting drains?
amount, colot, consistency, and order
when should you notify the physician?
when there is a larger amount of drainage collected
is inserted to maintain patency of the duct and to promote bile passage, this is after a _____________
T-Tube, cholecystectomy
small Oval; drains include a reservoir that collects drainage
jackson-pratt
accordion; drains include a reservoir that collects drainage
hemovac
four w’s post op
Wind: prevent respiratory complications
Wound: prevent infection
Water: monitor I & O
Walk: prevent thrombophlebitis
what is the the single most significant measure to prevent complications?
ambulation
Hemoglobin and Hematocrit client’s ability to tolerate blood loss involved with surgery
CBC
assess the immune system and healing potential
WBC
normal range for proper heart neuromuscular functioning
Fluid/Electrolytes Studies
___________ _________ability to clot normally post-surgery
____________ __________ ____ evaluates the extrinsic system
_______ _________ ___________ ____ assesses the intrinsic system
which both id the clotting mechanism
Coagulation Studies
Prothrombin Time (PT)
Partial Prothrombin Time (PTT)
_________ and ________________ gives basic info regarding the heart and lungs, determine whether cardiac and respiratory systems are healthy for _______ and ___________ ___________
X-ray & Electrocardiogram, surgery, general anesthesia
general screening for diseases such as renal problems or diabetes
Urinalysis
blood transfusion this is where the clients donates their own blood ahead a time
AUTOLOGOUS
done if blood transfusion is anticipated
blood type & cross match
what are risk factors that increase w/ age?
gass exchage issues, kidney, liver, and orientation
what organs are used to ridding the body of anesthesia
kidney and liver
if a pt has trouble w ____________ they are at a higher risk of falls- reorient
orientation
what should you check before surgery?
orientation, so you have a baseline
what may affect the way that the pt tolerates anesthesia and pain meds?
use of drugs
who are responsible for obtaining informed consent?
surgeons
how is responsibe for verifying that consent was obtained before treatment
nurses
what is the purpose of consent?
states the extent of action documented
what must be signed before any preop meds are given?
consent
if the pt has more question what should the nurse do?
contact the surgeon
what can the nurse do when it comes to consent?
they can witness the pt signing it
the consent form must have…
Are the clients full name, Doctor performing the procedure, the purpose, risks, and last the clients signature( Black Ink only)
If the client reverses a decision and decides against the surgery, the NURSE is __________ to inform the surgeon in order to prevent unwanted ___
OBLIGATED, TXT
NPO?
Nothing by mouth, decrease the likelihood of vomiting and decrease the risk of aspiration
You will also want to teach client about operative course. What will they expect when they wake up. Teach about pain relief, deep breathing, incentive spirometry, when they will get out of bed…
do this before the are wheeled to OR
what are meds that are held?
Prescription anticoagulants,
Oral diabetics, insulin dose may be changed
Aspirin (in many versions)
non-steroidal anti-inflammatory (NSAIDs) (in many versions)
Vitamin E
garlic
ginger
ginkgo biloba
Non prescription anticoagulants
what are meds that are given?
hypertension and anti-seizure meds
what kind of meds are given?
sedate, reduce anxiety, reduce gastric acidity, decrease N/V, reduce incidence of aspiration by drying respiratory secretions, or prevent incidence of infection.
Benzodiazepines - reduces anxiety, sedation, induces amnesic affect (push slowly) Monitor respiratory. depression, hypotension
give- versed
Narcotic/Opiate – use to supplement general anesthesia, short-acting analgesic during perioperative periods. (ANALGESIC reduce pain) (push slowly)
give - fentanyl
H2 recepter – Reduces gastric acid volume and concentration (hanging at a high port)
given - tagamet
Antiemetics - Gastric empty
given - reglan
Anticholinergics - reduces respiratory secretions, decrease risk of aspiration, decreases vomiting (used more in larger cases)
given - robinul
antiinfective, antibiotic – used prophylaxis in clients having surgery assoc. with high risk for surgery
given - ancef
example of an pre op check list?
Client has ID band, and allergy bracelet
Informed Consent is signed and witnessed
Diagnostic tests results are at front of chart
H & P with Hgt & Wgt
Pre-Op intervention completed
Pre-Op meds administered
V/S taken right before exiting Pre-Op
Client voided (can you get client up to void)
Family members present say see you later.
Check policy & procedure regarding dentures, glasses, hearing aids ( give to spouse, friend)
Proper attire – jewelry off, nail polish, make-up (also according to policy & procedure)
A _____ ______is called by any member of the surgical team, but usually by a specifically designated person, e.g. the ________ nurse.
“time out”, circulation
what is an awake time out?
when pt participates in the verification process e.g. surgical site and procedure
During the “time out”, all other activities are __________ to an extent which does not compromise patient safety.
suspended
The “time out” must be repeated ____________ for every _______ procedure performed on the same patient.
intraoperatively, additional
RN leadership role. Protects the patients’ safety and health. Monitors actions of the team. Verifies consent, coordinates team. Monitors aseptic practices.
Circulating nurse
Sets up sterile tables and assists during the procedure by handing instruments, counts all needles, sponges and instruments at end of surgery.
Scrub nurse: rn, lpn, or scrub assistant.
what are the three phases of anesthesia?
Induction
Maintenance
Emergence
tracheal intubation for airway patency
induction phases
positioned, surgery performed
Maintenance phases
anesthesia reversed; extubation
Emergence
general anesthesia?
Given inhalation and intravenous
CNS depressed:
Risk for Cardiac and respiratory problems
is a type of local, it’s done with a topical, cream or spray applied to the skin that blocks the nerve impulse.
Regional
lidocaine is used to depresses the nerve sensation (breast Biopsy, skin BX)
local
injected to produce a lack of sensation over a certain area, ( wrist surgery)
Nerve block
injected in the epidural space this can be used during abdomen or extremity surgeries ie: Maternity
Epidural block
local anesthetic is injected in the subarachnoid space – lower abdomen, perineum, and lower extremities ie: Hip fractures
spinal
what age group should you be aware of when it comes to leakage of CSF?
elderly
where does the an epidural go?
epidural space rather than the subarachnoid space that the spinal goes in
why does epidural require more medication?
because it doesn’t have direct contact with spinal cord or nerve roots.
where does spinal anesthesia go?
into subarachnoid space at L4-L5
what occurs when the anesthesia goes too high?
it will paralyze the respiratory muscles and will required mechanical ventilation until it wears off
which is the drug of choice for induction of anesthesia or for conscious sedation?
propofol
Rapid induction, rapid return to consciousness, minimum residual effects
Lack of memory of the surgical procedure
Decreased nausea and vomiting postop
propofol
Reduce anxiety preoperative
Produce mild sedation (unconsciousness) with little‑to ‑moderate respiratory depression with careful titration
promote amnesia
versed (midazolam)
what kind of does are required for elderly?
lower doeses
what kind of risks do elderly have and why?
They are at higher risk with surgery due to the change in their metabolism and tolerance for anesthesia. They are at higher risk for complications after as well.
what are examples of possible intra op complications?
N/V
Anaphylaxis
Hypoxia
Hypothermia
Malignant hyperthermia
Disseminated Intravascular Coagulation
what should you have available when pt is gagging?
turned on their side, suction used to remove saliva and gastric contents.
what would a pt be given in order to decrease the incidence of pneumonia?
an antacid to decrease the acidity in gastric contents
what kind of reaction may occur because of meds given in the OR
anaphylaxis - may be an immediate or delayed reaction
glucose metabolism is reduced and temp may fall causing metabolic acidosis
hypothermia - when the core body temp is below 98 degrees
why may hypothermia occur?
May occur as a result of infusion of cold fluids, inhalation of cold gases, open body wounds, advanced age, and meds.
Interventions: warm IV fluids, dry.
Rare inherited muscle disorder chemically induced by anesthetics.
Malignant hyperthermia
who is at risk for malignant hyperthermia?
strong bulky muscles, history of muscle cramps and weakness, unexplained temp elevations, and unexplained death of a family member during surgery that was accompanied by elevated temp
what are s/s of malignant htperthermia?
tachycardia (over 150) is often the first sign. Hypotension, oliguria, and later cardiac arrest. Rising temp is usually a late sign that occurs rapidly
involves hypercoagulation of the blood, with consumption of clotting factors and the development of microthrombi
Disseminated intravascular coagulation
widespread, with clots forming where they are not needed
Microthrombi formation
Microthrombi formation ses up (consumes) many of the available platelets and clotting factors, a condition known as…
disseminated intravascular coagulation (DIC)
what are s/s of disseminated intravascular coagulation (DIC)?
bleeding from puncture sites, gums
how do you treat disseminated intravascular coagulation (DIC)?
Treatment packed cells, fibrinogen, plasma, whole blood
what can occur when you transfer unconscious pt?
you can injure extremities
what is the first thing you want to note post op?
resp pattern and changes
monitor respirations frequently for residual effects of anesthesia and pain medication (resp. rate and depth as well as pulse ox and skin color)
resp paralysis
when would you need to get a catheterization for a ot post op?
7 or 8 hours and or when the bladder is palpable
what can a pt not do after surgery?
pt will not have anything to eat and they will have clear liquids and advance diets
________ may be a reaction to residual anesthesia or may be due to blood loss, position, or other medications
hypotension
what does a pacu nurse after being given report?
will monitor patency airway, vital signs, surgical site, coming off anesthesia, fluid status, pain control, other post operative orders ie: lab tests, IV fluids
___________ _____ ____________ may result from blood loss, hypoventilation, position changes, pooling of blood in extremities, or side effects of medication and anesthetics. Most common cause is _____ loss.
hypotension and shock, blood
pallor, cool moist skin, rapid breathing, cyanosis, rapid weak thready pulse, narrowing pulse pressure, ___ blood pressure, concentrated urine.
shock, low
s/s of Deep Venous Thrombosis (DVT)
Client has pain, edema usually in one leg
intervention for dvt?
Bed rest
Contact Physician immediately
prevention for dvt
Ted hose use intermittent devices ie: external pneumatic compression machine (SCDS or SCUDS)
Early ambulation
Adequate hydration
DVT dislodges, moves, and lodges in pulmonary circulation
Pulmonary Embolism
s/s of pulmonary embolism
Client has chest pain, dyspnea, tachycardia
intervention for pulmonary embolism
bed rest, contact physician immediately
prevention for pulmonary embolism?
Prevention includes adequately treating DVT
_____________ the closure or collapse of alveoli. Occurs frequently postop due to a __________ __________ __________ caused by anesthetic, pain medications and not taking deep breaths due to fear of pain.
Atelectasis, shallow breathing pattern
cough sputum production and low-grade fever, may be severe and cause dyspnea, tachycardia, tachypnea, pleural pain and central cyanosis.
s/s of atelectasis
cough and deep breathe, instruct client to use incentive spirometry splinted cough
s/s of prevention
when would a pt be at risk for hypoventilation?
Early in postop period PACU at risk for hypoxia due to hypoventilation and airway obstruction related to continued anesthetic effects
musle relaxed, when pt supine then lower jaw and tongue fall backward and the air passges become obstructed»_space;»> to fix tilt head back and push forward on the angle of the lower jaw (this pulls the tongue foward and opens the air passage)
hypoventilation
what should you help a pt do if they are have resp diffculty when you fear aspiration of vomit or excessive mucous?
turn to side or elevate hob
who is at a high risk for atelectasis?
postop pt
Causes include bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspiration.
what does atelectasis cause?
what do you assess upon arrival to med surg first?
Airway (patent?)
Breathing- Quality, pattern, rate, depth
Using accessory muscles?
Pulse ox?
Oxygen? Rate and device?
what do you assess upon arrival to med surg what else do you assess?
CV status: BP, pulse within patient’s baseline?
Peripheral pulses?
Heart rate/rhythm
Mental status:
How does it compare to prior to surgery?
Respond to verbal stimuli?
Temperature-
Near preop range?
IV fluids-
What is infusing? How much is remaining? What is rate needed? What rate is it set on?
Any tubes-
If there are they draining appropriately and what does the draining look like?
Surgical incision site-
How is it dressed? How much drainage on dressing?
Check under patient for further bleeding or drainage
_______pain control Allows the client to participate in recovery and avoid _________
Adequate, complications
- Use a pain scale administer and evaluate med effectiveness
- Obtain alternate meds or routes if pain is ineffective
- Teach client how to splint incision with movement
- Ways to changing position that lessen pull on incision
Adequate Pain Control
