Prei Op Flashcards
Exam 1
1
Q
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
A
preoperative
2
Q
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
A
intraoperative
3
Q
after surgery - occurs until pt is discharged from care of surgeon
monitors the patient following surgery, assesses complications, and provides teaching
A
postoperative
4
Q
Determine the origin of the presenting symptoms and extent of a disease process ie: Breast Biopsy
A
diagnostic
5
Q
to repair or removal of diseased organ or _____ normal physiological functioning ie: amputation of GREAT toe or removal of gallbladder
A
curative, restore
6
Q
_________ surgery decreases the spread of the disease process to prolong life or to alleviate pain. ie: partial tumor removal
A
palliative
7
Q
Correct a disease process or improve _______ appearance ____accident ie: rhinoplasty (hit in nose)
A
reconstructive, cosmetic, after
8
Q
Improve cosmetic appearance ie: Face lifts, Breast Implants, Collagen Lips
A
cosmetic
9
Q
_____________ remove disease tissue or organ and replace with ________ tissue ie: a few are kidney, heart, eyes, large bone
A
transplant, functioning
10
Q
Diagnostic
Curative
Palliative
Reconstructive
Cosmetic
Transplant
Emergent
Urgent
Elective
Inpatient
Outpatient
A
types of surgeries
11
Q
_______ surgery requiring immediate intervention to sustain life. Ie: gun shot, stabbing appendix
A
emergent, emergency
12
Q
________ surgery dictates the necessity to maintain health situations that are ____ life threatening. ie: bladder obstruction, intestinal obstruction
A
urgent, not
13
Q
__________ is usually performed at a ______ time with the client ie: Carpal tunnel, breast biopsies.
A
elective, convenient time
14
Q
Client that has been in hospital prior to surgery, and begins recovery as inpatient ____ surgery.
A
inpatient, after
15
Q
what are the three categories of surgical produres based on degree of urgency
A
elective, urgent, and emergency
16
Q
Client enters hospital or free standing outpatient center has surgery and is discharged _______ after ______ and stable from Anesthesia and the surgical procedure.
A
Outpatient, home after recovering
17
Q
what are the degrees of risk for surgery
A
major or minor
18
Q
minor surgeries are mostly _______
A
elective
19
Q
is usually brief, carries a low risk and results in few complications. ______ surgeries are mostly elective. e.i. Teeth extraction
A
Minor is low risk
20
Q
removal of major organs- requires hospitalization and may require specialized care e.i. removel or organ
A
Major: higher risk
21
Q
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.
A
health history
22
Q
testing is done when?
A
during pre-admission
23
Q
coping ability
anxiety level
support system
common fears
A
what are the psychosocial aspects of preop assessment?
24
Q
is a feeling of dread related to an identifiable source that the client validates. Grandparent died from Anesthesia
A
Common fears
25
do they have friends or family with them
support system
26
do they feel uneasy or a worry of the unknown
anxiety
27
how are they handling the upcoming surgery
coping ability
28
Patients who smoke are at _________ risk for ____________ complications due to decreased lung ciliary activity.
increased risk for anesthesia
29
how many weeks prior should a pt stop smoking?
4 to 8 weeks
30
why should a pt stop smoking before surgery?
reduce pulmonary issues and healing complication
31
Patients who ingest _________ or _____ _____ are at risk for adverse reactions to anesthetics and intraoperative medications
alcohol or illegal drugs
32
a pt will seize 48 to 72 hours after surgery if they are...
addicted to alcohol cuz they are having withdrawals
33
when should a pt d/c aspirin
7-10 days prior
34
when should herbal meds be d/c
2-3 weeks
35
a diabetic blood sugar may ____ during or shorty after surgery
drop
36
after surgery stress can cause an increase in blood surgar and ___ healing of the wounds
delay
37
the more involved the surgery....
the more involved the diagnostic testing
38
what is the purpose of preop assessment?
to determine the pt present health status and ability to tolerate the surgical procedure and anesthesia
39
separation of layers of incision wound
Dehiscence
40
an ________ would need surgical closure
Evisceration
41
protrusion of body organs through area where incision cam apart (with the abdomen the intestines may protrude)
total separation
Evisceration
42
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.
43
what are the different types of drainage?
serous
sanguineous
purulent
44
clear or slightly yellow (serum plasma of blood)
Serous
45
thick reddish, contains red blood cells and serum
Sanguineous
46
which drainage envoles an infection?
Purulent
47
result of infection, contains white blood cell, tissue debris, bacteria, thick, color varies with causative organisms
Purulent
48
what are the three tention of would healing?
Primary Intention
Secondary Intention
Tertiary Intention
49
not sutured, tissue heals by granulation process usually a large scar.
Tertiary Intention
50
wound is gaping, irregular granulation tissue fills in, some scaring
Secondary Intention
51
surgical wound pulled shut with sutures
incision edges are well-approximated
Primary Intention
52
drain is placed under your skin during surgery
hemovac
53
what should you document when empting drains?
amount, colot, consistency, and order
54
when should you notify the physician?
when there is a larger amount of drainage collected
55
is inserted to maintain patency of the duct and to promote bile passage, this is after a _____________
T-Tube, cholecystectomy
56
small Oval; drains include a reservoir that collects drainage
jackson-pratt
57
accordion; drains include a reservoir that collects drainage
hemovac
58
four w's post op
Wind: prevent respiratory complications
Wound: prevent infection
Water: monitor I & O
Walk: prevent thrombophlebitis
59
what is the the single most significant measure to prevent complications?
ambulation
60
Hemoglobin and Hematocrit client’s ability to tolerate blood loss involved with surgery
CBC
61
assess the immune system and healing potential
WBC
62
normal range for proper heart neuromuscular functioning
Fluid/Electrolytes Studies
63
___________ _________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)
64
_________ 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
65
general screening for diseases such as renal problems or diabetes
Urinalysis
66
blood transfusion this is where the clients donates their own blood ahead a time
AUTOLOGOUS
67
done if blood transfusion is anticipated
blood type & cross match
68
what are risk factors that increase w/ age?
gass exchage issues, kidney, liver, and orientation
69
what organs are used to ridding the body of anesthesia
kidney and liver
70
if a pt has trouble w ____________ they are at a higher risk of falls- reorient
orientation
71
what should you check before surgery?
orientation, so you have a baseline
72
what may affect the way that the pt tolerates anesthesia and pain meds?
use of drugs
73
who are responsible for obtaining informed consent?
surgeons
74
how is responsibe for verifying that consent was obtained before treatment
nurses
75
what is the purpose of consent?
states the extent of action documented
76
what must be signed before any preop meds are given?
consent
77
if the pt has more question what should the nurse do?
contact the surgeon
78
what can the nurse do when it comes to consent?
they can witness the pt signing it
79
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)
80
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
81
NPO?
Nothing by mouth, decrease the likelihood of vomiting and decrease the risk of aspiration
82
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
83
what are meds that are held?
Prescription anticoagulants,
Oral diabetics, insulin dose may be changed
84
Aspirin (in many versions)
non-steroidal anti-inflammatory (NSAIDs) (in many versions)
Vitamin E
garlic
ginger
ginkgo biloba
Non prescription anticoagulants
85
what are meds that are given?
hypertension and anti-seizure meds
86
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.
87
Benzodiazepines - reduces anxiety, sedation, induces amnesic affect (push slowly) Monitor respiratory. depression, hypotension
give- versed
88
Narcotic/Opiate – use to supplement general anesthesia, short-acting analgesic during perioperative periods. (ANALGESIC reduce pain) (push slowly)
give - fentanyl
89
H2 recepter – Reduces gastric acid volume and concentration (hanging at a high port)
given - tagamet
90
Antiemetics - Gastric empty
given - reglan
91
Anticholinergics - reduces respiratory secretions, decrease risk of aspiration, decreases vomiting (used more in larger cases)
given - robinul
92
antiinfective, antibiotic – used prophylaxis in clients having surgery assoc. with high risk for surgery
given - ancef
93
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)
94
A _____ ______is called by any member of the surgical team, but usually by a specifically designated person, e.g. the ________ nurse.
"time out", circulation
95
what is an awake time out?
when pt participates in the verification process e.g. surgical site and procedure
96
During the "time out", all other activities are __________ to an extent which does not compromise patient safety.
suspended
97
The "time out" must be repeated ____________ for every _______ procedure performed on the same patient.
intraoperatively, additional
98
RN leadership role. Protects the patients’ safety and health. Monitors actions of the team. Verifies consent, coordinates team. Monitors aseptic practices.
Circulating nurse
99
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.
100
what are the three phases of anesthesia?
Induction
Maintenance
Emergence
101
tracheal intubation for airway patency
induction phases
102
positioned, surgery performed
Maintenance phases
103
anesthesia reversed; extubation
Emergence
104
general anesthesia?
Given inhalation and intravenous
CNS depressed:
Risk for Cardiac and respiratory problems
105
is a type of local, it’s done with a topical, cream or spray applied to the skin that blocks the nerve impulse.
Regional
106
lidocaine is used to depresses the nerve sensation (breast Biopsy, skin BX)
local
107
injected to produce a lack of sensation over a certain area, ( wrist surgery)
Nerve block
108
injected in the epidural space this can be used during abdomen or extremity surgeries ie: Maternity
Epidural block
109
local anesthetic is injected in the subarachnoid space – lower abdomen, perineum, and lower extremities ie: Hip fractures
spinal
110
what age group should you be aware of when it comes to leakage of CSF?
elderly
111
where does the an epidural go?
epidural space rather than the subarachnoid space that the spinal goes in
112
why does epidural require more medication?
because it doesn’t have direct contact with spinal cord or nerve roots.
113
where does spinal anesthesia go?
into subarachnoid space at L4-L5
114
what occurs when the anesthesia goes too high?
it will paralyze the respiratory muscles and will required mechanical ventilation until it wears off
115
which is the drug of choice for induction of anesthesia or for conscious sedation?
propofol
116
Rapid induction, rapid return to consciousness, minimum residual effects
Lack of memory of the surgical procedure
Decreased nausea and vomiting postop
propofol
117
Reduce anxiety preoperative
Produce mild sedation (unconsciousness) with little‑to ‑moderate respiratory depression with careful titration
promote amnesia
versed (midazolam)
118
what kind of does are required for elderly?
lower doeses
119
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.
120
what are examples of possible intra op complications?
N/V
Anaphylaxis
Hypoxia
Hypothermia
Malignant hyperthermia
Disseminated Intravascular Coagulation
121
what should you have available when pt is gagging?
turned on their side, suction used to remove saliva and gastric contents.
122
what would a pt be given in order to decrease the incidence of pneumonia?
an antacid to decrease the acidity in gastric contents
123
what kind of reaction may occur because of meds given in the OR
anaphylaxis - may be an immediate or delayed reaction
124
glucose metabolism is reduced and temp may fall causing metabolic acidosis
hypothermia - when the core body temp is below 98 degrees
125
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.
126
Rare inherited muscle disorder chemically induced by anesthetics.
Malignant hyperthermia
127
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
128
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
129
involves hypercoagulation of the blood, with consumption of clotting factors and the development of microthrombi
Disseminated intravascular coagulation
130
widespread, with clots forming where they are not needed
Microthrombi formation
131
Microthrombi formation ses up (consumes) many of the available platelets and clotting factors, a condition known as...
disseminated intravascular coagulation (DIC)
132
what are s/s of disseminated intravascular coagulation (DIC)?
bleeding from puncture sites, gums
133
how do you treat disseminated intravascular coagulation (DIC)?
Treatment packed cells, fibrinogen, plasma, whole blood
134
what can occur when you transfer unconscious pt?
you can injure extremities
135
what is the first thing you want to note post op?
resp pattern and changes
136
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
137
when would you need to get a catheterization for a ot post op?
7 or 8 hours and or when the bladder is palpable
138
what can a pt not do after surgery?
pt will not have anything to eat and they will have clear liquids and advance diets
139
________ may be a reaction to residual anesthesia or may be due to blood loss, position, or other medications
hypotension
140
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
141
___________ _____ ____________ 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
142
pallor, cool moist skin, rapid breathing, cyanosis, rapid weak thready pulse, narrowing pulse pressure, ___ blood pressure, concentrated urine.
shock, low
143
s/s of Deep Venous Thrombosis (DVT)
Client has pain, edema usually in one leg
144
intervention for dvt?
Bed rest
Contact Physician immediately
145
prevention for dvt
Ted hose use intermittent devices ie: external pneumatic compression machine (SCDS or SCUDS)
Early ambulation
Adequate hydration
146
DVT dislodges, moves, and lodges in pulmonary circulation
Pulmonary Embolism
147
s/s of pulmonary embolism
Client has chest pain, dyspnea, tachycardia
148
intervention for pulmonary embolism
bed rest, contact physician immediately
149
prevention for pulmonary embolism?
Prevention includes adequately treating DVT
150
_____________ 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
151
cough sputum production and low-grade fever, may be severe and cause dyspnea, tachycardia, tachypnea, pleural pain and central cyanosis.
s/s of atelectasis
152
cough and deep breathe, instruct client to use incentive spirometry splinted cough
s/s of prevention
153
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
154
musle relaxed, when pt supine then lower jaw and tongue fall backward and the air passges become obstructed >>>>> 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
155
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
156
who is at a high risk for atelectasis?
postop pt
157
Causes include bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspiration.
what does atelectasis cause?
158
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?
159
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
160
_______pain control Allows the client to participate in recovery and avoid _________
Adequate, complications
161
1. Use a pain scale administer and evaluate med effectiveness
2. Obtain alternate meds or routes if pain is ineffective
3. Teach client how to splint incision with movement
4. Ways to changing position that lessen pull on incision
Adequate Pain Control
