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Acute and Chronic > Prei Op > Flashcards

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

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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

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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

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4
Q

Determine the origin of the presenting symptoms and extent of a disease process ie: Breast Biopsy

A

diagnostic

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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

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6
Q

_________ surgery decreases the spread of the disease process to prolong life or to alleviate pain. ie: partial tumor removal

A

palliative

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7
Q

Correct a disease process or improve _______ appearance ____accident ie: rhinoplasty (hit in nose)

A

reconstructive, cosmetic, after

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8
Q

Improve cosmetic appearance ie: Face lifts, Breast Implants, Collagen Lips

A

cosmetic

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9
Q

_____________ remove disease tissue or organ and replace with ________ tissue ie: a few are kidney, heart, eyes, large bone

A

transplant, functioning

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10
Q

Diagnostic
Curative
Palliative
Reconstructive
Cosmetic
Transplant

Emergent
Urgent
Elective
Inpatient
Outpatient

A

types of surgeries

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11
Q

_______ surgery requiring immediate intervention to sustain life. Ie: gun shot, stabbing appendix

A

emergent, emergency

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12
Q

________ surgery dictates the necessity to maintain health situations that are ____ life threatening. ie: bladder obstruction, intestinal obstruction

A

urgent, not

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13
Q

__________ is usually performed at a ______ time with the client ie: Carpal tunnel, breast biopsies.

A

elective, convenient time

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14
Q

Client that has been in hospital prior to surgery, and begins recovery as inpatient ____ surgery.

A

inpatient, after

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15
Q

what are the three categories of surgical produres based on degree of urgency

A

elective, urgent, and emergency

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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

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17
Q

what are the degrees of risk for surgery

A

major or minor

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18
Q

minor surgeries are mostly _______

A

elective

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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

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20
Q

removal of major organs- requires hospitalization and may require specialized care e.i. removel or organ

A

Major: higher risk

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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

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22
Q

testing is done when?

A

during pre-admission

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23
Q

coping ability
anxiety level
support system
common fears

A

what are the psychosocial aspects of preop assessment?

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24
Q

is a feeling of dread related to an identifiable source that the client validates. Grandparent died from Anesthesia

A

Common fears

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25
Q

do they have friends or family with them

A

support system

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26
Q

do they feel uneasy or a worry of the unknown

A

anxiety

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27
Q

how are they handling the upcoming surgery

A

coping ability

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28
Q

Patients who smoke are at _________ risk for ____________ complications due to decreased lung ciliary activity.

A

increased risk for anesthesia

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29
Q

how many weeks prior should a pt stop smoking?

A

4 to 8 weeks

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30
Q

why should a pt stop smoking before surgery?

A

reduce pulmonary issues and healing complication

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31
Q

Patients who ingest _________ or _____ _____ are at risk for adverse reactions to anesthetics and intraoperative medications

A

alcohol or illegal drugs

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32
Q

a pt will seize 48 to 72 hours after surgery if they are…

A

addicted to alcohol cuz they are having withdrawals

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33
Q

when should a pt d/c aspirin

A

7-10 days prior

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34
Q

when should herbal meds be d/c

A

2-3 weeks

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35
Q

a diabetic blood sugar may ____ during or shorty after surgery

A

drop

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36
Q

after surgery stress can cause an increase in blood surgar and ___ healing of the wounds

A

delay

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37
Q

the more involved the surgery….

A

the more involved the diagnostic testing

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38
Q

what is the purpose of preop assessment?

A

to determine the pt present health status and ability to tolerate the surgical procedure and anesthesia

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39
Q

separation of layers of incision wound

A

Dehiscence

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40
Q

an ________ would need surgical closure

A

Evisceration

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41
Q

protrusion of body organs through area where incision cam apart (with the abdomen the intestines may protrude)

total separation

A

Evisceration

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42
Q

what is the intervention you would need to preform for evisceration?

A

An intervention would be to cover with sterile dressing soaked in sterile saline then call Dr. for surgical closure.

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43
Q

what are the different types of drainage?

A

serous
sanguineous
purulent

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44
Q

clear or slightly yellow (serum plasma of blood)

A

Serous

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45
Q

thick reddish, contains red blood cells and serum

A

Sanguineous

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46
Q

which drainage envoles an infection?

A

Purulent

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47
Q

result of infection, contains white blood cell, tissue debris, bacteria, thick, color varies with causative organisms

A

Purulent

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48
Q

what are the three tention of would healing?

A

Primary Intention
Secondary Intention
Tertiary Intention

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49
Q

not sutured, tissue heals by granulation process usually a large scar.

A

Tertiary Intention

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50
Q

wound is gaping, irregular granulation tissue fills in, some scaring

A

Secondary Intention

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51
Q

surgical wound pulled shut with sutures
incision edges are well-approximated

A

Primary Intention

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52
Q

drain is placed under your skin during surgery

A

hemovac

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53
Q

what should you document when empting drains?

A

amount, colot, consistency, and order

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54
Q

when should you notify the physician?

A

when there is a larger amount of drainage collected

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55
Q

is inserted to maintain patency of the duct and to promote bile passage, this is after a _____________

A

T-Tube, cholecystectomy

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56
Q

small Oval; drains include a reservoir that collects drainage

A

jackson-pratt

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57
Q

accordion; drains include a reservoir that collects drainage

A

hemovac

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58
Q

four w’s post op

A

Wind: prevent respiratory complications
Wound: prevent infection
Water: monitor I & O
Walk: prevent thrombophlebitis

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59
Q

what is the the single most significant measure to prevent complications?

A

ambulation

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60
Q

Hemoglobin and Hematocrit client’s ability to tolerate blood loss involved with surgery

A

CBC

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61
Q

assess the immune system and healing potential

A

WBC

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62
Q

normal range for proper heart neuromuscular functioning

A

Fluid/Electrolytes Studies

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63
Q

___________ _________ability to clot normally post-surgery
____________ __________ ____ evaluates the extrinsic system
_______ _________ ___________ ____ assesses the intrinsic system
which both id the clotting mechanism

A

Coagulation Studies
Prothrombin Time (PT)
Partial Prothrombin Time (PTT)

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64
Q

_________ and ________________ gives basic info regarding the heart and lungs, determine whether cardiac and respiratory systems are healthy for _______ and ___________ ___________

A

X-ray & Electrocardiogram, surgery, general anesthesia

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65
Q

general screening for diseases such as renal problems or diabetes

A

Urinalysis

66
Q

blood transfusion this is where the clients donates their own blood ahead a time

A

AUTOLOGOUS

67
Q

done if blood transfusion is anticipated

A

blood type & cross match

68
Q

what are risk factors that increase w/ age?

A

gass exchage issues, kidney, liver, and orientation

69
Q

what organs are used to ridding the body of anesthesia

A

kidney and liver

70
Q

if a pt has trouble w ____________ they are at a higher risk of falls- reorient

A

orientation

71
Q

what should you check before surgery?

A

orientation, so you have a baseline

72
Q

what may affect the way that the pt tolerates anesthesia and pain meds?

A

use of drugs

73
Q

who are responsible for obtaining informed consent?

A

surgeons

74
Q

how is responsibe for verifying that consent was obtained before treatment

A

nurses

75
Q

what is the purpose of consent?

A

states the extent of action documented

76
Q

what must be signed before any preop meds are given?

A

consent

77
Q

if the pt has more question what should the nurse do?

A

contact the surgeon

78
Q

what can the nurse do when it comes to consent?

A

they can witness the pt signing it

79
Q

the consent form must have…

A

Are the clients full name, Doctor performing the procedure, the purpose, risks, and last the clients signature( Black Ink only)

80
Q

If the client reverses a decision and decides against the surgery, the NURSE is __________ to inform the surgeon in order to prevent unwanted ___

A

OBLIGATED, TXT

81
Q

NPO?

A

Nothing by mouth, decrease the likelihood of vomiting and decrease the risk of aspiration

82
Q

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…

A

do this before the are wheeled to OR

83
Q

what are meds that are held?

A

Prescription anticoagulants,
Oral diabetics, insulin dose may be changed

84
Q

Aspirin (in many versions)
non-steroidal anti-inflammatory (NSAIDs) (in many versions)
Vitamin E
garlic
ginger
ginkgo biloba

A

Non prescription anticoagulants

85
Q

what are meds that are given?

A

hypertension and anti-seizure meds

86
Q

what kind of meds are given?

A

sedate, reduce anxiety, reduce gastric acidity, decrease N/V, reduce incidence of aspiration by drying respiratory secretions, or prevent incidence of infection.

87
Q

Benzodiazepines - reduces anxiety, sedation, induces amnesic affect (push slowly) Monitor respiratory. depression, hypotension

A

give- versed

88
Q

Narcotic/Opiate – use to supplement general anesthesia, short-acting analgesic during perioperative periods. (ANALGESIC reduce pain) (push slowly)

A

give - fentanyl

89
Q

H2 recepter – Reduces gastric acid volume and concentration (hanging at a high port)

A

given - tagamet

90
Q

Antiemetics - Gastric empty

A

given - reglan

91
Q

Anticholinergics - reduces respiratory secretions, decrease risk of aspiration, decreases vomiting (used more in larger cases)

A

given - robinul

92
Q

antiinfective, antibiotic – used prophylaxis in clients having surgery assoc. with high risk for surgery

A

given - ancef

93
Q

example of an pre op check list?

A

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
Q

A _____ ______is called by any member of the surgical team, but usually by a specifically designated person, e.g. the ________ nurse.

A

“time out”, circulation

95
Q

what is an awake time out?

A

when pt participates in the verification process e.g. surgical site and procedure

96
Q

During the “time out”, all other activities are __________ to an extent which does not compromise patient safety.

A

suspended

97
Q

The “time out” must be repeated ____________ for every _______ procedure performed on the same patient.

A

intraoperatively, additional

98
Q

RN leadership role. Protects the patients’ safety and health. Monitors actions of the team. Verifies consent, coordinates team. Monitors aseptic practices.

A

Circulating nurse

99
Q

Sets up sterile tables and assists during the procedure by handing instruments, counts all needles, sponges and instruments at end of surgery.

A

Scrub nurse: rn, lpn, or scrub assistant.

100
Q

what are the three phases of anesthesia?

A

Induction
Maintenance
Emergence

101
Q

tracheal intubation for airway patency

A

induction phases

102
Q

positioned, surgery performed

A

Maintenance phases

103
Q

anesthesia reversed; extubation

A

Emergence

104
Q

general anesthesia?

A

Given inhalation and intravenous
CNS depressed:
Risk for Cardiac and respiratory problems

105
Q

is a type of local, it’s done with a topical, cream or spray applied to the skin that blocks the nerve impulse.

A

Regional

106
Q

lidocaine is used to depresses the nerve sensation (breast Biopsy, skin BX)

A

local

107
Q

injected to produce a lack of sensation over a certain area, ( wrist surgery)

A

Nerve block

108
Q

injected in the epidural space this can be used during abdomen or extremity surgeries ie: Maternity

A

Epidural block

109
Q

local anesthetic is injected in the subarachnoid space – lower abdomen, perineum, and lower extremities ie: Hip fractures

A

spinal

110
Q

what age group should you be aware of when it comes to leakage of CSF?

A

elderly

111
Q

where does the an epidural go?

A

epidural space rather than the subarachnoid space that the spinal goes in

112
Q

why does epidural require more medication?

A

because it doesn’t have direct contact with spinal cord or nerve roots.

113
Q

where does spinal anesthesia go?

A

into subarachnoid space at L4-L5

114
Q

what occurs when the anesthesia goes too high?

A

it will paralyze the respiratory muscles and will required mechanical ventilation until it wears off

115
Q

which is the drug of choice for induction of anesthesia or for conscious sedation?

A

propofol

116
Q

Rapid induction, rapid return to consciousness, minimum residual effects
Lack of memory of the surgical procedure
Decreased nausea and vomiting postop

A

propofol

117
Q

Reduce anxiety preoperative
Produce mild sedation (unconsciousness) with little‑to ‑moderate respiratory depression with careful titration
promote amnesia

A

versed (midazolam)

118
Q

what kind of does are required for elderly?

A

lower doeses

119
Q

what kind of risks do elderly have and why?

A

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
Q

what are examples of possible intra op complications?

A

N/V
Anaphylaxis
Hypoxia
Hypothermia
Malignant hyperthermia
Disseminated Intravascular Coagulation

121
Q

what should you have available when pt is gagging?

A

turned on their side, suction used to remove saliva and gastric contents.

122
Q

what would a pt be given in order to decrease the incidence of pneumonia?

A

an antacid to decrease the acidity in gastric contents

123
Q

what kind of reaction may occur because of meds given in the OR

A

anaphylaxis - may be an immediate or delayed reaction

124
Q

glucose metabolism is reduced and temp may fall causing metabolic acidosis

A

hypothermia - when the core body temp is below 98 degrees

125
Q

why may hypothermia occur?

A

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
Q

Rare inherited muscle disorder chemically induced by anesthetics.

A

Malignant hyperthermia

127
Q

who is at risk for malignant hyperthermia?

A

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
Q

what are s/s of malignant htperthermia?

A

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
Q

involves hypercoagulation of the blood, with consumption of clotting factors and the development of microthrombi

A

Disseminated intravascular coagulation

130
Q

widespread, with clots forming where they are not needed

A

Microthrombi formation

131
Q

Microthrombi formation ses up (consumes) many of the available platelets and clotting factors, a condition known as…

A

disseminated intravascular coagulation (DIC)

132
Q

what are s/s of disseminated intravascular coagulation (DIC)?

A

bleeding from puncture sites, gums

133
Q

how do you treat disseminated intravascular coagulation (DIC)?

A

Treatment packed cells, fibrinogen, plasma, whole blood

134
Q

what can occur when you transfer unconscious pt?

A

you can injure extremities

135
Q

what is the first thing you want to note post op?

A

resp pattern and changes

136
Q

monitor respirations frequently for residual effects of anesthesia and pain medication (resp. rate and depth as well as pulse ox and skin color)

A

resp paralysis

137
Q

when would you need to get a catheterization for a ot post op?

A

7 or 8 hours and or when the bladder is palpable

138
Q

what can a pt not do after surgery?

A

pt will not have anything to eat and they will have clear liquids and advance diets

139
Q

________ may be a reaction to residual anesthesia or may be due to blood loss, position, or other medications

A

hypotension

140
Q

what does a pacu nurse after being given report?

A

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
Q

___________ _____ ____________ 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.

A

hypotension and shock, blood

142
Q

pallor, cool moist skin, rapid breathing, cyanosis, rapid weak thready pulse, narrowing pulse pressure, ___ blood pressure, concentrated urine.

A

shock, low

143
Q

s/s of Deep Venous Thrombosis (DVT)

A

Client has pain, edema usually in one leg

144
Q

intervention for dvt?

A

Bed rest
Contact Physician immediately

145
Q

prevention for dvt

A

Ted hose use intermittent devices ie: external pneumatic compression machine (SCDS or SCUDS)
Early ambulation
Adequate hydration

146
Q

DVT dislodges, moves, and lodges in pulmonary circulation

A

Pulmonary Embolism

147
Q

s/s of pulmonary embolism

A

Client has chest pain, dyspnea, tachycardia

148
Q

intervention for pulmonary embolism

A

bed rest, contact physician immediately

149
Q

prevention for pulmonary embolism?

A

Prevention includes adequately treating DVT

150
Q

_____________ 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.

A

Atelectasis, shallow breathing pattern

151
Q

cough sputum production and low-grade fever, may be severe and cause dyspnea, tachycardia, tachypnea, pleural pain and central cyanosis.

A

s/s of atelectasis

152
Q

cough and deep breathe, instruct client to use incentive spirometry splinted cough

A

s/s of prevention

153
Q

when would a pt be at risk for hypoventilation?

A

Early in postop period PACU at risk for hypoxia due to hypoventilation and airway obstruction related to continued anesthetic effects

154
Q

musle relaxed, when pt supine then lower jaw and tongue fall backward and the air passges become obstructed&raquo_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)

A

hypoventilation

155
Q

what should you help a pt do if they are have resp diffculty when you fear aspiration of vomit or excessive mucous?

A

turn to side or elevate hob

156
Q

who is at a high risk for atelectasis?

A

postop pt

157
Q

Causes include bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspiration.

A

what does atelectasis cause?

158
Q

what do you assess upon arrival to med surg first?

A

Airway (patent?)
Breathing- Quality, pattern, rate, depth
Using accessory muscles?
Pulse ox?
Oxygen? Rate and device?

159
Q

what do you assess upon arrival to med surg what else do you assess?

A

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
Q

_______pain control Allows the client to participate in recovery and avoid _________

A

Adequate, complications

161
Q
  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
A

Adequate Pain Control

Acute and Chronic (15 decks)

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