Preop Flashcards
Reasons for surgery
Diagnosis (biopsy)
Cure (removal of ruptured appendix)
Palliation (cutting a nerve root)
*doesn’t cure just enhances life
Cosmetic (burn repair, breast reconstruction)
May be emergency/urgent or elective
Settings for surgery
Ambulatory surgery
Impatient surgery
Ambulatory surgery
aka (same day/outpatient)
Stable
Pt evaluated in office prior to procedure, gets medical clearance from PCP as needed
Inpatient surgery
May be planned admission
May be emergent or based on something found during admission
Perioperative nursing care
Preop: decision to do surgery until OR
Intraop: OR until PACU
Postoperative: Pacu until meeting w/ provider (last visit)
Pre op assessment***
Identify risk
Establish baseline for comparison
Including:
Health history
ROS
Head to Toe Exam
Health History ***
-Allergies and intolerances
-Past surgeries
-Women: LMP
-FH: malignant hyperthermia, Heart disease, or with anesthesia
-Medication list : all perscription, OTC, and herbal meds
*HTN and DM meds can interfere with anesthesia
-Substance abuse
*smoking, ETOH
Dentition: dentures or dental abcess
Why should we repost sulfa allergies ASAP?***
Some local anesthetics contain preservatives with bisulfate
What meds should you look out for in surgery ***
HTN
DM meds
Long term anticoagulants (warfarin) needs to be held for a certain time before surgery depending on the type
Asprin
Herbal meds
What herb meds should you hold and why ***
Garlic, Vit E, Gingko, fish oil: increase risk of bleeding
Kava, valerian: increase risk of sedation
Astragalus, ginseng: increase BP
Problem with piercings in surgery
Can cause arch with a spark and cause a fire
What to look out for in arthritis pts
Position in OR
DM risk in surgery ***
Hypoglycemia:
-delayed wound healing
-infection
Physical exam ***
VS, Glucose, Ht/Wt
Head to toe
What are some things you would report to the HCP?
VS
Labs
Anticoagulant use
H/o Issues with anesthesia
Psychological assessment
Identify gaps of knowledge and fear
Record relevant cultural beliefs
Common fears
Support hope
RBC
men: 4.3-5.7
Women: 3.8-5.1
Hgb
Men: 13-18
Women: 12-16
Hct
Men: 42-52%
Women: 37-47%
WBC
4,000-11,000
Platelets
150,000-400,000
Albumin
3.5-5
Sodium
135-145
Potassium
3.5-5
Glucose
70-110
Calcium
8.5-10.5
BUN
8-20
Creatinine
0.6-1.2
Preop testing/labs ***
CBC: wbc, hgb, hct, plt
Electrolytes, renal, liver function
HCG
UA
Type and cross match: for blood
Coags: PT/PTT, INR
EKG
CXR
PFT
ABG
Informed consent ***
Must be signed and surgeon/anesthesiologist must discuss:
-procedure/risk
-benefits and alternative treatments
Must get consent voluntarily and pt should show clear understanding before any sedating meds
Nurse should advocate for pt
surgeons responsibility
Situations where you can not get consent is***
Minor, mental incompetent, unconscious
Get emergency censent: document well the need for intervention (may have to fill out an incident report)
Preop teaching ***
-abdominal splinting
-plan for main management/ report pain
-deep breathing/ coughing
-early ambulation
-ROM exercises
-no driving postop (ambulatory surgery)
-what youll see/hear/smell
-drains/equipment theyll see postop
What complications are we trying to prevent with preop teaching ***
Bloodclots
Sepsis
Allergic reactions
Adverse reactions
Atelectasis
Preop meds
Classes to know ***
Antibiotics: start one hour before incisions
Beta blockers: reduce postop cardiac dysrhythmias
Antidiabetics (insulin): for blood surgar
Preop meds
Know drug names ***
Benzodiazapines: midazolam (relax them)
Opioids: fentanyl, morphine (relax them)
Anticholinergics: scopolamine (nausea)
Antiemetic: ondansetron (nausea)
Preop checklist ***
Signed infromed consent
ID band on/allergy bands
Site marked: done by pt with physician
Skin prep/hair removal
NPO
Chart ready
Personal items removed/labeled
Preop med given at bedside as ordered
Transport pt to OR
Chart with you, checklist complete
SBAR communicated to OR staff
Direct family to waiting room
Considerations for older adults
Discuss advanced directives
Leave glasses/hearing aids in until pt is under anesthesia
May have fear/anxiety not making it home
Increased risk of anesthesia/surgery
Fluid balance
