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XIO > Preoperative care > Flashcards

Preoperative care Flashcards

1
Q

Preoperative Phase:

A

Assessment; Review of each system and potential complications; medication reconciliation; preoperative teaching; preoperative checklist/consenting (could be 10 min or 3-4 months)

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2
Q

Intraoperative Phase: (nurse intra-operating room)

A

Intraoperative Phase: Role of the scrub nurse and circulating nurse; anesthetics

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3
Q

Postoperative Phase: (what could go wrong?)

A

Postoperative Phase: Immediate postoperative assessment priorities; potential complications; interventions to prevent complications;discharge planning

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4
Q

surgical setting

A

Ambulatory/Outpatient Surgery - just a few hours

Inpatient - hospitalized

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5
Q

outpatient preferred bc

A

infection.

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6
Q

23 hour hospital stay

A

must be discharged on 23rd hour to avoid charges

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7
Q

Surgical procedures can be classified By (PUR said the procedure)

A

By purpose: e.g., palliation (to make comfortable)

By degree of urgency: e.g., elective vs. emergenic (life or limb)
By degree of risk (degree of risk assigned by anesthesialogist)

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8
Q

John risk for surgery

A

high risk - smoking, etc.

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9
Q

preop (teach, plan and prep in the preop)

A

teaching, planning, prepping for sugery

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10
Q

preop assessment

A

Psychosocial - John has anxiety.

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11
Q

assessment

A

Past Health History
Past diagnoses -
current medical problems -
John - smoking, CAD,

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12
Q

preop assessment

A

Family health history

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13
Q

nervous system - preop

A

stroke, cognitive decline - can he follow instructions, mobility, parkinson’s (med admin should be a consideration - do you hold, or not?) mobility - paralysis -

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14
Q

cardiovascular - preop assessment

A

stents, coronary artery disease, what is his bp/HR. Could impact kidneys and stroke - at risk for clotting. Hes prob on anticoagulants

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15
Q

pulmonary assessment

A

smoking history (try to get him on nicotine patches) COPD, would likely want a chest x-ray, check for signs of infection, check oxygenation, does he have a history of cough, SOB, lung sounds

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16
Q

renal system

A

medications, diabetes, CAD, kidney function test, urinalysis, BUN/creatinine. Glucose in urine.

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17
Q

hepatic system (liver - glucose, bleeding, alcohol)

A

maybe consider he could have liver problems that impact glucose, bleeding times, liver failure, alcohol history. if pt drinks, ask what kind and how does he measure the drinks.

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18
Q

GI system

A

nothing by mouth, bowel prep, prob clear diet, (leak can cause peritonitis) worry about infection (diverticultis - looking for signs of acute infection, and potential for infection d/t diabetes)

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19
Q

muscle-skeletal

A

mobility issues during post-operative, padded table

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20
Q

nutrition

A

obesity (dehissence) and malnourishment (edema, skin breakdown)

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21
Q

endocrine

A

diabetes (wound healing, insulin managed appropriately, A1C, glucose, monitor glucose)

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22
Q

infection (CAP)

A

chronic infection, acute infection, and post op infection.

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23
Q

medications

A

reconcile meds, ask John’s wife to bring all of his meds.

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24
Q

Which meds are a problem?
Insulin 6 units Regular with 15unit NPH sub-cutaneous q am.
Aspirin 325mg PO q d.
Plavix 75 mg PO once daily
Ativan 0.5mg IVP on call to OR in AM.

A

get insulin order clarified, aspirin - bleeding, ativan - get consent before taking it, plavix - bleeding

we don’t use qd anymore***

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25
Q

allergies (LISBA)

A

latex, iodine, shellfish, bannana, avacado (all from same tree family)
antibiotics (and find out what the exact reaction is), tape allergies,

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26
Q

lab tests

A

CBC - Type & Cross - Urinalysis
- Pulse Oximetry - ECG - Xrays - pregnancy

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27
Q

Client Fears and Anxiety

A

not waking up, infection, colostomy, be awake during surgery, complications, pain post-operatively (this is why teaching is important), teach about pain management. encourage family to stay with him as long as possible. you can have the anesthesiologist speak with the patient also.

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28
Q

Geriatric Considerations

A

cognitive decline so have family there, decreased kidney functions, confusion, not following direction

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29
Q

NPO status - what to know? (just how long)

A

time frame

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30
Q

prescreening (prescreen for a walker)

A

usually done in dr. office. may need walker, etc.

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31
Q

Postoperative medications/prescriptions

A

very little time so teach during every interaciton

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32
Q

Postoperative transportation

A

arrange transport

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33
Q

Preoperative Phase
Teaching

A

d

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34
Q

coughing and splinting

A

preop if possible

35
Q

contraindications to coughing (coughing in my skull, eye and spine)

A

intercranial pressure, eye, spinal surgery

36
Q

turning

A

provide assistance

37
Q

leg exercises

A

prevent DVT and promote venous return

38
Q

pain management

A

what to expect, PCA (morphine pump)

39
Q

skin prep

A

showering the day before with chlorahexadine, advise John not get chloro on face and not put on lotion.

40
Q

shaving

A

don’t shave on surgical site - microabrations

41
Q

bowel prep

A

whatever comes out should be clear.

42
Q

Informed Consent

A

Only surgeon can consent pt - all you do is witness.
Physician ultimately responsible for obtaining consent
Nurse may be responsible for obtaining & witnessing pt signature
Nurse acts as pt advocate
Must be signed before preop meds given!
Emergencies? sometimes no time to consent - in this situation, it requires 2 surgeons signatures

43
Q

preop checklist checked…(check my tests, meds, and VS)

A

twice, Form that lists requirements to be ascertained before patient goes to OR
Documents diagnostic tests complete
Documents pre-op medication given
Documents VS

44
Q

intraoperative phase

A

Aseptic Technique (Surgical Asepsis)
Goal is to minimize contamination of wound and prevent post-op infection - NEED to review surgical technique in book

45
Q

universal protocol

A

Conduct a pre-procedure verification process
Mark the procedure site

Perform a “Time Out”

46
Q

operating room (intraoperative phase)

A

Role of Surgical Nurse
Scrub Nurse/Techćician
RN Circulator (problem-solver and advocate - make sure everything is ready, equipment)
Patient Advocacy
Nurse legally responsible for correct counts! (count - keep track of what is going to surgeon, ie sponges, to make sure that everything is accounted for)

47
Q

general anesthesia

A

intravenous Agents
Inhalation Agents
Adjuncts to General Anesthesia

48
Q

Postanesthetic Medications - used for what? (anxious after surgery)

A

Used to treat anxiety, pain, agitation
Watch for resp depression
Flumazenil used to reverse effects of benzodiazepines
Narcan used to reverse effects of opioids

49
Q

Surface or Topical

A

Examples include EMLA, Lidocaine

50
Q

Local Infiltration (infiltrate the nerves)

A

Injection into tissues
Regional Nerve Block
Injection into or around specific nerve or nerve group to promote anesthesia
Lymph node bx, cataract surgery

51
Q

Spinal Anesthesia (short spine ed)

A

shorter duration
Injection of local anesthetic into CSF found in subarachnoid space
Anesthesia can extend from xiphoid process to feet
Autonomic, sensory and motor block
For procedures involving lower abd, groin, perineum, lower extremity

52
Q

dont confuse a spinal headache with

A

a caffeine withdrawal headache

53
Q

Epidural Anesthesia (preg in thoracic and lumbar)

A

Injection of anesthetic into epidural space
Thoracic or Lumbar
Sensory pathways blocked, motor intact, unless high doses
Used intraop and postop continuous infusions
Commonly used in L&D, hip replacements, knee replacements, lower abd surgery

54
Q

Conscious Sedation (conscious of colonoscopy)

A

can respond and answer questions, but they are sedated. Pt. who had colonoscopy, ie morphine and versed.
Indications?
Nurses often responsible for administering meds & monitoring pt.

55
Q

Begins with admission to recovery

A

Verbal report by anesthesia & RN Circulator
General Information
Patient History
Intraoperative Management
Intraoperative Course.

56
Q

post op assessment (ABCs)

A

Adequacy of airway: Immediate priority assessment
Vital Signs
CV/peripheral perfusion Status:
LOC

57
Q

post operative -Presence of Protective Reflexes

A

Presence of Protective Reflexes: gag, cough
Activity: Able to move extremities, sensation

58
Q

Fluid Status:
post op assessment

A

I&O
IV infusion rate
Patency of tubing
Signs of dehydration/overload (catheter, fluid in lungs, edema, increase BP) defecit - decreases pulse, tenting, increased HR, decreased urine output

59
Q

Condition of Operative Site - post op

A

Dressing drainage: Amt, color, type
Mark
Inform – do not change. May reinforce
Patency & Character of drains
Catheter, tubes, JP, hemovac etc…
circle the stain and initial, see if it gets bigger over time.

60
Q

we dont change the first dressing,

A

usually it’s the surgeon.

61
Q

Discomfort

A

Pain - anesthesia and then pain meds

62
Q

Nausea and Vomiting

A

Nausea and Vomiting
Notify anesthesia
Position

63
Q

safety post op

A

side rails up and call light near

64
Q

Nursing Diagnoses
post op

A

Nursing Diagnoses
Ineffective Airway Clearance
Ineffective Breathing Pattern
Impaired Physical Mobility
Acute Pain
Impaired Tissue Integrity
Deficient/Excess Fluid Volume
Risk for Delayed Surgical Recovery

65
Q

Evaluation
Discharge Criteria: (report, VS, I&O)

A

Review Aldrete Score in Hinkle Figure 19-3
Report: Give report to floor
Documentation
- Usually flow sheet
- Document assessment,
communication, VS, I&O. Has pt. met
discharge criteria?

66
Q

Sequential Compression Device (SCDs)

A

to prevent DVTs

67
Q

Implementation (con’t)
NPO as ordered ice chips?

A

Ice - cold air, make sure it’s minimal

Monitor I&O
Maintain patency of drains
Up in chair as soon as possible
Ambulate as soon as possible most significant measure to prevent post-op complications
Advance diet as indicated

68
Q

potential complications (I’m shocked during surgery by the thumb, emboly and pneumonia)

A

Shock: Inadequate tissue perfusion
(First sign may be decreased urine output)

Hemorrhage

Thrombophlebitis

Pulmonary Embolus

Pneumonia

69
Q

Geriatric Considerations

A

May have more difficult and longer post-op recovery
Decreased resp function, cough: Risk of pneumonia
Decreased renal perfusion: Can’t compensate for CV changes
Under treatment of pain

70
Q

discharge teaching

A

Appropriate Referrals: i.e. Home Health Nurse
Follow-up appts
Supplies
Documentation

71
Q

degree of risk assigned by…

A

anesthesialogist

72
Q

preop checklist (VJ DICA on the checklist)

A

Documents safety data
ID band in place; 2 identifiers
Jewelry removed
Last void
Dentures removed
Informed consent verified
Patient Allergies

73
Q

surgical asepsis

A

can’t touch any object that isn’t sterile

74
Q

medical asepsis

A

contaminated if they are suspected to have pathogens - but can touch other objects

75
Q

shellfish (red orange fish)

A

iodine

76
Q

latex

A

avacado bannana

77
Q

asprin

A

ibprofen

78
Q

checklist checked twice

A

pre-op and intraop

79
Q

if spinal headache,

A

lay patient down

80
Q

who gives post op report?

A

anestheseologist bc they carried out all of the interventions. can be supplemented by nurse.

81
Q

post op - looking for what?

A

quick check to see if pt is breathing, talking if possible. nail beds, vital signs, mucus membranes, loc,

82
Q

post op spinal surgery - what do pt needs to do before discharge?

A

move extremities and sensation

83
Q

dehydration and fluid overload are

A

a possibility during surgery.

XIO (372 decks)

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