Preoperative care Flashcards

Question

Pain management

Answer 1

Teach them what to expect

Answer 2

no time to get ready for surgery and get consent

Answer 3

Preoperative showering: at least one day before surgery with chlorhexidine. No lotion. Shaving: How do we reduce the risk of SSI ( surgical site infections)? surgical site infection. Don't shave on the surgical site because there might be micro-abrasions and that can be a port of entry. If shaving occurs it's going to be before surgery.

Answer 4

Go through bowel prep make sure they have no stool in thier GI

Answer 5

Informed Consent Physician ultimately responsible for obtaining consent Nurse may be responsible for obtaining & witnessing pt signature but not getting the consent itself. The consent has to be before taking drugs otherwise it is not valid. Nurse acts as pt advocate Must be signed before preop meds given! Emergencies? no time to get a consent. in this case, it takes 2 surgeons' signatures. You assume that consent is present when there is an emergency.

Answer 6

It is checked twice by preoperative nurse and circulating nurse. The form that lists requirements to be ascertained (aviriguado )before the patient goes to OR Documents diagnostic tests complete (A type of test used to help diagnose a disease or condition) Documents pre-op medication given Documents VS Documents safety data ID band in place; 2 identifiers Jewelry removed Last void Dentures removed Informed consent verified Patient Allergies

Answer 7

Aseptic Technique (Surgical Asepsis) Goal is to minimize contamination of wound and prevent post-op infection

Answer 8

Conduct a pre-procedure verification process Mark the procedure site Perform a “Time Out”: it is to avoid errors. Ex: wrong limb. Everyone including the patient must know what is going to be done and where the surgery is going to be.

Answer 9

Role of Surgical Nurse: Steril field they are the ones who give the surgeons their tools Scrub Nurse ( assist the surgical team by donning sterile masks, gloves and gowns as well as aid the physician by passing instruments during surgery)/Technician RN Circulator: is the problem solver and advocate they make sure that the patient prep is complete. Patient Advocacy Nurse is legally responsible for correct counts! The scrub and circulating nurse are responsible for counts of sponges, and sharps. The 2 need to be in agreement.

Answer 10

Intravenous Agents Inhalation Agents Adjuncts to General Anesthesia

Answer 11

Used to treat anxiety, pain, agitation Watch for resp depression Flumazenil used to reverse effects of benzodiazepines(ex: versed which has an amnesia effect) Narcan used to reverse effects of opioids

Answer 12

Surface or Topical

Answer 13

Local Infiltration Injection into tissues Regional Nerve Block Injection into or around a specific nerve or nerve group to promote anesthesia Lymph node biopsy, cataract surgery

Answer 14

Injection of local anesthetic into CSF (Cerebrospinal fluid)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

Answer 15

Injection of an 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 (labor and delivery), hip replacements, knee replacements, lower abd surgery

Answer 16

Conscious Sedation Indications? (Conscious sedation is a combination of medicines to help you relax (a sedative) and to block pain (an anesthetic) during a medical or dental procedure.) Nurses are often responsible for administering meds & monitoring pt. but need special training

Answer 17

Conscious Sedation Indications? Nurses are often responsible for administering meds & monitoring pt. but need special training

Answer 18

With the patient's transfer to the recovery unit Verbal report by anesthesia & RN Circulator General Information Patient History Intraoperative Management Intraoperative Course

Answer 19

Adequacy of airway: Immediate priority assessment Airway looks good Iv fluids ok Tubes patent patient breathing well no bleeding Adequacy of airway: Immediate priority assessment Vital Signs: CV, periferal perfusion status of pulses perfusion of nail beds CV Status: LOC Presence of Protective Reflexes: gag, cough Activity: Able to move extremities, sensation

Answer 20

Fluid Status: I&O IV infusion rate Patency of tubing Signs of dehydration/overload Condition of Operative Site: Dressing drainage: Amt, color, type Mark Inform – do not change coz it's the surgeon who changes the first dressing. May reinforce Patency & Character of drains Catheter, tubes, JP, hemovac etc… Discomfort Pain Nausea and Vomiting Notify anesthesia Position Safety

Answer 21

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

Answer 22

Ongoing systems assessment vs q 5-15 min depending on pt condition plicies etc.. Interventions individualized depending on dx May need to medicate Communicate changes with MD

Answer 23

Discharge Criteria: 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?

Answer 24

Assessment Vital Signs Continue with systems assessment q 1-4 hrs. initially Closely monitor for potential complications

Answer 25

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

Answer 26

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

Answer 27

make flashcards

Answer 28

make flashcards

Answer 29

Shock: Inadequate tissue perfusion (First sign may be decreased urine output) a severe drop in blood pressure that causes a dangerous reduction of blood flow throughout the body. Hemorrhage Thrombophlebitis (an inflammatory process that causes a blood clot to form and block one or more veins, usually in the legs) Pulmonary Embolus (occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of the lung) Pneumonia

Answer 30

Shock: Inadequate tissue perfusion (First sign may be decreased urine output) Hemorrhage Thrombophlebitis Pulmonary Embolus Pneumonia Surgical Site Complications Complications With Elimination Dehiscence and Evisceration

Answer 31

Geriatric Considerations 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 (Reduced cardiac output or hypotension causes decreased renal perfusion) Under treatment of pain

Answer 32

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

Answer 33

delay of surgery has no ill effects. It can be scheduled in advance based on the patient's choice. Purpose: to remove or repair a body part. to restore function. to improve health. Examples: Tonsiloctomy, hernia repair, cataract extraction, and lens implantation, hemorrhoidectomy. facelift.

Answer 34

thrombocytopenia, hemophilia, recent myocardial infarction or cardiac surgery, heart failure, and dysrhythmias- increase the risk for anesthesia complications, including hemorrhage and hypovolemic shock, hypotension, venous stasis,

Answer 35

Respiratory disorders--such as pneumonia, bronchitis, asthma, emphysema, and chronic obstructive pulmonary diseases-increase the risk for respiratory depression from anesthesia as well as postoperative pneumonia, atelectasis, and alterations in acid-base balance.

Answer 36

Kidney and liver diseases influence the patient's response to anesthesia, affect fluid and electrolyte as well as acid-base balance, alter the metabolism and excretion of drugs, and impair wound healing.

Answer 37

Endocrine diseases, especially diabetes mellitus, increase the risk for hypoglycemia or acidosis, slow wound healing, and present an increased risk for postoperative cardiovascular complications.

Answer 38

May precipitate hemorrhage

Answer 39

Diuretics (may cause electrolyte imbalances, with resulting respiratory depression from anesthesia)

Answer 40

Tranquilizers (may increase the hypotensive ()(lowering the blood pressure) effect of anesthetic agents)

Answer 41

Adrenal steroids (abrupt withdrawal may cause cardiovascular collapse in long-term users)

Answer 42

Antibiotics in the mycin group (when combined with certain muscle relaxants used during surgery, may cause respiratory paralysis)

Answer 43

1-Diagnostic 2-Ablative 3-Palliative 4-Reconstructive 5-Transplantation 6-Constructive

Answer 44

• To make or confirm a diagnosis Breast biopsy, laparoscopy, exploratory laparotomy

Answer 45

To remove a diseased body part Appendectomy, subtotal thyroidectomy, partial gastrectomy, colon resection, amputation

Answer 46

To relieve or reduce intensity of an illness; is not curative Colostomy, nerve root resection, debridement of necrotic tissue, balloon angioplasties, arthroscopy

Answer 47

restore function to traumatized or malfunctioning tissue • To improve self- concept Scar revision, plastic surgery, skin graft, internal fixation of a fracture, breast reconstruction

Answer 48

To replace organs or structures that are diseased or malfunctioning Kidney, liver, cornea, heart, joints

Answer 49

To restore function in congenital anomalies Cleft palate repair, closure of atrial-septal defect

Answer 50

Major: May be elective, urgent, or emergency To preserve life * To remove or repair a body part * To restore function * To improve or maintain health Carotid endarterectomy, cholecystectomy, nephrectomy, colostomy, hysterectomy, radical mastectomy, amputation, trauma repair, CABG (coronary artery bypass graft)

Answer 51

• To remove skin lesions • To correct deformities Teeth extraction, removal of warts, skin biopsy, dilation and curettage, laparoscopy, cataract extraction, arthroscopy

Answer 52

Elective: Delay of surgery has no ill effects; can be scheduled in advance based on patient's choice To remove or repair a body part To restore function • To improve health • To improve self- concept Tonsillectomy, hernia repair, cataract extraction and lens implantation, hemorrhoidectomy, hip prosthesis (may also be urgent), scar revision, facelift, mammoplasty

Answer 53

Urgent: Usually done within 24- 48 hours • To remove or repair a body part • To preserve or restore health Removal of gallbladder, coronary artery bypass graft (CABG), surgical removal of a malignant tumor, colon resection, amputation

Answer 54

Emergency: Done immediately To prevent further tissue damage • To preserve life (plus purposes listed above) Control of hemorrhage; repair of trauma, perforated ulcer, intestinal obstruction; tracheostomy

Answer 55

Check for peripheral edema

Answer 56

Assess visual and hearing ability

Answer 57

Large habitual intake of alcohol require larger doses of anesthetic agents and postoperative analgesics. Patients who use illicit drugs are at risk for interactions with anesthetic agents. Patients who smoke are at higher risk for respiratory complications after surgery. They are at risk of hypoxia and postoperative pneumonia. Smoking compromises wound healing by constricting blood vessels and impairing blood flow to healing tissues

Answer 58

×-ray, electrocardiography, complete blood count (CBC), ejectrolyte levels, and urinalysis. Significant abnormal findings include an elevated white blood cell count (presence of infection), decreased hematocrit and hemoglobin level (presence of bleeding, anemia), hyperkalemia or hypokalemia (increased risk for cardiac problems), and elevated blood urea nitrogen or urinalysis results (potential kidney issues).

Answer 59

Deep breathing, coughing, incentive spirometry, leg exercises, turning in bed, early ambulation

Answer 60

During surgery the cough reflex is suppressed mucus accumulates in the trachea Rocchio passageways and the lungs do not ventilate fully. Respirations often are less effective as a result of anesthesia, pain and medication. alveoli do not inflate and may collapse, and secretions are retained, increasing the risk for atelectasis and respiratory infection Deep-breathing exercises hyperventilate the alveoli and prevent them from collapsing again, improve lung expansion and volume help to expel anesthetic gases and mucus, and facilitate oxygenation of tissues.

Answer 61

Incentive Spirometry An incentive spirometer is often ordered for patients having surgery. The proper technique for using it should be practiced preoperatively. This device helps to increase lung volume and inflation of alveoli and facilitates venous return. A gauge on the incentive spirometry device allows patients to measure their progress and provides immediate positive reinforcement for the breathing efforts. See Chapter 39 for more information.

Answer 62

Coughing Teaching Coughing and Splinting helps remove retained mucus from the respiratory tract and usually is taught in conjunction with deep breathing. Coughing is especially important in patients with an increased risk for respiratory complications. Because coughing is often painful, teach the patient how to splint the incision (i.e., support the incision with a pillow or folded bath blanket) and to use the period after pain medication has been administered to best advantage. See Guidelines for Nursing Care 30-2 on how to teach the patient how to cough effectively.

Answer 63

Leg Exercises: During surgery, venous blood return from the legs slows. In addition, some surgical positions, such as having the legs elevated in the lithotomy position (see illustration in Box 26-2 on page 699), decrease venous return. With circulatory stasis in the legs, thrombophlebitis, DVT, and the risk for emboli are potential complications. Leg exercises increase venous return through flexion and contraction of the quadriceps and gastrocnemius muscles. Leg exercises must be individualized to patient needs, physical condition, physician preference, and facility protocol

Answer 64

Turning in Bed: Turning in bed improves venous return, respiratory function, and intestinal peristalsis, and prevents the unrelieved skin pressure that would occur if the patient were to remain in only one position. Although turning in bed sounds like a simple procedure, incisional pain makes it difficult, underscoring the need for practicing it before surgery. To turn in bed, patients should raise one knee, reach across to grasp the side rail on the side toward which they are turning, and roll over while pushing with the bent leg and pulling on the side rail. A small pillow is useful for splinting the incision while turning. The patient should turn and change positions in bed every 2 hours when awake.

Answer 65

Early Ambulation: Although related to leg exercises and turning in bed, early ambulation has positive effects on the respiratory, cardiovascular, integumentary, musculoskeletal, gastrointestinal, and renal systems. Discussing the benefits during the preoperative period helps patients fully engage in this activity (as appropriate) postoperatively despite expected pain and discomfort.

Answer 66

Description of the procedure or treatment (its name, site, and side if applicable), potential alternative therapies, and the option of nontreatment The underlying disease process and its natural course Name and qualifications of the health care provider performing the procedure or treatment—provide an emphasis on shared decision making between the patient and provider(s) Explanation of the risks (nature, magnitude, probability of the risks) and benefits Explanation that the patient has the right to refuse treatment and that consent can be withdrawn Explanation of expected (not guaranteed) outcome, recovery, and rehabilitation plan and course Informed consent protects the patient, the health care providers, and the health care facility. The signed, dated, and timed form is a legal document as well as an ethical imperative. More detailed information about informed consent is included in Chapter 7.Advance directives, which are also legal documents, allow patients to specify instructions for health care treatment should they be unable to communicate these wishes postoperatively. This allows patients to discuss their wishes with family members in advance of the surgery. Suspension of a do-not-resuscitate (DNR) or allow-natural-death (AND) order, although not required for surgery, should be discussed as part of the informed consent process. Actions used in resuscitation (mechanical ventilation, vasoactive drips) are integral to the surgical process, and surgery itself poses specific risks where reversible cardiopulmonary arrest may occur (American College of Surgeons, 2014). It is important to discuss and document the exact wishes of the patient before surgery, especially related to resuscitation. See Chapter 43 for more information on advance care planning. The nurse is responsible and accountable for the verification of and witnessing that the patient or the legal representative has signed the consent document in their presence and that the patient, or the legal representative, is of legal age and competent to provide consent. They also confirm that the patient has sufficient knowledge to make a knowledgeable decision.

Answer 67

Sedatives, such as diazepam, midazolam, or lorazepam, to alleviate anxiety and decrease recall of events related to surgery

Answer 68

Anticholinergics, such as atropine and glycopyrrolate, to decrease pulmonary and oral secretions and to prevent laryngospasm

Answer 69

Narcotic analgesics, such as morphine, to facilitate patient sedation and relaxation and to decrease the amount of anesthetic agent needed

Answer 70

Neuroleptanalgesic agents, such as fentanyl citrate- droperidol, to cause a general state of calmness and sleepiness

Answer 71

Histamine-2 receptor blockers, such as cimetidine and ranitidine, to decrease gastric acidity and volume

Answer 72

Allow only a sterile object to touch another sterile object. Unsterile touching sterile means contamination has occurred. • Open sterile packages so that the first edge of the wrapper is directed away from the worker to avoid the possibility of a sterile surface touching unsterile clothing. The outside of the sterile package is considered contaminated. Opening a sterile package is shown and described in Skill 24-3 on pages 628-633. • Avoid spilling any solution on a cloth or paper used as a field for a sterile setup. The moisture penetrates through the sterile cloth or paper and carries organisms by capillary action to contaminate the field. A wet field is considered contaminated if the surface immediately below it is not sterile. • Hold sterile objects above the level of the waist. This will ensure keeping the object within sight and preventing accidental contamination. • Avoid talking, coughing, sneezing, or reaching over a sterile field or object. This helps to prevent contamination by droplets from the nose and the mouth or by particles dropping from the worker's arm. • Never walk away from or turn your back on a sterile field. This prevents possible contamination while the field is out of the worker's view. Keep all items sterile that are brought into contact with broken skin, or used to penetrate the skin to inject substances into the body or to enter normally sterile body cavities. These items include dressings used to cover surgical incisions, needles for injection, and tubes (catheters) used to drain urine from the bladder. • Use dry, sterile forceps when necessary. Forceps soaked in disinfectant are not considered sterile. • Consider the edge (outer 1 inch) of a sterile field to be contaminated. • Consider an object contaminated if you have any doubt as to its sterility.

Answer 73

what you use to shower before surgery

Answer 74

Steril field they are the ones who give the surgeons their tools

Answer 75

is the problem solver and advocate they make sure that the patient prep is complete.

Answer 76

assist the surgical team by donning sterile masks, gloves and gowns as well as aid the physician by passing instruments during surgery

Answer 77

assist the surgical team by donning sterile masks, gloves and gowns as well as aid the physician by passing instruments during surgery

Answer 78

used to reverse effects of benzodiazepines(ex: versed which has an amnesia effect)

Answer 79

used to reverse effects of opioids