Preoperative, Intraoperative, and Postoperative Care Flashcards
What are some basic purposes for operative procedures/surgeries?
Diagnosis - identify the presence of extent of a biological condition (biopsy)
Cure - eliminate or repair a pathological condition
Palliation - alleviate symptoms without providing a cure (colostomy, bypassing an inoperable obstruction of intestines)
Prevention - Reduce risk of developing a condition (bilateral mastectomy in someone with a high breast cancer risk)
Cosmetic improvement
Exploration - Examine an area in order to determine the nature or extent of disease
Explain the difference between emergent & elective surgery.
Emergent - Hospitalized from a sudden change in status, admitted from ED
Elective -
(ambulatory) minimally invasive , requires less than 24 hrs of monitoring post-op
Inpatient - requires more extensive monitoring by the healthcare team
(admitted same day or intentionally before the surgery)
What is the difference between clean & sterile technique? Provide examples of when you would use clean vs. sterile technique.
Clean - when administering meds, tube feedings, daily hygiene etc.
REDUCES # of Pathogens
Sterile - ELIMATES ALL PATHOGENS
- used in dressing changes
- cauterizations
- surgical procedures
What are the components of a comprehensive preoperative nursing assessment? Why is it important to know this?
Identity risk factors
Plan care to ensure safety
Subjective Date
- Determine patients psych status
- Identity risk factors (health history)
- review drug regimen (for drug interactions)
- allergies
- obtain baseline data
- Review the systems
Objective Date:
- Vital signs
- lab and diagnostic testing (serum electrolytes, CBC, EKG results ( pg 432)
What are the three types of preoperative teaching? Why is preoperative teaching important?
- Sensory - what will your patient hear, smell, or see/feel during surgery (it may be cold and bright or noisy)
2.) Process - General flow of the experience (when you arrive, you’ll be Brought to the preop care area)
3.) Procedural - more specific details about the process (times, etc)
What may increase risk of bleeding during and after surgery?
Certain medications that also work as anticoagulants / drug interactions
garlic
vit B3
fish oil
What would you do if a component of preoperative patient preparation is not complete?
cancel the surgery or halt it?
What is informed consent and why is it important?
Active shared decision making process between the person that is receiving care and a healthcare provider
Describe the intraoperative environment (unrestricted, semi-restricted, restricted).
Unrestricted - patient waiting rooms, locker rooms, nursing station at front desk (people in surgical closes interact with those in surgical attire)
Semi-Restricted - scrub attire and facial hair covering (recovery area/PACU)
Restricted - Full surgical attire (operating room scrub sink, clean area of OR)
What is the purpose of a “time-out” and when it is done?
- Confirm that all team members have introduced themselves by name and role
- Safety check before the skin incision:
-site - patient identifiers
- any patient concerns
- Discuss anticipated critical events:
- what are the expected next steps, operative duration, and expected blood loss?
- is everything sterile?
- has prophylactic antibiotics been given within the last 60 minutes
is essential imaging displayed?
What are the different roles of the surgical team?
RN - implements patient care (patient advocate)
LPN & Surgical Technologist - scrub nurse or circulating nurse role
Surgeon & Assistant - physician, conducts pro-op medical history ad performs surgical procedure
RN First Assistant - assistant surgeon, handles tissue, instruments, suturing, assists with hemostasis
Anesthesia Care Provider (ACP) - manages sedation , protects vital function of organs
Review the different levels of sedation. Note when a patient is able to respond
Minimal - PATIENT CAN RESPOND TO VERBAL COMMANDS (small amount of fentanyl or medazalame)
Moderate - Drug induced depression of consciousness , can respond to verbal commands when tapped a little
Deep - Patient is difficult to arouse but can respond to painful stimuli , respiratory drive can be compromise
General - COMPLETE LOSS OF CONCIOUSNESS
What are the different types of anesthesia techniques?
Local - Interrupts the generation of nerve impulses (lidocane) topical, nebulizer, etc
Moderate to deep sedation - patient is responsive and can breathe with no assistance (opioids, benzodiazepines) but does not feel pain
CAN COMPROMISE BREATHING IF NOT MONITORED WELL
Monitored Anesthetic Care (MAC)- Greatest flexibility to max sedation level to patients needs. Un responsive patient
(used w/ regional or local) used in same day procedures
Regional - Loss of sensation in an area without a loss of consciousness , pain relief after surgery
Route: Always injected into a central nerve or group of nerves
General - Loss of sensation and consciousness, requiring airway management (can be inhaled or IV)
What are the common risks and complications with anesthesia? How does age affect these risks?
Cardiac Arrest - CPR
Massive blood loss - hemostasis , isotonic fluids, blood products
Anaphylactic reactions - epi
Malignant Hyperthermia (hyper metabolic state of skeletal muscle, build up of Ca+ leads to muscle contracture, hypoxia, etc) - rare , triggersL succinylcholine and inhalation agents
treatment: Dantrolene
What are the components of an initial postoperative nursing assessment?
ABCs
Neuro (level of consciousness, orientation)
GI (Bowel sounds, presence of nausea or vomiting)
GU (Urine output)
Surgical Site (dressings and/or incisions, Drains)
Pain
Patient Safety (Fall risk assessment)
What are potential complications in the postoperative period for the respiratory system? What are the nursing interventions for each complication?
Respiratory
1. Airway Obstruction (caused by thick secretions, tongue falls back) , Hypoxia (<90% SpO2), hypoventilation (slow response rate leading to inc of CO2) - OCCUR IMMEDIATELY AFTER TRANSFER TO PACU
- Appear later- Actelectasis (anesthesia from surgery or post op pain), bronchial obstruction caused by retained secretions or decreased lung volumes , mucus trapped in the lungs, can develop to pneumonia
NURSING INTERVENTIONS:
Proper positioning
oxygen therapy
deep breathing and coughing
Freq position changes/ early ambulation
Hydration
What are common nursing diagnoses postoperatively? Why? What are the physiological bases for each?
-Risk for Alteration in neurological function
- Alterations in breathing pattern
-Alterations in fluid balance: fluid retention, Urinary retention, Fluid Deficit
-Alterations in electrolyte balance
- Alterations in Peripheral Vascular Circulation
-Alterations in Elimination
- Alterations in skin integrity
What are the three types of wound healing? Provide examples of each.
Primary Intention
Healing takes place when wound margin are approximated (surgical incision)
Secondary
Wounds with wide irregular, margins with extensive tissue loss (TRAUMA OR an ulceration)
Tertiary
Wound is contaminated and left often until infection clears. once infection is controlled, they do a delayed suturing to help with healing
Describe the three phases associated with primary intention (healing process)
Initial phase
Granulation Phase - replacing the clot with granulation tissues
Maturation Phase and scar phase
What are some potential complications associated with wound healing?
Infection - most common
adhesions - bands of scar tissue between or around organs
contractions - id excessive, can shorten muscle or scar tissue
dehiscence - disruption of previously joined wound edges
fistula formation - abnormal connection between organs or the skin
hypertrophic scars - overproduction of collage , larges raised red hard
keloid formation - hereditary , looks like a tumor of scar tissue
What measures are utilized in order to prevent surgical site infections (SSI)?
Prevention
- Prophylactic antibiotics
- Surgical site skin preparation
- Drain placement (place near an anastomosis , which is a connection between two structures that are otherwise diverging, that is at risk for leaking so that it doesnt collect and cause an infection)
- Preoperative blood glucose management
NURSING INTERVETIONS:
- Hand hygiene
- monitor incision side (access drain)
-Monitor vital signs
- nUTRITION ( HIGH PROTEIN, CARBS, AND VITAMISN)
- Patient teaching ( mild soap and water, dont scrub or soak, dressing changes as directed)
- Wound Management
What is the difference between a localized vs. systemic infection?
systemic - blood stream
localize d- only in one body part or organ
What are the key nursing roles in preoperative, intraoperative, and postoperative care?
Pre-Op - prepare patient for surgery, walk them through everything
Intra Op- patient advocate, ommunciatin and physical care
Post Op: care during post op period, recovery from anesthesia, prepare them to go home
What are potential complications in the postoperative period for the CV system? What are the nursing interventions for each complication?
Hypotensive ( BP < 90/60)
- Oxygen therapy
- IVF bolus
- Vasoconstrictive agents
Hypertensive (BP > 130/80)
- Treat cause
- Drug Therapy
Dysrhythmias
- Treat cause
Cardiac Output
- Maintain accurate I/O record
Hypokalemia
- Monitor Labs
- K+ replacement
Venous ThromboEmbolism (formation of blood clot in a vessel due to LIMITED MOBILITY)
- early ambulation
- sequential compression device
- pharmacologic prophylaxis
Syncope (temp loss of consciousness)
- Early ambulation
- IVF
What are potential complications in the postoperative period for the Neurologic system? What are the nursing interventions for each complication?
Emergence delirium (short-term neurologic alteration)
Delayed emergence
( delayed awakening from anesthesia)
Post-Op cognitive dysfunction
(decline in the patients cognitive function)
Delirium
INTERVENTIONS:
Access respiratory status and treat hypoxemia
Maintain safety
Pain management
Monitor fluid and electrolytes balance
Orient patient
Promote adequate nutrition and sleep
Early mobilization
Elaborate in temp rates relating to a fever
Mild Elevation <= 100.4 within the first 48 hours after surgery is just the body response to surgery
Moderate Elevation
>100.4 (first 48 hours after surgery) hints to lung congestion and dehydration
Elevation
> 100 (AFTER 48 hours) is an infection
What are potential complications in the postoperative period for the GI system? What are the nursing interventions for each complication?
Nausea and vomitting after surgery is norma
Constipation
can be caused by intestinal paralysis
immobility, alterations in fluid , opined pain management
Postop ileus
- spasms of the diaphragm
INTERVENTIONS:
IVF
slow introduction of oral intake
Antiemtics - for nausea
ambulate
gastric decompress
bowel rest
what oliguria vs low urine output
oliguria - less than or = 400 mL/24 hours
- control BP
low - 800 to 1500 mL/ 24 hours
urinary retention - depression of the NS system
