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)
