preoperative nursing Flashcards
describe whats include in the assessment portion of preoperative nursing phase
-history and physical (H&P)
-identification of risk factors and allergies
-medication and treatment assessment
-facilitating/reviewing diagnostic tests
-identification of teaching and psychosocial needs
-assessing for postsurgical support and referral needs
whats included in preoperative history assessment?
-developmental considerations
-medical history (comorbidities)
-surgical history
-allergies and meds (substance use such as ETOH, illicit drugs, nicotine)
-nutritional status
-ADLs and occupation
-sociocultural needs
-support system (learning and discharge needs)
history
what surgical history is important r/t surgery
-trach - may intubate different route
-malignant hyperthermia (also check fam history)
history
why are meds important to know preoperatively?
-some can interact with anesthesia
-ppl on blood thinners are gonna bleed out
history
what socialcultural needs are important to know preoperatively?
-will they receive blood products?
-who is the decision maker?
history
when should you have history and physical done before surgery?
30 days prior
physical exam
what are the compenents of the physical exam?
-general survey
-integumentary
-respiratory
-cardiovascular
-neurological
-GI/GU
-musculoskeletal
physical exam
describe general survey
-vital signs (want to figure out baseline bc anesthesia decreases bp)
-height and weight (most anesthesia is weight dosed)
physical exam
integumentary
look to make sure skin is intact
is there increased risk for skin infection?
physical exam
cardiovascular
-regular heartbeat?
-CHF?
-ejection fraction (how much blood is being pumped out? if its too low there is risk for volume overload)
physical exam
neurological
-establish A&O baseline
-crainial nerve function
physical exam
GI/GU
do they urinate and shit regularly? what are their normal patterns?
key considerations
comorbidities associated with CV system
HTN, MI, HF, arrythmias, CVA, thrombocytopenia, anemia
key considerations
comorbidities associated with respiratory system
COPD, asthma, pneumonia, bronchitis, URI
key considerations
comorbidities
-CV
-respiratory
-renal or heptic disease
-diabetes
meds
antibiotics in surgery
increase effect of anesthesia = more sleepy
meds
antiarrhythmics in surgery
decrease contractility
meds
anticonvulsants in surgery
effect metabolism of drugs
meds
antiHTN drugs in surgery
effect during anesthesia
meds
diruretics in surgery
-decrease BP and cause electrolyte shifts
meds
NSAIDS in surgery
increase bleeding risks
meds
ginsing in surgery
increase hypoglycemia
what are some risk factors in surgery?
-age
-nutritional status (malnutrition and obesity)
-fluid and electrolyte imbalance
-pregnancy
-previous surgical or anesthesia complications
what bloodwork is important for surgery?
-complete blood count (CBC)
-basic metabolic panel (BMP) or complete metabolic panel (CMP)
-coagulation studies
-blood type
-HCG
bloodwork
describe CBC
-WBC, RBC, HBG, HCT, platelets
-increase in WBC = risk for infection
-increased platelets = clot
decreased platelets = continue to bleed and bleed
bloodwork
what is included in BMP/CMP
-electrolytes
-BUN and creatinine
-glucose
-liver function
bloodwork
what is included in coagulation studies
-PT/INR (tells if pt will continue to bleed)
-PTT
bloodwork
what is HCG
prenancy test
lab values
RBCs
-men: 4.6-6.2 million/mm3
-women: 4.2-5.4 million/mm3
lab values
Hgb
-men: 13-18 g/dl
-women: 12-16 g/dl
lab values
Hct
-men: 42-52%
-women: 35-47%
lab values
WBCs
4500-11000/mm3
lab values
platelets
150-450 x 10^9/L
name some serum electrolytes
-Na+
-K+
-Cl-
-HCO3-
-glucose
serum electrolyte values
Na+
135-145 mmol/L
serum electrolyte values
K+
3.5-5.0 mmol/L
serum electrolyte values
Cl-
95-105 mEq/L
serum electrolyte values
HCO3-
bicarb
22-26 mEq/L
serum electrolyte values
glucose
70-110 mg/dl
renal function labs
creatinine
0.7-1.4 mg/dl
renal function labs
BUN
10-20 mg/dl
coagulation studies
prothrombin time (PT)
9.5-12 seconds
coagulation studies
international normalized ratio (INR)
0.76-1.27 (when not anticoagulated)
2-3 (when anticoagulated)
coagulation studies
activated partial thromboplastin time (aPTT)
20-39 seconds
coagulation studies
anti-factor Xa Assay
0.3-0.7 units/ml (when anticoagulated)
what imaging tests are used preoperatively
-CXR
-joint or bone Xrays
-CT
-MRI
whats included in cardiac workup
-EKG
-cardiac stress test
-sleep study
what are some preoperative nursing diagnoses
-knowledge deficit
-anxiety
-pain
-risk for infection
-impaired physical mobility
-disturbed body image
-disturbed sleep pattern
describe planning
-setting goals with the pt that are realistic and will help lead to a successful and complication free surgical experience
-many preoperative nursing interventions involve setting expectations and providing information
describe implementation
-teaching
-postoperative referrals
describe teaching
-general info
-communicating expectations/protocols
-providing anticipatory guidance
-verifying informed consent
describe postoperative referrals
-case management/social work
-DME (durable medical equipment)
-homecare, skilled nusing care
-prescriptions
-postoperative apppointments
what are some day of surgery preparations?
-NPO status, IV
-bowel prep/ empty bowel and bladder
-preoperative meds
-hygiene and skin prep
-removal of dentures, jewelery, hearing aids
-documentation completion and review
-provide directions and emotional support for patient and significant others
describe document review
-consent
-advanced directives
-preoperative checklist
