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102 > Pt 1 (Perioperative) > Flashcards

Pt 1 (Perioperative) Flashcards

1
Q

What is the difference between an urgent and an emergent surgery

A

An emergency surgery must be done right away to save the patient’s life, whereas an urgent surgery is performed to prevent any additional problems like removing a gallbladder to prevent stones.

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2
Q

What is an ablative surgery

A

Removing a body part (amputation)

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3
Q

What is the difference between constructive and cosmetic surgery

A

Constructive is to restore function to a body part (repairing cleft palate), while cosmetic is to improve personal appearance

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4
Q

Describe a patient classified as ASA I

A

They are a normal healthy patient (nonsmoking, no-minimal alcohol use, etc.)

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5
Q

Describe a patient classified as ASA II

A

They have mild systemic disease (smoker, social alcohol drinker, pregnant, obese, controlled DM/HTN, mild lung disease)

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6
Q

Describe a patient classified as ASA III

A

They have severe systemic disease (uncontrolled DM/HTN, COPD, morbidly obese, hepatitis, alcohol abuse, pacemaker, moderate reduction of cardiac ejection fraction).

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7
Q

Describe a patient classified as ASA IV

A

They have severe systemic disease that is a constant threat to their life (Recent MI, CVA, TIA, ongoing cardiac ischemia or severe valve dysfunction, sepsis, disseminated intravascular coagulation, end-stage renal disease not having dialysis)

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8
Q

What is a moribund patient

A

A patient who is not expected to survive without the surgery

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9
Q

What does AORN stand for and what do they do

A

Association of periOperative Registered Nurses - they set standards and guidelines

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10
Q

What type of allergies would I want to know about before surgery

A

Latex or penicillin

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11
Q

If a patient is not sure if they are allergic to latex, what can you ask them

A

If they have a reaction when eating apples, avocados, bananas, celery, chestnuts, melons, papayas kiwis, raw potatoes/tomatoes? Or if they have a reaction when blowing up a balloon? If they have a reaction to the elastic in their underwear

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12
Q

Is it our job to explain the surgical procedure to the patient

A

No - that’s the physician’s job

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13
Q

What does ectomy stand for

A

Excision or removal of “appendectomy”

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14
Q

What does lysis stand for

A

Destruction of “electrolysis”

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15
Q

What does orrhaphy stand for

A

Repair or suture “Herniorrhaphy”

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16
Q

What does oscopy stand for

A

Looking into “Endoscopy”

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17
Q

What does ostomy stand for

A

Creation of opening into “Colostomy”

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18
Q

What does plasty stand for

A

Repair or reconstruction of “mammoplasty”

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19
Q

Besides allergies, what else do we want to screen for?

A
  • Blood thinners
  • Cultural (Jehovah witness)
  • History of A-fib (can lead to blood clots)
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20
Q

What is a big plus of ambulatory surgeries, where you are going home the same day

A

You do not have to stay overnight in the hospital, where you are at risk for hospital acquired infections

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21
Q

Define local anesthesia

A

Usually given in your ambulatory setting, patient is healthy, they can tolerate the procedure, they’re not nervous, there is no sedation or loss of consciousness, they can go home the same day and eat and drink regularly.

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22
Q

What is regional anesthesia

A

It “blocks” a central nerve (spinal) or a group of nerves (ex plexus). That body region becomes numb. Usually for orthopedic procedures. If a patient has comorbidities, they will also probably get something to put them to sleep, so their HR doesn’t spike during surgery. Also given for C-sections. (you are still conscious)

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23
Q

What is a person at risk for when they receive a local anesthetic (from lidocaine)

A

Local anesthetic systemic toxicity (LAST)

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24
Q

What are early symptoms of LAST 5

A
  • Ringing or whoosing in ears
  • Confusion
  • Metallic taste
  • Oral numbness
  • Dizziness
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25
Q

If left untreated, what can LAST lead to

A

Seizures, coma and dysrhythmias

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26
Q

What is the difference between a spinal and epidural anesthesia

A

A spinal anesthesia is injected into the cerebrospinal fluid, while an epidural is injected into the epidural space and does not enter the cerebrospinal fluid (you can’t feel anything, but you can still move (does not block motor, only blocks sensory) - versus spinal, where you can’t move or feel anything)

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27
Q

Is intubation required for sedation

A

In mild to moderate, the patient is usually breathing on their own. For Deep sedation, they may need to be intubated.

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28
Q

What can a patient be intubated with under general anesthesia

A

Laryngeal mask airway (LMA) or a trachea tube.

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29
Q

Why would a person be put under general anesthesia

A
  • Surgery may be long
  • Need muscles to be relaxed
  • May be uncomfortable positions
  • Ventilation may need to be controlled
  • Patient refused local or regional techniques
  • Uncooperative
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30
Q

What is a fat embolism (risk during surgery)

A

Where subcutaneous fat can travel into the bloodstream and into your lungs

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31
Q

What are normal albumin levels

A

3.4-5.4

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32
Q

What can a deficiency in albumin indicate

A
  • Liver or kidney disease.

- Body is not absorbing enough protein.

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33
Q

What is our main goal in preop

A
  • Provide baseline data

- Identify risk factors

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34
Q

What other goals do we want to accomplish in preop

A
  • Prepare patient for surgery
  • Patient teaching
  • Complete our checklist
  • Interprofessional communication
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35
Q

What if the patient believes that they are going to die in the surgery

A

Notify the provider right away - the strong emotional state may put stress on the surgery (surgery might be delayed due to this)

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36
Q

If a patient has had juice or milk to drink before surgery, what should you do

A

Call anesthesia to inform them

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37
Q

What is the total surgical period called

A

Perioperative care

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38
Q

When assessing the respiratory system, what things should we ask

A
  • If they have had a cold or fever recently (if they have had an upper respiratory infection - surgery will probably be delayed)
  • If they have used their inhaler recently - have them bring it with them to take a few puffs the morning of to help open up the airways.
  • STOP BANG - for patients with sleep apnea, have them bring in their CPAP to use in the recovery room.
  • Want to know if they smoke, smoking should be stopped 6 weeks prior to surgery.
  • If they have COPD
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39
Q

If a patient has COPD, what are they at high risk for after surgery

A
  • Hypoxemia (low oxygen in blood)

- Atelectasis (alveoli become deflated)

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40
Q

What do you want to assess for in the nervous system

A
  • Check capillary refill
  • Nevers - assess by touch and feel
  • If they take gabapentin, take morning of surgery
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41
Q

What are we assessing for in the genitourinary system 8

A
  • Is and Os
  • If they look dehydrated
  • Do they look emaciated
  • How is their skin turgor
  • Kidney disease
  • Chronic UTIs
  • Renal function test (labs)
  • If a woman may be pregnant
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42
Q

Why is renal dysfunction scary for surgery

A

Renal dysfunction can lead to f&e imbalances, coagulopathies (blood doesn’t clot), increased risk for infection and impaired wound healing.

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43
Q

When assessing the hepatic (liver) system, what are we looking for 8

A

We are checking for signs of liver disease

  • Are they itchy
  • Do they have an altered mental status
  • Do we see jaundice
  • Ask about alcohol and tylenol
  • History of hepatitis
  • Obese - can indicate liver dysfunction
  • Enlarged abdomen
  • Perform a liver function test
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44
Q

Impaired hepatic function can cause what risks

A

Clotting abnormalities and adverse responses to drugs

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45
Q

What do we want to assess for the integumentary system

A
  • If they have any present cuts, document, in case they think we gave them the cut after surgery or they get an infection
  • Note any skin breakdown
  • History of pressure sores - may need more padding
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46
Q

What do we assess for in musculoskeletal

A
  • Assess any numbness/tingling
  • If they have a history of arthritis
  • Test ROM/strength
  • Patients will usually be on muscle relaxants
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47
Q

What is one major concern we have for the endocrine system

A

If the patient is diabetic

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48
Q

If the patient is diabetic, what are we doing

A

Don’t have them take oral diabetic medication the morning of surgery, if they are on insulin - take half of the dose.
- Check their sugar before surgery and during.

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49
Q

What are we assessing for with fluid and electrolytes

A

If the patient has had any episodes that might impact F&E, like vomiting, diarrhea or completing a bowel prep.

  • Check electrolyte levels before surgery
  • Be careful with older adults, they are less adaptive and more prone to overhydration or dehydration
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50
Q

What if a patient has a BMI greater than 40

A

Notify the OR team so they can prep.

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51
Q

What if a patient is underweight

A

They may need more padding then usual

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52
Q

What assessments do we want to do for nutritional status

A
  • Get their height and weight
  • If they have dentures or partials
  • How is their skin over bony prominences
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53
Q

What patients are at risk for VTE 8

A
  • History of thrombosis
  • Blood-clotting disorders
  • Cancer
  • Varicosities (twisted, large veins)
  • Obesity
  • Tobacco use
  • Heart failure
  • COPD
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54
Q

How can I help reduce fears

A

Use common language and avoid medical jargon

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55
Q

How can I help relieve anxiety

A

Give them information about what to expect

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56
Q

What if the patient has a fear of anesthesia

A

Notify the ACP, so they can talk to the patient

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57
Q

What does ACP stand for

A

Anesthesia care provider

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58
Q

Overall what things should be completed when prepping a patient 8

A
  • Medical history
  • Current medications
  • ROS, PA (review of systems, psychological assessment)
  • Obtain/review lab results
  • Psychosocial assessment
  • Teaching
  • Document findings
  • Assist ACP to rate patient for ASA class
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59
Q

What teaching should always be provided

A

Deep breathing, coughing and early ambulation.

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60
Q

Should antibiotics ever be started in preop

A

No it is always on-call in the operating room.

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61
Q

What can trigger malignant hyperthermia

A

Anesthesia

  • Can be from a combination of succinylcholine and inhaled anesthetics
  • Usually during general anesthesia
  • Also can be from trauma, stress and heat
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62
Q

In regards to malignant hyperthermia, what should be asked

A

It is genetic, so you should ask if someone in their family has had it.

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63
Q

Is a rise in body temperature an early symptom of malignant hyperthermia

A

No, it is not an early sign.

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64
Q

What is an early symptom of malignant hyperthermia 7

A
  • Blowing off a lot of CO2
  • Muscle rigidity
  • tachypnea (rapid breathing)
  • Tachycardia
  • Heart arrhythmias
  • Hyperkalemia
  • Hypercarbia (increase in CO2 in blood)
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65
Q

What is given for malignant hyperthermia

A

Dantrolene

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66
Q

In regards to recreational drug use and alcohol, what is important to remember

A

If they have used drugs and/or alcohol intake - it may take more medication to put them to sleep

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67
Q

What are some drugs that we really want to pay attention to when getting a history from our patient 7

A
  • Anticoagulatns (warfarin)
  • Aspirin
  • Corticosteroids
  • Cardiac meds
  • Diabetic meds
  • Anxiolytics/sedatives
  • Opioids
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68
Q

Why can corticosteroids be dangerous

A

They can thin out the blood

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69
Q

What labs tests are we performing prior to surgery 11

A
  • CBC (red blood cells)
  • BMP (basic metabolic panel)
  • CBG (sugar)
  • LFT (liver function test)
  • BUN/Creatinine
  • PT/INR (how fast blood is clotting)
  • T & CM (type and cross match (for blood donor))
  • hCG (pregnancy test)
  • ECG
  • CXR (chest x-ray)
  • Pulmonary function test (for heart and lungs)
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70
Q

What are the adequate levels of sodium

A

135-145

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71
Q

What are the adequate levels of potassium

A

3.5-5.0

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72
Q

What are the adequate levels of cratinine

A

0.6-1.2

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73
Q

What are the adequate levels of BUN

A

7-20

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74
Q

What are the adequate levels of PT (prothrombin time)

A

10-12 seconds

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75
Q

What is the adequate level of international normalized ration (INR)

A

Greater than 1

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76
Q

What is an adequate WBC count

A

4500-11,000

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77
Q

What are good CBG levels (glucose)

A

70-110

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78
Q

What are adequate albumin levels

A

3.5-5.5

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79
Q

What is an adequate PLT (platelet count)

A

F 12-16

M 13-18

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80
Q

What are adequate ALT levels

A

7-56

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81
Q

What are adequate AST levels

A

5-40

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82
Q

What can we put on a patient to prevent a DVT or PE

A

SCDs (sequential compression devices)

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83
Q

Are all patients at risk for a DVT or PE

A

Yes

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84
Q

If a patient has a history of a CV condition, what is likely to happen

A

They will have a cardiologist consult and be placed on telemetry leads

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85
Q

Before a nonemergency surgery, what must take place

A

The patient needs to give informed consent in the presence of a witness (nurse)

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86
Q

In order for informed consent to be valid, what must be met

A
  • Adequate disclosure of the procedure (PARQ - procedure, alternatives, risks and questions)
  • Patient must show that they understand the information that they are receiving
  • Consent must be given voluntarily
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87
Q

Who is ultimately responsible for obtaining consent

A

The surgeon

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88
Q

What if consent cannot be obtained and it is an emergency

A

The surgeon will proceed and you will fill out an unusual occurrence

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89
Q

What required legal forms should be in the patient’s chart (4)

A
  1. Informed consent
  2. Blood transfusions
  3. Advance directives
  4. Power of attorney
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90
Q

Is there a separate consent for anesthesia

A

Yes - the ACP is responsible for obtaining consent (you may witness the signature)

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91
Q

Who should mark the surgical site

A

The surgeon

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92
Q

Can consent be withdrawn at any time

A

Yes

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93
Q

What antibiotic is usually given to prevent a surgical site infection (SSI)

A

Cefazolin (Ancef)

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94
Q

If a patient is allergic to penicillin, can they have cefazolin

A

No - they are usually given clindamycin instead

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95
Q

What is given to decrease oral secretions

A

Atropine

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96
Q

What is given to increase gastric emptying

A

Metoclopramide

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97
Q

What drugs are usually given to decrease anxiety, induce sedation and add amnesic effects (loss of memory)

A
  • Midazolam (versed)
  • Lorazepam (ativan)
  • Diazepam (valium)
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98
Q

What drug is given to decrease gastric acid

A

Famotidine (pepcid)

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99
Q

What drugs are given for pain relief and sedation

A

Morphine and Fentanyl

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100
Q

When you are under anesthesia, will you have the urge to urinate

A

No

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101
Q

What eye medications are given for eye surgery

A
  • Mydriacyl (dilates the pupils)
  • Tetracaine (numbs the surface of the eye)
  • Pilocarpine (acute angle closure glaucoma)
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102
Q

What medication is given for someone having nasal surgery

A

Afrin - it constricts the blood vessels in the nose

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103
Q

When administering ear drops to adults, how do you pull back the ear

A

Back and upwards

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104
Q

When administering ear drops to pediatrics, how do you pull the ear back

A

Back and downwards

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105
Q

What is given if a patient has a history of sea sickness

A

Scopolamine patch behind the ear

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106
Q

Do we want more surgeries to be performed in the hospital or ambulatory

A

Ambulatory (healthier patients and shorter procedures)

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107
Q

What is in the unrestricted zone

A
  • Personnel in street clothes
  • Holding area
  • Locker room
  • Information areas
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108
Q

Can you wear street clothes in the unrestricted zone

A

No - you should have your surgical srubs on, jacket, shoe covers, head cover, mask and other PPE

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109
Q

What is taking place in the holding area in the unrestricted zone

A
  • Patients are waiting
  • Final identification and assessment
  • Friends/family allowed
  • Surgical care improvement project (SCIP) (includes patient warming, antibiotic administration, applying sequential compression devices)
110
Q

When should patients d/c st johns wart

A

A week prior to surgery

111
Q

Where will the anesthesiologist greet the patient

A

In the holding area

112
Q

What is it important to do with a diabetic before surgery

A

Warm them (every patient should be warmed up, but it is especially important for diabetics)

113
Q

When should the on-call antibiotics be given

A

30-60 minutes before incision

114
Q

Before putting the patient to sleep, what should happen in regards to the SCDs

A

They must be on and working prior to the patient being put to sleep

115
Q

When a patient is given an epidural/spinal, what are they always at risk for

A

Hypotension (they might feel like they’re going to pass out)

116
Q

What if a patient complains of a headache and they received a spinal

A

They may be having a cerebral spinal leak - call the anesthesiologist

117
Q

What can ketamine cause

A

Hallucinations

118
Q

Why do we want to keep the room quiet when a patient is waking up from anesthesia

A

If the room is loud, it can cause emergence delirium (especially for pediatrics)

119
Q

Where is it best to have the OR located

A

Next to the PACU and ICU

120
Q

How is the OR set up to prevent the transmission of infection 5

A
  • Filters and controlled airflow in the ventilating systems provide dust control
  • Positive air pressure prevents outside air from entering
  • Narrow range in temperature and humidity
  • UV lights
  • Strict cleaning protocols
121
Q

Who makes up the nursing team in the OR

A
  • Circulator

- Scrub RN (this can also be an LPN or surgical tech (ST))

122
Q

Who is supervised by the RN

A

The LPN or surgical tech

123
Q

What is anesthesia responsible for

A

Administering anesthetic and managing vital life functions (breathing, BP, etc.)

124
Q

What are the 3 improvement projects by the Surgical Care Improvement Project that focus on improving surgical outcomes

A
  1. Administering a prophylactic antibiotic within 30-60 minutes before surgery
  2. Applying a warming blanket
  3. Applying intermittent pneumatic compression devices
125
Q

What are the surgical sentinel events (never events)

A

Wrong surgical procedure, wrong body part or wrong patient

126
Q

When are the surgical timeouts

A
  • Right before the patient is given anesthesia

- Right before the surgery is going to start

127
Q

What are they identifying in a surgical timeout 7

A
  1. Right patient
  2. Patient history
  3. Signed consent forms
  4. Assessments
  5. Results of diagnostic studies
  6. Correct site marked (this should be done before the patient is put to sleep)
  7. Fire risk assessment
128
Q

What is a clean wound

A

Operative wound NOT entering the resp. GI or GU tracts (ie vascular, neuro, eye, orthopedic)

129
Q

What is a clean-contaminated wound

A

Operative wound entering the thoracic, GI or GU tract (ie GYN procedures, GU, appendectomy)

130
Q

What is a contaminated wound

A

Accidental injury or operative wound with gross contamination, spillage, foreign bodies.

131
Q

When are counts performed

A

Before, during and after surgery

132
Q

When are sterile gown and gloves put on

A

After you scrub in, and you’re in the OR

133
Q

Who lets us know when we can begin positioning

A

The ACP (it is after the patient has been put to sleep)

134
Q

What are your five responsibilities when assisting the ACP 5

A
  • Understand anesthetic administration and the effects
  • Know where emergency equipment and drugs are located in the OR
  • May place leads on patients
  • Remain at patient’s side to ensure safety
  • Assist in difficult intubations
135
Q

When positioning the patient, what do we want to think about 7

A
  • Is the operative site accessible
  • Is there airway going to be ok
  • Is this a correct skeletal alignment
  • Is this putting pressure on nerves, skin, boney prominences or eyes
  • Adequate thoracic excursion
  • Are we preventing occlusion of arteries and veins
  • Are we providing modesty
136
Q

How do you clean the surgical site

A

In a circular motion from clean to dirty

137
Q

What are the 4 types of local enesthesia

A
  1. Topical
  2. Ophthalmic
  3. Nebulized
  4. Injectable
138
Q

What are the advantages of local and regional anesthesia

A
  • Rapid recovery

- Little residual “hangover”

139
Q

What are the disadvantages of local and regional anesthesia

A
  • Discomfort
  • Hypotension
  • Seizures
  • Technical difficulties
140
Q

When a patient is given a spinal or epidural anesthesia, what should you watch for

A

Signs of autonomic nervous system blockade

  • Bradycardia
  • Hypotension
  • N & V
141
Q

Who administers drugs under conscious sedation

A

A nurse can under the direct supervision of a physician

142
Q

What are advantages of conscious sedation 8

A
  • The patient is responsive
  • They can breath on their own
  • Reduced fear and anxiety
  • Amnesia
  • Relief of pain
  • Patient cooperation
  • Stable vital signs
  • Rapid recovery
143
Q

What is conscious sedation used for

A

Routine, short-term surgical, diagnostic and therapeutic procedures

144
Q

What are the 3 phases of general anesthesia

A
  1. Induction
  2. Maintenance
  3. Emergence
145
Q

When is emergence anesthesia given (reversal agents)

A

In the OR

146
Q

What are complications from general anesthesia 9

A
  • Aspiration
  • Cardiac irregularities
  • Hypotension
  • Hypothermia
  • Hypoxemia
  • Laryngospasm
  • Malignant hyperthermia
  • Nephrotoxicity
  • Respiratory depression
147
Q

What are late sings of malignant hyperthermia

A
  • Elevated temperature
  • Myoglobinuria (excess myoglobin in urine)
  • Multiple organ failure
148
Q

What is happening in malignant hyperthermia 7

A
  • High carbon dioxide levels
  • Respiratory and metabolic acidosis
  • Increased oxygen consumption
  • Production of heat
  • Activation of the sympathetic nervous system
  • High potassium levels
  • Organs stop working
149
Q

How can general anesthesia be given

A
  • IV

- Inhalation

150
Q

What does TIVA stand for

A

Total intravenous anesthesia

151
Q

What is a negative side effect of inhalation agents

A

They can irritate the respiratory tract

152
Q

What is the typical process of general anesthesia

A

They will receive an IV with an induction agent, which will put them to sleep for a couple of minutes. Then an LMA or ET tube can be inserted. Then inhalation and IV agents can be given.

153
Q

How are inhalation agents given

A

Through the endotracheal tube or LMA

154
Q

What does the term adjuncts refer to

A

Other drugs added to the inhalation (we rarely use just one drug)

155
Q

What drug is given as a dissociative anesthesia

A

Ketamine

156
Q

What is given with Ketamine to help reduce the hallucinations

A

Midazolam (versed)

157
Q

What is important to remember if a patient is given ketamine

A

They need a quiet, unhurried environment to wake up in

158
Q

Because older adults can have changes in how they absorb, distribute or metabolize drugs, what should happen to the drugs that they are given

A

They should be carefully titrated

159
Q

What is a common complication with older adults

A

Emergence delirium

160
Q

Besides emergence delirium, what are other complications regarding older adults

A
  • May have trouble with communication (hearing and seeing)
  • Skin may be at risk from tape, electrodes, warming/cooling blankets
  • Positioning may be difficult if they have osteoporosis or arthritis
  • They are at risk for perioperative hypothermia
161
Q

What is an issue with anaphylactic reactions and the OR

A

Anaphylactic reactions may be masked by anesthesia

162
Q

What can recent use of tobacco lead to

A
  • Blood clots
  • Myocardial infarction
  • Death
  • Slow wound healing
  • Risk for infection
163
Q

Why is it important to establish a baseline of motor skills and mental status before surgery

A

So you can compare their mental status and motor skills after surgery

164
Q

What are indications of a DVT

A
  • Pain
  • Redness
  • Swelling
  • Warm to the touch
165
Q

What are indications of a pulmonary embolism

A

(When a clot caused by a DVT breaks off and travels to the lungs)

  • Chest pain
  • Dyspnea (Difficulty breathing)
  • Tachycardia
  • Hypoxia
166
Q

How does anesthesia increase the risk for atelectasis

A

Anesthesia decreases the function of the surfactant in the lungs, which leads to the collapse of alveoli

167
Q

What are the signs of a surgical site infection (SSI)

A
  • Redness
  • Swelling
  • Pain
  • Purulent (milky) or foul-smelling drainage
168
Q

Who is at risk for poor wound healing and infections 6

A
  • If you are a diabetic
  • Have chronic health problems
  • Poor diet
  • Obese
  • Older
  • Using corticosteroids
169
Q

What is dehisence

A

A separation of the wound or incisional edges (most common after abdominal surgery)

170
Q

Define evisceration

A

A complication of dehiscence, where organs begin to slip out

171
Q

Why do we fast before surgery

A

During surgery, stomach contents can move up to the mouth and into the trachea or lungs (aspiration)

172
Q

If a patient is having surgery on their hand, and the anesthesia delivered will provide them a with a temporary loss of feeling in their arm, what type of anesthesia is this?

A

Regional

173
Q

After surgery, when should a patient be repositioned

A

Once every hour

174
Q

Who is involved in a patient’s admission to the PACU

A
  • Anesthesia care provider
  • OR nurse
  • PACU nurse
175
Q

Can patient’s bypass phase I?

A

Yes they can go straight into phase II (these are usually our ambulatory surgeries)

176
Q

What system do we use to determine if a patient can transition to the next phase?

A

The modified aldrete scoring system

177
Q

When receiving a patient from the OR, what is your number one priority

A

ABC

178
Q

If the patient received a general anesthetic, what should they be receiving

A

Oxygen through a face mask at 10L

179
Q

When a patient is being discharged after a general anesthetic, what are the typical rules

A
  • Want someone with them for the next 24-48 hours
  • Don’t want them to drive
  • Don’t want them to eat a big meal (motility is slowed from the anesthetic, so they are at risk for vomiting)
180
Q

How many categories are there in the aldrete scoring system

A

5 categories

181
Q

A score of what, in the aldrete scoring system indicates that the patient is ready to transfer to the next phase of recovery

A

Score of 9 or 10

182
Q

What is rapid PACU progression (RRP)

A

Where a patient is rapidly progressed through phase I to phase II or inpatient care

183
Q

What is fast tracking

A

Where you admit ambulatory surgery patients directly to phase II care

184
Q

When receiving a patient in PACU, what information do we want to receive from the transfer team

A
  • Patient name
  • Age
  • Surgeon
  • Surgical procedure
  • Why they had the surgery
  • Medical history
  • Current medications
  • Allergies
  • Blood loss
  • What anesthetics were used
  • Fluid replacement
  • Urine output
  • Unexpected events or reactions
  • Vital signs and trends
  • Lab results
185
Q

What is the difference between MAC and general

A

Both are causing sedation, but general is also receiving a paralytic. With this paralytic, the patient cannot keep their airway open, so they are given a breathing tube. With MAC, the patient is not paralyzed and can still breath on their own.

186
Q

For airways, what are we checking

A

Patency

187
Q

For breathing, what are we checking 4

A
  • RR and quality
  • Breath sounds
  • Supplemental oxygen
  • Continuous pulse ox
188
Q

For circulation, what are we checking 5

A
  • ECG monitoring
  • Vital signs
  • Peripheral pulses
  • Capillary refill
  • Skin color and temperature
189
Q

For neurologic, what are we checking 4

A
  • LOC
  • Orientation
  • Sensory and motor status
  • Pupil size and reaction
190
Q

For genitourinary, what are we checking for 3

A
  • Intake
  • Output
  • Estimated blood loss (EBL)
191
Q

When checking an NG tube, what are we looking for

A

That the tube is in place, what kind of secretions are coming out of it (red=bad).

192
Q

For gastrointestinal, what are we looking for 2

A
  • Bowel sounds

- n&v

193
Q

What is a JP drain used for (closed drain)

A

Standard drainage

194
Q

What is a penrose drain used for (open)

A

Abscesses (used to clear out infection)

195
Q

Are hiccups good after a surgery

A

No, they may indicate that vomiting is coming soon

196
Q

What are signs of poor oxygenation from the cardiovascular system 5

A
  • BPs are out of wack (high or low)
  • HRs are out of wack (high or low)
  • Poor capillary refill
  • Decreased pulses
  • Decreased O2
197
Q

What are signs of poor oxygenation from the CNS 6

A
  • Restlessness
  • Agitation
  • Confusion
  • Muscle twitching
  • Seizures
  • Coma
198
Q

What are signs of poor oxygenation from the integumentary system

A
  • Flushed, cool or moist skin

- Cyanosis

199
Q

What are signs from the renal system of poor oxygenation

A
  • Urine output is less than 0.5ml/kg/hr
200
Q

What is the most common airway obstruction

A

The tongue

201
Q

Is snoring an obstruction

A

Yes

202
Q

What is hypoxemia

A

Low amount of oxygen in your blood

203
Q

What are common causes of hypoxemia (3)

A
  • Atelectasis
  • Aspiration
  • Bronchospasm
204
Q

Can atelectasis happen right after surgery

A

Yes - it can be from an increase in secretions, decrease in respiratory excursion or from general anesthesia.

205
Q

How is a person at risk for aspiration after surgery

A

Because the anesthesia depresses the respiratory protective airway reflex

206
Q

What is a sign of bronchospasm

A

Wheezing

207
Q

What type of patients do we most often see bronchospasm occur in

A
  • Smokers
  • Asthma
  • COPD
208
Q

Besides chest pain, what are other signs of a pulmonary embolism 5

A
  • Acute tachypnea (rapid breathing)
  • Dyspnea (difficulty breathing)
  • Tachycardia
  • Hypotension
  • O2 drops
209
Q

Why are patients on O2 after surgery

A
  • Helps to eliminate anesthetic gases

- Meets the increase demand for O2 due to decreased blood volume or increased metabolism

210
Q

Once the patient is awake, what am I having them do

A

Deep breathing, coughing and using the IS

211
Q

Why is coughing and deep breathing important

A

It helps to mobilize the built up secretions

212
Q

Should a patient still cough if they had abdominal surgery

A

Yes, but use a pillow to splint over the incision

213
Q

If a patient is vomiting, how would we want to move them

A

Move them to their side

214
Q

How should an unconscious patient be positioned in recovery

A

In the lateral “recovery” position

215
Q

What position should the patient be in once they are awake in recovery

A

Supine position

216
Q

When would we use a nasopharyngeal airway

A

When the patient is having trouble breathing and they are semi-obstructing. They are usually semi-conscious

217
Q

When would we use a oropharyngeal airway

A

When the tongue is completing obstructing, this may be evidenced by snoring

218
Q

What is good to do for patient who have just had abdominal surgery

A

Elevate their legs (this takes the weight off the abdominal incision)

219
Q

What are the signs of atelectasis

A
  • Breath sounds are decreased

- O2 has dropped

220
Q

What are interventions for atelectasis

A
  • Oxygen therapy
  • Deep breathing
  • IS
  • Early mobilization
221
Q

What can hypoventilation be from

A
  • Respiratory depression (from the anesthetics)
  • Mechanical (tight dressing)
  • Pain from surgery
222
Q

How often should a patient be repositioned to prevent respiratory complications

A

1-2 hours

223
Q

What are common post op cardiovascular complications 5

A
  • Hypotension
  • Hypertension
  • Dysrhythmias
  • VTE
  • Syncope (loss of consciousness due to drop in BP)
224
Q

What can hypotension cause

A

Hypoperfusion (low blood output) to vital organs

225
Q

What are signs of hypotension 5

A
  • Disorientation
  • Loss of consciousness
  • Chest pain
  • Hypoxemia
  • Loss of physiologic compensation
226
Q

What is the most common cause of hypotension after surgery

A

Fluid and blood loss (So give fluid!)

227
Q

What is a contributing factor to cardio problems

A

Fluid and electrolyte imbalances from surgery

228
Q

Why are patients at a higher VTE risk after surgery

A

The stress response from surgery can increase the clotting tendencies by increasing platelet production

229
Q

What can cause hypertension after surgery 4

A
  • Pain
  • Anxiety
  • Bladder distention
  • Respiratory distress
230
Q

What is syncope

A

Fainting (BP drops so you faint)

231
Q

What can cause syncope

A
  • Decreased cardiac output
  • Fluid deficits
  • Defects in cerebral perfusion (blood flow to the brain)
232
Q

How often should you be obtaining vitals signs in phase I

A

At least every 15 mintues

233
Q

What is the treatment for hypotension

A
  • Give O2

- Give IV fluid boluses

234
Q

What are treatments for hypertension

A
  • Giving pain meds
  • Helping them go to the bathroom
  • Warming them up
  • Correcting any respiratory problems
235
Q

What are 4 nursing interventions to prevent F&E and cardiovascular complications

A
  • Frequent vital signs monitoring
  • Continuous ECG monitoring
  • Adequate fluid replacement
  • Assess surgical site for bleeding
236
Q

Should you get someone up to walk right away after surgery

A

No - they still may have anesthesia in their body

237
Q

When ambulating someone after surgery, what are you watching for

A

Orthostatic BP

238
Q

When and to whom is low molecular heparin given

A

To our bariatric patients, because they are at risk for a blood clot (heparin is a blood thinner)

239
Q

What should you first suspect for emergence delirium

A

Hypoxia (give O2)

240
Q

What does POCD stand for

A

Postoperative cognitive dysfunction

241
Q

What is POCD and who does it primarily effect

A

POCD is a decline in the patient’s cognitive function weeks or months after surgery. It typically effects older patients.

242
Q

What is the reversal agent for benzodiazepine

A

Flumazenil

243
Q

What is the reversal agent for an opioid

A

Naloxone

244
Q

What are symptoms of alcohol withdrawal delirium 5

A
  • Restlessness
  • Insomnia
  • Nightmares
  • Irritability
  • Auditory or visual hallucinations
245
Q

What temperature and below is considered hypothermia

A

96.8

246
Q

What are the signs and symptoms of septicemia

A
  • Intermittent high fever

- Shaking chills

247
Q

When would we see a fever from an infection

A

3 days after the surgery

248
Q

If the patient has a normal temperature, how often should we take their temperature in the PACU

A

Every hour

249
Q

If the patient is hypothermic in the PACU, how often should we take their temperature

A

Every 15 minutes

250
Q

How should we treat shivering

A
  • Give O2 (they are using more O2 due to the shivering)

- Give opioids to help calm down the shivering

251
Q

How are we going to treat MH

A
  • Give dantrolene (Dantrium)
  • Cool the patient with ice packs
  • Correct the acid-base imbalances
252
Q

What makes a patient more likely to have n&v after surgery 6

A
  • Under 50
  • Being a female
  • History of motion sickness
  • Nonsmoker
  • The anesthetic or opioid used
  • The duration of the surgery
253
Q

What type of drug are we giving for n&v

A

Antiemetic drugs

254
Q

When should a patient void after a surgery

A

6-8 hours

255
Q

What if evisceration happens

A

Cover with sterile gauze soaked in normal saline. Try to have the patient put their knees up. Call the physician.

256
Q

What is the discharge criteria for phase I 9

A
  • Patent airway
  • Patient is awake
  • Vitals are at baseline
  • No excessive bleeding or drainage
  • No respiratory depress
  • O2 is above 90
  • Pain is managed
  • N&V controlled
  • Report given
257
Q

If you are having an ambulatory surgery done, what type of post care are you receiving

A

Phase II and/or extended observation postoperative care

258
Q

What is the discharge criteria for ambulatory surgery 7

A
  • Must be mobile and alert
  • Cannot drive (responsible adult present)
  • No IV opioids in the past 30 minutes
  • Minimal n&v
  • Voided if appropriate to surgical procedure or orders
  • Understands discharge instructions (has a copy)
  • May use post anesthesia scoring system to determine readiness
259
Q

What are some good discharge teachings after ambulatory surgery

A
  • What symptoms to report
  • Where and when to return for follow-up care
  • Reasons to seek help after discharge
  • Answers to questions
260
Q

What is MAC used for and where

A

Diagnostic or therapeutic procedures inside or outside the OR (used for lumps and bumps)

261
Q

Who must administer MAC

A

An ACP

262
Q

If a bowel falls out of a patient, should you try to put it back in

A

NO

263
Q

Who will place the the dressing on the patient when surgery is finished

A

The surgeon or the scrub RN

264
Q

How should a diet progress after surgery

A

Clear to full to soft to regular

265
Q

What area is sterile if you scrubbed in

A

Mid chest to abdomen

266
Q

What is emergent

A

Life or death

267
Q

What is urgent

A

Getting close to life or death

268
Q

What type of airway is used with general anesthetic

A

ET used with a paralytic

269
Q

Who is most at risk for fluid differences

A

The young and old

270
Q

Who is at risk for fluid and electrolyte imbalances

A

Anyone that loses blood

271
Q

How long should a patient remain NPO before surgery

A

6 hours with solid food and 2 hours with clear liquid

102 (5 decks)

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