Quiz #1 (Vulnerability, Informed Consent, Preoperative) Flashcards
what is necessary from patient before non-emergent surgery can be performed?
voluntary and written informed consent
why is voluntary and written informed consent needed before non-emergent Sx?
to protect the patient from unsanctioned Sx and protect the surgeon from claims of an unauthorized operation
how does informed consent help patients?
helps them understand the Sx that’s going to be performed
who’s responsibility is it to inform patient?
surgeons!!
what does surgeon need to tell patient to prepare them for surgery?
- clear and simple explanations of what the Sx will entail
- the benefits and possible risks
- alternatives and possible complications
- what to expect in the early and late post op periods
what must the nurse do before administering psychoactive premedication
MAKES SURE THE CONSENT FORM HAS BEEN SIGNED
What makes the form in-valid?
if it is obtained while patient is under influence of medications that can affect judgement and decision making
what circumstances is informed consent necessary? (4)
- Invasive procedures (surgical incision, biopsy, cystoscopy, paracentesis)
- Procedures requiring sedation and or anesthesia
- Non surgical procedure, as an arteriography that carries more than a slight risk to the patient
- Procedures involving radiation
when does patient sign consent form vs legal guardian?
patient signs if of legal age and mentally capable, otherwise signed by the legal guardian/family member
refusing to undergo a surgical procedure is a persons……
legal right and privilege
what makes someone requiring Sx vulnerable ?
countless stressors and previous personal experiences
schools in the 70’s believed that reducing anxiety minimized what?
minimized postoperative complications and reduced recovery time
list the 3 stages of the stress response?
- the alarm stage
- the resistance stage
- the exhaustion stage
what is the alarm stage
when the body initially exposed to the stressor and its resistance decreases
what is the resistance stage
when the body endeavours to adjust to the stressor
what is the exhaustion stage?
where the body’s adaptation energy is exhausted
what is one major factor in causing peri-operative vulnerability
anxiety
what are the three dimensions that vulnerability is classified into
social, psychological and physical
list the 5 factors that causes anxiety?
- waiting
- pain
- fear of unknown
- anesthesia
- surgery
describe social vulnerability?
• Demographic data in relation to potential for illness
Ex. Entering a developing country with possible illnesses
describe psychological vulnerability
Relates to the emotional effects of anxiety or stress which may cause actual or potential harm to the individuals identify or self esteem
Ex. getting told a nurse will be performing a head to toe assessment
define etic
etic (external) perceptions of harm (ex. impending anesthetic surgical procedure and technical theatre environment)
define emic
emic (internal) perceptions of harm
describe physical vulnerability
Caused by individuals inability to resist further harm as their existing condition have been compromised by disease or trauma
Ex. Injury on right leg and someone opening it up after several days where it starts bleeding a lot
differentiate between actual and potential vulnerability
actual: the known circumstances rendering an individual susceptible
potential: circumstances which may or may not causes vulnerability
what are the 5 antecedents for vulnerability to occur?
- surgical intervention
- admittance to hospital for Sx
- undergo general anesthesia (GA) or regional anesthesia (RA)
- preparation for Sx
- exposure to a stressor causing an anxietal response
why are patients vulnerable?
- because there’s an increased risk of harm
- a feeling of loss of power
what are the 6 QSEN competencies
- Patient centered care
- Teamwork and collaboration
- Evidence based practice
- Quality improvement
- Safety
- Informatics
client or decision maker of consent must be?
- adequately informed
- capable of giving/refusing consent
- free from coercion, fraud or misrepresentation
what is the RN’s role in consent?
• May ask the patient to sign
• May witness patient signing
• Clarifies the patient’s understanding
-Ensures the patient is not impaired prior to signing
who can provide informed consent?
• Individual
• Surrogate
• Emancipated minor
-Physician in an emergency
describe the infants act
- for people under 19
- provides rules for qualification as a “mature” minor
- mature minors can make own health decisions
- may consent to healthcare and treatments in their best interest, if HCP believes they are competent
what are implications of the infants act?
-no set age for when someone can give consent
name two responsibilities of the nurse as it relates to informed consent?
- Cannot allow patient to sign when under the influence
2. Witness the patient sign
What is your role if you feel the patient does not fully understand the procedure they are about to have?
○ Call physician/don’t let it be signed until they understand
what is considered the preoperative phase
begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the OR table
list things that should be involved in a preoperative assessment (12)
- nutritional and fluid status
- dentition
- resp. status
- hepatic and renal Fx
- endocrine Fx
- previous med use
- deep breathing, coughing and incentive spirometry
- preparing bowel
- preparing skin
what type of patients require hospital stays?
often trauma patients, acutely ill, patients undergoing major surgery, those who require emergency surgery and patients with concurrent medical disorders
all patients require what to prepare for surgery?
a comprehensive preoperative assessment and nursing interventions
older adults may have greater risks during perioperative periods. List the 3 factors that are critical to reduce it
- skillful preoperative assessment and Tx
- skillful anesthesia and surgery
- meticulous and competent postoperative and post anesthesia management
nutritional and fluid status: what should be assessed here
any nutritional deficiency (ex. malnutrition) should be corrected before surgery to provide adequate protein for tissue repair
why is the mouth important to assess before Sx?
decayed teeth or dental prostheses may become dislodged during intubation and occlude airway
why is respiratory status important to assess before Sx?
surgery is usually postponed if patient has resp. infection. those who smoke are urged to stop 4-8 weeks before to reduce pulmonary and wound healing complications
why is hepatic and renal fx important to assess before sx?
• Any disorder of the liver has an effect on how anesthetic agents are metabolized
• Kidneys are involved in excreting anesthetic medications and their metabolites
-Surgery is contraindicated if a patient has acute nephritis, acute renal insufficiency with oliguria or anuria or other acute renal problems
why is endocrine function important to assess before sx?
• Patient with diabetes is at risk for hypo/hyperglycemia
-Those who have received corticosteroids during the year preceding surgery are at risk for adrenal insufficiency
why is it important to know pt’s previous medication use?
many take over the counter (OTC) meds, aspirin is a common one. prudent to stop aspirin atleast 7-10 days before surgery if possible (especially if surgery is prone to more bleeding)
-use of herbal products need to be discontinued 2-3 weeks before
why is deep breathing, coughing, and incentive spirometry important to assess before?
Goal of preoperative nursing care is teaching optimal lung expansion and resulting blood oxygenation after anesthesia
why is a pain management assessment done?
to be able to differentiate between acute and chronic pain after the surgery
what’s the point of a skin assessment before surgery?
- goal of preoperative skin prep is to decrease bacteria without injury to skin
- If its not an emergency surgery, pt may be instructed to use a detergent germicide to cleanse skin area for several days before surgery
what is intraoperative ?
from the time patient is transferred to OR table ends with admission to PACU
what is post operative?
PACU administration to follow up evaluation in clinical setting or at home
what are the 5 categories of surgery
- emergent
- urgent
- required
- elective
- optional
what is emergent surgery?
surgery needed without delay!
what is urgent surgery?
within 24-30 hours
what is required surgery?
plan for a few weeks or months
what is elective surgery?
failure to have surgery is not catastrophic
what is optional surgery?
personal preference
what are the risk factors for surgical complications? (10)
- age (old and young)
- nutrition, dentition
- obesity
- immune function
- endocrine function
- fluid and electrolyte status
- pregnancy
- illicit drug use/alcohol
- smoking
- psychiatric/delirium history
what are the NPO guidelines for IH?
adults: no solids after midnight, clear fluids up to 3 hours prior to procedure
peds: no solids after midnight evening before surgery, formula up to 6 hours before, breast milk up to 4 hours before, clear fluids up to 3 hours
what are pre-op Dx/labs to look at? (8)
-cbc
-electrolytes (K, Na, Mg, Cl)
-coagulation (PT, PTT INR)
-renal fx (BUN, creatinine)
-glucose
-cross match if blood loss anticipated
-chest xray
-ECG (not for all)
(specific based on risk factors)
pre op medications to give? (4)
- IV started (Na, K)
- anxiolytics, sedation (AFTER consent)
- Abx (1hr pre or on call to OR)
- gastric acid reduction
whats the use of benzodiazepines before surgery?
- reduces anxiety
- induce sedation
- induce amnesia
- reduce anesthesia required
why would narcotics be given before surgery?
to relieve pain
why would gastric acid blockers and alkalinizers be good before surgery?
increases pH
why are antiemetics good before surgery?
decreases nausea and vomiting
why would Abx be used before surgery?
prophylactic prevention of infection
what is something to consider for pediatrics before surgery?
-spend time with them to build a relationship! Participate in activities that provide comfort/pleasure as much as possible
