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n233 final > QUIZ- preop and intraop > Flashcards

QUIZ- preop and intraop Flashcards

1
Q

preoperative=

A

from decision to have surgery up until transfer to the OR table

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2
Q

intraoperative=

A

from time patient is transferred to the OR table ends with admission to PACU

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3
Q

postoperative=

A

PACU admission to follow up evaluation in clinical setting or at home

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4
Q

emergent surgery…

A

without delay

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5
Q

urgent surgery…

A

within 24-30 hours

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6
Q

required surgery…

A

plan for a few weeks or months

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7
Q

elective surgery…

A

failure to have surgery is not catastrophic

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8
Q

risk factors for surgical complications?

A
  • age (old and young)
  • nutrition, dentition
  • obesity
  • immune function
  • endocrine function
  • fluid and electrolyte status
  • pregnancy
  • illicit drug use/alcohol
  • smoking
  • psychiatric/delirium history
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9
Q

common preoperative nursing diagnoses…

A
  • risk of infection
  • anxiety and fear
  • risk of adverse physical response to anesthetics, medications
  • risk of adverse outcomes related to risk factors
  • improper consent process
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10
Q

preop planning

A
  • patient will be physically and emotionally prepared for surgery
  • risk factors will be identified and the surgical team will be made aware
  • pre-op checks, paperwork and diagnostics will be complete and corrected
  • risk for infection will be minimized
  • patient will have knowlede related to surgery
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11
Q

preop interventions

A
  • pt safety= primary concern
  • provide preop teaching: expectations, post-op exercises
  • complete paperwork, check consent
  • re-confirm pt understands surgery
  • attend to family needs
  • bowel prep
  • skin prep (chlorhexidine scrub)
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12
Q

immediate preop prep?

A
  • complete checklist and chart
  • hospital gown, voiding, removal of dentures, jewelry, contacts etc
  • preop meds (lorazepam, antibiotics, anticoagulants
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13
Q

pre-op physicians orders include?

A

diagnostics, administer meds, initiate IV lines, complete pre-op skin care

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14
Q

pre-op evaluation?

A
  • is pt physically and emotionally prepared for surgery
  • any special risk factors accounted for?
  • all preop paperwork and processes complete?
  • skin prep and preop checklist complete?
  • can pt explain surgery, expectations, exercises?
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15
Q

NPO guidleines?

A

depends on procedure and agency

  • ex. peds: no solids after midnight, evening before surgery
    aduls: no solids after midnight, clear fluids up to 3 hours prior to procedure
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16
Q

pre-op diagnostics?

A
  • CBC
  • electrolytes
  • coagulation
  • renal function
  • glucose
  • cross match if blood loss anticipated
  • chest x ray
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17
Q

preop medications?

A

-IV started (sodium, potassium)
-anxiolytics, sedation (AFTER consent)
-antibiotics (1 hr pre or on call in OR)
gastric acid reduction (to prevent reflux/aspiration)

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18
Q

what are benzodiazepines used for?

A
  • reduce anxiety
  • induce sedation
  • induce amnesia
  • reduce anesthesia required
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19
Q

example of benzodiazepines?

A
  • midazolam

- lorazepam

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20
Q

what are narcotics used for?

A

to relieve pain

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21
Q

examples of narcotics?

A
  • morphine
  • demerol
  • fentanyl
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22
Q

what are gastric acid blockers and alkalinizers used for?

A

to increase pH

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23
Q

examples of gastric acid blockers/alkalinizers?

A
  • pantoprazole

- sodium citrate

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24
Q

what are antiemetics used for?

A

decrease nausea and vomiting

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25
Q

examples of antiemetics?

A

ondansetron

dimenhydrinate

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26
Q

what are antibiotics used for?

A

prophylactic prevention of infection

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27
Q

example of antibiotic?

A

cefazolin

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28
Q

scrub nurse ROLE

A

scrub nurse prepares and maintains sterile tables with required equipment

  • needs to anticipate what equipment and supplies will be required
  • performs counts of supplies to ensure all accounted for
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29
Q

circulating nurse ROLE

A

manages OR and pt safety (positioning)

  • verifies consent
  • coordinates the team
  • maintains environment
  • documents throughout the procedure
  • monitors pt
  • second verification of surgical procedure
  • performs counts of supplies to ensure all accounted for
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30
Q

RN first assistant?

A

more common in US, can assist the surgeon with the procedure (ex. cutting tissue, suturing, etc)

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31
Q

nurse anesthetist?

A

assesses patient
intubates patient
administers anesthetic meds and monitors pt throughout surgery
DEVELOPING in canada, more common in US

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32
Q

risk for longer surgeries for older patients risk?

A

prone for pressure injuries

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33
Q

surgeon role?

A

head of the surgical team! often a physician, performs the procedure dude!!

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34
Q

anesthesiologist role?

A

physician that has specialized

  • assesses pt, intubates pt, monitors vitals
  • adminsters anesthetics meds and monitors pt throughout surgery
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35
Q

what is the surgical safety checklist?

A

a checklist everyone has to follow to avoid error and mistakes in surgery, things can get left inside!!!
-hospitals may modify the tool

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36
Q

three parts of the surgical safety checklist?

A
  1. before induction of anaesthesia SIGN IN
  2. before skin incision TIME OUT
  3. before patient leaves operating room SIGN OUT
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37
Q

wht occurs in the sign in ???

A

right pt, site masked, anesthesia safety check, allergies

38
Q

what occurs in the time out ???

A

confirm all team members introduce self, anticipated critical events, confirm the PT, SITE, PROCEDURE

39
Q

what occurs in the sign out???

A

nurse verbally confirms w team: name of procedure, instruments, needle, sponge count are correct, specimen labeled

40
Q

nursing diagnosis’s in surgery?

A
  • risk for tissue injury
  • risk for anaphylaxis
  • risk for hypothermia
  • risk for joint injury
  • risk for hemorrhage
  • risk for n&v
  • risk for infection
  • risk for malignant hyperthermia
  • anxiety r/t surgery
41
Q

INTRAOPERATIVE complications

A
  • nausea and vomiting
  • anaphylaxis
  • hypoxia and resp complications
  • hypothermia
  • malignant hyperthermia
42
Q

nursing goals during INTRAOP period?

A

reduce anxiety

  • prevent positioning injuries
  • maintain pt safety
  • serve as pt advocate
  • avoid complications: PRIMARY goal
43
Q

protecting the pt from injury (things u do)?

A
  • pt identification
  • correct informed consent
  • verification of records of health history and examination
  • results of diagnostic test
  • allergies (include latex)
  • monitoring and modifying physical environment
  • safety measures (grounding of equip, restraints, not leaving a sedated pt)
  • verification and accessibility of blood
44
Q

what is an anesthetic

A

med that incudes anesthesia

45
Q

what is anesthesia?

A

CNS depression, loss of consciousness, loss of sensation

—-> can be general, regional, local

46
Q

what is general anesthesia?

A

CNS nerve impulses altered leading to reduced pain, sensation, loss of consciousness and resp depression

47
Q

general anesthesia meds can be:

A

inhaled (ex. nitrous oxide, isoflurane)
or
parenteral (ex. propofol)

48
Q

balanced anesthesia?

A

it is common to combine drugs to allow for lower doses of each drug to be administered and better control of the anesthetised state

49
Q

larger amounts of anesthesis are given…

A

at initiation, lesser during maintenance

50
Q

general anesthesias SUMMARY

A

major or long surgeries

  • UNCONSCIOUS
  • potential cardiac, resp, renal, liver effects
  • benefit: NO awareness of surgery
51
Q

epidural SUMMARY

A

surgeries to lower body, c-section

  • into epidural space surrounding dura mater of spinal cord
  • conscious
  • risks: hypotension, resp depression, infection risk, pruiritis
  • benefits: no headache, safer for pt with cardiac and resp comorbidities, flexible-prolonged pain relief
52
Q

spinal SUMMARY

A

surgeries to lower body short surgeries, C-section

  • conscious
  • pt lies on side in a knee to chest position
  • risks: hypotension, spinal headache, resp complications, increased infection risk
    benefits: safer for pt with cardiac and resp comorbidities, profound block
53
Q

moderate (conscious) sedation SUMMARY

A

endoscopy, pediatric procedures

  • SEMI conscious
  • risk: resp depression
  • benefit: patient compliance, amnesia
54
Q

local SUMMARY

A

small surgeries like cyst removal, mole removal
-conscious
-limited risks
safe

55
Q

what are adjunct anaesthetics

A
  • “helper drugs” complement the use of other drugs

- used w general anaesthetics for induction . of anaesthesia or to counteract adverse effects

56
Q

types of adjunct meds?

A
  • neuromuscular blocking drugs
  • benzodiazepines
  • opioids
  • anticholinergics
  • antiemetics
  • alpha2 adrenergic agonists
57
Q

procedural/moderate sedation… tell me more

A

anesthesia that does not cause complete LOC
used mostly in office or out-pt settings
-pts maintain airway, can respond to verbal commands
-most common used drugs: midazolam w or w/out fentanyl
-rapid recovery time
-in peds: oral

58
Q

regional/local anesthesia… tell me more

A
  • types: central (spinal and epidural) or peripheral (infiltration, nerve block, topical)
  • specific parts of body made insensitive to pain w/o major effects on CNS
  • awake and aware
  • may use lidocaine, bupivacaine etc
59
Q

spinal anesthesia.. tell me more

A

often injected once, can be continuous infusion

  • less med needed than epidural because it goes into CSF right around spinal cord
  • L4/5 to ensure it is below spinal cord
  • rapid acting (minutes)
  • block sensory, motor, and autonomic functions
60
Q

tell me more about epidural anesthesia!

A

can be performed anywhere along the vertebral colun and catheter often left in for continuous infusion

  • larger amounts of med
  • onset slower (has to diffuse through
  • can block sensory, motor and autonomic functions
61
Q

what is infiltration (as a local anesthesia)

A

small amounts injection to tissue (ex dental surgery)

62
Q

nerve block (as a local anesthesia)

A

larger amount injected when a nerve innervates a specific area

63
Q

topical (as a local anesthesia)

A

applied to skin/mucous membranes

64
Q

pantaprazole is a…

A

GASTRIC acid blocker….

increases gastric ph, decreases gastric acid secretion

65
Q

sodium citrate is a…

A

antacid, increases gastric pH

66
Q

anticholinergics …

A

atropine, scopolamine

  • decrease oral and resp secretions
  • PREVENT BRADYCARDIA
67
Q

mini med card on pantoprazole…

A

proton pump inhibitor

  • give preop to pt at risk of aspiration
  • inhibits gastric acid production and decreases gastric volume
  • slower onset
  • NURSING: assess epigastric, abdominal pain, frank/occult blood in stool/emesis, risk of C-diff infection
68
Q

mini med card on sodium citrate

A
  • alkalinizing agent (increase gastric pH)
  • given preop to pt at risk of aspiration
  • faster acting and preferred for emergency surgery
  • NURSING: minimal as only getting one dose preop, if given ongoing could cause metabolic acidosis
69
Q

mini med card on lorazepam (ativan)

A

type: benzodiazepine
use: adjunct anesthetic, reduce anxiety prior to surgery, produce amnesia
advantages: increases effects of anesthetics so less is required
NURSING: can cause dizziness, drowsy

70
Q

mini med card on lidocaine

A

type: anesthetic
use: can be used as regional/local anesthetic (topical, epidural, spinal, nerve block)
NURSING: as epidural/spinal: can cause resp depression, bradycardia, CNS depression. as a topical: numbing, minimal side effects

71
Q

mini med card on succinylcholine

A

type: neuromuscular blocking agent (muscle relaxant)
use: adjunct, relax skeletal muscles for surgery, for intubation
advantages: short duration, rapid onset
disadvantages: no effect on consciousness, pain. causes paralysis
NURSING: high alert med, can trigger malignant hyperthermia!!

72
Q

mini med card on nitrous oxide

A

INHALED
-for short procedures (often dental)
often used with other agents
advantage: rapid onset and recovery
disadvantage: weak anesthetic, can cause hypoxia, poor relaxant
NURSING: use w other meds that are longeracting
-monitor for hypotension, bradycardia, decreased CO, NV
-watch for chest pain and STROKE

73
Q

mini med card on isoflurane

A

INHALED
induction and maintenance of anesthesia
-rapid onset and recovery
-can increase effects of muscle relaxants!
DISadvantage: profound resp depression!!
NURSING: closely mintor reps, hypotension, transient tacycardia, malignant hyperthermia, n/v

74
Q

most widely used IV anesthetic?

A

propofol

  • indicated for general anesthesia
  • causes CNS depression
  • can cause death from resp arrest so monitor resp depress, hypotension, NARROW therapeutic range
75
Q

preferred anesthesia in any surgery?

A

local anesthesia, but mya increase pt anxiety

76
Q

what is malignant hyperthermia?

A
  • rare inherited muscle disorder
  • triggered by myopathies, emotional stress, heatstroke
  • susceptible to those with strong bulky muscles and history of muscle cramps
  • unexplained temp elevation!
77
Q

hypothermia:

A

pt temp drop, glucose metabolism is reduced, metabolic acidosis may develop

  • may occur bc of cold temp in OR
  • core body temp of 36.6 or less
78
Q

what is medullary depression

A

if too much anesthesia is given,

resps shallow, cyanosis, pupils will not contract, without prompt intervention—> death

79
Q

beginning anesthesia:

A

pt breathes in mixture, may be conscious, noises are exaggerated

80
Q

hazards of the surgery environment?

A

-faulty equipment or improper use, toxic substances, infectious wastes, cuts, needles, laser beams, unintentional retention of an object, exposure to blood and body fluids

81
Q

key points about the surgical environment?

A
  • strict aspesis
  • central location to all supporting services
  • special air filtration
  • risk of fire always present
  • unrestricted zones, restricted zone, and semi-restricted
  • do not hang masks around neck
  • room temp of 20-23 degrees, positive pressure reltive to adjacent areas
82
Q

acute liver disease is associated with

A

high surgery mortality bc liver is significant in metabolizing anesthesia

83
Q

aspirin and surgery>

A

stop it 7-10 days before

stop taking natural health products 2-3 weeks before as well

84
Q

pt who smoke and surgery?

A

urged to stop 4-8 weeks before to reduce pulmonary and wound healing complications

85
Q

elder considerations?

A
  • physiologic reserve
  • resp and cardiac complications are leading cause of post op morbidity
  • reserves lower, renal and hepatic functions depressed, GI reduced
  • dehydration, malnutrition, decreaased ability to perspire
86
Q

obese pt considerations?

A

increases risk

  • dehiscence of wound more popular
  • more demand on heart
  • shallow resps when supine
  • increased risk of hypoventilation
  • sleep apnea
87
Q

ambulatory surgery?

A

same day surgery outpatient, no overnight stay

88
Q

optional surgery?

A

patient can decide whether or not to have it, cosmetic surgery

89
Q

examples of emergent surgery

A

severe bleeding, bladder or intestinal obstruction, stab or wound, fractured skull

90
Q

urgent surgery example

A

acute gallbladder infection, urethral or kidney stones

n233 final (11 decks)

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