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Surgical Client Flashcards

1
Q

The preoperative assessment consists of

A

head-to-toe assessment
review of the client’s medical history and any laboratory or diagnostic tests that have been ordered prior to surgery
client’s awareness of the procedure
appropriate id bands
Allergies – medications, latex, contrast agents, and food products
* Anxiety level
* Vital signs including oxygen saturation
thromboembolism risk
Social support system
tolerance fo anesthesia
use of OCD or CAMS
occupations
medical/surgical history
knowledge and knowledge about surgery

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2
Q

What should be included in a health history ?

A

allergies
current meds
CV and resp diseases
CAD
COPD
OSA
CHF

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3
Q

Smoking and surgery can cause what?

A

blood clots, vasoconstriction, myocardial infarction, prolonged wound healing and even death.

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4
Q

Perioperative pain management should be considered when?

A

before, during, and after the surgery

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5
Q

Perioperative pain control utilizes multimodal therapy to decrease the need for .

A

opioids

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6
Q

What on the patient needs to be removed before surgery?

A

Dentures, piercings, or prosthetics need to be removed.

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7
Q

What is the role of the nurse when verifying consent?

A

the nurse’s role is to verify and witness that the client or representative has signed the consent in their presence, is of a legal age, and is competent
understands

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8
Q

What are common preop lab test?

A
  • Urinalysis
  • Blood type and cross match
  • CBC
  • Pregnancy test
  • Clotting studies
  • Blood electrolyte levels
  • Blood creatinine and BUN
  • ABGs
  • Chest x‐ray
  • 12‐lead ECG – required for all clients older than 40 years
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9
Q

What is some general information that patients need to be educated on before operations?

A

what time to arrive
where to check in, what to bring
the policy for visitors ow long the client can expect to stay.

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10
Q

Education for Preparation for surgery: (5)

A

NPO status: when to stop eating and drinking prior to the procedure.
Skin preparation: wash with a special soap at home
Medication: may be asked to stop taking certain medications and supplements
Tobacco and alcohol cessation: benefits of tobacco and alcohol cessation prior to surgery.
Resources should also be provided if needed.

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11
Q

education on postoperative expectations: (4)

A

What to expect immediately following surgery.
How pain will be rated and controlled immediately postoperatively and once at home.
The importance of coughing and deep breathing after surgery. This should include techniques for incision splinting and how to use an incentive spirometer.
Activity following surgery, including the importance of early mobility as well as any restriction
Diet
Early ambulation and ROM anxiety

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12
Q

What is AORN’s Comprehensive Surgical Checklist?

A

helps ensure that communication continues across the continuum of the perioperative phase

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13
Q

Risk Factors for Complications

A

age (older)
nutrition- malnourished
obesity- challenge to intubate so OSA
infection
substance abuse- tobacco, alcohol
medical history- diabetes, immunocompromised
pregnancy
respiratory diseases
CVD
Diabetes
Liver/kidney- endocrine disorders: hyper/hyperthyroidism
immunocompromise
coagulation defect
malignant hyperthermia

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14
Q

What are some chronic health conditions that puts older clients at risk for operative complications

A

chronic health conditions, such as hypertension, COPD, diabetes mellitus, and CAD

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15
Q

What is postoperative delirium and how long does it last?

A

confusion and disorientation after undergoing surgery. This condition is temporary and may come and go days to weeks after surgery.

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16
Q

Ways to avoid postoperative deleirum

A

risk factor identification
effective preoperative pain management
avoiding use of benzodiazepines as well as opioid-based pain medications

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17
Q

Geriatric Assessment (CGA) is helpful in identifying what?

A

ID’ing post op delirium sheet

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18
Q

Postoperative cognitive dysfunction (POCD) is what?

A

a serious condition for which both older adults and clients with preexisting neurocognitive disorders are at risk when undergoing anesthesia.
long term memory loss and can last for weeks and months

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19
Q

conditions that increase a client’s risk of developing POCD include

A

Alzheimer’s disease, history of stroke, and Parkinson’s disease

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20
Q

What are some complications of obese surgical patients? (4)

A

decreased oxygenation
increased time for the body to process anesthesia medications
respiratory complications when given narcotic analgesics or other sedatives
DVT
hypotension
atelectasis
wound infection
wound dehiscence
ileus
oliguria or AKI

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21
Q

Smoking can cause what complications?

A

difficult to regulate breathings under anesthesia and increases heart load.

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22
Q

Complication can range in severity by what? (5)

A

client’s age,
overall health,
medical history,
extent or degree of disease
, and surgery type.

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23
Q

What can cause DVT after surgery?

A

prolonged inactivity during and after surgery

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24
Q

. Manifestations of PE include

A

include chest pain, especially while taking a deep breath; difficulty breathing; tachycardia; and hypoxia.

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25
Preoperatively hypovolemia can be caused by: (3)
A lack of fluid intake due to NPO status Administration of bowel prep for abdominal surgery Physiological condition or injury that causes intravascular fluid loss
26
Intraoperatively hypovolemia can be caused by: (3)
Anesthesia-related medications that may cause widespread vasodilation and impaired myocardial function Loss of blood due to hemorrhage or coagulopathies Prolonged surgical time, especially open abdominal surgeries
27
hypovolemia is affected by what?
urgency of surgery (emergency versus elective), the type of surgery, and the length and complexity of surgery.
28
Hypervolemia
istory of chronic conditions that cause fluid retention, such as CHF or renal insufficiency or failure.
29
Surgical Wound Infection
warmth, green or yellow discharge wider incision redness and swelling
30
PACU nurse will monitor what?
monitor vital signs ALOC pain levels
31
where would a PACU nurse transfer a patient to?
acute care nurse
32
Causes of dehisence
abdominal surgery corticosteroid use in high doses infection
33
What is a treatment for ileus and why?
Treatment includes insertion of a nasogastric tube and IV fluids because the client will be NPO.
34
Risk factors of oliguria post op?
Other risk factors for this complication include older age, diabetes, heart failure, hypertension, and peripheral vascular disease. CKD
35
possible signs of post op oliguria
JVD mucous membrane changes rales abnormal heart sounds pitting edema
36
What are nurse's responsibilities during intraoperative surgical phase? (7)
verifying preoperative checklist is complete informed consent is signed surgical preparations for the scheduled procedure have been performed administering prescribed medications ensuring blood products are available if needed obtaining IV access
37
speak up is o ensure what?
correct procedure is performed on the correct client and the correct site
38
A “time-out” is performed when and by whom?
before the start of the procedure, before starting an additional procedure as applicable, and at the completion of the surgery by the circulating nurse
39
what does the ciculating nurse do?
coordinating the care of the client before, during, and after the surgical procedure
40
Circulating Nurse responsibilities
verifying the identity of the client assess for allergy check consent form complete and verify documents needed during the procedure assisting anesthesiologist safety, positioning, and monitoring of patient maintain sterility while providing supplies initiates a time out
41
Certified Surgical Technologist (CST), ensures what
the utensils used during surgery are sterile and ready for use sterile and ready for use applies suction assists with suturing transfers client in and out of surgical suite
42
What is the temperature of the surgical environment and why?
68° F and 75° F to decrease the growth of pathogens, thereby minimizing risk of contamination
43
What is the humidity of the surgical environment
20% and 60%.
44
who removes hair from the surgical site?
circulating nurse
45
types of local anesthetics
lidocaine and benzocaine
46
Local Anesthesia bad side effects
tachypnea and tachycardia. Other manifestations may include tinnitus, numbness around the mouth, drowsiness, a metallic taste, numbness, tremors, seizures, or coma.
47
what type of anesthesia affects both the motor and sensory nerves at the surgical site?
local
48
What kind of anesthesia should be used for repair of a broken bone, breast biopsy, and suturing a deep cut?
local
49
What kind of anesthesia for childbirth epidurals?
Regional Anesthesia
50
When are some advantages of moderate sedation?
The client is easy to arouse, is able to answer questions, and can follow simple requests to move or change positions.
51
What anesthesia affects cardiovascular and respiratory systems are inhibited?
general anesthesia
52
diazepam, lorazepam, and midazolam. are examples are what kind of anesthesia?
moderate sedation
53
Coughing and deep breathing are used to clear the airway and are recommended every how many hours for the postsurgical client
two
54
Interventions to prevent CV complications
for example, positioning, early ambulation, ankle pump exercises, SCD use, and antiembolism stockings
55
What is the Aldrete Score used for?
alculated to assess the client’s postanesthesia neural status.
56
Why is hydration important post op?
decrease clot formation due to immobility and increase blood volume lost from bleeding after surgery. decrease the risk of cardiovascular complications. Fluid intake decreases the likelihood of clot formation and increases blood volume. Clots form when the blood cells are concentrated and gather in the blood vessels.
57
what should be done for clients who have a distended bladder, are uncomfortable, and have not voided 6 to 8 hours?
put a straigh catheter and remove once bladder is emptied
58
Which clients are at increased risk for aspiration after surgery?
Clients who have problems swallowing are at an increased risk, as are those with dental problems and disorders of the esophagus (e.g., heartburn or cancer) or neurologic system (e.g., Parkinson’s disease or stroke).
59
What are nursing interventions for those who are experiencing post-op delirium
monitor the client’s neuro status monitor the client’s oxygenation status Medications that are nonessential put on hold mobilized when possible monitor the client’s fluid and electrolyte status.
60
What is malignant hyperthermia
Severe reaction to certain medications given during anesthesia that make the patient super febrile, usually caused by genetics
61
Clients who are obese with a BMI greater than what are at an increased risk for poor wound healing.
30
62
The nurse is reviewing the client's electronic medical record. Which of the following findings places the client at risk for a surgical complication? Glucose level Metformin Prednisone Type 2 diabetes mellitus Smoking history
Glucose level Prednisone Type 2 diabetes mellitus Smoking history
63
What starts and stops the intraoperative phase?
clients are moved on the OR bed and transferred to the recovery or post anesthesia
64
What should females be checked for preop?
pregnancy
65
Preop education
Post op procedures Mobile DVT Pulmonary infections Move, cough, deep breathe Incentive spirometers GOOOOAAL: go home right ASAP
66
Why is oliguria or acute kidney injury a complication of surgery?
hypovolemic because loss of blood and perhaps meds
67
Anesthesia and pain med post op patients must be considered for what
Fall Risks Aspiration Precautions Impaired Cognition
68
What are risk factors for general anesthesia?
family history of malignant hyperthermia respiratory disease cardiac diseases gastric contents (aspiration) alcohol or substance use disorder
69
What are risk factors for local anesthesia
Allergy to ester-type anesthetics alterations in peripheral circulation
70
What are some contraindications for propofol?
allergies to eggs and soybean oil
71
What is palliative care?
type of surgery of care to give patients a better quality of life, but not curative
72
What might people with shellfish be allergic to?
reaction to povidone-iodime
73
What might people with banana and kiwi be allergic to?
risk for latex allergy
74
What is the main role of the nurse when a patient is having surgery?
assess and identify risk
75
What might people with eggs and soybeen be allergic to?
propofol
76
Meds that place patients at high risk for surgical complications
* Antihypertensives * Anticoagulants * NSAIDs – stop ASA 1 week before surgery * Tricyclic antidepressants * Over‐the‐counter medications
77
Alcohol increases the risk for what and why?
bleeding because it destroys the liver, which synthesizes vitamin K, which is responsible for wound healing
78
What happens if a patient is stressed and anxious?
it triggers the SNS and increases cortisol and blood glucose because epinephrine is increased, and blood pressure
79
High-risk herbal medication Echinacea causes
hepatotoxic
80
High-risk herbal medication Ephedra causes
arrhythmias
81
High-risk herbal medication garlic, ginger, ginkgo biloba, ginseng causes
bleeding
82
High-risk herbal medication Kava and St. John's wort causes
sedative
83
High-risk herbal medication Valerian causes
anxiolytic
84
What should a nurse do when a client encounters anxiety and panic
sedatives and nonpharm interventions such as distraction, imagery, and music therapy
85
Why are some medications that should be stopped before surgery?
antihypertensives, anticoagulants, and antidepressantsW
86
Why is it important to monitor patients when they have respiratory problems?
anesthesia can depress respiration and heart function
87
What are some preoperative medications that nurses need to administer?
antiemetics sedatives * Antimicrobials – within 1 hour before incision * Beta blocker if using as maintenance * Anticoagulants – if with VTE risk * Eye drops – if with glaucoma
88
What are some surgical complications of diabetics?
stress will induce cortisol and raise blood glucose, needing more insulin
89
What are two types of regional anesthesia?
nerve block and field block
90
What type of anesthesia is an option when a patient has not been NPO sufficiently?
regional anesthesia
91
What type of anesthesia is used when prevention of postoperative pain is also a desired effect?
regional anesthsia
92
What diagnostic test is used to check kidney function?
BUN and creatinine
93
What are some surgical compliations of renal disease patients?
fluid overload lowered excretion
94
What are some surgical complications of hypothyroidism patients?
they are at risk for hypothermia and constipation
95
What are some surgical complications of Addison's disease patients?
they have low aldertrone so they pee a lot and lose a lot of sodium also have low Cortisol so they need more glucose
96
What are some surgical complications of Cushing's disease patients?
they have high aldertrone so they pee a less and have hypernatremia also have high Cortisol so they have hyperglucose ore prone to infection
97
What are field blocks useful for?
procedures of the chest, plastic surgery, dental, and hernia repairs
98
What procedures are nerve blocks useful for?
procedures of the chest, plastic surgery, dental, and hernia repairs
99
What should be avoided if someone has malignant hyperthermia?
succinylcholine
100
What are some examples of local anesthetics?

Fundamentals (15 decks)

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