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Fundamentals > Surgical Client > Flashcards

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
Q

Preoperatively hypovolemia can be caused by: (3)

A

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

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26
Q

Intraoperatively hypovolemia can be caused by: (3)

A

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

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27
Q

hypovolemia is affected by what?

A

urgency of surgery (emergency versus elective),
the type of surgery, and
the length and complexity of surgery.

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28
Q

Hypervolemia

A

istory of chronic conditions that cause fluid retention, such as CHF or renal insufficiency or failure.

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29
Q

Surgical Wound Infection

A

warmth, green or yellow discharge
wider incision
redness and swelling

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30
Q

PACU nurse will monitor what?

A

monitor vital signs
ALOC
pain levels

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31
Q

where would a PACU nurse transfer a patient to?

A

acute care nurse

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32
Q

Causes of dehisence

A

abdominal surgery
corticosteroid use in high doses
infection

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33
Q

What is a treatment for ileus and why?

A

Treatment includes insertion of a nasogastric tube and IV fluids because the client will be NPO.

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34
Q

Risk factors of oliguria post op?

A

Other risk factors for this complication include older age, diabetes, heart failure, hypertension, and peripheral vascular disease.
CKD

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35
Q

possible signs of post op oliguria

A

JVD
mucous membrane changes
rales
abnormal heart sounds
pitting edema

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36
Q

What are nurse’s responsibilities during intraoperative surgical phase? (7)

A

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

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37
Q

speak up is o ensure what?

A

correct procedure is performed on the correct client and the correct site

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38
Q

A “time-out” is performed when and by whom?

A

before the start of the procedure, before starting an additional procedure as applicable, and at the completion of the surgery by the circulating nurse

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39
Q

what does the ciculating nurse do?

A

coordinating the care of the client before, during, and after the surgical procedure

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40
Q

Circulating Nurse responsibilities

A

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

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41
Q

Certified Surgical Technologist (CST), ensures what

A

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
Q

What is the temperature of the surgical environment and why?

A

68° F and 75° F to decrease the growth of pathogens, thereby minimizing risk of contamination

43
Q

What is the humidity of the surgical environment

A

20% and 60%.

44
Q

who removes hair from the surgical site?

A

circulating nurse

45
Q

types of local anesthetics

A

lidocaine and benzocaine

46
Q

Local Anesthesia bad side effects

A

tachypnea and tachycardia. Other manifestations may include tinnitus, numbness around the mouth, drowsiness, a metallic taste, numbness, tremors, seizures, or coma.

47
Q

what type of anesthesia affects both the motor and sensory nerves at the surgical site?

A

local

48
Q

What kind of anesthesia should be used for repair of a broken bone, breast biopsy, and suturing a deep cut?

A

local

49
Q

What kind of anesthesia for childbirth epidurals?

A

Regional Anesthesia

50
Q

When are some advantages of moderate sedation?

A

The client is easy to arouse, is able to answer questions, and can follow simple requests to move or change positions.

51
Q

What anesthesia affects cardiovascular and respiratory systems are inhibited?

A

general anesthesia

52
Q

diazepam, lorazepam, and midazolam. are examples are what kind of anesthesia?

A

moderate sedation

53
Q

Coughing and deep breathing are used to clear the airway and are recommended every how many hours for the postsurgical client

A

two

54
Q

Interventions to prevent CV complications

A

for example, positioning, early ambulation, ankle pump exercises, SCD use, and antiembolism stockings

55
Q

What is the Aldrete Score used for?

A

alculated to assess the client’s postanesthesia neural status.

56
Q

Why is hydration important post op?

A

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
Q

what should be done for clients who have a distended bladder, are uncomfortable, and have not voided 6 to 8 hours?

A

put a straigh catheter and remove once bladder is emptied

58
Q

Which clients are at increased risk for aspiration after surgery?

A

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
Q

What are nursing interventions for those who are experiencing post-op delirium

A

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
Q

What is malignant hyperthermia

A

Severe reaction to certain medications given during anesthesia that make the patient super febrile, usually caused by genetics

61
Q

Clients who are obese with a BMI greater than what are at an increased risk for poor wound healing.

A

30

62
Q

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

A

Glucose level
Prednisone
Type 2 diabetes mellitus
Smoking history

63
Q

What starts and stops the intraoperative phase?

A

clients are moved on the OR bed and transferred to the recovery or post anesthesia

64
Q

What should females be checked for preop?

A

pregnancy

65
Q

Preop education

A

Post op procedures
Mobile
DVT
Pulmonary infections
Move, cough, deep breathe
Incentive spirometers
GOOOOAAL: go home right ASAP

66
Q

Why is oliguria or acute kidney injury a complication of surgery?

A

hypovolemic because loss of blood and perhaps meds

67
Q

Anesthesia and pain med post op patients must be considered for what

A

Fall Risks
Aspiration
Precautions
Impaired Cognition

68
Q

What are risk factors for general anesthesia?

A

family history of malignant hyperthermia
respiratory disease
cardiac diseases
gastric contents (aspiration)
alcohol or substance use disorder

69
Q

What are risk factors for local anesthesia

A

Allergy to ester-type anesthetics
alterations in peripheral circulation

70
Q

What are some contraindications for propofol?

A

allergies to eggs and soybean oil

71
Q

What is palliative care?

A

type of surgery of care to give patients a better quality of life, but not curative

72
Q

What might people with shellfish be allergic to?

A

reaction to povidone-iodime

73
Q

What might people with banana and kiwi be allergic to?

A

risk for latex allergy

74
Q

What is the main role of the nurse when a patient is having surgery?

A

assess and identify risk

75
Q

What might people with eggs and soybeen be allergic to?

A

propofol

76
Q

Meds that place patients at high risk for surgical complications

A
  • Antihypertensives
  • Anticoagulants
  • NSAIDs – stop ASA 1 week before surgery
  • Tricyclic antidepressants
  • Over‐the‐counter medications
77
Q

Alcohol increases the risk for what and why?

A

bleeding because it destroys the liver, which synthesizes vitamin K, which is responsible for wound healing

78
Q

What happens if a patient is stressed and anxious?

A

it triggers the SNS and increases cortisol and blood glucose because epinephrine is increased, and blood pressure

79
Q

High-risk herbal medication Echinacea causes

A

hepatotoxic

80
Q

High-risk herbal medication Ephedra causes

A

arrhythmias

81
Q

High-risk herbal medication garlic, ginger, ginkgo biloba, ginseng causes

A

bleeding

82
Q

High-risk herbal medication Kava and St. John’s wort causes

A

sedative

83
Q

High-risk herbal medication Valerian causes

A

anxiolytic

84
Q

What should a nurse do when a client encounters anxiety and panic

A

sedatives and nonpharm interventions such as distraction, imagery, and music therapy

85
Q

Why are some medications that should be stopped before surgery?

A

antihypertensives, anticoagulants, and antidepressantsW

86
Q

Why is it important to monitor patients when they have respiratory problems?

A

anesthesia can depress respiration and heart function

87
Q

What are some preoperative medications that nurses need to administer?

A

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
Q

What are some surgical complications of diabetics?

A

stress will induce cortisol and raise blood glucose, needing more insulin

89
Q

What are two types of regional anesthesia?

A

nerve block and field block

90
Q

What type of anesthesia is an option when a patient has not been NPO sufficiently?

A

regional anesthesia

91
Q

What type of anesthesia is used when prevention of postoperative pain is also a desired effect?

A

regional anesthsia

92
Q

What diagnostic test is used to check kidney function?

A

BUN and creatinine

93
Q

What are some surgical compliations of renal disease patients?

A

fluid overload
lowered excretion

94
Q

What are some surgical complications of hypothyroidism patients?

A

they are at risk for hypothermia and constipation

95
Q

What are some surgical complications of Addison’s disease patients?

A

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
Q

What are some surgical complications of Cushing’s disease patients?

A

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
Q

What are field blocks useful for?

A

procedures of the chest, plastic surgery, dental, and hernia repairs

98
Q

What procedures are nerve blocks useful for?

A

procedures of the chest, plastic surgery, dental, and hernia repairs

99
Q

What should be avoided if someone has malignant hyperthermia?

A

succinylcholine

100
Q

What are some examples of local anesthetics?

A

Fundamentals (15 decks)

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