Topic 2: Pre/Post-Op Flashcards
perioperative period
the total surigal episode
inpatient hospital setting
-same day admission
-patients who are already in the hospital
ambulatory surgery
includes outpatient, same-day, or short-stay surgery that does not require an overnight hospital stay (returns home on the same day)
Level 1 Trauma
will take everything, including multisystem trauma (stabbing, shooting, car accident)
-in house 24/7 OR team
level 2 trauma
will take single system traumas (fractured leg, head injury)
-OR tema 24/7
level 3 trauma
no longer has any in hous staff or physicians
provide limited services (no neuro or cardiac surgery)
-access to an on call OR team
level 4 trauma
no onsite staff, limited services for walk in patients only
elective surgery
not an emergency, has been schedules and there is plenty of time to prepare
urgent surgery
the patient must go to surgery/OR within 6 hours for a life or limb threatening surgery. These patients tend to be stable, and wait in the ER.
emergent surgery
These are the true emergencies where there will be loss of life or limb within one hour if the patient isn’t taken to surgery.
-These patient tend to be very unstable, are often airlifted by helicopter to a trauma center, and come from the ER or ICU
diagnostic surgery
Determines origin and cause of disorder
curative surgery
Resolves health problem by repairing or removing cause
restorative surgery
Improves client’s functional ability
palliative surgery
Relieves symptoms of disease process, but does not cure
prevention surgery
reduce risk of developing a condition (removal of a mole before it becomes malignant)
cosmetic surgery
Alters/enhances personal appearance
When does the preoperative phase begin and end?
Begins when patient is scheduled for surgery
Ends at time of transfer to Operating Room/Surgical Suite
what does the nurse assess for a preop patient
-baseline data for comparison
- identification and documentation
- drug reconciliation & allergies
-checks if the patient is educated about info from surgeon and post op procedures
-asses anxiety and promote patient coopertion
what is included in the education for pre op
Information about informed consent, dietary restrictions, bowel and skin preparations, exercises after surgery, and plans for pain management promote patients’ participation and help achieve the desired outcome.
what tool is used in helping nursed to rememeber the many things that must be done when getting a client ready for surgery
pre-operative check list
common fears
Fear of death
Fear of pain and discomfort
Fear of mutilation or alteration in body image
Fear of anesthesia
Fear of disruption of life functioning or patterns
lab testing: ABGs, pulse oximetry
Respiratory and metabolic function, oxygenation status
lab testing: blood glucose
metabolic status, diabetes mellitus
lab testing: BUN, creatinine
renal function
lab testing: chest x-ray
lung disorders, cardiac enlargement, HF
lab testing: CBC- RBCs Hgb, Hct, WBCs
anemia, immune status, infection
lab testing: electrocardiogram
heart disease, dysrhythmias
lab testing: electrolytes
metabolic status, renal function, diuretic side effects
lab testing: hCG
pregnancy
lab testing: liver function tests
liver status
lab testing: PT, PTT, INR, platelet count
coagulation status
lab testing: pulmonary function studies
pulmonary status
lab testing: serum albumin
nutritional status
lab testing: type and crossmatch
blood available fro replacement
lab testing: urinalysis
renal atatus, hydration, urinary tract infection
what lab test are VERY impotant to a surgeon
CBC because you need to know the PT and INR for BLEEDING TIME
what lab test are very important for a diabetic patient
BG and electrolytes
why is a stress response important to know before surgery
the stress response can be magnified, directly impact the body, and recovery can be affected.
what htree conditions ust be met for consent to be valid
adequate disclosure
clear inderstansing of the information
give consent voluntarily
what is the surgeons responsibility for legal preparation
inform the patient of why the surgery is needed, what the expected outcomes would be, and what the potential complications may be up to and including death. SURGEON IS RESPONSIBLE FOR OBTAINING CONSENT
what is the nurses responsibility for legal preparation
ensure the consent has been signed by both the patient and surgeon. WITNESS
when does the nurse need to make sure that the patient has signed for prior to consent
prior to any administration of sedation… this impairs their cognition so they are not legally responsible to sign.
what is is mandatory when surgery is performed on an organ/body part that has two of something…
site marking (The surgeon or designee (PA, assistant…) are responsible to mark it, so it can still be seen after the surgical drapes are applied.)
what are the two types of pre-op medications
regular medications
pre-op medications required for surgery
what should be done about regular medications before an operation
Consult with physician and anesthesia provider for instructions
Pre-Op medications required for surgery
this prepares the client’s body physically and psychologically
pre-op meds: antiemetics
decreases N/V
pre-op meds: benzodiazepines
to reduce anxiety, to induce sedation
pre-op meds: opioids
to relieve discomfort during pre op procedures
decrease amnount of anesthetic needed for induction
pre-op meds: histamine H2 receptor antagonist
to increase gastric pH
decrease gastic volume
pre-op meds: antacids
increase gastric emptying
pre-op meds: antichonlinergics
decrease oral and respiratory secretions (atropine
provides sedation
Pre-op meds: antibiotics
prevents post op infection
pre op client preparation
-Leave valuables with family or lock up with security
-Tape rings in place if cannot be removed (ring cutter)
-Ensure patient is wearing ID band(s)
what do we remove before surgery
Dentures
Prosthetic devices
Hearing aids
Contact lenses
Fingernail polish
Artificial nails
All jewelry
pre-op teaching: sensory information
Noise levels, smells, OR cold, blanket given, everyone in masks, ask questions, lights in OR bright, sound of machines and their purpose
pre-op teaching: procedural information
What to bring and wear to surgical center, changes in time of surgery, fluid and food restriction, bed and safety strap, physical prep: (bowel, skin), purpose of freq. vital signs assessment, anesthesia administration procedure, insertion of IV lines
pre-op teaching: exercises
Perform ROMs
pre-op teaching: process information
information about the general flow of surgery & where will caregivers can wait during surgery
Deep breathing exercises
demonstrating technique of deep breathing & coughing will assist pt in performing post-op.
incentive spirometry
a common postoperative breathing therapy using a specially designed spirometer to encourage the patient to inhale and hold an inspiratory volume to exercise the lungs and prevent pulmonary complications
when does post-op care begin
*Begins with completion of surgery and transfer to PACU, ambulatory care unit, or ICU
what are the priority interventions of the nurse post-op
A: Asses and airway
B: Breathing and blood
C: circulation and change in LOC
S: Safety
what assessment data is included in the PACU
*level of consciousness, temperature, pulse, respirations, oxygen saturation, blood pressure, and evaluation of the surgical area for bleeding (clotting).
after the intitial assesment upon admisssion to the PACU, how often are vital signs and heart sounds assesed
every 15 minutes until stable
post surgical bleeding is one of the most important things to check, why
it can cause the patient to go into hypovolemic shock
what does the nurse assess for fluid and electrolye imbalances
I&Os
Daily weights
hydration status
electrolytes
What is counted as input and output on the In/Out Sheet?
iv fluid
vomit
urine
wound drainage
oral intake
NG tube drainage
when should a nurse report inadequate urine output
if its <30 mL/hr
BAIR Hugger
Patient warming device used for Hypothermia because of after surgery causes shivering that increases oxygen demand and can induce hypoxemia.
what should a nurse do if their patient has paralytic ileus
insert an NG tube
(low intermittent suction)
what medications are used to reduce N/V
*Ondansetron (Zofran)
*Meclizine (Antivert, Dramamine)
*Scopolamine patch
after surgery bowel sounds can be delayed for up to 24 hours, so what would the nurse monitor
monitor for bowel sounds
why are NG inserted
*Decompress and drain stomach
*Promote GI rest
*Allow lower GI tract to heal
*Provide enteral feeding route
*Monitor any gastric bleeding
*Prevent intestinal obstruction
how often should the nurse asses NG tube drainage
every 8 hours
when is impaired wound healing most often seen after surgery
between 5 to 10 days after surgery
if there is wound dehiscence or eviceration, what should the nurse do
Notify the surgeon and remain with the patient if wound dehiscence or evisceration occurs.
o Have the patient lie flat (supine) with knees bent to reduce intra-abdominal pressure.
o Apply sterile, nonadherent, or saline dressing materials to the wound.
who performs the first dressing change
The surgeon usually performs the first dressing change to assess the wound, remove any packing, and advance or remove drains.
what technique is used during all dressing changes
aseptic technique
Physical & Emotional Signs of Acute Pain
*Increased pulse and blood pressure
*Increased respiratory rate
*Profuse sweating
*Restlessness
*Confusion (older adults)
*Wincing, moaning, crying
complementary and alternative therapies for pain
*Positioning
*Massage
*Relaxation/diversion techniques
when is hypoxemia most common after surgery
*Highest incidence occurs on 2nd postoperative day
what are the interventions for hypoxemia
*Airway maintenance
*Monitor (Spo2)
*Semi-Fowler’s position
*Oxygen therapy, breathing exercises
*Mobilization as soon as possible
how often should the nurse ass the tissue integrity of the incison site
each shift or at least every 8 hours and monitor for signs of infection.
