Unit 1: The Surgical Patient Flashcards
Masks are worn at all times in the restricted zone of the OR
True
An advantage of IV anesthesia is that the onset of the anesthesia is pleasant, therefore, it is often used.
True
Tachycardia is often the first sign of malignant hyperthermia
True
Shock results from hypervolemia
False- hypovolemia can cause shock
_______is the most common endocrinopathy.
Diabetes
The major purpose of withholding fluids before surgery is to prevent _______.
Aspiration
The ___________ phase begins when the patient is transferred onto the OR table and ends with admission to the PACU.
Intraoperative
________ is a state of narcosis, analgesia, relaxation, and reflex loss.
Anesthesia
Spinal anesthesia produces anesthesia of the lower extremities, _______, and lower abdomen.
Perineum
What phases does perioperative nursing include?
Preoperative, Intraoperative, Postoperative
What is the preoperative phase?
The period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table
What is the intraoperative phase?
The period of time from when the patient is transferred to the operating room table to when he or she is admitted to the postanesthesia care unit (PACU)
What is the postoperative phase?
The period of time that begins with the admission of the patient to the PACU and ends after a follow-up evaluation in the clinical setting or home
What is first-intention healing?
a method of healing in which wound edges are surgically approximated and integumentary continuity is restored without granulation
What is second-intention healing?
a method of healing in which wound edges are not surgically approximated and integumentary continuity is restored by the process of granulation
What is third-intention healing?
A method of healing in which surgical approximation of wound edges is delayed and integumentary continuity is restored by apposing areas of granulation
What factors would you include in the assessment of a surgical patient?
Fluid & nutritional status Drug & alcohol use Respiratory status Cardiovascular status Hepatic & Renal function Endocrine function Immune function Medication use Psychological factors Spiritual & Cultural beliefs Presence of genetic disorders
What is the preoperative checklist?
A list of elements that must be checked preoperatively, including: patient identification, correct documents, and patient understanding of the procedure
What is the role of the nurse in the informed consent process?
To ensure the patient/patient representative is provided the information necessary to enable them to evaluate the surgery before agreeing to it
as well as verifying that the patient signing the document is the patient receiving the operation
What are the routine screening tests for surgical patients?
Bloodwork Urinalysis Chest X-Ray Pulmonary function test ECG Pregnancy test
What are some age-related changes that put older adults at risk for surgery?
Decreased subcutaneous fat
Poor skin tugor
Tissue fragility
Decreased physiologic reserve
What are factors that place older adults at risk for surgery?
Age related changes
medications
medical history
What are the effects of medications taken preoperatively?
Medications will cause relaxation, lightheadedness, and drowziness
What are some key points to make during preoperative teaching?
the possible need for a ventilator, drainage tubes, etc
instruction for breathing and leg exercises
promote mobility
proper breathing techniques
pain intensity scale
What are characteristics of patients under general anesthesia?
not arousable, even with painful stimuli
lose ability to maintain ventilatory function
require assistance maintaining a patent airway
What is Stage I of general anesthesia?
Beginning Anesthesia: warmth, dizziness, detachment; may hear buzzing or ringing, may sense inability to move extremities
What is Stage II of general anesthesia?
Excitement: struggling, shouting, talking, singing, laughing, crying; often avoided if anesthesia is given quickly and smoothly
What are the different types of anesthesia?
General anesthesia
Local anesthesia
Moderate sedation/analgesia
Monitored anesthesia care
What is Stage III of general anesthesia?
Surgical Anesthesia: reached by continuous administration; pt is unconscious
What is Stage IV of general anesthesia?
Medullary Depression: too much anesthesia has been administered; cyanosis; can be fatal
What is Local Anesthesia?
Blocks the nerves in the CNS & PNS, can be used alone or in conjunction with other types; topical or local infiltration
What is Regional Anesthesia?
A form of local anesthesia where an anesthetic agent is injected around nerve so the area the nerve supplies is anesthetized
What are examples of regional anesthesia?
Spinal, epidural, peripheral nerve blocks
What is Moderate sedation/analgesia?
Sedation without anesthesiologist; conscious sedation
What is monitored anesthesia care?
Potential for a deeper level of sedation where the sedation/analgesia is always monitored by and anesthesiologist
What do moderate sedation & monitored anesthesia have in common?
Depress a pt’s LOC to a moderate level to enable surgical, diagnostic, or therapeutic procedures to be preformed while ensuring the pt’s comfort and cooperation
Allows pt to maintain a patent airway, retain protective airway reflexes, respond to verbal and physical stimuli, and recover more rapidly
What is emergent surgery?
Life-threatening, needs to be done ASAP
What is urgent surgery?
Necessary, but can wait 24 hours
What is required surgery?
necessary, but can wait
What is elective surgery?
Unnecessary, but will make quality of life better
What is optional surgery?
No medical need; cosmetic
What are the types of surgical techniques?
Conventional
Laparoscopic
Robotic
Natural orifice
What types of bloodwork is completed pre-operatively?
CBC
Electrolytes
Chem 7
PT, PTT, & Clotting
What percentage of surgery is outpatient?
70-90%
What is the anesthesiologist’s assessment focused on?
Cardiac history
respiratory history
previous anesthesia experiences
current medications
Pre-operative checklist criteria
Vitals Height & weight consent signed? H&P charted/dated? Diagnostics NPO ID Band Allergies hospital gown jewelry off disposition of valuables meds given pt voided
What are common pre-op orders?
NPO (usually @ 12a)
IVF
Medications OK to give
What are common pre-op preps?
Skin- cleanse/clip hair
Bowel
Prior to the surgery, the patient is nervous and does not understand hte procedure or how it will be preformed; the nurse should…
Have the HCP come and explain & review the procedure with the patient
Who’s in the OR?
Primary surgeon Assistant surgeon Scrub nurse Circulating nurse Anesthesia provider
SURGICAL TIME OUT prevents
Wrong person
wrong procedure
wrong site
What is malignant hyperthermia?
An inherited complication of general inhalation anesthesia; causes contractillity of muscles leading to extreme hyperthermia
What are the sympotms, in order, of MH?
Tachycardia* Tachypnea Hypercarbia/hypoxemia Muscle rigidity venticular dysrhythmias Lactic acidosis Extreme hyperthermia
What is the treatment of MH?
Stop anesthetic
Hyperventilate 100% O2
Cool
IV dantrolene
How do you prevent a patient from MH?
Obtain a family history
What criteria is used to evaluate if a PACU pt is ready for discharge?
Stable BP Adequate respiratory function Adequate O2 sat Spontaneous movement/movement on command AAOx3 Urine output of > 30 ml/hr absent n/v
What is the role of the RN during pt admission to PACU?
assess pt maintain patent airway maintain cardiovascular stability relieve pain & anxiety Control n/v prep for discharge
What are possible immediate post-op complications?
Respiratory depression laryngospasm aspiration cardiac arrest hypo/hypertension dysrhythmias syncope
What is the intervention to post-operative respiratory depression?
Verbal stimulation
administer naloxone
What is the intervention to post-operative nausea/vomiting?
Administer metaclopromide or promethazone
What is the intervention for post-operative hypothermia?
Warming blanket
What is the intervention to post-operative pain?
IV push
PCA
epidural
morphine, fentanyl, hydromorphone
Identify tasks that can be delgated to UAP
vital signs repositioning pt assistance with ambulation collecting UA height & weight
Describe the use of patient controlled analgesia (PCA) in the post-op period
allows pt to control the administration of their medication w/i predetermined safety limits
Describe the use of epidural analgesia in the post-op period
the infusion of opiods or local anesthetic agents into the epidural space
What are common post-operative complications?
DVT/PE Infection Pneumonia UTI Sepsis Wound dehiscence evisceration
What is a cataract?
The clouding/opacity of the eye lens
What are the assessment findings of cataracts?
painless, blurry vision
abnormal color perception
dim surroundings
What kind of surgery is cataract surgery?
required, outpatient
What are complications of cataract surgery?
Minimum eye pain Hemorrhage Infection increased intraoccular pressure Toxic anterior segment syndrome
What are the expected outcomes of cataract surgery?
improved vision
better ADL performance
minimal to no pain
