w3_Ch9_OR Flashcards
1
Q
safety during the surgical experience
A
- national patient safety goal
- SBAR
- surgical care improvement plan (SCIP)
- surgical safety checklist
- teamSTEPPS
2
Q
role of nurse in PERI-op care
A
- prep pt for surgery
- assist/obs patient during operation
- prevent/treat postop complications
- prepare pt for discharge
3
Q
importance of nursing assessment
A
- ID risk factor
- assess ALL body systems
- correct, minimize, or prevent potential problems
- dev. preop & postop teaching plans (individualized)
- provides a baseline of physical & functional ability
4
Q
PRE-op focus of the nurse
A
- provide information (what is happening after surgery)
- ensure informed consent obtained
- ensure site marking
- implement dietary restrictions
- patient teaching
5
Q
PRE-op P.A.
A
- focus is on prep for surgery & ensuring safety
- obtain base line V.S.
- focus on problem areas ID by clients history & on all body sys affected by the surgical procedure (cardiovas. & resp)
- review labs & diagnostic tests
- report abnormal assess findings to surgeon & anesthesia ppl
6
Q
T/F: all patients get a chest xray & EKG
A
true
7
Q
PRE-op teaching prevent POST-op complications
A
- scheduled drugs used
- explain intestinal & skin prep
- explain tubes, drains, vascular access
- sensation & discomfort info
- methods to prevent resp & cardiovasc complications: breathing xcise, IS, splinting incision, coughing, leg xcise, ambulation & mobility (within 24hrs get out of bed)
8
Q
informed consent
A
- obtained from pt or legal guardian responsible guardian
- voluntary and revocable any time
- includes: condition requiring surgery, surgical procedure to be performed, risks/benefits of procedure, tx options and prognosis
(use common language & med terms)
9
Q
surgeon vs nurse role, informed consent
A
- surgeon: obtain signed consent before sedation is given & surgery is performed
- nurses role: to clarify facts presented by MD and dispel myths
10
Q
intestinal prep
A
- GI surgery
- bowel or intest prep are to prevent injury to the colon & reduce # of intest bacteria
- enema or laxative may be ordered by MD
11
Q
skin prep
A
- shower using antiseptic solution
- dont shave, just trim
12
Q
PRE-op EHR review
A
- documentation, preop procedures, orders are complete
- check surgical consent form for signature
- consent signed
- site marked
- doc allergies, ht & wt
- ensure NPO
- lab/test results in chart, abnormals noted
- notify surgical team of special needs, concerns, instructions
13
Q
general anesthesia
A
- complete loss of consciousness
- intubated
14
Q
complications of general anesthesia
A
- malignant hyperthermia= tx with dantrolene
- overdose
- unrecognized hypotension
- complications of specific anesthetic agent
- complications of intubation (sore throat)
15
Q
immediately after surgery
A
- focus on the nurse’s assessment & intervention
(pt safety, hemodynamic stability, recognition & prevention of postoperative complications) - history (rvw preoperative assess, ID potential surgical complications)
16
Q
post op: respiratory system
A
- assess for patent airway, adequate gas exchange
- note artificial airway
- O2 delivery device
- check lungs q4 hrs for first 24hrs following surgery
17
Q
post op: cardiovascular system
A
- assess vitals & compare w/ baseline
- report BP changes 25% higher or lower than baseline
- monitor for cardiac depression, fluid vol deficit, shock, hemorrhage, & drug effects
- apply antiembolism stockings (prevent DVT) and pnuematic compression devices if ordered
18
Q
post op neuro. assessment
A
- cerebral function & LOC
- orientation to person, place, & time (GCS)
- motor & sensory function , after general anesthesia
19
Q
post op fluid/elec/acid base assessment
A
- intake & output
- hydration status
- IV fluids
- acid base balance
- NG tube drainage (GI surgery)
20
Q
post op: renal/urinary
A
- return of urination
- effects of drugs on urination
- signs of urine retention
- report urine output <30mL/hr (foley catheter, remove post void 6-8hrs)
- no foley, assess 24 hr output
21
Q
post op: GI assessment
A
- post op n/v (PONV)
- intestinal peristalsis
- NG drainage, if applicable
- constipation
- slowed down peristalsis from anesthesia increase n/v, constipation
22
Q
post op: pain assessment
A
- pain/discomfort expected after surgery
- pain assessment: continuous assessment needed
23
Q
post op: psychosocial assessment
A
- assess for signs of anxiety
- reassure pt safety
- assess caregiver (include w/teaching)
- refer as needed
24
Q
integumentary system
A
- normal wound healing
- drainage: sanguineous, serosanguineous, serous
- impaired wound healing, seen most often 5-10 days after surgery (dehiscence/evisceration)
25
Q
dehiscence/evisceration
A
- sterile H20
- sterile drape
- bent knees
26
Q
nurses areas of concern in the PACU
A
- hypoxia
- fluid volume/blood loss
- hypothermia
- postop n/v
- pain
27
Q
hypoxia
A
- airway obstruction, muscles relax from anesthesia
- hypoventilation, delay excretion from anesthesia
- laryngospasm, irritation from secretions/inhalants/medications
28
Q
imbalanced fluid volume assessment
A
- monitor at least hrly for postop bleeding
- mark drainage on dressing
- monitor drainage under pt
- monitor internal bleeding (decrease BP, increased HR, decreased CO)
- monitor signs of fluid overload or dehydration
- report to the surgeon any changes
29
Q
hypothermia, d/t
A
- treat pt w/ core temperature <36c/96.8f, shivering, peripheral vasoconstriction or piloerection
d/t: suppression of CNS anesthesia
30
Q
hypothermia prevention
A
- warm cotton blankets
- socks
- head covering
- limit skin exposure
- maintain room temp 68-75f
