WEEK 1: The Role of the Practical in the admission, discharge and transfer surgical client Flashcards
Define perioperative nursing
-Perioperative nursing refers to the specialized care provided to surgical clients before (preoperative), during (intraoperative), and after (postoperative) surgery.
-The goal is to ensure patient safety, optimize outcomes, and provide emotional and physical support throughout the surgical experience.
Describe the nursing care of the client in the perioperative period
-Preoperative Care: Assess health history, perform a physical exam, verify informed consent, provide preoperative teaching, and prepare the client physically (e.g., fasting, skin preparation).
-Intraoperative Care: Maintain sterility, monitor the patient’s vital signs, assist the surgical team, and document intraoperative events.
-Postoperative Care: Monitor recovery, manage pain, prevent complications (e.g., infection, DVT), and educate the patient on self-care at home.
Define- informed consent
-Informed consent is the patient’s voluntary agreement to undergo a specific procedure after receiving adequate information about the procedure, risks, benefits, and alternatives.
Describe the three elements involved in informed consent
-Disclosure: The patient is provided with all relevant information.
-Capacity: The patient has the ability to understand the information and make decisions.
-Voluntariness: The decision is made freely without coercion.
What is the practical nurse’s role in the informed consent process? What is the physician or Nurse Practitioner’s role?
Practical Nurse: Ensure the consent form is signed and documented and reinforce the patient’s understanding of the procedure.
Physician/Nurse Practitioner: Provide detailed information about the procedure, risks, benefits, and alternatives.
Define how the following can be surgical risk factors:
Age
Nutrition
Obesity
Immunocompetence
Fluid and electrolyte imbalances
Pregnancy
-Age: Older adults may have slower healing and increased risks (e.g., cardiovascular or respiratory complications).
-Nutrition: Malnutrition delays healing, while deficiencies in protein and vitamins affect immune response.
-Obesity: Increases the risk of wound infection, delayed healing, and respiratory complications.
-Immunocompetence: A weakened immune system heightens the risk of infection.
-Fluid and Electrolyte Imbalances: Can lead to complications such as arrhythmias or delayed healing.
-Pregnancy: Increases risks due to physiological changes and potential harm to the fetus.
How do the following factors influence surgical outcomes?:
Emotional responses
Age
Hydration and nutrition
Smoking and alcohol use or misuse
Chronic Diseases
-Emotional Responses: Anxiety and fear can affect recovery and pain tolerance.
-Age: Older adults may have decreased physiological reserves.
-Hydration and Nutrition: Adequate hydration and nutrition improve healing and reduce complications.
-Smoking and Alcohol Use: Impair oxygenation and liver function, delaying healing.
-Chronic Diseases: Conditions like diabetes or hypertension increase the risk of complications.
State how you would provide support to the client in the perioperative period:
Psychological support
Physical support
Emotional support
Psychological Support: Address fears and provide reassurance.
Physical Support: Ensure proper preparation (e.g., fasting, hygiene).
Emotional Support: Build trust and maintain open communication.
Outline the pre-operative teaching the practical nurse would provide for the client regarding the following:
Equipment
Drainage devices
Pain management
NPO and preoperative medications
Types of anesthesia (general, spinal, local)
Positioning during surgery
Recovery room
-Equipment: Educate about IVs, monitors, and oxygen therapy.
-Drainage Devices: Explain their purpose and use.
-Pain Management: Discuss medication options and non-pharmacological methods.
-NPO and Preoperative Medications: Explain fasting requirements and medication purposes.
-Types of Anesthesia: Describe general, spinal, and local anesthesia.
-Positioning During Surgery: Explain how positioning aids surgical access.
-Recovery Room: Prepare the patient for post-anesthesia monitoring.
What is the purpose of perioperative exercises?
To improve lung function and circulation and prevent complications such as pneumonia or DVT.
Explain how to carry out the following post-op exercises correctly and indicate the frequency (how often) they are to be done:
Diaphragmatic breathing
Coughing
Turning – position changes
Leg exercises
Using incentive spirometry
-Diaphragmatic Breathing: Inhale deeply, hold for 3-5 seconds, and exhale. Repeat 10 times/hour.
-Coughing: Perform after deep breathing to clear secretions. Repeat 2-3 times/hour.
-Turning/Position Changes: Change position every 2 hours to prevent pressure ulcers.
-Leg Exercises: Flex and extend ankles, rotate feet, and press knees down. Repeat 5-10 times/hour.
-Incentive Spirometry: Inhale slowly to reach the target volume. Perform 10 times/hour.
Explain how you would instruct the client to splint (support) an incision when turning, coughing, etc.
Place a pillow or rolled blanket over the incision. Instruct the patient to hold it firmly while coughing or moving to reduce pain and prevent dehiscence(splitting open of a wound).
State the purpose of the preoperative checklist.
To ensure all required preparations are complete for patient safety.
What is included in the pre-operative checklist? Make a list.
-Confirm patient identity.
-Verify informed consent.
-Document allergies.
-Ensure fasting compliance.
-Record preoperative vital signs.
-Verify removal of jewelry, prosthetics, and dentures.
-Confirm administration of preoperative medications.
-Note special considerations (e.g., latex allergy).
Indicate the purpose of preoperative medications and when medications are given.
-To reduce anxiety, minimize secretions, prevent infections, and manage pain.
-Administered 30-60 minutes before surgery.
Describe the role of the practical nurse in the preoperative phase/preparation of a client for surgery, from patient admission to transport to the operating room/surgical suite.
Perform assessments and document findings.
Reinforce preoperative teaching.
Verify informed consent.
Prepare the patient physically and emotionally.
Assist with transport to the surgical suite.
Indicate the importance (interpretation) of the following preoperative diagnostic tests:
Complete blood count
Serum electrolytes
Coagulation studies
Serum creatinine
Blood urea nitrogen (BUN)
Glucose
-Complete Blood Count (CBC): Detects anemia or infection.
-Serum Electrolytes: Identifies imbalances that may affect cardiac or neurological function.
-Coagulation Studies: Assesses bleeding risk.
-Serum Creatinine/BUN: Evaluates kidney function.
-Glucose: Monitors for Hyperglycemia (blood sugar levels are too high) or Hypoglycemia (blood sugar levels are too low).
Outline the client’s preparation on the day of surgery (hygiene, hair, and cosmetics, prosthesis, valuables, bowel and bladder, vital signs, documentation, special procedures, preoperative medications, latex sensitivity, or allergy).
-Hygiene: Perform preoperative bath.
-Hair and Cosmetics: Remove makeup, nail polish, and hair accessories.
-Prosthesis: Remove dentures, glasses, and hearing aids.
-Valuables: Secure personal items.
-Bowel and Bladder: Ensure voiding before surgery.
-Vital Signs: Record baseline readings.
-Documentation: Verify completion of the checklist.
-Special Procedures: Complete enemas or preoperative antibiotics as ordered.
-Latex Sensitivity: Note allergies.
Describe ways to avoid the wrong site and wrong procedure surgery.
Perform a preoperative verification process.
Mark the surgical site.
Conduct a “time-out” in the operating room.
Define the following:
General anesthesia
Regional anesthesia
Local anesthesia
Conscious sedation
-General Anesthesia: Induces unconsciousness.
-Regional anesthesia: Blocks sensation in a specific area (e.g., spinal block).
-Local Anesthesia: Numbs a small, localized area.
-Conscious Sedation: Reduces anxiety while maintaining responsiveness.
Outline postoperative instructions for the ambulatory surgical client.
Activity
Diet
Recheck (physician/ NP/clinic visit or follow-up)
Wound assessment/care
Pain control
Other
-Activity: Encourage gradual return to normal activities.
-Diet: Start with clear fluids and progress as tolerated.
-Recheck: Schedule follow-up visits.
-Wound Care: Teach proper hygiene and signs of infection.
-Pain Control: Educate on medication use.
-Other: Reinforce breathing exercises and mobility.
State the cause and implications of the following postoperative complications:
Atelectasis
Pneumonia
Hypoxemia
Pulmonary embolism
Hemorrhage
Thrombophlebitis
Paralytic ileus
Abdominal distension
Nausea and vomiting
Urinary retention
Respiratory: Atelectasis, pneumonia, hypoxemia (Intervention: Deep breathing exercises).
Circulatory: Hemorrhage, thrombophlebitis, DVT (Intervention: Compression stockings, ambulation) .
Urinary: Retention, infection (Intervention: Encourage fluids, monitor output).
Gastrointestinal: Paralytic ileus, nausea (Intervention: Gradual diet advancement, ambulation).
Outline ways to promote urinary elimination postoperatively (fluids, activity, etc.)
-Fluids: Encourage oral fluids (unless contraindicated) to promote hydration and urine production.
-Ambulation: Encourage early mobilization to stimulate bladder function.
-Positioning: Assist the patient to sit upright during voiding (if possible).
-Monitor Output: Measure and document urinary output regularly.
Outline the nursing care plan for the surgical client.
-Assessment:
= Monitor vital signs, pain levels, and wound site.
= Assess for complications like infection, bleeding, or fluid imbalances.
-Goals:
= Prevent complications.
= Promote comfort and recovery.
= Facilitate early mobilization and discharge readiness.
-Interventions:
= Pain management using pharmacological and non-pharmacological methods.
= Perform wound care and dressing changes as per protocol.
= Encourage deep breathing exercises and mobility.
= Maintain IV fluids and monitor electrolyte balance.
-Evaluation:
= Patient demonstrates adequate pain control.
= Wound healing progresses without infection.
= Patient tolerates oral intake and demonstrates mobility.
