Week 12 - Preop Care Flashcards
what are nursing goals and focus in the preop period (6)
- get baseline of pts health & document it (know if anything is diff postop)
- identify any potential risks that we can decrease or be on high alert for
- ensure pt knows purpose of surgery
- decrease pt’s anxiety
- teach pt what to expect postop (how they will feel, where they will be)
- avoid catastrophies that could happen in the OR
how can we decrease a pts anxiety in the preop period (4)
explain to them:
- what they see
- what they hear
- where they will be taken on the stretcher
- people who will be around them
what are some potential catstrophes that can occur in the OR (6)
- disability
- injury
- bleed out
- MI
- stroke
- death
what are various indications for surgery (5)
- diagnostic/exploratory (ex. biopsy)
- curative (ex. remove a tumour)
- palliative (manage symptoms)
- constructive/cosmetic
- preventive
what are 2 degrees of urgency/surgical settings
- emergency
- elective
what is an emergency surgery (2)
- life or death situation
- no time to plan
ex. car accident, trauma
what is an elective surgery
- surgery is scheduled
what are 3 scenarios of elective surgery
- pt already on unit
- same day admission
- same day surgery (ambulatory)
describe elective surgery where the pt is already on the unit (2)
- surgery planned/scheduled
- pt is “on the slate”
describe elective surgery r/t same day admission
- pt admitted the day of their surgery & requires 1 night or more hospitalization post-op
describe elective surgery r/t same day surgery (ambulatory) (2)
- surgery requiring 2-3 hr post-op stay
- for shorter surgeries
what are things to consider when assessing the pre-op pt (5)
- psychosocial history
- past health history
- medications
- allergies
- review of systems (things that may cause problems in OR or in recovery)
what should consider r/t psychosocial history pre-op (2)
- anxiety
- common fears (ex. disability, postop pain, sedation, death)
what should you consider r/t past health history in the preop period
- identify conditions that put the pt at risk
what are some health conditions that put the pt at risk of complications in surgery (11)
- comorbidities
- smoking
- alcohol
- FHx
- previous complications w surgery
- obesity
- pregnancy
- DM
- CVS disease
- HTN
- MI
what is the recommendation r/t smoking preop
- stop smoking 6 weeks before or at least decrease the amt
higher amt of packs/year = greater risk of complications
what should you consider r/t medications in the preop period (4)
any:
- prescription
- street drugs
- alcohol
- herbal use
why is it important to know medication use prior to surgery (3)
- certain meds may increase or decrease the potency of anasthetics, sedation, etc.
- anticoags etc. increase risk of bleeding
- some meds used for surgeries are toxic to fetus (know last period, if pregnant)
what is an imp consider r/t insulin preop (2)
- may require dose change d/t NPO postop
- do BG checks before surgery and throughout
what is important to consider r/t allergies in the preop period (3)
- find out if true allergy or intolerance (ask what happened when they took the med)
any allergies to: - drug
- latex
what things increase the risk of latex allergy (5)
- history of contact dermatitis
- allergy to nuts, bananas, avacados
- neural tube defects
- multiple operations
- repeated bladder cath
what are some common/routine pre-op diagnostic tests (6)
- blood tests
- kidney function tests
- liver function tests
- CXR (heart and lungs)
- pulmonary tests (lungs)
- EKG (heart)
what blood tests are commonly done preop (6)
- CBC
- WBC
- electrolytes
- glucose
- coags (PTT, IN)
- blood type and screen (so can get some quickly if pt needs)
what diagnostics for kidney function is commonly done preop (3)
- UA
- creatinine
- BUN
what diagnostics for liver function are commonly done preop
- LFTs
why is it imp to complete diagnostic testing done preop (2)
- can compare it to the postop info
- under general anasthesia, pt wont be able to tell if you they have angina for ex.
what should be considered r/t nervous system preop (2)
- cognitive deficits
- sensory deficits
what should be considered r/t CVS preop (4)
- pre-existing heart conditions
- blood thinners
- heart valves
- pacemaker
what should be considered r/t resp system preop (2)
- obesity (decreased ability to cough, fat may hold onto meds)
- resp problems (chronic and recent)`
what should be considered r/t urinary system preop (2)
- renal function
- obstruction
- can impact drug clearance*
what should be considered r/t the integumentary system preop (2)
- skin rashes
- pressure ulcers
- impacts position during surgery*
what should be considered r/t musculoskeletal system preop (2)
- mobility problems
- how will the pt ambulate postop?
what should be considered r/t endocrine system preop
- insulin dosage for diabetic pts
what should be considered r/t fluid, electrolyte, and nutritional status preop (2)
- poor nutrition (= poor healing, need less meds)
- obesity
what should preop teaching focus on
- things you will do before/after surgery
what preop teaching should be done r/t breathing (3)
- DB&C exercises
- use splinting when necessary (pillow on abd to help cough)
- use of incentive spirometer
what preop teaching should be done r/t ambulation (3)
- ambulate early postop critical
- leg exercises as soon as awake postop –> active not passive
- TED stockings, SCD intra and postop
what preop teaching should be done r/t nutrition (3)
- most surgeries require NPO for a period pre-op (can take meds w sips of water)
- increase diet slowly postop –> only eat when BS return
- nausea common postop –> ask nurse for meds to help w this
what preop teaching is done r/t grooming (5)
- take a bath or shower the morning of surgery
- remove nail polish, artificial fingernails, hair clips, and jewerly before surgery
- dentures and eyeglasses removed and stored during surgery
- no contact lenses permitted in OR
- hearing aids vary by pt (some may be completely deaf)
why is it imp to remove nail polish and artificial fingernails preop (2)
- imp to see the nail bed
- O2 sat
why is it imp to remove dentures and glasses preop
- may interfere w admin of anasthetic
why is it imp to remove jewerly preop
- if edematous, jewerly may impair circulation
what preop teaching is done r/t medications (4)
- take meds as ordered preop
- stop taking meds, OTC meds, herbal remedies as suggested by the physician, anasthesiolist, or surgeon preop
- assess what the pt has or has not taken preop
- note time & amt of insulin dose
what preop teaching r/t pain control should occur r/t pain control (3)
- educate pt to ask for pain meds as needed
- types of pain control (epidural, PCA, etc.)
- assess if pt currently taking analgesia for an underlying condition (ex. arthritis)
why is it imp to assess if the pt takes any pain meds for other conditions
- meds for post-op pain may not help pain for an underlying condition
what preop teaching should be done r/t drains, dressings, and tubing (3)
- tell pt about any drains they will have post-op
- teach about any dressings (sutures, staples) to be expected post-op
- teach about any tubing (IV, NG, epidural) tubing to be expected postop
what preop teaching should be done r/t safety (3)
- use call bell
- side rails up postop
- do not crawl over side rails to get out of bed
what general preop information should be given to the family and pt (4)
- parking for visitors
- time to be at the hospital and time of surgery
- waiting areas for family while in surgery
- length of expected stay postop
what should you consider with different populations (ex. adults, child, geriatric) (5)
- lvl of comprehension
- depth of explanation
- reading comprehension
- what is the person capable of understanding
- what will help their anxiety
what are freq used preop meds (7)
- benzos
- narcotics
- H2R antagonists
- antacids
- antiemetics
- antibiotics
- anticholinergic
what are 2 exmaples of benzos given preop
- versed (Midazolam)
- valium
why are benzos given preop (3)
- decrease anxiety
- sedative
- anasthesia
why are narcotics given preop (2)
- decrease intraop anasthesia required
- decrease pain
what is imp prior to giving benzos or narcotics preop
- consent for surgery before
why are antiemetics given preop
- decrease NV postop
- decrease risk of aspiration
describe antibiotics preop
- 1 dose of ancef given before skin is cut
why are anticholinergic meds given preop (2)
- dry out/decrease resp secretions
- imp if intubating or oral symptoms
what is imp to assess before giving narcotics
- vasodilate = may decrease BP = assess BP prior
how far in advance to surgery are diagnostic tests / nursing assessment of the pt at preop admin clinic done
- days to weeks to 6 months prior to surgery
why are diagnostic tests/nursing assessment in the preop admin clinic done in advance of surgery (3)
- to decrease surgical delays due to an unexpected health history
- to provide pt w clear info and answer questions so they are prepared
- to educate and allow for questions regarding
what questions might the pt have preop (4)
- meds to be stopped or taken before surgery
- NPO instructions
- pain mngmt options
- postop discharge and care
what should be done the day of the surgery
focused pre-op assessment
what nursing assessments are done on the day of surgery (6)
- review previous physical exam and identify any new concerns or changes
- note allergies
- ensure consults & tests requested were completed and documented
- establish baseline data (VS, neuro status) for comparison intra & post-op
- review meds the pt has taken (did they follow instructions?)
- latest oral intake (date, time, what)
- assess knowledge of surgery, emotional readiness, and that consent is signed
- support family and ensure there is postop support when discharged
what is included in the preop checklist (12)
- informed consent
- ID bracelet and/or allergy bracelet
- remove everything
- remove valuables and leave w fam or store
- baseline VS
- sensory deficits/language
- voiding
- safety
- preop meds
- blood glucose
- H&P
- diagnostic reports
- make sure consent is on chart
- dentures, prosthetics. piercings
- send entire chart
when is informed consent required
- for all elective surgery
informed consent must (3)
- state correct procedure
- be informed (risks and benefits)
- be voluntary
what is required for informed consent (2)
- done before any preop meds given that interfere w comprehension
- need mental capacity to consent
if the pt is unclear about the surgery, what can be done
- contact surgeon and they will explain again
what do you do r/t informed consent if the pt is unconscious? what if there is no family?
- unconscious = consent from family
- no family = dr has right to do whatever is necessary
describe the nurses role r/t informed consent
- nurse can witness if it has been explained by the surgeon and the pt understands
what is a special consideration r/t day surgery
- pt cannot leave to go home until they meet discharge criteria
what is discharge criteria for day surgery (8)
- LOC (awake, orientated)
- VS (at baseline)
- mobility
- pain and NV (under control)
- void (before they leave)
- must have responsible adult at home
- need surgery specific instructions and follow up appt
- transportation home –> pt cannot drive themselves
what is included in preparing for the postop pt on the unit (10)
- check ward routine
- IV pole & pump
- vital signs record
- postop bed (will come down on stretcher)
- suction/O2 –> hook up and check it
- post op sponge bath
- postop assessment
- talk to pt
what is included in postop assessment (4)
- IV access
- dressings & any shadowing
- thorough H2T
- get full baseline assessment and compare it to how pt looks now
