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NURS 3512 - Class 7-12 > Week 12 - Preop Care > Flashcards

Week 12 - Preop Care Flashcards

1
Q

what are nursing goals and focus in the preop period (6)

A
  • 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
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2
Q

how can we decrease a pts anxiety in the preop period (4)

A

explain to them:

  • what they see
  • what they hear
  • where they will be taken on the stretcher
  • people who will be around them
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3
Q

what are some potential catstrophes that can occur in the OR (6)

A
  • disability
  • injury
  • bleed out
  • MI
  • stroke
  • death
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4
Q

what are various indications for surgery (5)

A
  • diagnostic/exploratory (ex. biopsy)
  • curative (ex. remove a tumour)
  • palliative (manage symptoms)
  • constructive/cosmetic
  • preventive
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5
Q

what are 2 degrees of urgency/surgical settings

A
  • emergency

- elective

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6
Q

what is an emergency surgery (2)

A
  • life or death situation
  • no time to plan
    ex. car accident, trauma
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7
Q

what is an elective surgery

A
  • surgery is scheduled
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8
Q

what are 3 scenarios of elective surgery

A
  1. pt already on unit
  2. same day admission
  3. same day surgery (ambulatory)
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9
Q

describe elective surgery where the pt is already on the unit (2)

A
  • surgery planned/scheduled

- pt is “on the slate”

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10
Q

describe elective surgery r/t same day admission

A
  • pt admitted the day of their surgery & requires 1 night or more hospitalization post-op
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11
Q

describe elective surgery r/t same day surgery (ambulatory) (2)

A
  • surgery requiring 2-3 hr post-op stay

- for shorter surgeries

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12
Q

what are things to consider when assessing the pre-op pt (5)

A
  • psychosocial history
  • past health history
  • medications
  • allergies
  • review of systems (things that may cause problems in OR or in recovery)
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13
Q

what should consider r/t psychosocial history pre-op (2)

A
  • anxiety

- common fears (ex. disability, postop pain, sedation, death)

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14
Q

what should you consider r/t past health history in the preop period

A
  • identify conditions that put the pt at risk
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15
Q

what are some health conditions that put the pt at risk of complications in surgery (11)

A
  • comorbidities
  • smoking
  • alcohol
  • FHx
  • previous complications w surgery
  • obesity
  • pregnancy
  • DM
  • CVS disease
  • HTN
  • MI
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16
Q

what is the recommendation r/t smoking preop

A
  • stop smoking 6 weeks before or at least decrease the amt

higher amt of packs/year = greater risk of complications

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17
Q

what should you consider r/t medications in the preop period (4)

A

any:

  • prescription
  • street drugs
  • alcohol
  • herbal use
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18
Q

why is it important to know medication use prior to surgery (3)

A
  • 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)
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19
Q

what is an imp consider r/t insulin preop (2)

A
  • may require dose change d/t NPO postop

- do BG checks before surgery and throughout

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20
Q

what is important to consider r/t allergies in the preop period (3)

A
  • find out if true allergy or intolerance (ask what happened when they took the med)
    any allergies to:
  • drug
  • latex
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21
Q

what things increase the risk of latex allergy (5)

A
  • history of contact dermatitis
  • allergy to nuts, bananas, avacados
  • neural tube defects
  • multiple operations
  • repeated bladder cath
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22
Q

what are some common/routine pre-op diagnostic tests (6)

A
  • blood tests
  • kidney function tests
  • liver function tests
  • CXR (heart and lungs)
  • pulmonary tests (lungs)
  • EKG (heart)
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23
Q

what blood tests are commonly done preop (6)

A
  • CBC
  • WBC
  • electrolytes
  • glucose
  • coags (PTT, IN)
  • blood type and screen (so can get some quickly if pt needs)
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24
Q

what diagnostics for kidney function is commonly done preop (3)

A
  • UA
  • creatinine
  • BUN
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25
Q

what diagnostics for liver function are commonly done preop

A
  • LFTs
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26
Q

why is it imp to complete diagnostic testing done preop (2)

A
  • can compare it to the postop info

- under general anasthesia, pt wont be able to tell if you they have angina for ex.

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27
Q

what should be considered r/t nervous system preop (2)

A
  • cognitive deficits

- sensory deficits

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28
Q

what should be considered r/t CVS preop (4)

A
  • pre-existing heart conditions
  • blood thinners
  • heart valves
  • pacemaker
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29
Q

what should be considered r/t resp system preop (2)

A
  • obesity (decreased ability to cough, fat may hold onto meds)
  • resp problems (chronic and recent)`
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30
Q

what should be considered r/t urinary system preop (2)

A
  • renal function
  • obstruction
  • can impact drug clearance*
31
Q

what should be considered r/t the integumentary system preop (2)

A
  • skin rashes
  • pressure ulcers
  • impacts position during surgery*
32
Q

what should be considered r/t musculoskeletal system preop (2)

A
  • mobility problems

- how will the pt ambulate postop?

33
Q

what should be considered r/t endocrine system preop

A
  • insulin dosage for diabetic pts
34
Q

what should be considered r/t fluid, electrolyte, and nutritional status preop (2)

A
  • poor nutrition (= poor healing, need less meds)

- obesity

35
Q

what should preop teaching focus on

A
  • things you will do before/after surgery
36
Q

what preop teaching should be done r/t breathing (3)

A
  • DB&C exercises
  • use splinting when necessary (pillow on abd to help cough)
  • use of incentive spirometer
37
Q

what preop teaching should be done r/t ambulation (3)

A
  • ambulate early postop critical
  • leg exercises as soon as awake postop –> active not passive
  • TED stockings, SCD intra and postop
38
Q

what preop teaching should be done r/t nutrition (3)

A
  • 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
39
Q

what preop teaching is done r/t grooming (5)

A
  • 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)
40
Q

why is it imp to remove nail polish and artificial fingernails preop (2)

A
  • imp to see the nail bed

- O2 sat

41
Q

why is it imp to remove dentures and glasses preop

A
  • may interfere w admin of anasthetic
42
Q

why is it imp to remove jewerly preop

A
  • if edematous, jewerly may impair circulation
43
Q

what preop teaching is done r/t medications (4)

A
  • 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
44
Q

what preop teaching r/t pain control should occur r/t pain control (3)

A
  • 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)
45
Q

why is it imp to assess if the pt takes any pain meds for other conditions

A
  • meds for post-op pain may not help pain for an underlying condition
46
Q

what preop teaching should be done r/t drains, dressings, and tubing (3)

A
  • 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
47
Q

what preop teaching should be done r/t safety (3)

A
  • use call bell
  • side rails up postop
  • do not crawl over side rails to get out of bed
48
Q

what general preop information should be given to the family and pt (4)

A
  • 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
49
Q

what should you consider with different populations (ex. adults, child, geriatric) (5)

A
  • lvl of comprehension
  • depth of explanation
  • reading comprehension
  • what is the person capable of understanding
  • what will help their anxiety
50
Q

what are freq used preop meds (7)

A
  • benzos
  • narcotics
  • H2R antagonists
  • antacids
  • antiemetics
  • antibiotics
  • anticholinergic
51
Q

what are 2 exmaples of benzos given preop

A
  • versed (Midazolam)

- valium

52
Q

why are benzos given preop (3)

A
  • decrease anxiety
  • sedative
  • anasthesia
53
Q

why are narcotics given preop (2)

A
  • decrease intraop anasthesia required

- decrease pain

54
Q

what is imp prior to giving benzos or narcotics preop

A
  • consent for surgery before
55
Q

why are antiemetics given preop

A
  • decrease NV postop

- decrease risk of aspiration

56
Q

describe antibiotics preop

A
  • 1 dose of ancef given before skin is cut
57
Q

why are anticholinergic meds given preop (2)

A
  • dry out/decrease resp secretions

- imp if intubating or oral symptoms

58
Q

what is imp to assess before giving narcotics

A
  • vasodilate = may decrease BP = assess BP prior
59
Q

how far in advance to surgery are diagnostic tests / nursing assessment of the pt at preop admin clinic done

A
  • days to weeks to 6 months prior to surgery
60
Q

why are diagnostic tests/nursing assessment in the preop admin clinic done in advance of surgery (3)

A
  • 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
61
Q

what questions might the pt have preop (4)

A
  • meds to be stopped or taken before surgery
  • NPO instructions
  • pain mngmt options
  • postop discharge and care
62
Q

what should be done the day of the surgery

A

focused pre-op assessment

63
Q

what nursing assessments are done on the day of surgery (6)

A
  • 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
64
Q

what is included in the preop checklist (12)

A
  • 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
65
Q

when is informed consent required

A
  • for all elective surgery
66
Q

informed consent must (3)

A
  • state correct procedure
  • be informed (risks and benefits)
  • be voluntary
67
Q

what is required for informed consent (2)

A
  • done before any preop meds given that interfere w comprehension
  • need mental capacity to consent
68
Q

if the pt is unclear about the surgery, what can be done

A
  • contact surgeon and they will explain again
69
Q

what do you do r/t informed consent if the pt is unconscious? what if there is no family?

A
  • unconscious = consent from family

- no family = dr has right to do whatever is necessary

70
Q

describe the nurses role r/t informed consent

A
  • nurse can witness if it has been explained by the surgeon and the pt understands
71
Q

what is a special consideration r/t day surgery

A
  • pt cannot leave to go home until they meet discharge criteria
72
Q

what is discharge criteria for day surgery (8)

A
  • 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
73
Q

what is included in preparing for the postop pt on the unit (10)

A
  • 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
74
Q

what is included in postop assessment (4)

A
  • IV access
  • dressings & any shadowing
  • thorough H2T
  • get full baseline assessment and compare it to how pt looks now

NURS 3512 - Class 7-12 (49 decks)

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