Week 2 - Perioperative Flashcards
What are the 3 components to peri-operative?
- preoperative
- intraoperative
- post operative
What are the different classifications of surgical procedures?
- seriousness
- urgency
- purpose
in regards to the different classifications of surgical procedures describe major serious procedure?
- involves extensive reconstruction or alteration in body parts
- poses great risks to well-being
in regards to the different classifications of surgical procedures describe minor serious procedure?
- involves minimal alteration in body parts
- designed to correct deformities
- involves minimal risks compared with major procedures
in regards to the different classifications of surgical procedures describe elective urgency procedure?
- usually optional
- may not be necessary for health
in regards to the different classifications of surgical procedures describe urgent urgency procedure?
- necessary for pt health
- may prevent additional problems from developing
- not necessarily emergency
in regards to the different classifications of surgical procedures describe emergency urgency procedure?
- must be done immediately to save life or preserve function of body part
in regards to the different classifications of surgical procedures describe a diagnostic purpose procedure?
- surgical exploration that allows physician to confirm diagnosis
- may involve removal of tissue for further diagnostic testing
in regards to the different classifications of surgical procedures describe a ablative purpose procedure?
excision or removal of diseased body part
in regards to the different classifications of surgical procedures describe a palliative purpose procedure?
- relieves/ reduces intensity of disease symptoms
- will not produce cure
in regards to the different classifications of surgical procedures describe a reconstructive/restorative purpose procedure?
restores function or appearance to traumatized/ malfunctioning tissues
in regards to the different classifications of surgical procedures describe a procurement for transplant purpose procedure?
- removal of organ, tissues or both from person pronounced dead for purpose of transplantation into another person
in regards to the different classifications of surgical procedures describe a reconstructive purpose procedure?
restores function lost or reduced as result of congenital anomalies
in regards to the different classifications of surgical procedures describe a cosmetic purpose procedure?
performed to improve personal appearance
What is included in the nursing process for pre-operative?
- assessment
- nursing diagnosis
- planning
- implementation
- evaluation
in regards to the nursing process for pre-operative what is included in the assessment?
- psychological status
- physiological factors
- baseline data/ allergies
- lab/ diagnostic tests completed
- cultural and ethnic factors
- info given to pt is adequate
- pregnancy status
- planned or emergency surgery
- pre-op consults as ordered by surgeon
- best possible medication history
- NPO status
- use of substances
- provide/ clarify info about surgical experience
- assess emotional state/ readiness
psy
in regards to the nursing process for pre-operative what is included in the assessment?
- psychological status
- physiological factors
- baseline data/ allergies
- lab/ diagnostic tests completed
- cultural and ethnic factors
- info given to pt is adequate
- pregnancy status
- planned or emergency surgery
- pre-op consults as ordered by surgeon
- best possible medication history
- NPO status
- use of substances
- provide/ clarify info about surgical experience
- assess emotional state/ readiness
- psychosocial needs of pt/ family
- discharge planning/ post-op teaching
in regards to the nursing process for pre-operative assessment what is included in the lab tests?
- PT
- INR
- iron
- platelets
- potassium
define informed consent
- don’t need to explain surgery
- need to confirm that pt doesn’t have anymore questions/ understand what surgeon explained to them
older adults are more likely to experience perioperative complications than younger adults, why?
- more likely to have chronic illnesses
- have lower % of body water
- reduced kidney and liver function
- may be poorly nourished
in regards to older adults how can having a lower % of body water increase their risk of experiencing perioperative complications ?
more likely to experience fluid and electrolyte
disturbances
in regards to older adults how can having a reduced liver and kidney function increase their risk of experiencing perioperative complications ?
metabolize and excrete drugs slower increasing risk of toxic effect
in regards to older adults how can being poorly nourish increase their risk of experiencing perioperative complications ?
impair wound healing
What herbs and supplements can cause complications?
- echinacea
- feverfew
- garlic
- ginger
- ginko biloba
- ginseng
- goldenseal
- licorice
- saw palmetto
- St. John’s wort
- valerian
- Vitamin E
- Kava
what medications should be checked pre-op and the day of the procedure?
- glucocorticoids
- anti-diabetics
- blood thinners
- cardiac medications
why do you need to check for glucocorticoids pre-op and the day of the procedure?
- suppress adrenal function
- will either be on pre-printed orders to take or not to/ dose
what are glucocorticoids?
steroids
why do you need to check for anti-diabetics pre-op and the day of the procedure?
- pt NPO
- watch for hypoglycaemia
- surgeon may have changed orders
why do you need to check for blood thinners pre-op and the day of the procedure?
- need to be discontinued a certain amount of time prior to surgery
- prevents blood from clotting so pt could bleed out during surgery
what are some examples of blood thinners?
- heparin
- warfarin
- LMWH
- ASA
- plavix
- NSAIDS
what are some examples of cardiac medications?
- betablockers
- ACE inhibitors
- ARBs
- diuretics
are betablockers held pre-op?
typically given but check orders
are Ace inhibitors and ARBs held during surgery? why?
- yes
- associated with hypotension during surgery
- can impair renal function
are diuretics help pre-op? why?
- yes
- lead to postoperative hypovolemia and hypotension
what do you need to fill out on the best possible medication history form prior to surgery?
- when last dose of each medication was taken
what do you always need to check for medication orders prior to surgery?
surgical PPO and written pre-operative orders
after your nursing assessment for pre-op surgery you may come to some nursing diagnoses relevant to surgical nursing. What are they?
- deficient fluid volume
- infection
- perioperative positioning injury
- deficient knowledge
- impaired physically
- acute pain
- powerlessness
- ineffective airway clearance
- allergic reaction to latex
- anxiety
- disturbed body image
- ineffective thermoregulation
- ineffective breathing pattern
- ineffective coping
- fear
what is the purpose of planning in regards to the nursing process for pre-op?
- pt teaching
- prepare pt for post- op
what do you need to go over with the pt in the planning portion of the nursing process for pre-op?
- review pain management
- activity to prevent atelectasis
- deep breathing/ coughing
- post op diet
- wound care
- common complications to watch for
- discharge plan/ if they need help
what are the 3 key elements needed to have informed consent?
- must be voluntary
- must have mental capacity to consent
- must be properly informed
for informed consent what would be needed if the pt didn’t have the mental capacity to consent?
written permission by legally appointed representative is needed
what are common pre-op medications the patient may receive the day of surgery?
- sedatives
- prophylactic antibiotics
- pain medications
- anti-emetics
- bronchodilators
what are examples of medications that reduce stomach acid?
H2 receptor blockers
- ranitidine
proton pump inhibitors
- pantoprazole
what are examples of medications that reduce oral/ respiratory secretions and dilate bronchi?
anticholinergics
- atropine
what are examples of sedative medications?
benzodiazepines
- lorazepam
- ativan
what are examples of prophylactic antibiotic medications ?
- cefazolin
what pain medication would the pt get prior to going in for surgery?
tylenol
what are examples of bronchodilators?
salbutamol
what are examples of anti-emetics?
- metoclopramide
- dimenhydrinate
once the pt has completed their surgery where do they go ?
PAR/ PACU
when is the pt transferred out of the PAR/ PACU?
- maintain airway
- has stable vital signs
- conscious/ oriented
- pain/ nausea managed
- pt stable
- have a bed on different floor
when the pt is in the process of being transferred from the PAR to a ward what will happen prior to the pt going to the ward?
the PACU/ PAR nurse will call and give report to primary RN
what will the PACU/ PAR nurse include in her handover report to the primary RN prior to the pt arriving on the ward?
- how they did in surgery
- current status
- important events/ interventions
- recent meds
- in/out from OR and PAR
- review important dr orders
- last analgesic/ antiemetic given
- type of anaesthesia
what must the ward nurse complete prior to the patient arriving on the ward?
- have all safety equipment ready at bedside
- check safety equipment is working
- have bed at appropriate height
once the pt arrives on the floor what assessments will the nurse complete?
- across the room
- visually assess pt
- primary survey (ABC)
- ABCDEFG
- full head to toe assessment with vitals
- pain
what is included in the visual assessment of the patient?
- able to answer questions
- how is there breathing overall
- any obvious concerns
- visualize any tubes/ drains
what does ABCDEFG stand for?
A - airway
B - breathing
C - circulation
D - disability (depth/ LOC), discomfort
E - environment/ everything for surgery
F - full set of vitals/ freedom from risk
G - gather information/ chart
when assessing the A (airway) in the ABCDEFG assessment what are you looking for?
- open/ patent airway
- gag reflex
when assessing the B (breathing) in the ABCDEFG assessment what are you looking for?
- resp rate
- use of accessory muscles
- normal depth
- able to speak full sentences
- position
in regards to B (breathing) in the ABCDEGF assessment, what questions are you going to ask the pt?
- any SOB?
- difficulty breathing?
when assessing the C (circulation) in the ABCDEFG assessment what are you looking for?
- pulse (radial and apical)
- O2 sats
- BP
- check any bleeding is under control
- check IV site is patent/ IV is infusing as ordered (rate/ solution)
- ## ask pt if they have chest pain, palpitations
when assessing the D (disability/ discomfort) in the ABCDEFG assessment what are you looking for?
- alert
- respond to verbal, painful stimuli or not at all
- oriented X3
- assess pt pain
when assessing the E (everything from surgery) in the ABCDEFG assessment what are you looking for?
- wound/ dressings dry/ intact
- drains/ tubes are in situ/ functioning
- braces/ splints in situ
- other ordered treatments are taken care of
when assessing the E (environment) in the ABCDEFG assessment what are you looking for?
- safety equipment has been checked and is working correctly
- bed brakes on
- bed rails are up
- bed is in lowest position
- pt has the call bell/ knows how to use it
when assessing the F (full set of vital signs/ freedom from risk) in the ABCDEFG assessment what are you looking for?
- VS at timed increments
- parameters to maintain
- orders to implement interventions
when assessing the G (gather information and chart) in the ABCDEFG assessment what are you looking for?
chart important information
- type of anesthesia used
- drugs received in PAR
- amount of blood/ fluid pt lost/ received
- pts vital signs in PAR/ PACU and interventions they perform
what happens to all the doctors orders after the patient has bad surgery?
- they are cancelled and need to be reordered
if the pt has an epidural or PCA all supplemental sedatives, anticoagulants and pain medication must be okayed by who ?
anesthesia regardless if ordered by MRP post-op
does a pt need to notify nurses when they have their first pee after surgery? Why?
- yes
- if pt doesn’t void need to bladder scan and look for urine retention/ distended bladder
- needs to be addressed quickly
when you are presented with multiple pt problems how do you prioritize them? (need to put in order that you would respond to them)
- immediately life or limb threatening problems
- serious but not immediately life-threatening problems
- prevention of future complications or problems
- routine, non-urgent care/tasks
what are the different levels of Maslow’s hierarchy of needs starting from the bottom going to the top?
- physiological
- safety
- love/ belonging
- esteem
- self-actualization
in Maslow’s hierarchy of needs what is included in the physiological level?
- breathing
- food
- water
- sex
- sleep
- homeostasis
- escertion
in Maslow’s hierarchy of needs what is included in the safety level?
security of:
- body
- employment
- resources
- morality
- the family
- health
- property
in Maslow’s hierarchy of needs what is included in the love/ belonging level?
- frienship
- family
- sexual intimacy
in Maslow’s hierarchy of needs what is included in the esteem level?
- self-esteem
- confidence
- achievement
- respect of others
- respect by others
in Maslow’s hierarchy of needs what is included in the self-actualizatoin level?
- morality
- creativity
- spontaneity
- problem solving
- lack of prejudice
- acceptance of facts
