Week 2- Perioperative Care and Assessment Flashcards

1
Q

3 components of periop

A

preop
intra op
post op

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2
Q

Seriousness classification of surgery
- major
- minor

A
  • involves extensive reconstruction or alteration in body parts, poses great risk to wellbeing
  • involves minimal alteration in body parts; often designed to correct deformities; involves minimal risks compared with major procedures
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3
Q

examples of major surgeries

A

CABG
colon resection
removal of larynx
resection of lung lobe

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4
Q

example of minor surgery

A

cataract extraction
facial plastic surgery
tooth extraction

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5
Q

types of urgency surgeries

A

elective
urgent
emergency

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6
Q

elective surgery

A
  • usually is optional
  • may not be necessary for health

ex: bunionectomy, facial plastic surgery, breast reconstruction, removal of wart

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7
Q

urgent surgery

A
  • is necessary for patient health
  • may prevent additional problems from developing (tissue destruction or impaired organ function) not necessarily emergency

ex; excision of cancerous tumour, removal of gallbladder for stones, vascular repair for obstructed artery (CABG)

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8
Q

emergency

A

must be done immediately to save a persons life or preserve function of body part

ex: repair of perforated appendix, repair of traumatic amputation, control of internal hemorrhaging

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9
Q

diagnostic purpose of surgery

A

surgical exploration that allows physician to confirm diagnosis may involve removal of tissue for further diagnostic testing

ex: exploratory laparotomy (incision into peritoneal cavity to inspect abdominal organs)
breast biopsy

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10
Q

ablative surgery

A

excision or removal of diseased body part
amputation, removal of appendix, cholecystectomy

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11
Q

palliative surgery

A

relieves or reduces intensity of disease symptoms will not cure

ex: colostomy, debridement of necrotic tissue, removal of brain tumor

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12
Q

reconstructive or restorative surgery

A

restores function or appearance to traumatized or malfunctioning tissues

ex: internal fixation of fractures, scar revision

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13
Q

procurement for transplant

A

Removal of organs, tissues, or both from a person pronounced dead for purpose of transplantation into another person.

Sometimes there are living donors such as one person donating a kidney to another.

ex: kidney, heart or liver

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14
Q

purpose of constructive

A

Restores function lost or reduced as a result of congenital anomalies

repair of cleft palate, closure of atrial septal defect

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15
Q

cosmetic surgery purpose

A

performed to improve personal appearance

ex: rhinoplasty

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16
Q

purpose of pre op assessment

A

more than HTT
baseline information
want them to be safe
might be specific based on surgery

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17
Q

Older adult considerations

A

Are more likely to experience perioperative complications than younger adults because they
- more likely to have chronic illness
- have lower % of body water- so more likely to experience fluid and electrolyte disturbances
- Tend to have reduced liver and kidney function – so they metabolize and excrete drugs slower, increasing the risks for toxic effect
- May be poorly nourished – which can impair healing

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18
Q

review _____ with patients to confirm accuracy

A

BPMH

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19
Q

always check

A

surgical PPOs and written pre op orders

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20
Q

meds to check pre op day of procedure

A
  1. Glucocorticoid (e.g. prednisone, dexamethasone)
  2. Anti-Diabetics - patient is NPO so watch for hypoglycemia and check pre-operative orders. The MRP may have changed orders for the day of surgery and the patient may not require insulin or oral hypoglycemics
  3. Cardiac medications- Check orders
    Betablockers – typically given but check orders
    ACE inhibitors and ARBs have been associated with hypotension during surgery & can impair renal function -check
    Diuretics may lead to postoperative hypovolemia and hypotension -check
  4. Blood thinners – Usually held - Heparin, Warfarin, LMWH (Should they be stopped a certain amount of time prior to surgery?); ASA(? dosage dependent) & NSAIDS & Plavix are sometimes held because of bleeding properties
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21
Q

herbs and supplements that cause complications

A

Echinacea
Feverfew
Garlic
Ginger
Gingko biloba
Ginseng
Goldenseal
Licorice
Saw palmetto
St John’s wort
Valerian
Vitamin E
Kava

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22
Q

surgical checklist

A

confirm, identification ,allergies, informed consent, laterality, blood products, NPO status
has pt voided/catheter
skin prep (no makeup, nail polish)
pre op meds with a sip of water
check OR slate
Removal of jewelry and personal items (give to family if possible). Glasses/hearing aides - can take to OR with them, but need to be removed prior to surgery
Patient history (on back side of form) and past anesthetic reactions e.g. Malignant Hyperthermia (MH)

23
Q

patient teaching to _____
examples

A

prepare then for post op

Review pain management
Activity to prevent atelectasis
Deep breathing and coughing exercises
Post op diet
Wound care
Common complications to watch for
Discharge – how long is the stay? Will they need help post-op?

24
Q

who must sign consent form

A

surgeon

25
Q

RN must ask the patient if they have received

A

enough information and understand the reason for surgery

26
Q

3 key elements for consent to be valid

A
  1. Must be voluntary
  2. Must have mental capacity to consent (or written permission by legally appointed representative)
  3. Must be properly informed
27
Q

consent
- must
- cannot
- when is is not required

A

relate to the treatment
be obtained through misrepresentation or fraud
life or limb true emergency may not require consent. check policy

28
Q

common pre op meds

7

A
  1. Medications that reduce stomach acid :
    - H2 Receptor blockers (e.g. Ranitidine), Proton pump inhibitors (e.g. Pantoprazole)
  2. Medications that reduce oral/respiratory secretions & dilates bronchi
    - Anticholinergics (e.g. Atropine)
  3. Sedatives
    - Benzodiazepines (e.g. Lorazepam/Ativan)
  4. Prophylactic Antibiotics (e.g. 2g Cefazolin IV 30min before incision/on call to OR)
  5. Pain medications (e.g. Tylenol PO given 60-90 min preop)
  6. Anti-emetics (e,g. Metoclopramide/Dimenhydrinate)
  7. Bronchodilators
    (e.g. Salbutamol)
29
Q

pt will go from or to

A

PAR or PACU

30
Q

when can pt be transferred to the floor

A
  • maintain airway
  • stable VS
  • conscious and oriented
  • pain and nausea are managed
  • patient is stable
31
Q

PACU will call

A

and give report to primary surgical ward nurse

32
Q

transfer from PAR to WARD
- have all
- check
- have bed
- PAR nurse will

A
  • equipment ready at bedside: IV pole, vital machine, slider board, other patient specific equipment (e.g. OSAM, blanket warmer
  • safety equipment is working correctly and board has all items
  • at appropriate height for transfer and covers pulled back
  • will give report on surgery, anesthetic, and head to toe assessment on patient (report for floor patients will generally be over the phone, critical care/monitored patients will be in person with PAR nurse)
  • will review how surgery went, dr orders and last analgesic/antiemetic given
33
Q

post op primary assessment

A
  1. visually assess the pt and say hello:
    - answer
    - color
    - breathing
    - obvious concerns
    - tubes and drains
  2. get help to transfer pt to bed
  3. full primary survey= ABGs (including VS and pain)
  4. ABCDEFG
34
Q

Airway

A
  1. Is patient is able to maintain an open airway?
  2. Patient should have an intact gag reflex (so can protect airway against aspiration)
35
Q

How will you know that the patient has a patent airway?

A
  • talking to you
  • listen to lungs
  • sats
  • proper positioning
36
Q

breathing

A
  1. is pt breathing easily
    - RR
    - accessory muscles
    - depth
    - speak in full sentences
    - position normal
37
Q

breathing assessment
ask pt
-
-
-

A

any SOB
difficulty breathing
if on o2 attach it and set to right rate

38
Q

circulation assessment
- check
- check
- check
- ask

A
  • pulse (radial and apical), o2 sats, BP
  • bleeding is under control
  • check IV site is patent and IV is infusing as ordered (rate/solution)
  • ask pt if they have any chest pain or palpitations
39
Q

do not remove any dressings as this

A

opens them up to potential infection.
If dressing are saturating, add more gauze on top.
Ideally wounds stay covered for 24-48 hours

40
Q

Disability/discomfort

A

is patient alert
- only respond to verbal?
- only respond to pain?
- no response?
is patient orientedx3
assess pt pain
- scale
- opqrstuv

41
Q

environment
- check on pt
- everythign else

A

Wounds/dressings are dry and intact
Drains/tubes are in situ and functioning
Braces/splints are in situ
Other ordered treatments are taken care of

Safety Equipment has been checked and is working correctly (should be done BEFORE patient arrives!!!)
Bed brakes are on
Bed rails are up, as appropriate
Bed is in lowest position
Patient has the call bell (and knows how to use it)

42
Q

full set of vital signs/freedom of risk

A
  • Check vital signs if not already completed or need to be done at timed increments
  • Remember to include temperature (do we have parameters for Temp and interventions e.g. blanket warmers or blood cultures)
  • Check heart rate, BP, are there parameters to maintain and orders to implement interventions?
  • Check O2 sats: Apply supplemental oxygen if < 92% on room air or increase oxygen rate if < 92% unless ordered otherwise.
  • Resp. rate for 60 seconds, is it regular?
43
Q

check chart for important information

A

What type of anesthesia did the patient have?
What drugs did the patient receive in PAR? When is next timed dose due?
How much blood/fluid did the patient lose/receive?
What were the patient’s vital signs in PAR? What interventions did they perform?

44
Q

Dr orders are transcribed in

A

kardex

45
Q

all orders prior to surgery are

A

are CANCELLED and only post-op orders now stand

46
Q

all med orders prior to surgery are

A

CANCELLED and all need to be reordered

47
Q

if pt has an epidural or PCA all supplemental _____, _____, _____ must

A

sedative, anticoagulants, pain meds must be okayed by anesthesia regardless if ordered by MRP post op

48
Q

  • -
A

air entry clear
s1 and s2 no extra sounds
abdomen flat, soft, non tender, Bowel sounds present

49
Q

visually inspect the body

A

Visualize every site where there is a dressing, drain, or tube
Roll patient to the side to visualize the patient’s back

50
Q

when pt voids post op

A
51
Q

how to prioritize

A

Immediately life or limb threatening problems
NEXT&raquo_space; serious but not immediately life-threatening problems
NEXT&raquo_space; prevention of future complications or problems
LASTLY» routine, non-urgent care/tasks

52
Q

first assess
sedond
third
fourth

A
  • immediate life or limb threatening issues
  • serious, but not immediately life/limb threatening
  • prevention of future complications
  • routine, non urgent
53
Q

maslows hierarchy of needs

A

physiological
safety
love/belonging
esteem
self actualization

54
Q
A