Week 3: Intraop/Periop/Anesthesia Flashcards
Ambulatory Surgery
include outpatient, same day, or short stay surgery that does not require an overnight hospital stay
Bariatrics
having to do with patients that are obese
Informed Consent
the patients autonomous decisions about whether to undergo a surgical procedure, based on the nature of the condition, the treatment options, and the risks and benefits involved
Intraoperative Phase
period of time that begins with transfer of the patient to the operating room area and continues until the patient is admitted to the postanesthetic care unit
Minimally invasive surgery
surgical procedures that use specialized instruments inserted into the body either through natural orifices’ or through small incisions
Perioperative Phase
period of time that constitutes the surgical experience; includes the preoperative, intraoperative, and postoperative phases of nursing care
Postoperative Phase
period of time that begins with the admission of the patient to the post anesthesia care unit and ends after follow up evaluation in the clinical setting or home
Preadmission Testing
diagnostic testing performed before admission to the hospital
Preoperative Phase
period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table
Anesthesia
a state of narcosis or severe CNS depression produced by pharmacologic agents
Anesthesiologist
the physician trained to deliver anesthesia and to monitor the patients condition during surgery
Anesthetic Agent
the substance, such as a chemical or gas, used to induce anesthesia
Circulating Nurse (Or Circulator)
RN who coordinates and documents patient care in the OR
Laprascope
a thin endoscope inserted through a small incision into a cavity or joint using fiber optic technology to project live images of structures onto a video monitor; other small incisions allow additional instruments to be inserted to facilitate laparoscopic surgery
Malignant Hyperthermia
a rare life threatening condition triggered by exposure to most anesthetic agents inducing a drastic and uncontrolled increase in skeletal muscle oxidative metabolism that can overwhelm the bodys capacity to supply oxygen, remove CO2, and regulate body temperature, eventually leading to circulatory collapse and death if untreated; often inherited as an autosomal dominant disorder
Moderate Sedation
previously referred to as conscious sedation, involves the use of sedation to depress the level of consciousness without altering the patients ability to maintain a patent airway and to respond to physical stimuli and verbal commands
Monitored Anesthesia Care
Moderate sedation given by an anesthesiologist or certified registered nurse anesthetist (CRNA)
Registered Nurse First Assistance
a member of the OR team whose responsibilities may include handling tissue, providing exposure at the operative field, suturing and maintaining hemostasis
Restricted Zone
area in the OR where scrub attire and surgical masks are required; includes OR and sterile core areas
Scrub Role
RN, license practical nurse, or surgical technologist who scrubs and dons sterile surgical attire, prepares instruments and supplies, and hands instruments to the surgeon during the procedure
Semi restricted Zone
area in the OR where scrub attire is required; may include areas where surgical instruments are processed
Surgical Asepsis
absence of microorganisms in the surgical environment to reduce the risk of infection
Unrestricted Zone
area in the OR that interfaces with other departments; includes patient reception area and holding area
Most common orthopedic procedures in the US
total knee replacement/total knee arthroplasty
What 4 variables can be used to reduce length of stay for those undergoing total knee replacement
Comprehensive Preoperative Patient Education
Pain Control Using Multimodal Analgesic Regimens
Physical Therapy on the Day of Surgery
Proactive Discharge Planning
Self Report
The ability of an individual to give a report - in this case, of pain, especially intensity; the most essential component of the pain assessment
Titration
Upward or downward adjustment of the amount (Dose) of an analgesic agent
Comfort Function Goal
the pain rating identified by the individual patient above which the patient experiences interference with function and quality of life (e.g. activities the patient needs or wishes to perform)
Intraspinal
“within the spine”
refers to the spaces or potential spaces surrounding the spinal cord into which medications can be given
synonymous with neuraxial
Neuraxial
of the CNS
synonymous with intraspinal
Agonist Antagonist
a type of opioid that binds to the kappa opioid receptor site acting as an agonist (capable of producing analgesia) and simultaneously to the mu opioid receptor site acting as an antagonist (reversing mu agonist effect)
Withdrawal
result of abrupt cessation or rapid decrease in dose of a substance upon which one is physically dependent
it is not necessarily indicative of addiction
Ceiling Effect
an analgesic dose above which further dose increments produce no change in effects
Tolerance
a process characterized by decreasing effects of a drug at its previous dose, or the need for a higher dose of drug to maintain an effect
Addiction
a chronic neurologic and biologic disease characterized by behaviors that include one or more of the following:
impaired control over drug use
compulsive use
continued use despite harm
craving to use the opioid for effects other than pain relief
Physical Dependence
the body’s normal response to administration of an opioid for 2 or more weeks
withdrawal symptoms may occur if an opioid is abruptly stopped or an antagonist is given
Opioid Induced Hyperalgesia (OIH)
A phenomenon in which exposure to an opioid induces increased sensitivity, or a lowered threshold, to the neural activity conducting pain perception
it is the “flip side” of tolerance
Hydrophilic
readily absorbed in aqueous solution
Metabolites
the product of biochemical reactions during drug metabolism
Lipophilic
readily absorbed in fatty tissues
Efficacy
the extent to which a drug or another treatment “works” and can produce the effect in question - analgesia in this context
Half Life
the time it takes for the plasma concentration (amount of drug in the body) to be reduced by 50% (after starting a drug, or increasing its dose)
after four to five half lives, a drug that has been discontinued generally is considered to be mostly eliminated from the body
Adjuvant Analgesic Agent
a drug that has a primary indication other than pain (e.g. anticonvulsant, antidepressant, sodium channel blocker, or muscle relaxant) but is an analgesic agent for some painful conditions; sometimes referred to as coanalgesic
Preoperative Phase
period of time from decisions for surgery until patient is transferred into the OR
Intraoperative Phase
period of time from when the patient is transferred into the OR to admission into the PACU
Postoperative Phase
period of time from when a patient is admitted to the PACU to follow up evaluation in the clinical setting or at home
What are the 5 purposes for surgery
Diagnostic
Curative
Palliative
Cosmetic
Functional
What are the 2 types of surgery
outpatient
inpatient
Outpatient Surgery
“Same day, short stay, ambulatory, 23 hour”
Can be done in hospitals or surgi-centers
The majority of surgeries are ____ surgeries at 85%
outpatient
In order to have an outpatient surgery done, what requirement must be met?
They must be a relatively “healthy” individual with no comorbidities or ones that are under control
They have to meet certain criteria -if they are not met they will be admitted overnight to stay incase complications arise
What are the criteria for discharge from outpatient surgery
Ability to drink
Ability to void
Ability to walk on their own
Inpatient Surgery
reserved for complex surgical procedures and/or resource intensive recovery
ex: total joints, neurological, major vascular/cardiac, trauma
Advantages of Outpatient Surgery
Decreased psychological stress
Decreased exposure to nosocomial infections
Economic Benefit
Less separation anxiety, especially for kids
Disadvantages/Challenges of Outpatient Surgery
Difficult to do if they live alone and cannot drive themselves home
Increased patient teaching needs d/t short amount of time in the clinic
No skilled observations for complications occur at home
Pain control - oral meds and pain pumps not present/misuse
What nursing activities are included during the preoperative period
- Establish baseline assessment of patient via a preoperative interview!!
a. Physical and emotional assessment (+ Med history)
b. Anesthesia history
c. Allergies or genetic problems (ex: latex allergy)
d. necessary testing ordered and performed
e. preparatory education about recover from anesthesia and post op care
What are some of the things done during preadmission testing by the healthcare team
initial preoperative assessment
teaching appropriate to the patients needs
involvement of the family in interview
completed preoperative diagnostic testing
verifying patient understanding of surgeon specific preoperative orders
discuss, review advanced directive document
begin discharge planning by assessing patient postoperative transportation, etc
When is preadmission testing usually done
usually this is done for more inpatient surgeries and longer stays
preadmission testing includes all physical/physiological testing and diagnostic testing done and any emotional testing and education
What is preadmission testing like for scheduled out patients
usually minimum amounts of testing are ordered since the patient should be “Healthy” already and due to the type of surgery
This testing will be performed when the patient arrives to the hospital on the day of the surgery most likely
What is preadmission testing like for scheduled in patients
usually performed several days to weeks prior to date of the surgery
urinalysis, blood work (CBC, lytes, H&H), CXR, EKG>40yo, any other MD ordered test done
Due to patient health status or type of surgery these test results may need to be reviewed prior to proceeding with the surgery
Nursing roles and Responsibilities during the Preoperative Phase
- Assessment
- Patient Support
- Patient Preparation and SAFETY
- Patient Education (TEACHING!!!!)
- Patient Advocate
What things are included in the preoperative nursing assessment
nutritional and fluid balance assessment
drug and alcohol usage
respiratory status
cardiovascular status
hepatic and renal function
endocrine status
previous medication use
psychosocial status
spiritual and cultural beliefs
Everything should be included from head to toe to spirit!
Prior to Preoperative Teaching, the nurse should know
history of patient illness
rationale for surgery (WHY)
nature of the surgery (curative, palliative, disfiguring, ostomies, etc)
patient readiness to learn based on factors like: age, mental status, preexisting knowledge about condition, family rxn to surgery
How they learn best
When does preoperative teaching take place
it ideally starts in the physicians office and continues until the patient arrives in the OR
bedside in an emergency
On the day of, inpatients will have it done during the PAT visit but outpatients will have a phone interviews where it occurs or the morning of
What are some useful teaching methods for preoperative teaching
verbal
written information
return demonstration
combination of them
During preoperative teaching, aside from just providing information, what else should the nurse do
guide the patient through the experience and allow ample time for questions
address concerns and fears about anesthesia
provide information that clears up misconceptions
reinforce explanation of the procedure
MD (nurse can be witness) obtains informed consent
What things must be done prior to a surgery (immediate and weeks prior)
explanations of preop procedures
removal of jewelry and nail polish
lab testing
skin prep - cleansing, possible shaving
enemas or bowel preps for intestinal surgery
rationales for withholding food and fluids - like NPO after midnight prior
use of OTC supplements - stop using medications deemed 2-3 weeks prior to surgery
What are some topics to teach the patient about preop
preoperative medications and IV lines
Post op procedures: TCDB, IS, leg exercises, moving in bed/splinting/getting out of bed, equipment expected post op (NG, catheter, drains, NPWT, dressings)
important of reporting pain and discomfort
what will be done to relieve pain like changing position and medications
What are the Criteria for Informed Consent
- Voluntary
- Explains: procedure and risk, benefits and alternatives, offers to answer questions, withdrawal statements, statements if protocol differs from usual
- Competency to sign
- Emancipated minor or not
What are some nurse responsibilities during the informed consent phase
- Have consent signed BEFORE giving any psychoactive medications
- Reinforce information supplied by physician
- WITNESS PATIENT SIGNATURE (be their advocate)
Special Surgical Populations
Geriatric
Pediatrics
Obesity/Bariatrics
Patients w/ physical or mental disability
Patients w/ co morbid conditions
Patients with limited support systems
Geriatric Population Considerations
Pain assessment
May fail to report symptoms
visual and hearing acuity changes
less physical reserve for recovery (cardiac conditions, dehydration, arthritis, skin integrity, endurance)
sensitivity to temp changes
confusion
clear communication
greater risk for anesthesia problems
Due to the high elderly risks in surgery it is very important to do what things
- Skillful preop assessment and treatment
- Skillful anesthesia and surgical technique
- Meticulous and competent post anesthesia management
Pediatric Population Considerations
provide age specific teaching
family oriented teaching should be done - parents can reinforce teaching
sensitivity to temperature change - use warm blankets, a warm room, warming devices
safety concerns
size of equipment an instruments used
