WEEK 3 : PreOP Flashcards
staff who interact with pt and their roles
surgeons and their team
surgeon and their team ( surgical resident, attending physician )
operates- their focus
meets with pt before OR
Gets consent
( explain the purpose of the surgery follow the risks and the process answer any questions )
what abt anesthesiologist ( staff who interact with pt & their roles
(may have resident/ther dr with them )
- manages the sedation/anesthethic vital signs and intubates/oxygenates pt
what is this describing : focus on the pt ( not the actual surgery ) keeping pt in best condition during the surgery
anesthesiologist
this meets with pt before the OR- looks in their mouth/examines airway
anesthesiologist
true or false. all the meds to give them under sedation and keeping track of the body is the anesthesiologist job.
true
nursing goal and focus in pre op period , what are the two aspects that are very important
communication and documentation are very critical !
true or false. identifying and manage potential risks - drs do alot of critical thinking !
true
help pt through the experience of having surgery- “prepare” the pt such as
reason
what is being done
expect post op
true or false. once the nurse is done the pt is sent off and then another nurse is sent off to take care of the pt
we need to know their baseline
- mental status
-mobility no other problems develop
true
what do we need to identify in order to avoid risks during operating?
red flags or risks .. as many can be managed but or staff need to be preapred
avoid catastrophes that could happen in the OR ( no surprises ) what type of potential problems could occur?
hemorrhage, stroke, MI , hypoxia, arrhythmia can lead to permanent disability or death
what should we warn pts about post op
questions such as names, allergies, dob ( this is going to be repeated )
informed consent. legal requirement, reflects professional ethics. is this true or false.
this is true
what remains in the chart?
who’s responsibility is it for the informed consent?
specific forms
surgeons
Pt is giving surgeon permission to do the surgical procedure (elective and life saving, if pt A&O, mentally competent). Will talk also to family (in person, on phone). Must:
- On consent form it states the procedure – what is being done
- Discuss surgical procedure with pt in terms they understand, includes the risks &
benefits - bevoluntary
- Patient “signs the consent”
what is the nurses role during the informed consent occurence?
professional and ethnical duty
true or false. the pt needs to be clear headed which means that the pt should not be on any what ? bonus.
the pt needs to be clear headed
- no narcotics
- no benzons
- the surgeons responsibility
true or false. the dr has the ability to save pts life
- if the pt is in critical condition, no family has been found.
true
true or false. during pre-op where NPO, give some meds IV and painkiller
true
true or false. all documents and plan is clear during pre op to get the pt prepared for the OR
true
surgical settings : degree of urgency and risk
what could occur during an emergency situation
no time to plan, or death situation
for example : a big heart attack, bypass surgery, a car accident
pt may already be a pt on a unit listed as E1 or E2 and E3 or come in by ambulance, this undergoes that emergency degree of urgency.
true
what is considered as a very emergent
E1
what is an elective surgery ?
surgery is scheduled
- pt already on unit- surgery planned/scheduled- on the “slate”
- same day admission
what does slate mean
the list of the patients name who anesthologist and surgeon have
same day admission elective surgery
admitted the day of their surgery, and stays in the hospital
same day surgery ( ambulatory )- ‘smaller, less risky surgeries” elective surgery
surgery requiring 2-3 hr post op stay
may be in a med clinic or office setting
discharged directly home
taking a pre op history
think how this links to “surgical risk ‘
age, general status of health, surgery to have, allergies,
head to toe assesment
medical hx , chronic disease, current infection
when a pt is coming to the hospital or clinic , these are less risky surgery, stay on the unit for a short time and go home.
same day surgery ( ambulatory )
name of the following if these are important linking to surgical risks
- Surgical Hx – anesthesia issues, recovery, pain control
- Social Hx (drugs, alcohol, meds, prescribed and OTC, herbs & supplements)
- Family Hx (problems with anesthetic or poor surgical recovery)
- Psychosocial status, Cultural, Spiritual
what are the complications during OR or POSTop
age>65 increase the risk, there organs are not functioning at the functioning level due to old age
alcoholi ( delirium tremens, DTs) - can have seizures , they can die from withdrawals , protocols are devleop to make sure they do not die
how long should we stop for drug use, smoking ( and is this important for complications during OR or POSTop )
stop 6 weeks, try nicotine patch ( can affect the resp system )
true or false. herbs and supplements, could lead to complications during the OR or postop.
yes, they can interfere with blood pressure, sedation, and clotting with supplements
obese or cachexic could also increase risk for complications during the OR or postop
yes this is true ( nutrition-wound healing, skin breakdown, pressure )
what could impact in wound healing and breakdown of their skin
cachexic
some medications you should look for : complications during the OR or POSTop
anticoagulant, immunosuppressants, antihypertensives
what inhibits platelet aggression
anticoagulant
asa should be stopped before a surgery for how long?
2 weeks
antihypertensives should still be taken, due to the cardiac ( bp could go too high during surgery ), any resp, or deals with immune ( this should be taken )
true
if a pt is pregnant they will probably need to do either 2 things
cancel
or carry on but change the type of anesthetic so it doesn’t harm the fetus
routine/common pre op lab tests are
blood tests : cbc, wbc, electrolyres, glucose
- coags- ptt, inr ( coumadin )
blood type & screen - so can get some quickly to pt if needed
true or false . * U/A, crea, BUN * LFTs
* CXR
* Pulmonary tests * EKG are seen as common diagnostic dx testing for or
true
give rationale why we may want to know these :
* Routine/Common Pre-op Lab Tests
* Blood tests – CBC, WBC, electrolytes, glucose
* Coags: PTT, INR (coumadin)
* Blood type & screen – so can get some quickly to pt if needed
* U/A, crea, BUN * LFTs
* CXR
* Pulmonary tests * EKG
lengthy or a big operation if a patient does bleed get them quickly ordered them to have blood available pre op before its done
urine analysis to let us know abt their kidney function
liver function baseline
chest xray gives us info abt their lungs or heart and lungs are functioning
rhythym of their heart, or previous mi
this is given for their baseline
true or false=. in order to miniize anxiety : encourage communication , promote rest, distraction, teaching family or caregiver
true
helping the patient recover is very huge : what is the one thing we need them to know prior to surgery in terms of breathing
deep breathing and coughing exercsies pop-op
splinting when necessary- helps manage pain
incentive spirometer
what some risks post op that could occur to the pt ?
pulmonary complciatins such as pneumonia, decrease lung expansion when they have geenral anesthethic
remind me what incetive spirometry does again
to see what sizes breaths ( lungs inflated to prevent pneumonia )
ambulation and sitting ( getting out of bed ) : they need to be encouraged and be active
- ‘Dangling’ at the bedside
- Leg exercises, DVT prophylaxis
the next day to get up to be encourage they need to be active
- range of motion exercises
can help with what ?
go in depth
this can prevent dvt ( prevent pneumonia )
dvt they’ll be receiving dalterparin or heparin or stocking scds and kept on post op especially if they had a bone or joint surgery also support gi or urinary flow decreased muscle loss, and mood
nutriton is also a prep op teaching
what are usually the requiemnt for most surgeries
require NPO for a period pre-op
we want that stomach empty, we want to make they do not have risk of vomitting therefore aspirate
true or false. pts can still take po meds, but just sop of water to go down. nausea is very common post ip because of the meds given
true
true or false. diet should be increased slowly, and easy to swallow, we want that bowel sounds to be returned.
true
true or false. may require “specific “ bowel prep “ . laxatives to make sure its clear and maybe a tumour remove so make sure following orders.
true
what does DAT mean
diet as tolerated
true or false. nausea is common postip, dat, increased diet slowly and clear fluids
true
what are the pre op teaching when it comes to grooming/skin
name 3
take a bath or shower morning or srgery ( antibacterial soap )
remove nail polish, artifical fingernails, hair clips jewelry
remove dentures eyeglasses contancts
true or false. remove prosthethics , piercings should be implemented when it comes to grooming/skin in pre op teaching.
true
checking their nail bed should be implemented
yes
true or false. hearing aids with often keep it
because the prep op hallway may still be ble to follow directions and not be scared
and then a nurse after they are under, will take it off and put their name ( a nurse and give it back to them so it doesn’t get lost
true
take medication as ordered pre-op, stop taking prescribed medications, otc medications and herbal remedies as suggested by the physician, anesthesiologist or surgeon pre-op. would this be true or false
true
what type of medications would be taken still ?
asthma, antihypertensives, anti-seizures, all those needs to be taken but with a sip of water
true or false. insulin or metformin ( take amount of time, so this pt is npo ) so order should be implemented
since the pt wont be drinking, putting on iv to manage iv ( iv fluids )
true
pain meds for arthritis etc ? should be implemented
true
what undergoes pain control
ask for pain medication as needed post op
types of pain control ( epidural, patient controlled analgesia )
is pt currently taking analgesia for an underlying condition?
pre-op teaching
drains, dressings & tubing
tell patient about any drains they will have post op (Jackson Pratt, hemovac)
dressings ( staples, sutures)
tubing: iv, ng, or epidural tubing
what undergoes safety
use call bell/side rails up post op ( just to keep them safe )
what are pre op information for pre op teaching
parking for visitors
time to be at hospital and time of surgery
true or false. Waiting area for family while in surgery – “patient is the priority” Length of expected stay post-op. Where pt will go
true
considerations re.adult, child, geriatric
what would you do differently and why ?
level of comprehension
depth of explanation
reading comprehension
true or false. what is the person capable of understanding and what will help their anxiety when it comes to considerations : adults , child, geriatric?
true
frequently used pre-op meds
benzo
narcotics
h2 receptor antagonists
antacids
are antiemetics, antibiotics typically use in pre op meds ?
yes
what is typically common use meds?
fentanyl, and morphine
ranitidine is what kind of drug ?
h2 receptor antagonists, ( pre-op to help decrease gastric volume )
ranitidine, is for what ?
we want that stomach empty less gastric in it asap, make sure they do not throw up ( decrease n & v ) decrease aspiration
abx - 1 dose of nsaid is given in the pre op area ( 2 doses post op )
decreases chance of infection
what is antichlonergic for ?
Atropine - decrease secretion if they’re doing oral surgery
RN completes the Pre-Op checklist : either the Day of Surgery or prior shift
baseline, vs, ht, weight
id and/or allergy bracelet
recent head to toe assessment documented- preop baseline
should the prep op meds given ? were preop instructions followed? oral intake, meds
true
define all of these are true : rn completes the pre-op checklist : either the day of surgery or prior shift
* Location of valuables, dentures/prosthetics/piercings
* Recent tests, labwork
* Void/foley
* Surgical site marked
* NPO/blood glucose
* H&P, diagnostic reports & consent is on chart
true
day surgery : special considerations
patient cannot leave to go home until they meet discharge criteria
LOC
VS
MOBILITY
PAIN AND N&V
void
responsible adult at home
- Surgery specific instructions & follow-up appt – what is abnormal?
- Transportation Home - Cannot Drive Self !!!
- House/apartment keys, warm clothes, call family, get prescriptions, food, etc… * Stay home, don’t make any big decisions
these are true when it comes to day surgery
true
what is another word for day surgery?
ambulatory
awake intact reflexes in their baseline ( mobility ) talking and everything back to normal
true or false.
true
need to be baseline, no bleeding, mobility is baseline pain and nausea needs to be controlled
meds is given during this post op time
t3s or oxycodone teaching done
true
less than 2 hours to perform 3 to 4 hours to recover post op
and leave that place and go home .if the pt has more severe pain or n and v that was not anticipated then admitted to unit typically shorter and less complicated
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