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H & Illness 4: A & C illness > WEEK 3 : PreOP > Flashcards

WEEK 3 : PreOP Flashcards

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1
Q

staff who interact with pt and their roles

surgeons and their team

A

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 )

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2
Q

what abt anesthesiologist ( staff who interact with pt & their roles

A

(may have resident/ther dr with them )
- manages the sedation/anesthethic vital signs and intubates/oxygenates pt

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3
Q

what is this describing : focus on the pt ( not the actual surgery ) keeping pt in best condition during the surgery

A

anesthesiologist

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4
Q

this meets with pt before the OR- looks in their mouth/examines airway

A

anesthesiologist

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5
Q

true or false. all the meds to give them under sedation and keeping track of the body is the anesthesiologist job.

A

true

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6
Q

nursing goal and focus in pre op period , what are the two aspects that are very important

A

communication and documentation are very critical !

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7
Q

true or false. identifying and manage potential risks - drs do alot of critical thinking !

A

true

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8
Q

help pt through the experience of having surgery- “prepare” the pt such as

A

reason
what is being done
expect post op

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9
Q

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

A

true

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10
Q

what do we need to identify in order to avoid risks during operating?

A

red flags or risks .. as many can be managed but or staff need to be preapred

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11
Q

avoid catastrophes that could happen in the OR ( no surprises ) what type of potential problems could occur?

A

hemorrhage, stroke, MI , hypoxia, arrhythmia can lead to permanent disability or death

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12
Q

what should we warn pts about post op

A

questions such as names, allergies, dob ( this is going to be repeated )

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13
Q

informed consent. legal requirement, reflects professional ethics. is this true or false.

A

this is true

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14
Q

what remains in the chart?
who’s responsibility is it for the informed consent?

A

specific forms
surgeons

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15
Q

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:

A
  • 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”
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16
Q

what is the nurses role during the informed consent occurence?

A

professional and ethnical duty

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17
Q

true or false. the pt needs to be clear headed which means that the pt should not be on any what ? bonus.

A

the pt needs to be clear headed
- no narcotics
- no benzons
- the surgeons responsibility

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18
Q

true or false. the dr has the ability to save pts life
- if the pt is in critical condition, no family has been found.

A

true

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19
Q

true or false. during pre-op where NPO, give some meds IV and painkiller

A

true

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20
Q

true or false. all documents and plan is clear during pre op to get the pt prepared for the OR

A

true

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21
Q

surgical settings : degree of urgency and risk

what could occur during an emergency situation

A

no time to plan, or death situation
for example : a big heart attack, bypass surgery, a car accident

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22
Q

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.

A

true

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23
Q

what is considered as a very emergent

A

E1

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24
Q

what is an elective surgery ?

A

surgery is scheduled
- pt already on unit- surgery planned/scheduled- on the “slate”
- same day admission

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25
Q

what does slate mean

A

the list of the patients name who anesthologist and surgeon have

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26
Q

same day admission elective surgery

A

admitted the day of their surgery, and stays in the hospital

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27
Q

same day surgery ( ambulatory )- ‘smaller, less risky surgeries” elective surgery

A

surgery requiring 2-3 hr post op stay
may be in a med clinic or office setting
discharged directly home

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28
Q

taking a pre op history
think how this links to “surgical risk ‘

A

age, general status of health, surgery to have, allergies,
head to toe assesment
medical hx , chronic disease, current infection

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28
Q

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.

A

same day surgery ( ambulatory )

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29
Q

name of the following if these are important linking to surgical risks

A
  • 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
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30
Q

what are the complications during OR or POSTop

A

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

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31
Q

how long should we stop for drug use, smoking ( and is this important for complications during OR or POSTop )

A

stop 6 weeks, try nicotine patch ( can affect the resp system )

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32
Q

true or false. herbs and supplements, could lead to complications during the OR or postop.

A

yes, they can interfere with blood pressure, sedation, and clotting with supplements

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33
Q

obese or cachexic could also increase risk for complications during the OR or postop

A

yes this is true ( nutrition-wound healing, skin breakdown, pressure )

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34
Q

what could impact in wound healing and breakdown of their skin

A

cachexic

35
Q

some medications you should look for : complications during the OR or POSTop

A

anticoagulant, immunosuppressants, antihypertensives

36
Q

what inhibits platelet aggression

A

anticoagulant

37
Q

asa should be stopped before a surgery for how long?

A

2 weeks

38
Q

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 )

A

true

39
Q

if a pt is pregnant they will probably need to do either 2 things

A

cancel
or carry on but change the type of anesthetic so it doesn’t harm the fetus

40
Q

routine/common pre op lab tests are

A

blood tests : cbc, wbc, electrolyres, glucose
- coags- ptt, inr ( coumadin )
blood type & screen - so can get some quickly to pt if needed

41
Q

true or false . * U/A, crea, BUN * LFTs
* CXR
* Pulmonary tests * EKG are seen as common diagnostic dx testing for or

A

true

42
Q

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

A

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

43
Q

true or false=. in order to miniize anxiety : encourage communication , promote rest, distraction, teaching family or caregiver

A

true

44
Q

helping the patient recover is very huge : what is the one thing we need them to know prior to surgery in terms of breathing

A

deep breathing and coughing exercsies pop-op
splinting when necessary- helps manage pain
incentive spirometer

45
Q

what some risks post op that could occur to the pt ?

A

pulmonary complciatins such as pneumonia, decrease lung expansion when they have geenral anesthethic

46
Q

remind me what incetive spirometry does again

A

to see what sizes breaths ( lungs inflated to prevent pneumonia )

47
Q

ambulation and sitting ( getting out of bed ) : they need to be encouraged and be active

A
  • ‘Dangling’ at the bedside
  • Leg exercises, DVT prophylaxis
48
Q

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

A

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

49
Q

nutriton is also a prep op teaching

what are usually the requiemnt for most surgeries

A

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

50
Q

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

A

true

51
Q

true or false. diet should be increased slowly, and easy to swallow, we want that bowel sounds to be returned.

A

true

52
Q

true or false. may require “specific “ bowel prep “ . laxatives to make sure its clear and maybe a tumour remove so make sure following orders.

A

true

53
Q

what does DAT mean

A

diet as tolerated

54
Q

true or false. nausea is common postip, dat, increased diet slowly and clear fluids

A

true

55
Q

what are the pre op teaching when it comes to grooming/skin

name 3

A

take a bath or shower morning or srgery ( antibacterial soap )

remove nail polish, artifical fingernails, hair clips jewelry
remove dentures eyeglasses contancts

56
Q

true or false. remove prosthethics , piercings should be implemented when it comes to grooming/skin in pre op teaching.

A

true

57
Q

checking their nail bed should be implemented

A

yes

58
Q

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

A

true

59
Q

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

A

true

60
Q

what type of medications would be taken still ?

A

asthma, antihypertensives, anti-seizures, all those needs to be taken but with a sip of water

61
Q

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 )

A

true

62
Q

pain meds for arthritis etc ? should be implemented

A

true

63
Q

what undergoes pain control
ask for pain medication as needed post op

A

types of pain control ( epidural, patient controlled analgesia )
is pt currently taking analgesia for an underlying condition?

64
Q

pre-op teaching
drains, dressings & tubing

A

tell patient about any drains they will have post op (Jackson Pratt, hemovac)

dressings ( staples, sutures)

tubing: iv, ng, or epidural tubing

65
Q

what undergoes safety

A

use call bell/side rails up post op ( just to keep them safe )

66
Q

what are pre op information for pre op teaching

A

parking for visitors
time to be at hospital and time of surgery

67
Q

true or false. Waiting area for family while in surgery – “patient is the priority” Length of expected stay post-op. Where pt will go

A

true

68
Q

considerations re.adult, child, geriatric

what would you do differently and why ?

A

level of comprehension
depth of explanation
reading comprehension

69
Q

true or false. what is the person capable of understanding and what will help their anxiety when it comes to considerations : adults , child, geriatric?

A

true

70
Q

frequently used pre-op meds

A

benzo
narcotics
h2 receptor antagonists
antacids

71
Q

are antiemetics, antibiotics typically use in pre op meds ?

A

yes

72
Q

what is typically common use meds?

A

fentanyl, and morphine

73
Q

ranitidine is what kind of drug ?

A

h2 receptor antagonists, ( pre-op to help decrease gastric volume )

74
Q

ranitidine, is for what ?

A

we want that stomach empty less gastric in it asap, make sure they do not throw up ( decrease n & v ) decrease aspiration

75
Q

abx - 1 dose of nsaid is given in the pre op area ( 2 doses post op )

A

decreases chance of infection

76
Q

what is antichlonergic for ?

A

Atropine - decrease secretion if they’re doing oral surgery

77
Q

RN completes the Pre-Op checklist : either the Day of Surgery or prior shift

A

baseline, vs, ht, weight
id and/or allergy bracelet
recent head to toe assessment documented- preop baseline

78
Q

should the prep op meds given ? were preop instructions followed? oral intake, meds

A

true

79
Q

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

A

true

80
Q

day surgery : special considerations
patient cannot leave to go home until they meet discharge criteria

A

LOC
VS
MOBILITY
PAIN AND N&V
void
responsible adult at home

81
Q
  • 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

A

true

82
Q

what is another word for day surgery?

A

ambulatory

83
Q

awake intact reflexes in their baseline ( mobility ) talking and everything back to normal

true or false.

A

true

84
Q

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

A

true

85
Q

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

just read!

A

H & Illness 4: A & C illness (20 decks)

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