WEEK 3 : PreOP Flashcards by mary doe

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 )

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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

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

anesthesiologist

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

anesthesiologist

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

true

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

communication and documentation are very critical !

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

true

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

reason
what is being done
expect post op

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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

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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

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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

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what should we warn pts about post op

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

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

this is true

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

specific forms
surgeons

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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”

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what is the nurses role during the informed consent occurence?

professional and ethnical duty

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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

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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

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

true

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

true

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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

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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

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what is considered as a very emergent

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what is an elective surgery ?

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

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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 just read!