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Theory II > Week 3 - Preop > Flashcards

Week 3 - Preop Flashcards

1
Q

What tool completed by nurses before pt goes for surgery or procedures? Accurate completion of this tool is essential.

A

Pre-Operative Screening Tool

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2
Q

What pre-operative assessments must the nurse get? (10)

A
  • Current health status
  • Allergies
  • Medications
  • Previous surgeries
  • Mental status
  • Understanding of the surgical procedure and anesthesia
  • Smoking, alcohol, and other mind-altering substances
  • Coping
  • Social resources
  • Cultural and spiritual considerations
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3
Q

In addition to the pre-op form criteria, make sure.. (9)

A
  • Ensure pt is NPO, meds with sips only
  • Patient education (do they understand procedure? post-op exercises; Teaching Moving, Leg Exercises, Deep Breathing, and Coughing, on text pages 1024–1027 in Kozier)
  • Psychological support to patient
  • Ensure Consent form on chart (surgical, blood)
  • Ensure ID band and Allergy band
  • Do not shave the area…this done in OR
  • Collect patient chart, complete nursing notes and place MAR in chart
  • Tell family where to wait
  • If needed: start IV, give medication, catheter etc.
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4
Q

True or False?

After a procedure the patient may return directly to your unit without a report.

A

True!

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5
Q

When the patient arrives from a procedure, what does the nurse have to check?

A

Check the procedure records for information when the patient arrives.

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6
Q

Post-surgery is different than post-procedure. In post-surgery, the patient will go the ____ until they are stable. The _____ nurse will call with report before the patient arrives on your unit.

A

PACU (post-anesthesia care unit)

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7
Q

What are you to do upon arrival of pt to nursing care unit? (3)

A
  1. Assist with transferring the patient from the stretcher to bed
  2. Perform head-to-toe assessment, vitals, check IV lines, O2 etc.
    - VP COWF
  3. Check the chart for orders:
    - Labs, ECGs, X-rays
    - Medications
    ○ Antibiotics, analgesia, antiemetics- check when last given on OR (operating room) or PACU records.
    ○ All pre-op meds needs to be reordered postop… if not, notify MD
    - Restrictions: diet, activity etc.
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8
Q

What does VPCOWF mean?

A 
V- VITAL SIGNS
P- PAIN
C- CONSCIOUSNESS
O- OXYGENATION
W- WOUND (DRESSING)
F- FLUID BALANCE
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9
Q

How often should the nurse check for vital signs after the procedure/surgery?

A
  • Q15 min x 2, Q30 min x 2, Q1H x 2 then Q4H for 24 hrs
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10
Q

When taking vital signs, what will the nurse watch for? (2)

A
  • Watch for BP and HR changes r/t shock, bleeding

- Watch for RR (resp.rate) changes- decreased in anesthetic reversal or too much analgesia

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11
Q

When assessing for pain for post-op… (3)

A
  • Pain scale with vital signs and ensure pain medication coverage
  • Encourage pt to take around the clock if tolerated
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12
Q

C is for CONSCIOUSNESS: What do you mean by assessing for consciousness? (3)

A

Level of Consciousness, arousability, orientation

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13
Q

O is for OXYGENATION: What do you mean by assessing for consciousness? What would you do of the O2 sats were low?

A

Oxygen saturations with vital signs, administer O2 if needed

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14
Q

W- WOUND (DRESSING): The nurse must ensure that the wound dressing is ___ and ____.

A

Dry & Intact

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15
Q

If there is drainage notes in the dressing, what should the nurse do? What should the nurse report/watch out for?

A

Possibly reinforce, report frank blood.

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16
Q

If there is any drainage, assessments must be done. What assessments?

A

Assess drains - empty every shift and document, rest & report excess drainage

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17
Q

F is for FLUID BALANCE: What do you mean for fluid balance?

A
  • IV rate and volume (include volume from OR and PACU)
  • Check for negative balances
  • Ensure urine output is greater than 30 ml/hr
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18
Q

In post-procedure/surgery, ensure urine output is greater than ___ml/hr

A

30

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19
Q

Although pain and discomfort are expectations following surgery, inadequate ______ is unacceptable.

A

pain management

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20
Q

The consequences of inadequate pain management put increased _____ upon the body, with harmful effects.

A

stressors

21
Q

Uncontrolled pain can lead to serious medical complications, including ____ and ___ formation.

A

pneumonia and DVT

22
Q

Surgical pain can impair recovery and has the potential to progress to ______.

A

chronic pain.

23
Q

Patients with chronic pain may become ___ or ____ and be unable to carry out the activities of daily living.

A

depressed or anxious

24
Q

Other Considerations… (10)

A
  • Call bell in reach, emesis basin nearby
  • Keep NPO until bowel sounds return then sips to fluids to DAT
  • Mouth care
  • Position on side
  • Administer O2 as ordered
  • Encourage post-operative exercises (DB&C etc.)
  • Monitor for complications
  • Sit-up at side of bed late day 1, ambulate day 2
  • Begin discharge planning and teaching
  • Keep documentation up-to-date
25
Q

Purpose of Exercise.. Moving benefits.

4

A

–Promote venous return
–Mobilize secretions
–Stimulate gastrointestinal motility
–Facilitate early ambulation

26
Q

Purpose of Exercise.. Leg exercises benefits. (3)

A

–Promote venous return

–Prevent thrombophlebitis and thrombus formation

27
Q

Purpose of Exercise. Deep breathing and coughing benefits. (3)

A

–Enhance lung expansion
–Mobilize secretions
–Prevent atelectasis and pneumonia

28
Q

A condition in which one or more areas of your lungs collapse or don’t inflate properly

A

atelectasis

29
Q

How is “Diaphragmatic (deep) Breathing” done?

A
  • Breathe out gently and fully
  • Then take a deep breath through nose and mouth, letting the abdomen rise as the lungs fill with air.
  • Hold this breath for a count of five.
  • Exhale and let out the air through nose and mouth.
  • Repeat this exercise 15 times with a short rest after each group of five.
30
Q

Repeat this exercise[Diaphragmatic (deep) Breathing] ___ times with a short rest after each group of five.

A

15

31
Q

How is beneficial “Coughing” done?

A

–Lean forward slightly and place hands across the incisional site to act as a splint-like support
–With mouth slightly open, breathe in fully.
–“Hack” out sharply for three short breaths.
–Then, keeping mouth open, take in a quick deep breath and immediately give a strong cough once or twice.

32
Q

– Promotes lung expansion by deep breaths using visual feedback
- It teaches the pt how to take slow deep breaths.
- A medical device used to help patients improve the functioning of their lungs
– Instruct patient to use 10x/hr. while awake

A

Incentive Spirometer

33
Q

In using an incentive spirometer, how often should the pt use it?

A

Instruct patient to use 10x/hr. while awake

34
Q

To prevent ______, instruct the patient to exercise the legs while on bed rest.

A

thrombophlebitis

35
Q

•Leg exercises are easier if the patient is in a _____ position with the head of the bed slightly raised to relax abdominal muscles.

A

supine

36
Q

How often should the pt do leg exercises?

A

Repeat leg exercises every 1 to 2 hours

37
Q

Respiratory post-op complications (3)

A

–Pneumonia (Lung infection)
–Atelectasis (Lung collapsion or inflation dysfunction)
–Pulmonary embolism (Moving blood clots in the lungs)

38
Q

Circulatory post-op complications (7)

A

–Hypovolemia (decreased blood volume)
–Hemorrhage (bleeding)
–Hypovolemic shock (organ failure r/t to low blood volume -20% or 1/5-)
–Thrombophlebitis (Inflammation of the veins due to blood clots)
–Thrombus (Blood clot intact)
–Embolus (Travelling blood clot)

39
Q

Urinary post-op complications (2)

A

–Urinary retention

–Urinary tract infection

40
Q

Gastrointestinal post-op complications (5)

A

–Nausea and vomiting
–Constipation
–Tympanites (Inflammation of inner ear)
–Postoperative paralytic ileus (Paralysis of the intestine)

41
Q

Wound

A

–Wound infection
–Wound dehiscence (wound ruptures along surgical suture)
– Wound evisceration (abdominal organs come out of the ruptured incision)

42
Q

Psychological post-op complication

A

Postoperative depression

43
Q

What nursing interventions are done when a wound dehiscence/evisceration occurs?

A

Place in low Fowler’s position and instruct to lie quietly to minimize protrusion of body tissues.

44
Q

What nursing interventions are done when a wound evisceration occurs? (2)

A

– Cover protruding organs with sterile dressings moistened with sterile saline solution
- Take vital signs
– Notify surgeon immediately

45
Q

Dressings should be ____, ____ & ____.

A

clean, dry, and intact

46
Q

Assess wound for: (6)

A 
(ASD-SPD)
–Appearance
–Size
–Drainage
–Swelling
–Pain
–Drains or tubes
47
Q

Discharge Teaching (7)

A

Top Needs:

  1. Identification of complications and when to seek help
  2. Activity restrictions
  3. Wound care
  4. Pain management
  5. Risk Reduction
  6. If day surgery: must have ride home, no driving or important decisions
48
Q

If day surgery: must have ride home, no driving or __________.

A

important decisions

49
Q

4 ways in promoting wound healing.

A
  1. Maintaining moist wound healing
  2. Providing sufficient nutrition and hydration
  3. Preventing wound infections
  4. Proper positioning

Theory II (2 decks)

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