Week 5 Peri-Operative Care Flashcards
1
Q
Goals of Nursing Actions
A
- Collecting & interpreting information to determine risks associated with surgery
- Optimizing client’s health before & after surgery
2
Q
Pre-Operative Risk Factors
A
- Age (physiological reserve)
- Immunocompromised
- Previous operations
3
Q
Intra-Operative Risk
A
- Anesthesia
4
Q
Post-Operative Risk Factors
A
- Complications
- Healing
5
Q
Pre-Operative Patient Risk Factors
A
- Less physiologic reserve
- Comorbidities
- Health status
- Past surgical experiences
- Allergies
6
Q
Less Physiological Reserve
A
- Old age
- Young age
- Pregnancy
- Many comorbid health conditions
7
Q
High Risk Comorbidities
A
- Cardiac
- Respiratory
- Diabetes
- Renal/hepatic disorders
- Pain disorders
8
Q
Medications
A
- Full history prescribed, over the counter, natural health products
- Blood thinners & diuretics: high risk
9
Q
Labs & Investigations
A
- Identify risk factors
- Overall health status
- CBC, Cr, electrolytes, ECG
10
Q
Renal Lab Indicators
A
- Ability to metabolize anesthesia
- Manage fluid changes from surgery
11
Q
Hemoglobin Level
A
- Surgery causes blood loss
- Insufficient Hb pre-op = concern
12
Q
Platelets INR
A
- Info on bleeding risk
13
Q
WBC Level
A
- All surgeries have infection risk
- Low WBC = difficult to fight infection
14
Q
Na Indicates
A
- Overall homeostasis
- Fluid balance
15
Q
K Level
A
Cardiac stability
16
Q
Consent
A
- Informed consent legal mandate
- Surgeon responsible for providing info for consent
- No minimum age for consent
- Identify concerns with validity of consent
- Witness patient signature on form
17
Q
Teaching
A
- Pain management
- Resp deep breathing & coughing
- Movement for venous return
- Incision splinting
18
Q
Prepping for Op
A
- Holding nutrition
- Insert IV
- Implement appropriate orders
19
Q
Scrub Nurse Role
A
- Setting up sterile field
- Prep equipment
- Passes supplies to surgical team
- Monitors aseptic technique
- Performs sponge, needle, instrument count
- Sends specimens to lab
20
Q
Circulating Nurse Role
A
- Monitors client
- Coordinates team
- Monitors aseptic practice
- Verifies consent
- Performs second surgical safety checklist
- Counts with scrub nurse
- Transfers client to PACU
21
Q
RN-First Assist (RNFA)
A
- Care under supervision of surgeon
- Intraoperative performance of surgical first assistant techniques
22
Q
RN-Anesthesia Assistant (RNAA)
A
- Provide anesthesia care under direct supervision of anesthesiologist/medical directives
- Similar role fulfilled by RTs who have completed anesthesia assistant program
23
Q
Post-Op Care Priorities
A
- Assess immediate response to surgery
- Health status
- Pain
24
Q
Readiness of Transfer from PACU
A
- Return to baseline vitals
- Sufficient pain management
- Improving LOC
- Nausea/vomit controlled
- Wound dressing intact
25
LOC Complications
- Failure to return to baseline
- Delirium
- Low Glasgow coma
26
LOC Expected Values
- Moving towards alert & oriented
- Expected drowsiness within 24hrs of surgery
27
ABC's Complications
- Hypoxia
- Atelectasis
28
ABC's Expectations
- Patent airway
- Normal rate, rhythm, depth
- Deep breathing & coughing
29
Hypoxia Findings
- Dyspnea
- Bradypnea
- Low SpO2
- Cyanosis
30
Atelectasis Findings
- Dyspnea
- Tachypnea
- Low SpO2
- Cyanosis
- Increased HR
31
Opiate Pain Meds - Impact on Airway/Breathing
Airway depression
32
Expected Circulation
- Normal HR/BP
- Temperature, colour
- Bleeding as expected based on surgery
- Heart rhythm
33
Circulation Complications
- Hypotension
- Hypothermia
- Hemorrhage/hypovolemic shock
- Dysrhythmias
- DVT
- PE
34
Hypothermia Findings
- Low temp
- Shivering
- Piloerection
35
Dysrhythmias Findings
- Changes in BP/HR
- Abnormal rhythm
36
Deep Vein Thrombosis Findings
- Pain in lower extremities
- Cramping
- Leg swelling
- Red
- Pain
37
PE Findings
- SOB
- Chest pain
38
Prophylaxis
- Low molecular weight heparins
- Decreased risk of bleeding compared to heparin
- SC injections - 2 inches from umbilicus
- Mild bruising normal
39
Mobility Interventions
- Pain management
- Compression stockings
- Sequential compression devices
- Elevate legs
- Interprofessional team
40
Surgical Site Complications
- Infection
- Dehiscence
- Evisceration
41
Dehiscence Findings
Edges of wound unintentionally not-approximated
42
Evisceration Findings
- Edges of would unintentionally not-approximated
- Fascia +/-
- Organs visible or protrude
43
Lines, Tubes, Drains Complications
- Insertion site infection - phlebitis, interstitial
- Failure to drain - dry tubing
44
GI, GU Complications
- Nausea & vomiting
- Aspiration - NPO until recovered from sedation
- Paralytic ileus
- Oliguria
45
Paralytic Ileus Findings
- Abdominal distension
- Absence of bowel sounds
46
Oliguria Findings
- Urine output <30ml/hr
- Bladder distension
47
Ambulatory
- Readiness of discharge
- Health teachings
48
Admission
- Monitor health status & pain
- Risk for complications
- Health teaching
- Discharge planning
49
Health Teachings
- Diet
- Care of wound site /dressings
- Bathing recommendations
- Medication instructions - side effects
- Activities allowed or prohibited
- Symptoms to report
- Follow up appointments & prescriptions
- Home care contact numbers
- Ensure transportation arrangements
