Week 6: Perioperative care and pain Flashcards
untreated pain can result in
unnecessary suffering, physical dysfunction,
psychosocial distress, impaired recovery from acute illness and surgery,
immunosuppression, and sleep disturbances.
inadequate pain mgmt can be due to
lack of knowledge and skills to adequately assess and treat pain; misconceptions about pain; and inaccurate and inadequate information regarding addiction, tolerance, respiratory depression, and
other adverse effects of opioids.
nursing role in pain mgmt
(1) assessing pain and communicating this
information to other health care providers, (2) ensuring the delivery of effective pain
relief measures, (3) evaluating the effectiveness of these interventions, (4) monitoring
ongoing effectiveness of pain management strategies, and (5) providing education to
patients and their families regarding pain management approaches and possible
adverse effects.
physiological pain dimension
genetic, anatomical, and
physical determinants of pain.
sensory discriminative component of pain
recognition of sensation is painful
motivational affective component of pain
emotional response to pain experience
behavioural component of pain
observable actions used to express or control pain
cognitive evaluative component of pain
beliefs attitudes memories and meaning attritbuted to pain
sociocultural dimension of pain
demographics, support systems, social roles, past pain experiences, and culture
nociception
physiological process by which information about tissue damage
is communicated to the central nervous system. Nociception involves transduction,
transmission, perception, and modulation.
nociceptive pain
caused by damage to
somatic or visceral tissue. Somatic pain may be described as aching or throbbing.
neuropathic pain
caused by damage to nerve cells or changes in spinal cord
processing. Difficult to treat, this type of pain is typically described as burning,
shooting, stabbing, or electrical in nature.
acute pain
diminishes over time as healing occurs
persistent pain
lasts for long period, often defined as past the time when an expected acute pain or acute injury should subside
every pain assessment should include
evaluation of the sensory-discriminative
component: pattern, area, intensity, and nature (PAIN) of the pain.
equinalgesic dose
dose of one analgesic that is equivalent in pain-
relieving effects compared with another analgesic.
pain meds are divided into 3 categories
nonopioids, opioids, and conanalgesics or adjuvent drugs
adjuvent analgesic therapies include
antidepressants, anticonvulsants, corticosteroids, and local anaesthetics
neuroablative interventions
performed for severe pain that is unresponsive to all other therapies
neuroaugmentation
electrical stim of the CNS
transcutaneous electrical nerve stimulation
delivery of an electric current through electrodes applied to skin surface over painful region, trigger points, or over a peripheral nerve
ambulatory surgery
also called same day surgery, can be conducted in emergency
departments, endoscopy clinics, doctors’ offices, and outpatient surgery units in
hospitals.
preoperative teaching involves the following
Three types of information: sensory (what patients will see, hear, smell, and feel
during surgery), process (general information about what will happen), and
procedural (more specific details).
o Different patients, with varying cultures, backgrounds, and experiences, may want
different types of information.
o All teaching should be documented in the patient’s medical record.
o All patients should receive instruction about deep breathing, incentive spirometry,
coughing, and moving postoperatively.
informed consent is valid if
it is voluntary, pt has mental capacity to consent, and the pt is properly informed
on the day of surgery the nurse is responsible for
o Final preoperative teaching
o Readiness assessment
o Communication of pertinent findings from diagnostic procedures and consults to
appropriate health care providers
o Ensuring that all preoperative preparation orders have been completed
o Ensuring that records and reports are present and complete to accompany the
patient to the OR
o Verifying the presence of a signed operative consent
o Laboratory data
o A history and physical examination report
o Baseline vital signs
o Nurses’ notes complete to that point
surgical suite
controlled environment designed to maximize infection
control and provide a seamless flow of patients, personnel, and operative instruments,
equipment, and supplies.
unrestricted area
personnel in street clothes can interact with those in scrubs
semirestricted area
personnel must wear surgical attire and cover all head and facial hair
restricted area
includes the OR, and all areas where sterile supplies are opened, the scrub sink area, and clean core, masks are required
in the holding area the nurse
identifies and assesses the patient, gives
preoperative medications, and, in some institutions, initiates intravenous (IV)
infusions before the patient is transferred into the OR or to an anaesthesia block
room. Minor procedures such as inserting intravenous (IV) catheters and arterial
lines, peripheral and spinal nerve blocks, and drug administration may occur here.
circulating OR nurse role
The circulating nurse is neither scrubbed, gloved, nor gowned, and
remains in the unsterile field. The perioperative nurse orchestrates the preparation of the OR with other members of the surgical team. The nurse is usually the first member of the surgical team to greet the patient on arrival to the surgical suite and
advocates for the patient throughout the intraoperative experience
scrub nurse role
the scrub nurse is often a practical nurse who performs surgical hand
asepsis, is gowned and gloved in sterile attire, and remains in the sterile field assisting
the surgical team by preparing and handling instruments.
general anesthesia
loss of sensation with loss of consciousness, skeletal
muscle relaxation, amnesia, analgesia, and elimination of the somatic, autonomic,
and endocrine responses, including coughing, gagging, vomiting, and sympathetic
nervous system responsiveness.
local anesthesia
loss of sensation without loss of consciousness. Local
anaesthesia may be induced topically or via infiltration intracutaneously or
subcutaneously.
regional anesthesia
loss of sensation to a region of the body without loss
of consciousness when a specific nerve or group of nerves is blocked with the
administration of a local anaesthetic (e.g., spinal, epidural, or peripheral nerve
block).
procedural sedation
refers to the technique of
administering IV sedatives or procedural agents with or without analgesics.
Procedural sedation with analgesia results in depressed levels of consciousness
but patients do maintain independent control of their airway and, subsequently,
oxygenation.
malignant hyperthermia
a rare metabolic disease characterized
by hyperthermia with rigidity of skeletal muscles that can result in death
phase 1 post op care
▪ Care during the immediate postanaesthesia period
▪ Focused on the patient’s basic life-sustaining needs
▪ Constant, vigilant monitoring
▪ Goal: Prepare patient for safe transfer to phase II or inpatient unit
phase 2 post op care
▪ Surgery patient is ambulatory
▪ Goal: Prepare patient for transfer to extended-care environment or home
with discharge teaching
extended observation post op care
▪ Ongoing care for patients who will be admitted to the unit and those who
require observation or interventions
▪ Goal: Prepare patient for self-care.
potential respiratory complications in the PACU
airway obstruction, hypoxemia, and hypoventilation
potential cardiovascular complications in PACU
hypotension, hypertension, and dysrhythmias
potential neurological complications in PACU
emergence delirium, delayed awakening, and agitation
potential GI complications in PACU
post op nausea and vomiting
potential urinary complications in PACU
postop oliguria and acute urinary retention
