week 7 prt 2 Flashcards
when does the nursing preoperative interview usually occur?
likely occurs on the day of surgery
what is the purpose of the preoperative interview?
- obtain pt health information
- determine the pts expectations about surgery and anesthesia
- provide and clarify information about the surgery experience
- assess the pts emotional state and readiness for surgery
- provide discharge planning and postoperative teaching for the pt
what should be asked about a pts past health history?
- medical problems
- past hospitalizations
- previous surgeries
- reactions to anesthetics
- menstrual and obstetrical history (need to know if pregnant)
- family medical history
- current medications (nurse should check with an anesthesiologist to ensure which meds should be stopped and which should be taken on day of surgery)
- allergies (including drugs. chemicals, latex, pollen), pts on blood thinners need to stop before surgery
- high stress: higher blood sugar
- always continue insulin for a diabetic pt going through surgery
what does preoperative teaching do for the pt?
increases pt satisfaction and may reduce fear, anxiety, stress (the duration of hospitalization), and recovery time following discharge
- tell pt what they will see, hear, smell and feel during the surgery
(OR is cold, so they can ask for a warm blanket. Lights will be bright, and there will be lots of unfamiliar sounds
what should all pts receive instruction about?
deep breathing, incentive spirometry, coughing, and moving after surgery
what is informed consent?
is an active, shared decision-making process between the provider and the recipient of care
-the process protects the pt, surgeon, and the hospital and its employees
what MUST be disclosed about the surgery?
- disclosure of the diagnosis
- the purpose of the proposed tx
- the risks and consequences of the proposed tx
- the probability of successful outcome and risk of alternative tx
- the prognosis if tx is not instituted (what happens if they don’t get surgery)
who is ultimately responsible for obtaining consent
the physician, the nurse may witness the pts signature
in the immediate post-anaesthetic period, what are the most common causes of airway compromise?
includes obstruction, hypoxemia, and hypoventilation
what is the most common cause of airway obstruction from an extremely sleepy pt after surgery?
blockage of the airway by a pts tongue
what are the most common causes of respiratory problems for postoperative pts in the clinical unit?
are atelectasis and pneumonia especially after abdominal and thoracic surgery
the post operative development of mucus plugs (built up mucus in lungs) and decreased surfactant production are directly related to what?
- related to hypoventilation, constant recombant position, ineffective coughing, and history of smoking
what observations may indicate impaired ventilation?
the observation of slowed breathing or diminished chest and abdominal movements during respiratory cycle
regular monitoring of what helps the nurse to recognize early signs of resp complications?
regular monitoring of vital signs and use os a pulse oximetry in conjunction with a thorough resp assessment
what bed position maximinzes respirations?
supine position with the head of the bed elevated maximizes the expansion of the thorax and decreases the pressure of the abdominal contents of of the diaphram
what does deep breathing facilitate?
- deep breathing facilitates gas exchange, prevents alveolar collapse and move respiratory secretions to larger airway passages
- pt should be taugh to take in slow, deep breaths, through nose, hold, and then breath through mouth to exhale
how many times should a pt be deep breathing?
10 times every hours while awake
-an incentive spirometer is helpful in providing visual feedback of respiratory effort
