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75 Cards in this Set
- Front
- Back
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Perioperative Care (3 phases)
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Pre-Operative phase
Intra-Operative phase Post-Operative phase |
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What is the pre-operative phase?
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Time from when the decision for surgical intervention is made to when the pt. is transferred to OR table
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What is the intra-operative phase?
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Time that begins with transfer to OR table and continues until the pt is admitted to post-anesthesia floor
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What is the post-operative phase?
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Time that begins with the admission of pt to post-anesthesia floor and ends with follow up evaluation in clinical setting or at home.
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Pre-Operative Assessment
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Health Hx
Physical examination |
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Informed Consent
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Pt's autonomous decision about whether to undergo a surgical procedure
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Health Factors that affect pre-op patients
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Malnutrition issues
Dehydration Dental issues Drug/Alcohol Use Respiratory Status Cardio status Hepatic & Renal Status Endocrine Status Immune Function Emotional Status |
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Immediate Pre-Op Nursing Interventions
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Hospital Gown
Remove hair pins, cover hair completely Mouth inspection No jewelry Void immediately before |
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Epidural Anesthesia
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Injecting anesthetic agent into the epidural space of spinal cord
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Local Anesthesia
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Injection of solution containing anesthetic into the tissue at planned incision site
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Surgical Asepsis
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Absence of microorganisms in the surgical environment to reduce risk for infection
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Intra-operative Complications
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Nausea & Vomiting
Anaphylaxis Hypoxia & Respiratory Complications Hypothermia Malignant hyperthermia |
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Malignant Hyperthermia
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Rare inherited muscle disorder that is chemically induced by anesthetic agents
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Adverse Effects of surgery/anesthesia
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Allergic reactions
Cardiac dysrhthmias Myocardial depression Over/Under sedation Hypoexmia Drug toxicity |
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Moderate Sedation
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Sedation to depress the level of consciousness without altering the pt's ability to maintain a patent airway & respond to physical stimuli and verbal commands
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T/F: Esters have a high risk for allergic reactions
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False
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Example of an Ester anesthetic
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Novocain
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Methods of Administration for anesthetics
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Topically
Injection -infilitration, nerve block, iv, epidural, spinal |
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What are the 2 types of general anesthetics?
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Inhalation & Intravenous
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Name 4 stages of Anesthesia
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Stage 1:Beginning anesthesia
Stage 2:Excitement Stage 3:Surgical anesthesia Stage 4:Medullary Depression |
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T/F: It is safe to use epi with cocaine
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False
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Regional Anesthesia
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Agent injected around nerves so that the region supplied by those nerves is anesthetized
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Epidural Anesthesia
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Injecting agent into epidural space that surrounds the dura mater of spinal cord
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Spinal Anesthesia
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Extensive conduction nerve block that is produced when an agent is introducted into the subarachnoid space at lumbar level (L4 & L5)
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Potential Intra-operative Complications
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Nausea
Vomiting Anaphylaxis Hypoxia & other respiratory issues Hypothermia Malignant Hyperthermia |
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Dehiscence
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Partial or complete separation of wound edges
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Evisceration
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Protrusion of organs through the surgical incision
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PACU- what does it stand for?
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Postanesthesia Care Unit
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2nd Intention Healing
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Method of healing in which wound edges are not surgically approximated integumentary continuity is restored by the process of GRANULATION
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3rd Intention Healing
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Method of healing in which surgical approximation of wound edges is delayed & integumentary continuity is restored by apposing areas of GRANULATION.
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nursing responsibilties in the perioperative care
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consent
witness document educatie safety assessment discharge planning |
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trauma and serious/chronic illnesses to assess for during the perioperative period
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A llergy
B leeding C ortisone D iabetes E mboli |
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how long prior to surgery does someone need to stop smoking
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4-8weeks
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you are interviewing a client considering surgery. he mentions that he takes garlic, ginko, and ginseng. you know these herbs are a potential problem because...
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they potentiate bleeding times
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your patients chart says he takes st. johns wart. what can you expect (if he didnt stop) in his surgical recovery period?
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prolonged anestesia
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you are told to hang an iv of vancomycin in the preop setting. you know that this drug must be hung how long before surgery?
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60 mins prior
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elective surgery
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surgery that is scheduled in advance because it does not involve a medical emergency
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epidural anesthesia
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is regional anesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia, or pain relief, rather than complete anesthesia, which is total lack of feeling
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evisceration
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1. Removal of the viscera or of the contents of a cavity.
2. Spilling out of abdominal contents resulting from wound dehiscence. |
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informed consent
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An informed consent can be said to have been given based upon a clear appreciation and understanding of the facts, implications, and future consequences of an action. In order to give informed consent, the individual concerned must have adequate reasoning faculties and be in possession of all relevant facts at the time consent is given.
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malignant hyperthermia
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An autosomal dominant disease marked by skeletal muscle dysfunction after exposure to some anesthetics or other stressors. Body temperatures may climb above 105° F. The condition may be fatal.
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palliative surgery
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An operation performed on an incurable CA, which is justified to ↓ severity of Sx and improve the quality of life, relieve pain
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PACU
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A unit to which patients are admitted after surgery for the monitoring of signs and symptoms that suggest that they may have poorly tolerated their anesthesia or operation.
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What are the different types of locations for surgery (2)
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Inpatient and ambulatory
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What are some of the roles of a nurse in the perioperative phase?
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Pain Management
Consent forms (witness signature) documentation Education Safety Assessments Set up and prep of patient Patient advocate Discharge planning |
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Reasons Surgery (5)
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Diagnostic ( Biopsy)
Curative (Appendix cure) Reparative (Trauma victims) Reconstructive/Cosmetic Palliative—Alleviate Pain |
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Urgency for surgery (5)
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Emergent-without delay
Urgent-within 24-30hr Required-within few wks-months Elective Optional |
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Circumstances Requiring Informed Consent are....
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Invasive procedures
Procedures with sedation/anesthesia Non-surgical procedures that cause risk for pt. Radiation procedures |
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What is the ABCDE acronym stand for in the perioperative patient?
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Allergies
Bleeding Disorders related meds Cortisone or steriod use Drugs & Diabetes Emboli |
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What are some risk factors for the perioperative patient
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Extremes of age
Pregnancy Nutritional Status Hepatic and Renal Status Extremes of weight Fluid/electrolyte Pulmonary Status Endocrine Allergies Alcohol, drug, or nicotine use Cardiovascular Immune Function Infection/sepsis Mental disability |
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T/F- Tobacco use decreases the healing time and should be stopped 4-8 weeks before surgery
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True
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T/F- It is not important to ask a perioperative patient if they are taking dietary supplements.
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False- it is important.
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What are some medications that cause issues with anesthesia?
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Corticosteroids
Diuretics Phenothiazines Antiseizure Medications Thyroid Hormone Tranquilizers Insulin Antibiotics Anticoagulants Opioids NSAIDS |
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T/F: Anticipate alcohol withdrawal delirium (DT’s) up to
72 hours after withdrawal with operative patients |
True
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Teaching need of perioperative patient (4 aspects)
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Sensory information
Psychosocial information Procedural information Expectations for recovery |
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T/F- Teaching operative info too far in advance the patient is at risk for forgetfulness
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True
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T/F- It is important to document patient teaching.
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True
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List areas of perioperative teaching
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Pain Management
Cough/Deep Breathing Equipment Ambulation/Turning Coping Strategies |
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________ is important for the postoperative patient because it promotes circulation, improves venous stasis return and provides optimal pulmonary function
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Mobility
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What are the 3 area of physical care for the preoperative patient?
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Prep the skin
Prepare the GI tract Nutritional care |
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What vitamins assist with tissue synthesis and wound healing
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Vitamin A, B, C and Zinc
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T/F Vitamin C assists with capillary and antibody formation
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True
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Vitamin _______ assists with capillary and antibody formation
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A
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What vitamins counter the negative effects of antibiotics
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Vitamin B
Vitamin K |
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T/F- NPO status is not important for the preoperative patient.
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False- majorly important due to risk for aspiration during surgery
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T/F- A nurse should obtain an informed consent after pre-op meds are given
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False- before
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After a pre-op medication is given what are 4 things the nurse should do?
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1- Lower bed and put up rails
2- Darken lights 3- Place call light in reach 4- Document properly |
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What are some of the common pre-op medications?
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Tranquilizers
Sedatives Analgesics Anticholinergics Antiemetics |
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List the 4 operative positions that are used for safety concerns during surgery
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Dorsal recumbent
Trendelenburg Lithotomy Lateral |
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What are some common guidelines for surgical asepsis?
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Sterile Technique
Non-scrubbed in people do not touch sterile field Sterile to Sterile movement Clean skin meticulously Sterile drapes cover all but the surgical site |
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T/F- Moderate sedation interferes with the airway
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False- it does not it lowers LOC
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Complications Malignant Hyperthermia
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Tachycardia Increased metabolism
Increased oxygen consumption Acidosis (respiratory and metabolic) Tachypnea Rigidity Fever/profuse sweating . Muscle damage |
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Lowering the head of the bed and raising the legs is an intervention of hemorrhage and shock in the post-op pt.
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True
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Major complications of Post Op Day 1
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Atelectasis
Pneumonia Constipation Wound Infection DVT |
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Atelectasis causes ________ in breath sounds, cough & _________
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decreases
crackles |
