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139 Cards in this Set
- Front
- Back
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involves the care of patients before, during, and after surgery
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perioperative nursing
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one of the most highy organized and powerful specialty organizations within the profession of nursing (has to do with surgery)
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Association of periOperative Registered Nurses (AORN)
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begins with the client's decision to have surgery and ends when the client enters the OR
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preoperative phase
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Name three areas of focus in nursing care during the preoperative phase
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-identifying existing health concerns
-planning intraoperative and postoperative needs -providing preop teaching for client and family |
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more than ____% of surgery in the U.S. is provided in outpatient settings
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70%
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body system, purpose and degree of risk are ways that ______ can be classified
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surgery
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surgical incisions that enter the GI, GU, and respiratory tracts have a higher risk for __ than does surgery of other systems
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infection
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If an organ ruptures or or surgery is required to repair a penetrating injury, the risk of infection is ________ regardless of the body system involved
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high
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involves removal of a diseased body part
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ablative surgery
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undertaken to confirm or negate a diagnosis
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diagnostic surgery
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examples of diagnostic surgery
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biopsy, fine-needle aspiration, cardiac cath
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done to alleviate discomfort or other disease symptoms without producing a cure
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palliative surgery
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examples of palliative surgery
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tumor debulking, sciatic nerve block
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performed to restore function
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reconstructive surgery
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surgery to improve appearance (eg face lift)
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cosmetic surgery
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can surgery be both cosmetic and reconstructive
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yes. eg, car accident victim
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replaces a malfunctioning body part, tissue, or organ
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transplant surgery
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surgery in which an organ is harvested from someone pronounced brain dead for transplantation for another person
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procurement surgery
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emergency, urgent, and elective surgery are ways to classify surgery by
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degree of urgency
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requires transport to the OR ASAP to preserve the patient's life or function
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emergency surgery
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examples of emergency surgery
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internal hemorrhage, rupture of an organ, and trauma (eg car accident)
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scheduled within 24 to 48 hours to alleviate symptoms, repair a body part, or restore function
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urgent surgery
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removal of a cancerous breat or ORIF are examples of
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urgent surgery
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performed when surgery is the recommended course of action, but the condition is not time-sensitive
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elective surgery
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torn ligament, removal of rectal polyps, or rhinoplasty are examples of
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elective surgery
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minor surgery and major surgery are ways of classifying surgery by what
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degree of risk
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associated with a high degree of risk (blood loss, involve vital organs, be prolonged or complicated, or involve potential for post-op complications
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major surgery
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CABG, organ transplants, nephrectomy, and colon resection are examples of
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major surgery
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often performed on an outpatient basis, involves little rish and usually has few complications
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minor surgery
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hernia repair, arthroscopy, and breast biopsy are examples of what type of surgery
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minor surgery
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what ages are at the greatest risk during surgery
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the very young and the very old
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why are infants at an increased risk during surgery
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immature immune, respiratory, CV, liver, and renal systems; also their blood volume is low and even a small loss may be risky
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less physiological reserve and comorbid condition conditions are reasons why this group are at an increased risk for surgery
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older adults
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what disease is especially troublesome regarding wound healing following surgery
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diabetes
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what medication can be given to young children to reduce anxiety before surgery
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Verset
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the ________ surgical candidate is a healthy yong adult who takes no medications
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ideal
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patients with altered __________ may be unable to comprehend preop instructions or give informed consent for surgery
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cognition
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Name two examples of how over the counter meds can increase the risk of surgery
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-many herbs can cause potassium loss (increasing the risk for dysrythmias)
-Vit E can cause increased bleeding |
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long term alcohol abuse conributes to liver disease, predisposing the patient to what?
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bleeding
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habitual substance abusers may have a cross tolerance to anesthetic and analgesic agents, causing them to need _______ than normal doses
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higher
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drugs that may potentiate (increase) the action of anesthetic agents
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antibiotics
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druge that increase the risk of hypotensionn during surgery
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anti-hypertensives
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drugs that alter fluid and electrolyte balance (esp K)
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diruetics (eg Lasix)
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a standardized vocabulary designed by the AORN to describe the care of perioperative clients
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Perioperative Nursing Data Set (PNDS)
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consists of four domains: the health system, behavioral responses, physiological responses, and safety
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PNDS
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the first nursing language developed by a specialty organization that has been recognized by the ANA
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PNDS
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consists of 74 nursing diagnoses, 133 interventions, and 28 outcomes
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PNDS
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What minimum diagnostic tests are performed in the pre-op phase
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CBC, UA, EKG (over 50)
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diagnostic tests, physical preparation, and preop teaching are the _______ ___________ for the pre-op phase
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standard practices
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identify Risk diagnoses only if the patient has an underlying condition that would place him at a ____ risk than the average surgical patient
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higher
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since all pre-op patients are in need of teaching, you do not need this diagnosis unless you believe the client may not learn or the information is too complex to remember
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Deficient Knowledge
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outcomes that demonstrate that the patient is adequately prepared for surgery include what
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-is well informed about the surgery
-provides informed consent -knows what to expect post-op -has a minimum of anxiety |
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before a surgical procedure is performed, the law requires the surgeon to obtain what
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informed consent
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can a nurse witness the consent form
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yes
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once signed and witnessed, the informed consent is part of the client's record and accompanies him/her to the what?
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OR
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It is the nurse's responsibility to ensure that the patient was not ________ into signing the informed consent form
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coerced
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the patient must be alert, rational, mentally competent, and not _______ when he/she signs the informed consent form
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sedated
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Although the nurse may witness the informed consent form, who has the responsibility of discussing it with the client and getting the signature
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the surgeon
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True or False: the informed consent form tells the client that he/she may refuse the surgery or withdraw consent at any time
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TRUE
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True or False: As patient advocate, the nurse must ensure that the surgeon has explained the procedure and answered all questions. If the patient has further questions or you have questions about the patient's competence, notify the surgeon and delay sending the patient to surgery
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TRUE
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if the patient is a child, be sure to include who in the teaching and assessments
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the parents or caregivers
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you can use toys, simple langusge, and play in teaching a child to facilitate what?
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understanding
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because anxiety and anesthesia reduce GI motility, and to decrease the risk of nausea and vomiting, clients are usually NPO how long before surgery
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8 hours
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depending on the surgery and fcility, patients may be asked to do what the evening before surgery
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shower or scrub the surgical site with an antibacterial solution (eg, Phisohex or Betadine)
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currently, enemas are only given for surgeries involving what
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the colon
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sometimes this type of med is given before surgert to reduce bacteria
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antibiotic
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True or False: Indwelling catheters are routinely inserted for surgery
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FALSE: only if it is important to keep the bladder empty during surgery or if fluid status is being carefully monitored
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these may be ordered to relax the patient, reduce respiratory secretions, or reduce the risk of vomiting and aspiration
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preop meds
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if the surgery time is likely to vary, the pre-op meds may be order to be given _______ ______. This means that the OR staff will call when it is time to do so.
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on call
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many routine meds are ________ on the day of surgery
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held
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why would insulin be held or reduced by half on the day of surgery
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the patients NPO status will keep the blood sugar lower than usual
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elastic stockings that compress the veins of the legs and increase venous return to the heart
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antiembolism stockings
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these may be applied preop to prevent venous pooling during surgery and decrease the risk of thrombus formation
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antiembolism stockings
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this preop med is used to reduce gastric acidity
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H2 receptor antagonists (eg, Tagamet, Zantac)
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the perioperative phase that begins when the patient enters the OR and ends when she is admitted to the PACU
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intraoperative phase
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the personnel who care for the client during the surgical procedure are called the what?
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intraoperative team
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the intraoperative team is divided into two groups. What are they?
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the clean team and the sterile team
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members of this team include the surgeon, surgical assistant, and scrub nurse
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sterile team
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this person sets up the sterile field, prepares the surgical instruments, assists with sterile draping, anticipates the surgeon's needs, and maintains the sterile field
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scrub nurse
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an RN with additional training and education in surgical techniques and is also part of the sterile team
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RN first assistant
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True or False: the Registered Nurse First Assistant serves as an assistant to the surgeon, and works with the surgeon to oerform the procedure
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TRUE
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True or False: Clean team members may enter the sterile field in an emergency.
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FALSE: CLean team members may never enter the sterile field
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This team is composed of the anesthesiologist or CRNA, the circulating RN, biomedical techs, and radiology techs.
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the clean team
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an RN who applies the nursing process to coordinate all activities in the OR.
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circulating nurse
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True or False: one important aspect of the circulating nurse is to attend to the patient during the administration of anesthesia. In some cases, the circulating nurse administers sedation.
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TRUE
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This is used to obtain analgesia, muscle relaxation, and amnesia during surgery
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anesthesia
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produces rapid unconsciousness and loss of sensation
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general anesthesia
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the depression of respiratory and circulatory muscles (increasing the risk for pneumonia and thrombophlebitis) and an increased risk for death, MI, stroke, and malignant hyperthermia are two disadvantages of
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general anesthesia
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a rare, often fatal, metabolic condition that occurs during the use of muscle relaxants and inhalation anesthesia
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malignant hyperthermia
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in this anesthesia-related condition, skeketal muscles become rigid, and the temperature rises rapidly. Predisposition to this condition is hereditary.
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malignant hyperthermia
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an altertaive to general anesthesia that provides intravenous sedation without loss of consciousness
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conscious sedation
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True or false: during conscious sedation, the patient may be sleepy , but can easily be aroused by touch or speech
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TRUE
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Name two advantages of conscious sedation
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1. the risks associated with general anesthesia are eliminated
2. recovery is rapid |
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True or False: two examples of procedures used in conscious sedation are bronchoscopy and cosmetic surgery
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TRUE
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prevents pain in the area of the procedure by interrupting nerve impulses to and from the area
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regional anesthesia
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In regional anesthesia, the client remains alert but is _______ in the involved area.
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numb
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regional anesthesia may be administered by _______ of the surgical site and surrounding tissues with local anesthetics such as lidocain (Xylocaine) or bupivacaine (Marcaine)
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inflitration
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what type of procedures is regional anesthesia appropriate for
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minor, ambulatory procedures
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Name four types of regional anesthesia
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local anesthesia, nerve block, spinal anesthesia, epidural anesthesia
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this produces loss of pain at the desired site (eg a wound to be sutured)
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local anesthesia
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the injection of an anesthetic into and around a nerve or group of nerves
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nerve block
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a nerve block technique in which a tourniquet is placed on an arm or leg, and an anesthetic is injected below the level of the tourniquet
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Bier (intravenous) technique
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True or False: A bier block prevents both venous return and arterial flow
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FALSE: it prevents venous return while allowing arterial flow
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True or false: in a Bier block the patient feels no pain as long as the tourniquet is in place
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TRUE
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To prevent tissue damage a Bier block must be left in place no longer than how many hours
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2 hours
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the injection of an anesthetic into the CSF in the subarachnoid space. It blocks sensation below the level of the injection
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spinal anesthesia
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True or false: a headache after spinal anesthesia must be closely monitored and may require additional treatment from the anesthesia staff
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TRUE
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Occasionally in spinal anesthesia a higher level of anesthesia than desired happens and the anesthesia travels up the spinal cord. This may reduce RR and cardiac rate. What can be done to prevent resp. paralysis
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putting the patient in Fowler's position
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True or False: in spinal anesthesia, sudden hypotension may occur due to pervasive vasodialation
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TRUE
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requires the insertion of a thin catheter into the epidural space. Anesthesia is introduced through the catheter
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epidural anesthesia
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which is safer, spinal anesthesia or epidural anesthesia
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epidural
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why is epidural anesthesia safer than spinal anesthesia
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-because the anesthesia does not enter the subarachnoid space and the depth of anesthesia is not as great
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True or False: durgs used in epidural anesthesia are more concentrated than in spinal anesthesia, and if it is injected too deeply (into subarachnoid space) hypotension and resp parylysis can occur and mechanical ventilation is necessary
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TRUE
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Why is edpidural anesthesia ideal for obstretic procedures
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the mother is awake to bond with the newborn and mobility is not limited for too long
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surgical skin preparation reduces the risk of postop wound infection by reducing the number of ______ at the operative site
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microbes
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True or false: the surgical site is routinely shaved
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FALSE: remove hair only if it is abundant in the area of surgery or if the physician requests it. Hair removal increses the risk of abrasions or nicks in the skil, which can act as a portal of entry for bacteria
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access to the patients's airway, the need to monitor VSs, comfort, safety, and the surgical site dtermine what
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the placement of the patient in surgery
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When is the patient usually positioned
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after anesthesia is administered
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what are some tools that are used to position the patient
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straps, pillows, wedges, surgical table attachments
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who is responsible for preventing positioning injuries
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the circulating nurse
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Due to the long time spent in one position, surgical patients are at risk for what?
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pressure ulcers
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what is one measure to prevent pressure ulcer formation during surgery
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padding bony prominences
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who monitors the I/O of a patient during surgery as well as handles tissue samples and coordinates with the pathologist
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the circulating nurse
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who performs counts of sharps, sponges, and insrtuments
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the curculating nurse
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why is it important to perform counts of sharps, sponges, and insrtuments?
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to ensure that none are left inslde the patient
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this phase of perioperative nursing begins when the patient enters the PACU and ends when the patient has healed from the procedure
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post-op phase
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The post op phase consists of what two phases
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-recovery from anesthesia
-recovery from surgery |
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Who accompanies the patient to the PACU following surgery
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-the anesthesiologist or CRNA and the circulating nurse
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the first postoperative phase is known as the
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postanesthesia or immediate post op phase
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normally, nurses working in the PACU have training in what?
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critical care
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true or false: the immediate post op phase begins when the patient is transferred from the operating table to a gurney for transport to the PACU.
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TRUE
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recovery from surgery begins when the patient is transferred from the ________ and admitted to the surgical unit
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PACU
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After a quick focused assessment, how often does the RN assess the patient in the PACU
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every 5 to 15 minutes
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can the patient have a CPAP mechine in the PACU
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yes
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-the patient is conscious and easily reoriented
-the patient is able to maintain a patent airway independently -VSs are stable and within acceptable limits -patient can move all extremities ha could preop -patient is urinating at least 30 mL per hour and has proper I/O -dressings are dry and intact and wounds are considered appropriate for the procedure This is all evidence of what |
the patient is recovering fromm anesthesia
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how often should you assess the patient whe he/she arrives on the floor from PACU?
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-upon arrival
-every 15 minutes for the 1st hour -every 30 minutes for the next 2 hours -every hour for the next 4 hours -every four hours after that (may vary by institution) |
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True or False: All postop patients should receive a risk diagnosis
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FALSE: except in certain situations (eg, the patient has comorbidities) you will not need to wirte potential "risk for" diagnoses
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in the post op phase, clients with increased risk for thrombpphlebitis may have this device ordered, which is a plastic sleeve with chambers wrapped around the patient's legs.
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sequential compression device (SCD)
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True or False: In a Sequential Compression Device, pressure starts at the ankle and inflates. Then it moves up the leg, the lower chamber deflating as soon as the higher one inflates. It starts over again at the base of the ankle.
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True
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