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54 Cards in this Set
- Front
- Back
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What is the pre-op period? what is the role of the nurse?
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The pre-op period starts when the discussion is made to have surgery.
Pre-op then ends once the patient enters the surgery suite. |
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What is the role of the nurse during the preop period?
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Teaching and support
Listening Monitor fluids and electrolytes Assist with elimination Provide hygiene measure Promote rest Safety for patient and valuables Special orders Assist with religious requirements Baseline vital signs Make sure all records are complete |
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What are the different types of surgeries? Give examples of each.
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Diagnostic (ex. biopsy)
Curative (excise a tumor) Restorative (Knee replacement) Palliative (Correcting a problem such as inserting a GTube to compensate for inability to swallow) Cosmetic (Breast Implants) |
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What is the difference between Radical and Simple surgery?
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Radical surgery involves several areas of the body while simple involves just one part of the body.
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What are the degrees of urgency and give examples.
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Emergent - requires immediate attention/life threatening (w/o delay- GSW)
Urgent - Requires prompt attention (w/in 24-30hrs - acute gallbladder) Required - Needs to have surgery (w/in a few weeks - thyroid disorders) Elective - should have surgery (failure to have it isn't a bad thing -simple hernia) Optional - Decision is solely the patients (personal preference - cosmetic surgery) |
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What do the following suffixes mean?
-ectomy -lysis -orrhaphy -oscopy -ostomy -otomy -plasty |
-Excision or removal
-Destruction of -Repair or suture -Looking into -create permanent opening -Cutting into/incising -Reconstruction of |
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What are the causes of pre-op stressors and what can the nurse do to alleviate them?
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Pain and discomfort
The unknown Mutilation Death Anesthesia Disruption of life pattern Burden to the family - The nurses role to alleviate these issues is to provide teaching/educate the patient. |
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What would be the nursing diagnosis for these issues?
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Anxiety r/t the surgical procedures
Fear r/t perceived threats Knowledge deficit of pre-op procedures and post-op expectations Collaborative DX: -At risk for ineffective airway clearance -Risk for fluid volume deficit. |
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What are the factors affecting surgical risks?
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Age
General Health Nutritional status Respiratory status Genitourinary Cardiovascular status Hepatic function Neurological Musculoskeletal Narcotic/ETOH use Psychological factors Spiritual or cultural beliefs Previous medication usage |
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These drugs have could potentially interact with anesthetics. Describe the effects:
Diuretics Antibiotics Anticoagulants Steroids Herbal Antiarrhythmics Antihypertensives Antiseizure Glaucoma Insulin |
Loss of electrolytes
Resistant organisms Decreased clotting ability Decreased immunity Interactions unknown Cardiac complications Hypotensive crisis Can alter anesthesia metabolism Respiratory/cardiac collapse Insulin levels fluctuate |
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What is an informed consent?
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The patient's autonomous decision to undergo surgery.
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Describe the components of the informed consent.
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-MD's responsibility
-Pt/legal guardian must understand -Form must be dated/timed/witnessed -Signed prior to pre-op meds -Legal age: 18 |
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List pre-op safety measures
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-Bed rails up
-Allergies noted -Notify MD about abnormal labs -ID band on -Limb ID to prevent errors -Prosthesis secured -Perform latex allergy assessment -Perform pre-op teaching |
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What pre-op medications produce sedation and cause amnesia?
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Benzodiazepines:
Midazolam (Versed) Lorazepam (Ativan) Diazepam (Valium) |
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What pre-op medications decrease pain?
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Narcotics/Opioids:
Demoral Morphine Fentanyl |
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Name the H2 receptor antagonists.
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Prevacid
Pepcid |
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What is Maalox?
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an antacid
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Name the pre-op medications that prevent nausea and vomiting.
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Antiemetics/Antihistamines:
Phenergan Vistaril |
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Name the pre-op meds that decrease both respiratory and gastrointestinal secretions.
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Anticholinergics:
Atropine Robinul |
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What classification are the pre-op meds Heparin and Lovenox?
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Anticoagulants.
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Describe the physical environment of both the operative room and the pre-op holding area.
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Unrestricted Zones: An area in the OR that interfaces with the other departments (includes reception and holding area). Regular clothing is permitted.
Semi-restricted Zones: Scrub clothing and caps Restricted Zones: Scrubs, shoe covers, caps and masks (sterile zone) |
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What does a surgical suite look like?
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Bare in appearance
Low temps to reduce the risk of infection. Strict adherence to guidelines to surgical asepsis. Has both a sterile and non-sterile zones. |
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What is the function of the Holding Room Nurse?
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Review medical records
Make sure all paperwork is completed. Gives emotional support to the client and the family. Starts IV Administers pre-op meds Teaches the patient. |
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What is the role of the CRNA or the Anesthesiologist?
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Administers pre-op assessment/meds.
Administers anesthetics, fluids, meds, blood products. Monitors the pts VS, O2, ABG's, and EKG readings. In charge of post-anesthesia recovery for the first 24 hours. |
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What is the role of the nurse or the surgical tech?
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Specially trained
Knowledgable in anatomy, physiology, and surgical procedures. Hands equipment, performs surgical hand scrub Counts all needles, sponges and instruments w/circulator nurse both before and after. Sets up sterile tables/special equipment. Assists w/draping Labels specimens |
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What is the role of the surgeon?
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Pre-op history
Decides what kind of procedure to perform. Manages pt. safety in the OR Provides post-op management. |
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What is the role of the surgical assistant or the RNFA (Registered Nurse First Assistant also known as the Scrub Nurse)?
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Practices under direct supervision of the surgeon.
May perform part of the surgery. Scope of practice depends on each state's nurse practices act. |
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What is the role of the Circulating Nurse?
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In charge of the time-out moment
Coordinates activities/pt safety Ensures all equipment is available. Positions pt. correctly for procedure. Asses urine output/blood loss Responsible for documentation Skin preparation Ensures team maintains sterile technique. Notifies PACU personnel |
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What are the principles of Surgical Asepsis?
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Prevent contamination of surgical wounds
Handwashing - only scrubbed personnel can come into contact with sterile fields and the patient. |
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What are the health hazards of a surgical environment?
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Laser risks for both the eyes and the skin
Inhalation of laser plume Fire/electrical hazards Exposure to blood and other bodily fluids. |
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What are the concerns when it comes to patient positioning?
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The pt should be comfortable.
Operative field must be adequately exposed. Respiration should not be impeded. Nerves must be protected from undue pressure. Light restraints may need to be used. Patient safety precautions Dorsal recumbent (usual position) |
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What procedure is used to sterilize the equipment AKA the aseptic technique.
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Autoclaving - high pressure saturated steam at 121 degrees Celcius for 15-20 minutes.
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What are the factors that determine type of anesthetic agent?
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Type of surgery
Health of the patient Age/cooperation of the patient |
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What are the types of sedation/anesthesia?
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Minimal
Moderate Deep Anesthesia |
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Describe general anesthesia.
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Can't feel
Can't remember Unconscious Loss of muscle tone/reflexes Pt. requires total care/close monitoring Cannon maintain ventilator function and requires assistance maintaining a patent airway. |
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How is a general anesthetic administered?
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Either by inhalation or by I.V.
Inhalation: ET Tube Controlled respiration Gaseous agents: nitrous oxide Reversible INTRAVENOUS: metabolized by the kidneys/liver nonexplosive onset is pleasant duration of action is brief reversible |
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What are some complications of general anesthesia?
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Nausea/vomiting
Inadequate ventilation Malignant Hyperthermia Hypothermia Anaphylaxis Disseminated Intravascular Coagulation |
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What is Regional Anesthetic?
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Only the area being operated on is anesthetized.
The pt is awake and aware of their surroundings. |
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What are the different types of regional anesthetic?
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-Field block: Around the operative site.
-Nerve block: Into the nerve group (Axillary, caudal) -Spinal/Intrathecal: Into the subarachnoid space -Epidural: Injection into the epidural space. |
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Define Moderate, or Conscious, Sedation.
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IV administration of sedatives to reduce anxiety and control pain.
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Define MAC (monitored anesthesia care).
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A moderate sedation used for patients who are unable to tolerate general anesthesia.
Administered by an anesthesiologist and must be able to convert to general anesthesia at any given moment. |
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Define Local Anesthesia.
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Injection of solution containing the anesthetic agent into the tissues at the planned incision site.
Can be topical (ointment of spray) or infiltrating (injected into the tissue) |
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Define post op. When does it begin and when does it end?
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A stage in a surgical procedure when the patient leaves the OR and ends upon discharge from medical care.
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What are the phases of the post-op stage?
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Phase I: During immediate recovery; intensive nursing care
Phase II: Pt. prepared for self-care or care in hospital, extending care setting Phase III: Pt. prepared for discharge. |
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What is a PACU?
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Post Anesthesia Care Unit
-Located adjacent to the OR -Kept quite and clean w/low lighting |
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What are the roles of the PACU?
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-Receives report
-Monitors pt for complications -Performs assesment using the Modified Aldrete Scoring System -Must of a score of 8-10 before discharge |
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What is the role of the PACU Nurse?
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-Receives report: Pt. name, Surgeon name, surgical procedure, type of anesthesia and any complications, any meds given and why, present condition and V/S, tubes, dressings, fluids, neurological status, and other medical conditions
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What are the responsibilities of the Floor RN upon receiving a post-op patient?
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Prepare the room
Assist the patient to the bed Safety Review orders Personal appearance/affects of the pt. Allows family to visit. |
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What are the two types of IV tubing?
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Primary Tubing: Main line used for maintenance, has a long line, used for the pump and for extended periods of time.
Secondary Tubing: Used for piggyback and for intermittent medications such as antibiotics, electrolytes or phenergan. Secondary lines run with gravity. |
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How often do you change the tubing?
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q 72 hours
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How often do you change the bags?
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q24h
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Blood uses what?
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A double headed snake line that has two ports, must run with Saline ONLY, you must prime the line first and you also have to stay with the pt for 15 minutes following a transfusion.
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What is a PICC Line?
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Peripherally Inserted Central Cath, change every 72 hours
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Can a nurse insert a Triple Lumen Deep Line?
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No, they can only assist a doctor.
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