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300 Cards in this Set
- Front
- Back
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Term used to describe interventions associated c clients experience
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perioperative nsg.
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3 stages of perioperative nsg
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pre, intra, post
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when does the preoperative phases start?
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c decision of surgical intervention
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when does preoperative phase end?
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when client is transferred to OR bed
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who makes the decision about surgical intervention?
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its collaborative
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when does the intraoperative phase start?
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when admitted to OR
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when does the intraoperative phase end?
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when transferred to recovery rm
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when does postoperative phase begin?
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when admitted to recovery rm
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when does post op phase end?
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with follow up visit
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What 5 classifications of surgery are there?
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diagnostic
curative palliative cosmetic restorative |
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Why is diagnostic surgery done?
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to verify a suspected dx
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ex of a diagnostic surgery
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biopsy
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what's the reason for a curative surgery?
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to remove or repair diseased or damaged tissue or organs.
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ex of curative surgery
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appendix, cholecystectomy
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what's the reason for a palliative surgery?
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to relieve symptoms
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ex of a palliative surgery?
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cut nerves in certain places, gastrostomy tube
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what's the purpose of cosmetic surgery?
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to repair by improving func or appearance
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ex of cosmetic surgery:
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rhinoplasty
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what's the purpose of restorative surgery:
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to improve functional ability
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ex of restorative surgery:
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joint surgery, jaw replacement, laser eye surgery
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Classifications of surgery according to degree of urgency:
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Emergency
urgent or imperative planned or required elective Optional |
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why is emergency surgery performed?
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immediate/life threatening
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ex. of emergency surgery:
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appendicitis, aneurysm, gunshot wound
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urgent or imperative surgery is done for things:
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that req. prompt attn (24-48hrs)
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Whats an ex. of imperative/urgent surgery?
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kidney stones
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Requires surgery within a few days or weeks
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planned or req. surgery
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ex of a planned or req. surgery:
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tonsillectomy, thyroid, hernia
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ex of elective surgery
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simple hernia, knee surgery
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during the pre op phase, the nurse does what?
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health hx
-tell them what to expect after surgery -meds -preop instructions |
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during the intra op phase, the nurse does what?
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position pt properly, time in and out, right site, surgery, prepare with tools.
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during the post op hase the nurse does what?
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education, dressing changes, physical restricition, special diet, c&DP, fluids, bowels functioning, psychosocial
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What is it called when you should have surgery but failure to not is not catastrophic
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elective
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decision to have surgery is determined by clients personal preference
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optional
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ex of optional sugery
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cosmetic
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3 risk factors for the surgical client
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age
nutrition chronic disease |
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what influences one's response to the stress of surgery
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age
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pulmonary disease and smoking affect:
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post op resp status.
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client has increased secretions and decreased ability to expel anesthesia with
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pulmonary disease and smoking
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the purpose of the preoperative assessment is
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to ensure safety
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provides baseline for providing perioperative care
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preoperative assessment
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the preop assessment assists with identifying
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risk factors
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after 30 y.o., organs decline ______ every year
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1 %
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the elderly's (>65) response to stress is
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decreased
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the elderly have a gradual decline in
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physiological reserve
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_________ has a loss in artery and vessel elasticity
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the elderly
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aging is at what level?
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cellular
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@ risk for aspirations starts @ age
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50
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alcoholism and ilicit drugs can
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cause serious s/a with anesthesia and surgery
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people with immunosuppressive diseases are
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@ increased risk for infection (e.g. CA & HIV)
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people with renal/hepatic disease have
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decreased metabolism and execretion of anesthetics and meds
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ppl with renal/hepatic disease have ________ problems
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coagulation
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__________may experience post op bleeding and poor wound healing
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ppl with renal/hepatic problems.
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infants are at risk during surgery because their ________ is undeveloped
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temp control
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the physiological assessment assesses:
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integumentary status
resp status circulatory status nutritional status elimination status neurosensory musculoskeletal |
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client with DM req. _______ levels to be drawn morning of surgery
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serum glucose
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electrolytes have to be taken within 30 days of surgery if the client is on: (3)
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diuretics
antihypertensives hx cardiac/renal dx |
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OR room is cold to decrease
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bacteria growth
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NPO status should be ___-___ hours prior to surgery to prevent aspiration)
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8-10
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parenteral fluids are started before surgery to prevent
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dehydration and electrolyte imbalance
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developed as alternative to bld transfusions
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bloodless surgery program
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keep parent in
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infant's line of vision
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if parent is unable to be with infant,
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place familiar object with infant
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when preparing children for procedure, limit
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number of strangers entering room during procedure
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During procedure with child, use sensory soothing measures such as: (3)
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stroke skin
talk softly give pacifier |
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encourage parent to______ after procedure
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comfort child\
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what should you do if child has temper tantrum
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ignore it
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use ________ words to describe procedure
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neutral
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malnourished ppl are @ risk for complications because
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wounds wont heal
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the obese pt having surgery is at risk because
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diff breathing, moving, ambulating, > risk for airway obstruction, increase soft tissue in upper airway
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ppl with cardiovascular disease are @ risk and prone to complications because
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theres a decrease in the blood to organs
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Males >50 and postmenopausal women must have ___ within 1 yr of surgery
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ekg
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ppl with hx of heart disease must have ___ within 3 mo of surgery
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ekg
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all clients must have what blood test done prior to surgery?
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hct
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when assessing someones circulatory status, assess:
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hr, rhythm, sounds, color
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ppl with hx of resp dx must have_____ prior to surgery
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CXR
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during the psychosocial assessment, assess the following: (8)
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psychological readiness
knowledge of surgery preop fear and anxiety support system meds med allergies immunosuppression substance abuse |
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________ is common after surgery
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constipation
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ppl with hx of liver disease need to have a
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liver function test
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ppl with kidney problems need to have a ________ within _______ days of surgery. If abnormal, ___ &____ are obtained
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urine analysis
14 bun creatinine |
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30 mL lost in adult is equivalent to ___mL lost in adult
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850
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when is the area marked by the surgeon? When?
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Holding area
just prior to surgery |
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the limb or area marked by surgeon usually in holding area just prior to surgery is called:
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correct site surgery
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what if someone is in for surgery but they have a resp infection?
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surgery is postponed
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If client has resp infection during surgery it can cause _________ and ___________ which could lead to resp failure
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atelectasis
bronchospasm |
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If while doing your physiological assessment, you find your client has musculoskeletal problems, you should check ______, because__________
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meds
might cause coagulation problems |
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what is it called when consent is freely given without coercion?
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consent voluntarily given
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how many ppl need to witness a phone consent for surgery?
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2
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when must the consent to medical services and anesthetic need to be completed
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no more then 30 days prior to surgery.
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when should the client bathe prior to surgery?
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evening before
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instruct pre op client to stop smoking how long before surgery?
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4-6 wks
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client should use incentive spirometer___x per hour or Cough and deep breathe __-___x per hour
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10
5-10 |
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what position should the pre op client lay in while deep breathing?
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semi fowlers
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preop meds are generally given ___ before surgery "on call" to OR
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1
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4 types of medications administered preoperatively
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tranquilizers
narcotics anticholenergic antibiotics |
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what 3 types of tranquilizers could be given preoperatively
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midazolam (versed)
diazapam (valium) lorazepam (lorazepam) |
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what are 3 types of narcotic analgesics administered preoperatively?
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meperidine (demerol)
Morphine Fentanyl (sublimaze) |
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What are 3 types of anticholenergics administered preoperatively?
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glycopyrrolate (robinul)
-atropine scopolamine |
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do you need an order to get a client oob after surgery?
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yes
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clients with abd surgery or knee/hip surgery need to get oob when?
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1 day after surgery
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3 ways to promote circulation and prevent venous stasis (DVT) in the preop client
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leg exercises
antiembolic stockings pneumatic compression device as ordered |
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instruct client to ___ just prior to surgery
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void
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when does shaving the operative site occur?
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just prior to surgery
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some biological agents such as erythropoetin, a hormone produced by the kidney, stimulates
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rbc production
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children younger then 5 fear:
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what will happen when they wake
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schoolage children fear:
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anesthesia itself
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children older then 9 fear:
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anesthesia, surgery, death
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since schoolage children fear anesthesia, let them:
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place with the mask
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can parents go into the OR with their child?
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yes
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where should you perform painful procedures on a child?
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in a seperate room, not in a crib or bed.
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use distraction techniques when preparing a child for a procedure such as:
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sing a song WITH the child
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allow child to wear ____ under gown
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underpants
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what are 3 potential neuropsychologic problems with the post op patient?
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pain
fever delirium |
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3 potential urinary problems with the post op pt.
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retention
infection renal failure |
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4 potential integumentary problems with the post op pt.
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infection
hematoma dehiscence and evisceration keloid formation |
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6 potential respiratory problems with the post op pt.
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airway obstruction
hypoventilation aspiration of vomitus atelectasis pneumonia hypoxemia |
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5 potential cardiovascular problems with the post op pt.
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hemorrhage
hypotension and shock thrombosis and phlebitis pulmonary embolism postural hypotension |
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4 potential fluid and electrolyte problems with the post op pt.
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fluid overload
fluid deficit hypokalemia/hyperkalemia acid-base disorders |
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5 potential GI problems with the post op pt.
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n/v
distention and flatulence paralytic ileus hiccups delayed gastric emptying |
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when admitted into PACU (post anesthesia care unit) from the OR, what is the priority assessment?
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resp
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two common causes of inadequate airway exchange is:
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airway obstruction
hypoventilation |
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airway obstruction is caused by muscle relaxants or narcotics and causes:
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the tongue to fall to the back of the mouth
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Mucous accumulation is seen:
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esp in smokers or pts w/previous resp conditions.
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mild ___________ is common for the first 48 hrs after surgery
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hypoxemia
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the client must meet the following criteria to be discharged from the pacu to go to the med-surg floor or discharged to home.
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1. uncompromised pulmonary fx
2. stable v/s 3. orientation to person, place and time. 4. adequate urine output 5. n/v and pain under control |
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who discharges client from pacu?
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anesthesia
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incomplete expansion of the lung or at least a portion of the lung
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atelectasis
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all post op clients have some degress of _________ but it usually resolves.
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atelectasis
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what adventitious sounds do you hear with atelectasis?
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crackles or decreased breath sounds
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Where do you hear adventitious sounds with atelectasis?
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bases of lungs
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what sound do you hear upon percussion on the pt with atelectasis
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flatness
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atelectasis is caused by
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airway onstruction
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what 2 things can cause airway obstruction resulting in atelectasis?
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mucous plug in bronchiole tree
viscous bronchial secretions |
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inflammation on the lungs which can occur following surgery
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pneumonia
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3 causes of pneumonia following surgery:
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retained secretions
lack of periodic Deep breaths infection |
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inhalation of gastric contents into the tracheobronchial system
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aspiration
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if pt has secretions while being assessed in the pacu:
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turn client to one side and suction
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maintain ___________ and __________ airway until gag reflex returns
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oropharyngeal
nasopharyngeal |
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in the pacu, pt should maintain _______ position unless contraindicated or bld pressure falls
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semi fowlers
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a considerable loss of fluid from surgery:
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hypovolemia
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if a particular area is painful, it could mean:
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hemorrhage
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if someone is bleeding in their abd, they may have pain where?
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in their back
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if someone is cleeding in the groin from femoral artery, they will feel:
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numbness or coolness in toes
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excessive blood loss may lead to:
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shock
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client may complain of ___________ preceeding shock
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impending doom
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pulls from intracellular and intersitial spaces into bld vessels:
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hypertonic fluids
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replaces fluid loss from tissues by moving water out of bld vessels into the intracellular and interstitial spaces
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hypotonic fluids
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match serum osmolarity and are used to increase intravascular vol and boost perfusion to vital orgrans
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isotonic fluids
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aka plasma volume expanders
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colloids
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a normal component of blood. Pulls fluid from extravascular space to vascular space
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albumin
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same volume expanding characteristics as albumin but is artificial
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hetastarch
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a glucose polymer that stimulates the properties of albumin also increases vol in the vascular space (same thing albumin does)
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dextran
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drying out of a wound
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desiccation
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overhydration of a wound or cells
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maceration
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what is maceration caused by?
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perspiration
incontinence excessive drainage |
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how is maceration controlled?
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by performing freq. dressing changes
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why is maceration not good?
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it can delay wound healing
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what is the proper position of the pt who shows signs of shock?
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elevate lower extremities by 20 degrees.
knees straight trunk horizontal head slightly elevated |
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inflammation of a deep vein in conjunction with blood clotting.
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dvt
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The high risk period for a pulmonary embolism is:
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2-14 days post op
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a clot or embolus traveling in the blood stream which was dislodged from an original site. Clot travels into pulmonary artery or one of its branches and blocks it off
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pulmonary embolism
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if nothing is done to treat a pulmonary embolism, death can:
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occur within 30 min
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a common post op complaint is:
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n/v
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the complaint of n/v postoperatively is more common in :
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women and children more then men
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nausea from anesthesia should last no more then _______ after surgery
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12-24 h
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if n/v occur more than 4 days then its prob from
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post op narcotics
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txt for constipation in the post op client
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get oob to walk asap
encourage fluids as appropriate cathartics or enema to stimulate peristalsis |
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urinary retention should resolve in the post op client:
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within 48 h
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if the post op's urinary output is not ___cc/hr, REPORT!
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30
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if a post op client with a catheter has the catheter removed, they should void:
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within 6-8 h
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D T V stands for
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due to void
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leakage of cerebral spinal fluid at the dual puncture site which decreases the csf pressure that normall cushions the brain causing:
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spinal headache
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what type of h/a is often seen after general anesthesia?
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sinus
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why do post op pt.'s usually have a sinus h/a?
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gas is trapped in the sinuses causing pressure
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hoarseness is normal for first 24h after extubation. beyond 24h could indicate:
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laryngeal nerve injury, vocal cord problems.
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if post op pt has hoarseness beyond 24 hrs, they should:
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notify anesthesiologist
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wound that is closed at time it is made:
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primary intention closure
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wounds heal by secondary intention when there is bacterial contamination &/or extensive tissue loss
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secondary intention closure
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wound edges should be water tight in 48 h
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primary intention closure
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One advantage to this type of wound closure is that it allows wound to heal w/o trapping in infection
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delayed/tertiary closure
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type of wound closure that hase well approximated edges and minimal scarring
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primary intention wound closure
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What are 3 examples in which we would use a delayed or tertiary wound closure:
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gun shot wound
motor vehicle accident ruptured appendix. |
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what is one example in which we would use primary intention closure:
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surgical incision
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the wound is closed with sutures, staples, or could be closed below the epidermis with absorbable sutures
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primary intention closure
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what type of wound closure would be used with an animal bite or a pressure ulcer?
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secondary intention closure
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Wounds that are left open following surgery, because of bacterial contamination are closed with:
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delayed or tertiary closure
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wound is closed at fascia and muscle level. The subcutaneous layer and skin is left open
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secondary intention closure
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wound is kept moist with dressing. It's cleaned and debrided, usually by repeated packing.
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delayed or tertiary closure
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the inflammatory or reaction phase of wound healing lasts about ____
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3-4 days
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the proliferative or regenerative phase of wound healing lasts:
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4-21 days
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the maturation or remodeling phase of wound healing lasts
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3wks to 3yrs
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characterized by the extreme alteration in arousal, orientation, perception, affect and attn. (pt is freq. combative)
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emergence delirium
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what does sanguineous drainage mean?
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bloody
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what does serosanguanous drainage look like?
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thin, red/yellowish
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what does purulent drainage look like?
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yellow/pus
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what does serous drainage look like?
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thin
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its normal for wound edges to be inflamed and swollen for _____
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2-3days
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a planned alteration of the human body designed to arrest, alleviate or eradicate some pathological process
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surgery
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perioperative nursing practice can be preformed in a variety of setttings: (4)
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hospital
freestanding ambulatory centers clinics physician offices |
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There are a variety of roles a registered nurse can have during the intra op period: (6)
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-scrub person
-circulator -manager -researcher -educator -rn first assistant (RNFA) |
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four intraoperative nursing diagnoses:
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risk for infection
risk for imbalanced fluid vol risk for imbalanced body temp risk for injury |
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Before surgery is started there is a time out. During this time out, they check:
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-right pt
-right procedure -right site/side |
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15-30% TBV loss is a ____ problme
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moderate
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30-45% of TBV lost is a ________ problem
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major
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15% of TBV loss is a _____ problem
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minor
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>45% TBV loss is a _______ problem
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catastrophic
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When monitoring for blood loss, do a visual inspection of:
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suction containers
sponges/dressings drain devices |
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what was the first lecture to nurse?
|
surgical instrument preparation for surgery
|
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what year did perioperative nursing start?
|
1978
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what are the four areas we pay attn to during surgery? (the four areas of primary concern)
|
infection
heat loss fluid vol injury |
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what is the best technique to limit blood loss?
|
direct pressure
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why is direct pressue the best technique to limit blood loss?
|
because there are no foreign material
|
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Ice can help:
|
decrease bleeding
|
|
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What are four types of volume replacement?
|
homologous blood
autologous blood hemodilution intraop blood salvage |
|
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In the reverse trendelenburg, which is higher the feet or the head?
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HEAD
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in the trendelenburg position, which is higher, the feet or the head?
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feet
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partial or complete loss of sensation, with or without the loss of consciousness
|
anesthesia
|
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A reversibe, unconscious state characterized by amnesia, analgesia, depression of relexes, muscle relaxation and homeostasis
|
general anesthesia
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types of anesthesia:(5)
|
general
regional local conscious sedation monitored anesthesia care (MAC) |
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2 types of IV barbiturates used for induction:
|
penthotal
brevital |
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4 types of IV drugs used for induction:
|
bartbiturates
non barbiturates opiods neuromuscular blocking agents |
|
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2 types of IV Non barbiturates used for induction:
|
Ketamine
propofol |
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what 2 types of IV drugs used for induction have rapid induction?
|
pentothal
ketamine |
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what 3 types of iv drugs used for induction are short acting?
|
brevital
|
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ketamine
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propofol
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what is a rapidly metabolized iv drug used for induction?
|
propofol
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used to relax the jaw and vocal cords providing continued muscle relaxation during surgery.
|
neuromuscular blocking agents
|
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decision for type of anesthesia?
|
-type, duration, local of surg procedure
-preanesthetic physicla condition -emergency |
|
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what do all opiods do?
|
depress respiration
|
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4 examples of opiods:
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morphine
fentanyl surentanil citrate meperidine hcl |
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3 stages of anesthesia:
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induction
maintenance emergence |
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how many stages does induction have?
|
4
|
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what are the for stages of induction?:
|
sedation
excitment operative danger |
|
|
three types of general anesthesia:
|
inhalation
iv balanced |
|
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what are 4 potential hazards related to electrosurgical safety?
|
faulty unit
skin to metal skin to moisture grounding pad placement |
|
|
the administration of an anesthetic agent to one part of the body by local infiltration or topical application of anesthetic
|
local anesthesia
|
|
|
3 types of regional anesthesia?
|
spinal block
epidural block regional field blocks |
|
|
reversible loss of sensation, without the loss of consciousness, in a specific area or region of the body whenlocal anesthetic is injected to block or anesthetize nervefiber in and around the operative site
|
regional anesthesia
|
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|
emergence from anesthesia is the reversal:
|
of neuromuscular blocking agent
|
|
|
pressre on the cricoid cartilage during inductino of anesthesia does what?
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compresses esophagus preventing passive regurgitation of stomach contents into the airway
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a state that allows pt to tolerate unpleasant procedures while maintaining adequate cardiopulmonary fx and the ability to respond purposefully to verbal and tactile command
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conscious sedation
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who should a pt stop smoking 4-6 wks prrior to surgery?
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has to do with hgb carrying capacity and general health of resp tract
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maintain vol by diluting blood.....but complications may occur.
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Hemodilution
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What can you dilute the blood with, with hemodilution?
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ringers lactate
hetastarch dextran |
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WHO MAY perform the intraop blood salvage?
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anesthesiologist
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pts need to be warmed up to recover from
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anesthesia
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pharmacological hemostatic agents can be ____ or ____. they are used to ____blood loss. 2 examples are:
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topical/inj/decrease/lidocaine, epinephrine
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how many inches above the elbow is sterile?
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3
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4 methods of sterilzation/disinfection?
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steam
gas radiation hydrogen |
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how often can blood be donated?
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every 4th day
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blood can be donoted no lesss then __ hrs pre op.
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72
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3 things to protect with laser safety
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eye
tissue fire |
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what are four factors that affect the surgical positioning:
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-safety
-surgeon pref -exposure of site -anesthesia administration |
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describe supine
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face up
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describe prone
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face down
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laying on your side is
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lateral
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inhalation anesthetics control resp. usings
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gaseous and volatile agents
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what are some types of inhalation anesthetics
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nitrous oxides
the "ANES" |
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one advantage with inhalation anesthetics is:
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rapid induction
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anesthesia used most often for surgeries of the head, neck, upper torso, and abd
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general anesthesia
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if someone has a spinal h/a: (4)
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increase fluid vol
caffenated drinks calm/quiet environment pain control |
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complications associaated with anesthesia:
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hypotension
hypertension coughing and laryngospasm difficult intubation cardiac arrest malignant hyperthermia |
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what type of disorder is malignant hyperthermia?
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genetic
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meds that may stimulate erythropoesis
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fe
folic acid vit c b12 |
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in stage one of anesthesia, the pt is still awake, resps and eye mvmnts are normal. pt can be:
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hypersensitive at this time
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the goal of anesthesia is to get to what stages?
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3 back to one.
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if untreated and progression of atelectasis occurs, it can result in: (7)
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confusion
cough duspnea fever hypoxemia tachypnea |
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what type of percussion will you hear with pneumonia?
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dullness
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what adventitious sounds heard with pneumonia?
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crackles and wheezing
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what color sputum found in pneumonia?
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rusty/purulent
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where will the pneumonia pt have pain?
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pleuritic chestc
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clients at risk for regurgitation are :
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over sedated
obese pregnant comatose |
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2 types of meds to prevent of minimize aspiratin:
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histamine
antiemetics |
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an early sign of hypovolemia is:
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narrowing pulse pressure
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if hemorrhaging, ,client may rept:
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spots before eyes
ringing ears confused, lethargic, agitated air hunger |
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If someone has ringing ears, confusion, lethargy, agitation, air hunger, and spots before eyes..do what 1st?
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take pulse ox!
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____ wounds are painful, itchey, covered with scab
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dry
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ANTISEPTICS AND CLEANING AGENTS CAN BE
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cytotoxic
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relief of hiccups may be:
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eliminating hot and cold fluids...take swallows of h2o whil holding breath
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ileus obstruction can lead to:
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vomiting fecal matter
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how do you treat ileus or bowel obstruction?
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insert NG tube
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main reason for post op constipation is
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narcotics
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treatment for urinary retention post op
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catheter
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clients should be in what position to help with spinal h/a
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lay flat
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problem with local anesthesia
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wears off quick
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muscle aches may occur from
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intraop poisoning
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healing takes place from the base of the wound by granulation, contraction and re epithliazation with:
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secondary intention closures
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youll always have scar under skin with
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seconday intention closure
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once infection is controlled or no longer present, wound is stapled or sutured
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delayed or tertiary closure
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wound bed is prepared for healing by removing dead tissue by
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phagocytosis and monoctyes
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the wound starts to form granulation tissue in the
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proliferative or regenerative stage
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wound regains 70-75% of original strength during this phase
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maturation or remodling phase
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the partial of total separation of wound layers
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dehiscence
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total separation of wound layers with protrusion of visceral organs
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evisceration
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evisceration is an emergency situation bc
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tissues can dry out and bacteria can invade affected tissue
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what do you do with eviscerations?
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put sterile guaze withnormal saline,l call dr.
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_______ can be a good indicator of wound healing
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wound edges
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txt for delirium tremons
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give sedatives
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delirium tremons starts with
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no sleep
restlessness tachycardia |
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what 3 skin things happen with gbd?
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diaphoresis
pruritis jaundice |
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complete destruction of allmicroorganisms leaving no viable forms of organisms including spores
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sterilzation
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