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62 Cards in this Set
- Front
- Back
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Standards of Care
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Association of perioperative RNs
The Joint Commission National Priorities Partnership CDC Institute for healthcare improvement Never events |
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Highest risk for infection post op
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GI,GU and respiratory
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Ablative
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remove diseased part
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diagnostic
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figure out what's wrong. Ex. Biopsy or colonoscopy
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Palliative
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not curing, improving symptoms
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Reconstructive
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restore function
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Cosmetic
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plastic surgery, improve appearance
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Transplant
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replace diseased organs
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procurement
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harvesting organs, taking organs from braindead to put into someone else. Has to be viable organs.
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Emergent
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ASAP for life or function of organ
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Urgent
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within 24-48 hours
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Elective
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recommended, not life or death situation
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Major surgery
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significant blood loss, vital organs, potential post op complications. Inpatient surgery.
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minor surgery
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outpatient surgery, ex. breast biospy
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Comorbid
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disease process person has, not for surgery, has condition that can impact surgery. Ex. diabetes, HTN, PVD
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Clean wound
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unaffected and not in respiratory, GU, or GI. Wasn't infected before surgery.
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Clean contaminated
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Not infected before surgery, but in GI, GU or respiratory.
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Contaminated
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Trauma, before OR. Already contaminated. Ex. Gunshot, stabbed.
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Infected
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already infecyed before OR. Ex. gangrenous toe.
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Factors affecting surgical risk:
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Age
type of wound preexisting health conditions mental status personal habits medications allergies |
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Preoperative phase
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Begins when client decides to have surgery, ends when client enters OR.
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Intraoperative phase
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Begins when patient enters operating suite, ends when patient admitted to PACU.
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Post operative phase
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Begins when client enters PACU, ends when client has healed from surgery.
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Preoperative Nursing Responsibilities
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Preop phase
Preop nursing assessment Preop screening tests Surgical consent Preop checklist Preop teaching Documentation |
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Preop nursing assessment: Nursing hx
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health history
physical status mental status medications, allergies knowledge/understanding of surgery and anesthesia cultural and spiritual factors access to resources coping strategies use of ETOH or drugs |
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Physical assessment
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focus on symptoms that indicate risk for surgery
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Preop screening tests
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CBC
UA ECG, EKG CXR Surgical consent form: surgeon's responsibility to be signed by patient surgeon must obtain informed consent part of medical record signed and witnessed patient alert, rational, mentally competent, not sedated, adult 2 witnesses for telephone consult consent for sterilization |
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Consent form includes:
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Type of Surgery
Name and qualifications of surgeon Risks, benefits, alternative options Statement regarding client's right to refuse or withdraw consent. |
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Surgical consent: surgeon's responsibilities
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Provide necessary information and determine patient's competence.
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Surgical consent: Nurse's responsibilities
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Verify surgeon explained procedure, answered questions.
Verify form signed If patient has questions or if you question patient's competence, notify surgeon and do not send patient to OR. Document concerns and notification of surgeon. |
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Preop Teaching
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Prepares patient for surgery and recovery.
Reduces fears Reduces postop complications Discuss what to expect before, during and after surgery. |
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Preop physical prep
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1. Patient id
2. NPO status 3. vital signs, ht/wt 4. Surgical site prep 5. Patient voids 6. Remove: prosthesis, jewelry, glasses/contacts 7. TED stockings 8. Routine meds 9. Surgical site id/marking 10. Preparation medications 11. Bowel prep 12. Secure valuables |
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Intraoperative phase
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begins when patient enters operating suite, ends when patient admitted to PACU
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Focus of nursing care:
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maintain safe environment
assist the intraop team operative personnel |
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Sterile Team
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Scrub nurse
RNFA Surgeons and assistants |
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Scrub nurse responsibilities
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1. Set up sterile field
2. Prepare surgical instruments 3. Performs surgical prep 4. Assists with draping around operative side. 5. Anticipates surgeon's needs. 6. Maintains integrity of sterile field. |
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Clean team
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Circulating RN and CRNA
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Circulating RN responsibilities
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1. Greets pt in preop area, performs brief assessment.
2. Verifies consent/site correct and preop checklist completed. 3. Coordinates OR activities 4. Monitors patient and sterile field 5. Manages care of patient 6. Attends to patient during induction. 7. Maintains safe, comfy environment 8. Positions patient properly 9. Monitors I&O 10. Provides supplies during surgery 11. Handles specimens 12. Performs sponge, sharp, instrument counts with scrub nurse. 13. Documents care and client responses. 14. Communicates with outside personnel. 15. Responds to emergencies. |
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Anesthesiologist or CRNA
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Preop: Assesses patient
Orders diagnostic studies Orders preop meds Assigns ASA level |
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Anesthesiologist or CRNA
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Intraop: administers anesthesia
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Anesthesiologist or CRNA
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Post op: Transports patient to PACU with circulating RN, orders post op medications.
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General anesthesia
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Inhaled or IV
Depress CNS, relax muscles Rapid loss of consciousness and sensation. |
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Advantages of general anesthesia:
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No anxiety
patient motionless dose easily adjusted |
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Disadvantages of general anesthesia:
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Respiratory and circulatory muscles depressed
Requires intubation Risk of death, MI or stroke Risk of malignant hyperthermia N/V, sore throat, shivering, confusion |
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Conscious Sedation
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Administered IV
Sedation, analgesia, amnesia |
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Advantages of conscious sedation:
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Pain and anxiety managed
Risks of general anesthesia avoided Recovery rapid. |
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Regional Anesthesia
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Infiltration of site/nerve with anesthetic
Interrups nerve impules, numbness |
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Advantages for regional anesthesia:
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Rapid recovery
Avoid risks of general anesthesia |
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Local anesthesia
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applied topically or injected, loss of pain sensation at site
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Potential complications of anesthesia:
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Aspiration
Vasomotor instability: Hypotension, diminished peripheral perfusion Respiratory depression Cardiovascular compromise |
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Two parts of post op care:
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Recovery from anesthesia: client remains in PACU until recovered from anesthesia.
Recovery from surgery. |
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Potential complications of most surgeries:
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Hypothermia
fluid and electrolyte imbalance excessive bleeding musculoskeletal injury secondary to positioning |
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PACU nursing care:
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Receives patient and report
Performs quick, focused assessment |
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Post op nursing care on the surgical unit:
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Receives report from PACU nurse
Performs initial assessment Reassess patient every 15 mins for 1st hr. Q 30 mins for next 2 hours, Q hr for next 4 hrs. Q 4 hr. Continued assessment for post op complications Patient teaching |
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Potential Post op Complications
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Respiratory: Aspiration pneumonia, atelecstasis, pneumonia, PE
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Potential Post Op Complications
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Cardiovascular: Thrombophlebitis, embolus, hemorrhage, hypovolemia
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Potential post Op Complications
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GI/GU: N/V, abdominal distention, constipation, Ileus, renal failure, urinary retention, UTI
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Potential Post Op complications
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Psychosocial: Depression, Anxiety/fear, disturbed body image, role changes
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Dehiscence
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Separation of wound, usually 6-8 days post op. Sudden increase in serosanguinous drainage, Position patient to prevent stress on incision, apply sterile dressing soaked in sterile saline, instruct client to remain quiet, avoid straining, Notify surgeon immediately.
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Evisceration
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Protrusion of organs or tissues through incision, same nursing care as dehiscence, infection
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Preventing post op complications
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Incentive spirometry
coughing and deep breathing splinting incision repositioning, early ambulation SCDs, foot pumps, TEDs Hydration, nutrition, bladder, bowel wound care pain mgmt Pt education |
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Post op teaching
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1. Tx regimen including rationale
2. Expected outcome and effects of surgery. 3. Nutritional considerations 4. Lifestyle modifications 5. Activity limitations, recommendations 6. Signs and symptoms of complications 7. F/u visits 8. Community resources |
