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131 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Approximately ___% of elective surgeries are now performed in an ambulatory or outpatient setting.
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60
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Often, surgical patients who require hospital ______ are trauma patients, acutely ill patients, patients undergoing major surgery, patients who require emergency surgery, and patients with a concurrent medical disorder.
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stays
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The acuity and complexity of surgical patients and procedures have ______ in the inpatient setting.
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increased
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Pressure to reduce hospital stays and contain costs has resulted in diagnostic ______ ______ (___) and preoperative preparation before admission to the hospital.
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preadmission testing (PAT)
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The increasing use of ______, same-day, or short-stay surgery, means that patients leave the hospital sooner, which increases the need for teaching, discharge planning, preparation for self-care, and referral for home care and rehabilitation services.
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ambulatory
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______ and perianesthesia nursing addresses the nursing roles relevant to the three phases of the surgical experience: preoperative, intraoperative, and postoperative.
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Perioperative
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Includes outpatient (same-day) surgery that does not require an overnight hospital stay or short stay, with admission to an inpatient hospital setting for less than 24 hours.
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ambulatory surgery
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The patient's autonomous decision about whether to undergo a surgical procedure; based on the nature of the condition, the treatment options, and the risks and benefits involved.
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informed consent
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Period of time from when the patient is transferred to the operating room table to when he or she is admitted to the postanesthesia care unit (PACU).
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Intraoperative phase
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Period of time that constitutes the surgical experience; includes the preoperative, intraoperative, and postoperative phases of nursing care.
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Perioperative phase
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Period of time that begins with the admission of the patient to the PACU and ends after a follow-up evaluation in the clinical setting or home.
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Postoperative phase
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Diagnostic testing performed before admission to the hospital.
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Preadmission testing (PAT)
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Period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table.
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Preoperative phase
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Initiates initial preoperative assessment
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care
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Initiates teaching appropriate to patient's needs
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care
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Involves family in interview
Verifies completion of preoperative testing |
Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care
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Verifies understanding of surgeon-specific preoperative orders (eg, bowel preparation, preoperative shower)
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care
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Assesses patient's need for postoperative transportation and care
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care
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Completes preoperative assessment
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care
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Assesses for risks for postoperative complications
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care
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Reports unexpected findings or any deviations from normal
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Admission to Surgical Center or Unit
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Develops a plan of care
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Admission to Surgical Center or Unit
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Answers patient's and family's questions
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Admission to Surgical Center or Unit
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Explains phases in perioperative period and expectations
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Admission to Surgical Center or Unit
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Reinforces previous teaching
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Admission to Surgical Center or Unit
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Verifies that operative consent has been signed
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Admission to Surgical Center or Unit
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Coordinates patient teaching with other nursing staff
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Admission to Surgical Center or Unit
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Assesses patient's status, baseline pain and nutritional status
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; In the Holding Area
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Communicates patient's emotional status to other appropriate members of the health care team
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; In the Holding Area
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Provides psychological support
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; In the Holding Area
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Takes measures to ensure patient's comfort
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; In the Holding Area
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Administers medications if prescribed
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; In the Holding Area
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Establishes intravenous line
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; In the Holding Area
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Verifies surgical site and marks site per institutional policy
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; In the Holding Area
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Identifies patient
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; In the Holding Area
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Reviews chart
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Preoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; In the Holding Area
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Maintains aseptic, controlled environment
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Maintenance of Safety
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Positions the patient;
Functional alignment, Exposure of surgical site |
Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Maintenance of Safety
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Applies grounding device to patient
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Maintenance of Safety
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Ensures that the sponge, needle, and instrument counts are correct
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Maintenance of Safety
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Completes intraoperative documentation
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Maintenance of Safety
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Transfers patient to operating room bed or table
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Maintenance of Safety
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Effectively manages human resources, equipment, and supplies for individualized patient care
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Maintenance of Safety
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Calculates effects on patient of excessive fluid loss or gain
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Physiologic Monitoring
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Reports changes in patient's vital signs
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Physiologic Monitoring
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Distinguishes normal from abnormal cardiopulmonary data
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Physiologic Monitoring
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Institutes measures to promote normothermia
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Physiologic Monitoring
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Provides emotional support to patient
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Psychological Support (Before Induction and When Patient Is Conscious)
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Continues to assess patient's emotional status
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Psychological Support (Before Induction and When Patient Is Conscious)
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Stands near or touches patient during procedures and induction
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Intraoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Psychological Support (Before Induction and When Patient Is Conscious)
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Identifies patient by name
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Transfer of Patient to Postanesthesia Care Unit,
Communicates intraoperative information |
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Communicates presence of family and/or significant others
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Transfer of Patient to Postanesthesia Care Unit,
Communicates intraoperative information |
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Communicates necessary equipment needs
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Transfer of Patient to Postanesthesia Care Unit,
Communicates intraoperative information |
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Reports patient's preoperative level of consciousness
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Transfer of Patient to Postanesthesia Care Unit,
Communicates intraoperative information |
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Describes physical limitations
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Transfer of Patient to Postanesthesia Care Unit,
Communicates intraoperative information |
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Describes intraoperative factors (eg, insertion of drains or catheters; administration of blood, analgesic agents, or other medications during surgery; occurrence of unexpected events)
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Transfer of Patient to Postanesthesia Care Unit,
Communicates intraoperative information |
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Reports patient's response to surgical procedure and anesthesia
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Transfer of Patient to Postanesthesia Care Unit,
Communicates intraoperative information |
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Identifies type of anesthetic used
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Transfer of Patient to Postanesthesia Care Unit,
Communicates intraoperative information |
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States type of surgery performed
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Transfer of Patient to Postanesthesia Care Unit,
Communicates intraoperative information |
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Determines patient's immediate response to surgical intervention
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Postoperative Assessment Recovery Area
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Assesses patient's readiness for transfer to in-hospital unit or for discharge home based on institutional policy (eg, Alderete score, see Chapter 20)
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Postoperative Assessment Recovery Area
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Provides oral fluids if prescribed for ambulatory surgery patient
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Postoperative Assessment Recovery Area
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Administers medications, fluid, and blood component therapy, if prescribed
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Postoperative Assessment Recovery Area
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Maintains patient's safety (airway, circulation, prevention of injury)
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Postoperative Assessment Recovery Area
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Assesses patient's pain level and administers appropriate pain relief measures
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Postoperative Assessment Recovery Area
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Monitors patient's physiologic status
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Postoperative Assessment Recovery Area
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Continues close monitoring of patient's physical and psychological response to surgical intervention
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Surgical Unit
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Assists with discharge planning
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Surgical Unit
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Determines patient's psychological status
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Surgical Unit
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Assists patient in recovery and preparation for discharge home
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Surgical Unit
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Provides teaching to patient during immediate recovery period
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Surgical Unit
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Assesses patient's pain level and administers appropriate pain relief measures
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Surgical Unit
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Provides follow-up care during office or clinic visit or by telephone contact
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Home or Clinic
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Determines family's perception of surgery and its outcome
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Home or Clinic
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Assesses patient's response to surgery and anesthesia and their effects on body image and function
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Home or Clinic
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Reinforces previous teaching and answers patient's and family's questions about surgery and follow-up care
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Postoperative Phase
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Examples of Nursing Activities in the Perioperative Phases of Care; Home or Clinic
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The postoperative patient is subject to 5 potential respiratory complications such as:
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Ateletasis; pneumonia; pulmonary embolism; aspiration
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The postoperative patient is subject to 2 potential neurologic complications such as:
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Delirium; stroke
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The postoperative patient is subject to a potential skin complication such as:
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Breakdown
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The postoperative patient is subject to 2 potential urinary complications such as:
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Acute urine retention; urinary tract infection
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The postoperative patient is subject to 3 potential functional complications such as:
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Weakness; fatigue; functional decline
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The postoperative patient is subject to 6 potential wound complications such as:
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Infection; dehiscence; evisceration; delayed healing; hemorrhage; hematoma
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The postoperative patient is subject to 3 potential gastrointestinal complications such as:
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Constipation; paralytic ileus; bowel obstruction
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The postoperative patient is subject to 2 potential cardiovascular complications such as:
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Shock; thrombophlebitis
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skin temperature (cold and clammy, warm and moist, or warm and dry) are clues to ______ function.
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cardiovascular
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Although a change in mental status or postoperative restlessness may be related to anxiety, pain, or medications, it may also be a symptom of _______ ______ or ______. These serious causes must be investigated and excluded before other causes are pursued.
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oxygen deficit or hemorrhage
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______ is characterized by chills and fever, tachycardia, and tachypnea.
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Pneumonia
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______ remains a risk for the patient who is not moving well or ambulating or who is not performing deep-breathing and coughing exercises or using an incentive spirometer. Signs and symptoms include decreased breath sounds over the affected area, crackles, and cough.
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Atelectasis
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Nursing Interventions
Preventing Respiratory Complications |
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Respiratory depressive effects of ______ medications, decreased lung expansion secondary to pain, and decreased mobility combine to put the patient at risk for common respiratory complications, particularly atelectasis (alveolar collapse; incomplete expansion of the lung), pneumonia, and hypoxemia
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opioid
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Nursing Interventions
Preventing Respiratory Complications |
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With ______ ______ ______, the symptoms are often vague, with perhaps a slight elevation of temperature, pulse, and respiratory rate, as well as a cough. Physical examination reveals dullness and crackles at the base of the lungs. If the condition progresses, the outcome may be fatal.
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Hypostatic pulmonary congestion
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Nursing Interventions
Preventing Respiratory Complications |
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Risk for ______ is present in patients who have undergone major surgery (particularly abdominal), are obese, or have preexisting pulmonary problems. ______ can be detected by pulse oximetry, which measures blood oxygen saturation.
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hypoxemia
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Nursing Interventions
Preventing Respiratory Complications |
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______ indicate static pulmonary secretions that need to be mobilized by coughing and deep-breathing exercises.
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Crackles
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Nursing Interventions
Preventing Respiratory Complications |
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When a mucus plug obstructs one of the bronchi entirely, the pulmonary tissue beyond the plug collapses, and massive ______ results.
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atelectasis
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Nursing Interventions
Preventing Respiratory Complications |
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To clear secretions and prevent pneumonia, the nurse encourages the patient to ______ frequently and take ______ breaths at least every 2 hours. Coughing is also encouraged to dislodge mucus plugs. These pulmonary exercises should begin as soon as the patient arrives on the clinical unit and continue until the patient is discharged. Even if he or she is not fully awake from anesthesia, the patient can be asked to take several deep breaths. This helps expel residual anesthetic agents, mobilize secretions, and prevent alveolar collapse (atelectasis).
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turn; deep
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Nursing Interventions
Preventing Respiratory Complications |
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Careful ______ of abdominal or thoracic incision sites helps the patient overcome the fear that the exertion of coughing might open the incision.
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splinting
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Nursing Interventions
Preventing Respiratory Complications |
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Analgesic agents are administered to permit more effective coughing, and ______ is administered as prescribed to prevent or relieve hypoxia. To encourage lung expansion, the patient is encouraged to yawn or take sustained maximal inspirations to create a negative intrathoracic pressure of -40 mm Hg and expand lung volume to total capacity.
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oxygen
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Nursing Interventions
Preventing Respiratory Complications |
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A common recommendation for use of the incentive spirometer is ___ deep breaths every hour while awake.
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10
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Nursing Interventions
Preventing Respiratory Complications |
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Early ______ increases metabolism and pulmonary aeration and, in general, improves all body functions. The patient is encouraged to be out of bed as soon as possible (ie, on the day of surgery, or no later than the first postoperative day). This practice is especially valuable in preventing pulmonary complications in older patients.
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ambulation
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Nursing Interventions
Preventing Respiratory Complications |
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There is a well-known correlation between frequency of complications and intensity of ______. Intense ______ stimulates the stress response, which adversely affects the cardiac and immune systems.
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pain; pain
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Nursing Interventions
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Cardiovascular insufficiency occurs three times more frequently, and the incidence of infection is five times greater, in people with poor postoperative ______ control.
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pain
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Nursing Interventions
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A systolic blood pressure of less than ___ mm Hg is usually considered reportable at once.
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90
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Promoting Cardiac Output
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If the patient has an indwelling urinary catheter, hourly outputs are monitored and rates of less than ___ mL/hour are reported
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30
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PostOp considerations
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If the patient is voiding, an output of less than ___ mL per 8-hour shift is reported
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240
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PostOp considerations
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Decreased ______ and ______ levels can indicate blood loss or dilution of circulating volume by IV fluids.
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hemoglobin; hematocrit
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PostOp considerations
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Venous stasis from dehydration, immobility, and pressure on leg veins during surgery put the patient at risk for deep vein ______.
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thrombosis
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PostOp considerations
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If disruption of a wound occurs, the patient is placed in _____ ______ position and instructed to lie quietly. These actions minimize protrusion of body tissues. The protruding coils of intestine are covered with sterile dressings moistened with sterile saline solution, and the surgeon is notified at once.
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low Fowler's
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PostOp care
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Age of patient
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The older the patient, the less resilient the tissues. Handle all tissues gently.
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Factors Affecting Wound Healing
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Handling of tissues
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Rough handling causes injury and delayed healing. Handle tissues carefully and evenly.
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Factors Affecting Wound Healing
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Hemorrhage
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Accumulation of blood creates dead spaces as well as dead cells that must be removed. The area becomes a growth medium for organisms. Monitor vital signs. Observe incision site for evidence of bleeding and infection.
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Factors Affecting Wound Healing
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Hypovolemia
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Insufficient blood volume leads to vaso-constriction and reduced oxygen and nutrients available for wound healing. Monitor for volume deficit (circulatory impairment). Correct by fluid replacement as prescribed.
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Factors Affecting Wound Healing
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Edema
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Reduces blood supply by exerting increased interstitial pressure on vessels Elevate part; apply cool compresses.
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Factors Affecting Wound Healing; Local factors
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Too small
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Permits bacterial invasion and contamination Follow guidelines for proper dressing technique.
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Factors Affecting Wound Healing; Inadequate dressing technique
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Too tight
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Reduces blood supply carrying nutrients and oxygen
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Factors Affecting Wound Healing
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Nutritional deficits
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Protein-calorie depletion may occur.
Insulin secretion may be inhibited, causing blood glucose to rise. Correct deficits;this may require parenteral nutritional therapy. Monitor blood glucose levels. Administer vitamin supplements as prescribed. Keep wounds free of dressing threads and talcum powder from gloves. |
Factors Affecting Wound Healing
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Foreign bodies
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Foreign bodies retard healing. Keep wounds free of dressing threads and talcum powder from gloves.
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Factors Affecting Wound Healing
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Oxygen deficit
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Rationale: (tissue oxygenation insufficient) Insufficient oxygen may be due to inadequate lung and cardiovascular function as well as localized vasoconstriction. Encourage deep breathing, turning, controlled coughing.
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Factors Affecting Wound Healing
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Drainage accumulation
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Rationale: Accumulated secretions hamper healing process. Monitor closed drainage systems for proper functioning.
Institute measures to remove accumulated secretions. |
Factors Affecting Wound Healing
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Corticosteroids
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Rationale: May mask presence of infection by impairing normal inflammatory response Be aware of action and effect of medications patient is receiving.
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Factors Affecting Wound Healing; Medications
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Anticoagulants
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Rationale: May cause hemorrhage
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Factors Affecting Wound Healing; Medications
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Broad-spectrum and specific antibiotics
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Rationale: Effective if administered immediately before surgery for specific pathology or bacterial contamination. If administered after wound is closed, ineffective because of intravascular coagulation.
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Factors Affecting Wound Healing; Medications
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Patient overactivity
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Rationale: Prevents approximation of wound edges. Resting favors healing. Use measures to keep wound edges approximated: taping, bandaging, splints.
Encourage rest. |
Factors Affecting Wound Healing; Medications
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Systemic disorders
Hemorrhagic shock Acidosis Hypoxia Renal failure Hepatic disease Sepsis |
Rationale: These depress cell functions that directly affect wound healing. Be familiar with the nature of the specific disorder. Administer prescribed treatment. Cultures may be indicated to determine appropriate antibiotic.
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Factors Affecting Wound Healing; Medications
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Immunosuppressed state
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Rationale: Patient is more vulnerable to bacterial and viral invasion;defense mechanisms are impaired. Provide maximum protection to prevent infection. Restrict visitors with colds; institute mandatory hand hygiene by all staff.
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Factors Affecting Wound Healing; Medications
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Wound stressors
Vomiting Valsalva maneuver Heavy coughing Straining |
Rationale: Produce tension on wounds, particularly of the torso. Encourage frequent turning and ambulation and administer antiemetic medications as prescribed. Assist patient in splinting incision.
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Factors Affecting Wound Healing; Medications
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Decreased mobility, decreased oral intake, and opioid analgesics contribute to difficulty having a ______ movement.
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bowel
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PostOp care
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Anesthetics, anticholinergic agents, and opioids interfere with the perception of bladder fullness and the urge to ______ and inhibit the ability to initiate ______ and completely empty the bladder.
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void; voiding
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PostOp care
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The patient is expected to void within ___ hours after surgery (this includes time spent in the PACU).
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8
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PostOp care
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When indicated, intermittent catheterization may be prescribed every 4 to 6 hours until the patient can void spontaneously and the postvoid residual is less than ___ mL.
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100
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PostOp care
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Postoperative _____, characterized by confusion, perceptual and cognitive deficits, altered attention levels, disturbed sleep patterns, and impaired psychomotor skills, is a significant problem for older adults.
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delirium
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PostOp care; Gerontologic Considerations
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Physical activity should ______ be neglected while the patient is confused, because physical deterioration can worsen delirium and place the patient at increased risk for other complications.
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not
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PostOp care; Gerontologic Considerations
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Problems confronting the elderly postoperative patient, such as pneumonia, altered bowel function, deep vein thrombosis, weakness, and functional decline, often can be prevented by early and progressive ______.
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ambulation
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PostOp care; Gerontologic Considerations
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