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59 Cards in this Set

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conscious sedation/analgesia
type of anesthesia used for short procedures; the iv administration of sedatives and analgesics raises the pain threshold and produces an altered mood and some degree of amnesia, but the patient maintains cardiorespiratory function and can respond to verbal commands.
embolus
foreign body or air in the circulatory system
thrombophlebitis
inflammation in a vein associated w/ thrombus formation
urgency of surgery
elective
urgent
emergency
degree of risk: surgery
major or minor
purpose of surgery
diagnostic
ablative (removed diseased body part)
palliative
reconstructive
transplantation
construction
Preoperative Patient Care: Hospitalized Patient
Steps in nursing interventions for pre-op to follow. Will follow action-rationale format.
1. Identify patients for whom surgery is a greater risk.
(High risk: very young/elderly, obese or malnourished, fluid/electrolyte imbalance, patients in poor general health from chronic disease and infectious processes, patients taking meds and extremely anxious patients)

Rationale: ID of pts that are high risk can help prevent complications after surgery.
2. Review the nursing databas, history, and physical examination. Check that the baseline data is recorded; report those that are abnormal.
Rationale: Review identifies pts who are surgical risks.
3. Check that diagnostic testing has been completed and results are available; id and report abnormal results.
Rationale: This check may influence the type of surgery performed and anesthetic used, as well as timing of surgery or the need for additional consultation.
4.Promote optimal nutrition and hydration status as ordered.
Rationale: This promotes wound healing.
5. ID learning needs of pt and family.
Rationale: This enhances surgical recovery and allays anxiety by preparing pts for post-op convalescence, discharge plans, and self-care.
6. Conduct preoperative teaching re: coughing and deep-breathing exercises w/ splinting.
Rationale: Deep-breathing exercises improve lung expansion and volume, help expel anesthetic gases and mucus from the airway, and facilitate the oxygenation of body tissues. Coughing helps remove retained mucus from the respiratory tract. Splinting minimizes pain while couging or moving.
6A (coughing and deep-breathing exercises w/ splinting)
Assist pt to semi-fowler's position, leaning forward.
6B
Have pt splint a chest or abominal incision by holding a folded bath blanket or pillow against the incision.
6C
Tell pt to take a deep breath and hold it for 3 seconds.
6D
Encourage pt to "hack" out three short coughs after holding breath.
6E
With mouth open pt should take a quick breath.
6F
Encouraging pt to cough deeply once or twice and then take another deep breath.
7. Conduct preoperative teaching re: respiratory therapy regimens such as incentive spirometry.
Rationale: Incentive spirometry improves lung expansion, helps expel anesthetic gases and mucus from the airway, and facilitates oxygenation of body tissues.
7A (incentive spirometry)
An incentive spirometer helps increase lung volume and promot inflation of the alveoli.
7B
Assist pt to semi-Fowler's position.
7C
Setting the volume goal indicator on the spirometer.
7D
PT will hold the device and place lips around the mouthpiece to creat a seal, then taking a deep breath in.
7E
The pt can observe progress toward the goal by watching the balls or diaphragm or spirometer elevate or lights go on (depending on equip). Have pt repeat 5-10 times q 1-2 hours.
8. Conduct preoperative teaching re: management of pain after surgery.
Rationale: Using ordered analgesics to minimize pain helps to prevent postoperative complications.
9. Conduct preoperative teaching re: leg exercises.
Rationale: Leg exercises promote venous return and decrease complications related to venous stasis.
9A Leg Exercises
Assist to semi-Fowler's position.
9B
Raise pts right foot and keep it elevated for a few seconds.
9C
Extend lower portion of leg.
9D
Lower the entire leg to the bed. This exercise is repeated five times w/ each leg.
9E
Pt points toes of both feet toward the foot of the bed w/ both legs extended.
9F
Pt pulls toes toward chin on both feet.
9G
Pt makes circles w/ both ankles, first one way and then the other.
10. Provide preoperative teaching re: early ambulation and turning in bed.
Rationale: Turning and moving in bed helps to minimize pain and prevent postoperative complications.
10A
Instruct the pt to raise one knee and reach across to grasp the siderail on the side of the bed toward which he/she will be turning.
10B
Help pt to roll over while he/she pushed w/ leg bent and pulls on the side rail.
10C
Showing pt how to use small pillow to splint a ches or abdominal incision while turning.
10D
After pt is turned, provide support w/ pillows behind the pts back.
13. Document
Document what actions were taken.
14. Provide emotional support. Answer questions realistically. Provide spiritual assistance if requested. Include family when possible.
Rationale: This allays family and patient misconceptions and fears.
15. Follow preoperative fluid and food restrictions.
Rationale: This reduces risk for vomiting and aspiration during surgery. Anesthetic agents temporarily depress GI function and processes.
16. Prepare for elimination needs during and after surgery.
Rationale: Anesthetic agents and abd. surgery interfere w/ normal elimination function. A urinary catheter inserted preoperatively minimizes risk for inadvertent trauma to bladder during surgery.
17. Attend to pts special hygiene needs.
Rationale: This decreases risk for infection.
18. Provide for adequate rest.
Rationale: Rest minimizes stress before surgery.
19. Day of surgery: Check that proper id band is on pt.
Rationale: Double-checking ensures id of pt.
20. Check consent forms.
Rationale: Legally required.
21. Check vitals.
Rationale: Provides baseline data for comparison.
22. Hygiene and oral care.
Rationale: Promotes comfort and prevents intraoperative complications during anesthesia inducion.
23. Continue nutritional and hydration prep.
Rationale: This prepares pt for operative procedure.
24. Remove accessories from client. (ie., cosmetics, jewelry, nail polish, dentures...)
Rationale: These interfere w/ assessment during surgery.
25. Place values in an appropriate area.
Rationale: This ensures safety of valuables and personal possessions.
26. Have pt empty bladder and bowel before surgery.
Rationale: Minimizes the risk for injury or complications after surgery.
27. Attend to any preoperative orders.
Rationale: This prepares the pt for operative procedures.
28. Complete preoperative checklist and record of pts pre-op prep.
Rationale: This ensures accurate documentation and communication w/ perioperative nurse caring for pt.
29. Administer preoperative meds as prescribed by physician/anesthesia provider.
Rationale: Meds reduce anxiety, provides sedation, and diminishes salivary and bronchial secretions.
30. Raise side rails, place bed in lowest position. Instruct pt to remain in bed or on stretcher.
Rationale: Ensures safety of pt.
31. Move pt from bed to transport stretcher if necessary. Reconfirm pt id and document.
Rationale: Helping pt to move prevents injury. Reconfirming ensures correct pt.
24. Prepare room for pts return.
Rationale: Promotes efficient care in the post-op period.