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48 Cards in this Set
- Front
- Back
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What are the peri-operative phases? |
1. Pre-op - beginning with decision that surgery is needed until pt is on the operating table 2. Intra-op - OR admission til transferred to recovery 3. Post-op - Recovery room admission until complete recovery |
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Surgical procedures are classified by: |
1. degree of urgency
2. degree of risk 3. purpose 4. combination of 1-3 |
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What are the degrees of urgency? |
1. Elective - not needed/ pt opts for procedure (breast aug or even c-section) 2. Urgent - pt needs it but it is not life or death at the time (knee replacement or enlarged prostate) 3. Emergency - life threatening; immediate to preserve life, body part, or body function. |
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What are the degrees of risk? |
1. Major - requires hospitalization; prolonged time; higher risk for complications; involved major body organs; potential post-op complications; general or spinal anesthesia (no local) 2. Minor - general or local anesthesia; can be in dr office or outpatient facility; brief surgery (less than 1hr); less than 2 hr of recovery; low risk; few complications |
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What are the purposes of surgical procedure? |
1. Ablative - removal of diseased portion 2. Palliative - decrease symptoms 3. Constructive - ex. mastectomy 4. Reconstructive - ex. rebuild breast 5. Diagnostic - ex. biopsy; take sample 6. Transplant - replace organ or limb |
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Informed consent |
-legal document required for every surgery that protects the pt, dr & facility / hospital -must be in understandable terms. Must specify description of surgery, risks, alternatives, name & qualifications of personnel, effects of declining procedure, & advise the pt can refuse or withdraw consent at anytime -person performing surgery responsible for consent & explain. Nurse is a witness to pt signing & that pt understands what the dr explained -Consents are not legal if minor, confused, sedated, or incompetent |
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How do you prepare a pt psychologically? |
1. Communicate guidelines -must tell dr if pt is convinced they will die 2. Teach post-op activities (prior to surgery while they are A&O) 3. Surgical events & sensation - let them know when surgery is scheduled, duration, what will be done before, during and after surgery & what sensations to expect 4. pain management 5. physical activities - to speed up recovery |
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What sensations will a pt experience after surgery? |
-dry mouth (from meds) -drowsiness (from anesthesia) -sore throat (from endotracheal tube) -gradual return of feeling -low tolerance -incision pain -IV fluid -may have tight dressing -nausea from anesthesia |
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How do you teach pt about pain management? |
-Pain med ordered by dr, given by nurse -explain PRN (ask before severe) -if pain is not alleviated, can obtain different med -pain given by injection first day (because NPO) -oral once food intake and physical activity increases -very little addiction. Allow pt to tolerate physical activity needed for recovery -use relaxation techniques |
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What are the most common causes of post-op complications? |
Cardiovascular & Pulmonary issues -teach physical activity to prevent these issues |
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Why should you teach deep breathing exercise for post-op? |
-During surgery cough reflex is suppressed. Mucous accumulates in tracheal bronchial tree. Lungs do not inflate fully. -After surgery respiration in shallow; aveoli do not inflate properly and can lead to lung collapse & further accumulation of secretion -Breathing will hyperventilate aveoli to prevent collapse, improve lung expansion, expel anesthesia, & facilitate O2 to cells. |
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Why should you teach coughing for post-op? |
-coughing helps remove secretion -Splint incision by holding incision site -Use period after administration of pain meds |
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Why should you teach leg exercise for post-op? |
Venous return slows causing circulatory stasis. If this is prolonged, can lead to Thrombophlebitis & emboli -leg exercises increase venous return by flexion and contraction of the leg muscle |
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Physical Preparation for surgery |
Physical exam (heart, lung & bowel sound)
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General screening tests & labs prior to surgery |
-Chest xray -CBC -Pt/PTT - bleeding risks (if time is high, -EKG -BMP (for electrolytes) -urinalysis *Nurse is responsible for making sure they are completed based on dr order, recorded and report abnormalities. |
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Why and how is skin prepped for surgery? |
-skin is first line of defense. Incision breaks the defense & increase risk of infection. -skin is cleansed & scrubbed with antibacterial soap. Can be done by pt night before surgery -shampoo and clean finger nails -Site may be shaved but done immediately before surgery because a cut can grow bacteria. Now done in holding room. |
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Bowel Prep for Surgery |
Not necessary unless surgery is on the GI tract in which dr will order cleansing enema until clear.
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Urinary prep for surgery |
-foley cath may be ordered to prevent bladder distention or accidental injury to bladder -if no foley, ask pt to void |
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Nutritional prep for surgery |
NPO 8-12 hours before surgery or after midnight to reduce gastric acid (prevents aspiration of gastric acid if pt vomits). -Remove all fluid & food from pt room & notify dr if pt does eat or drink |
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Sleep & Rest prep for surgery |
Important for best condition for surgery If a hypnotic med is administered, it is considered the beginning of anesthesia. Risky. |
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What is the pre-op check list completed? |
Day of surgery. Sent with pt to holding room. |
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Prep patient for surgery |
remove all items -if keep wedding ring, tape it -hearing aids stay, Notify OR -make narrative note in nurses note -transfer pt to holding room -prep post-op room for return |
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Intra-operative Care |
-Assessment -pre-op check list -skin prep -start IV -pre-op meds (on-call to the OR) -transfer from holding room to surgery |
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Scrub nurse |
-Wear protective gear -Give surgeon all equipment & anticipate needs -Prepare sterile table -must know asepsis technique, anatomy, tissue repair, & surgical procedure -must know what to do during emergency |
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Circulating Nurse |
-Protects pt during surgery by controlling environment like cleanliness, room temp, lighting, etc. monitor aseptic technique -pt advocate -counts instruments with scrub nurse before & after surgery (to make sure they aren't inside pt) -assess pt before surgery -get extra supplies & monitor equipment -document! -Give report when transfer to recovery room |
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What effects does anesthesia produce? |
1. Narcosis - loss of consciousness if general 2. Analgesia 3. Relaxation 4. Loss of reflexes |
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How can general anesthesia be administered? |
-inhalation - most common -IV (catamine - produces hallucination) -rectally -orally |
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What are the 4 stages of inhalation? |
1. Beginning anesthesia 2. Excitement 3. Surgical 4. Overdose |
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Explain the beginning stage of inhalation |
Breathed in agent. Pt feels warm, detachment, numbness, dizziness & buzzing in the ear. Still conscious. Noises are exaggerated. Need to keep noise level down. |
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Explain the excitement stage of inhalation |
Uncontrolled movements (laughing, crying, struggling, talking). Reflexes are exaggerated so avoid noises and touch (may punch) |
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Explain the surgical stage of inhalation |
Unconscious. Can be maintain for hours.
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Explain the overdose stage of inhalation |
Undesired stage -too much has been given or adverse reaction is occurring -Results in: paralysis of the diaphragm causing respiratory collapse or vasomotor constriction |
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Regional Anesthesia |
-person remains awake -lose sensation to a region of the body -administered by injection or applied topically near a nerve. Blocks stimuli from reaching CNS. |
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How can regional anesthesia be administered? |
1. topically - mucous membranes, burns, open wounds 2. local infiltration (injection) 3. nerve blocks - block nerve to specific area 4. spinal blocks - lower ab & lower extremities. post op care similar to lumbar puncture (place dorsal recumbent to prevent CNS leakage) |
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Types of Post Op Care |
1. Immediate - occurs in the recovery room 2. Lasting Care - occurs from return to room to total recovery |
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Immediate Post-op Care |
Emphasize to prevent complications -vitals taken every 10-15 minutes until stable (compare to baseline vitals) -total assessment every 15 minutes |
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Recovery Nurse Respiratory assessment |
-monitor respiratory rate, rhythm, depth & observe skin color -suction secretions -administerO2 if needed |
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What is the most common recovery room emergency? |
respiratory obstruction due to -secretion accumulation -tongue obstruction (snoring is red flag) -laryngeal spasm -laryngeal edema (from trach tube) -vomiting |
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How do you position a pt with respiratory obstruction |
open airway by -extending neck -lay on side (head to side) -raise bed to fowlers |
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Recovery Nurse Cardiovascular assessment |
-BP, Pulse, skin color and wound |
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Recovery Nurse CNS assessment |
Check for return of reflexes. They return in reverse order: -Patient in unconscious -Start responding to touch and sound -Drowsy & awake but not oriented -Awake & oriented *Orient by touching and call pt by name |
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Recovery Nurse fluid assessment |
-skin turgor -vital signs -urinary output -wound drainage -IV fluid -vomiting |
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Who is more prone to post-op nausea? |
-women -children -obese (fat cells hold the anesthesia) -people prone to car sickness |
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Recovery Nurse wound assessment |
COCA color odor consistency amount |
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Recovery Nurse general condition assessment |
-give pain meds if stable -give blankets (most pt are cold & warming helps eliminate anesthesia) -physical safety |
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Transferring pt from recovery room to unit |
-must be stable -recovery nurse gives verbal report to unit nurse |
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Assessment by Unit Nurse |
-vitals (every 15 min - 4hrs til stable) -color & temp of skin -orientation - level of consciousness -IV - fluid type, amount, rate, tubing & site -wound assessment & dressing -check all tubes and drains (foley, gi, o2) -comfort & pain & nausea -Document time of arrival |
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Cardiovascular complications |
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