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79 Cards in this Set
- Front
- Back
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Name the Peri-operative phases:
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Pre-operative
Intra-operative Post-operative |
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When does Perioperative nursing begin?
Where does it take place? |
before pre-op, during intra-operaqtive, and after surgery (post-op)
hospitals, surgical centers attached to hospitals, freestanding surgical centers or in health care providers office |
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What is stressed in the perioperative model?
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Continuity
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Why is anesthesia provided to the patient?
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analgesia, muscle relaxation and amnesia
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When does Pre-op begin?
When does Intra-op begin? When does Post-op begin? |
begins with the phase surgery is needed and lasts until pt is rolled into OR
extends from admission to OR to Recovery Room when the pt is admitted to recovery and lasts until complete recovery from surgery |
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What are the surgical procedure classifications?
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1. urgency
(elective, urgent, emergency) 2. Degree of risk (major, minor) 3. Purpose (ablative, palliative, constructive, reconstructive, diagnostic, transplant) 4. Combinations |
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What is the classification for surgical removal of a disfiguring scar?
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elective (in urgency), minor (in seriousness), and reconstructive (in purpose)
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sometimes the same operation is performed for different reasons on different clients. Give an example:
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gastrectomy maybe an emergency procedure to resect a bleed ulcer or
as an urgent procedure to remove a cancerous growth |
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The classification indicates to the nurse the ___ of ____ a client requires
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level of care
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Who are at most risk with Anesthesia?
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clients that are:
volume depleted or have poor cardiac function |
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Give example of Major and Minor surgical procedures?
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extensive reconstruction--coronary artery bypass, colon resection, removal of larynx, resection of lung lobe
minimal alteration in body part--cataract extraction, facial plastic surgery, tooth extraction |
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Define elective, urgent and emergency surgical procedures:
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elective-by choice, not necessary for health (hernia repair, bunionectomy)
Necessary for health; prevents other problems from occuring (excission of ca) save life (repair of traumatic amputation) |
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What is an ablative surgical procedure?
Palliative procurement for transplant constructive: |
excision or removal (amputation)
relieves symptoms (debridement of necrotic tissue) Removal or organs (kidney transplant) Restores function (repair cleft palate) |
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How do you prepare the patient psychologically?
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Communication guidelines
Sensations before, during and after Pain management Teaching post-op activities reduce anxiety, listen & give time line |
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What is the nursing intervention for surgery
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Pre-op check list
Pre-op screening tests (labs: cmp, cbc, h&H, pt, INR, electrolytes, EKG, chest xray, UA) pre-op physcial exam Hygiene and skin prep Elimination (npo 8-12 hours) Nutrition/Fluids Sleep and rest (sleeping pill) |
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What does the informed consent do?
explain what it does? What is the nurses responsibility |
protects pt, physican, institution
must be understandable legal document person performing procedure gets consent nurse witnesses the signature makes sure patient understands |
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What is a nursing intervention for a patient w/ CHF and why?
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provide in the pre-op period beta-blocker meds b/c they may experience a further decline in cardiac function in both intra-op and post-op
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What are risk factors for surgical clients?
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age
nutrition obesity immunocompromise F/E imbalance Pregnancy |
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What factors should you assess clients for with previous surgeries and why?
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motion sickness, nausea, and vomiting b/c they increase the risk for aspiration
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General anesthetics increase:
and what do they stimulate? |
airway irritation and stimulate pulmonary secretions, which the airways retain as a result of reduction in ciliary activity
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What needs to be removed from the patient the day of surgery?
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all clothing; except gown
prostetics glasses, contacts jewlery or cover w/ tape (sparks) denturesWhat |
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What are important indicators of nutritional status?
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Height, weight, and history of weight loss
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What does an elevated temperature increase the risk for?
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F/E imbalance after surgery
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What is an indicative of respiratory or sinus infection?
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sinus drainage
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What lab values become elevated when a patient is dehydrated?
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BUN
Hematocrit |
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Consents are NOT legal if the patient is:
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minor, confused, sedated incompetent
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Intra-op is the second phase in nursing care. When does it begin and ends in the ....
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begins in operating table to recovery room
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Anesthesia produces:
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narcosis
analgesia (loss of pain, reflexes) relaxation loss of reflexes |
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If the surgery involves lower GI system or lower abdominal organss what must the lient receive?
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Cathartic or enema prevent intra-op incontinence and post-op constipation
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If colon surgery is planned the physcian will order a ___ for the patient.
What is the number of times a nurse may administer successfully? |
enema "until clear"
3 |
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What do sedative-hypnotics do when given the night before surgery?
Give example: |
affect and promote sleep
(temazepan (restoril)) |
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Anxiolytic agents act on what to relieve anxiety?
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cerebral cortex
(alprazolam (xanax)) |
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What sensations should the client expect post surgery?
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blurred vision (anesthesia provider applies poitment to eyes to prevent corneal damage)
pain at surgical site tightness of dressing dryness of mouth sore throat (endotracheasl tube) |
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In pre-op, what post-op exercises are taught to the client?
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diaphragmatic breathing
incentive spirometry coughing turning leg exercises |
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Explain incentive spirometry procedure:
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lips completely cover mouthpiece
inhale slowly hold breath for 35 seconds once max goal of volume achieved exhale slowly repeat 10-12 per session End w/ 2 coughs after the end of 10-12 IS breaths |
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Explain controlled coughing:
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upright position
take 2 slow breaths inhaling thru nose exhaling thru mouth inhale deeply 3rd time for 2-3 conseutive coughs w/out inhaling between coughs splint incision if necessary cough 2-3 times every 2 hrs while awake |
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What are the leg exercises for post-op complications?
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buttocks lifts
leg position for turning foot circles dorsiflexion & plantar flexion Quadriceps setting hip/knee movements |
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Pre-op medications cause?
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drowsiness and dry mouth
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Who is most at risk for latex allergies?
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children w/ spina bifida
urogenital abnormalities spinal cord injury |
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What are signs/symptoms of latex allergies?
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urticaria
flat or raised red patches to vesicular scaling bleeding eruptions |
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What are the 3 principles of the protocol for pre-op verification:
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1. marking of the operative site
2. multiple structures &levels of the spine 3. time out (correct client, procedure, site and any implants) |
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Interventions continue during and after _____.
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surgery
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Responsibilites of the circulating Nurse
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must be an RN
endotracheal intubation blood admin sterile technique safe OR environment assest surgeon/surgical team by operating non-sterile equip additional supplies verifies sponges &instrument count documentation |
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Responsibilities of the scrub nurse:
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maintains sterile field
applies sterile field, drapes hands instruments& supplies to surgeons counts sponges/instruments |
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General Anesthesia is ____ to reverse and allow the client to recover with fewer ____ _____
What routes is it given? |
easier
negative effects IV inhalation |
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3 phases of anesthesia:
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induction (admin of anesthetic agents/endotracheal intubation)
maintenance (postioning, prep for skin for incision) emergence (anesthetics are decreased & client begins to awaken) |
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What are the side effects for general anesthesia?
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cardiovascular depression
irritability respiratory depression liver/kidney damage |
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Regional anesthesia (aka Local) causes what to happen?<br /><br />What is the method of induction?
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awake, loss of sensation in the area of the body--no loss of consciousness (does not require endotracheal tube) but the client is sedated<br />spinal, epidural or peripheral nerve block
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Local Anesthesia involves the loss of ____ at the ____ _____.
The anesthetic agent, ____ inhibits ___ ____ until the drug diffuses into the circulation. It is common for ____ procedures |
sensation desired site
lidocaine nerve conduction minor |
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Conscious Sedation is a depressed ___ of _____. A client must maintain ___ ____ and adequate _____.
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level of consciousness
patent airway ventilation |
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What equipment must be available when using local anesthesia or conscious sedation?
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resuscitation
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Define Narcosis?
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loss of consciousness
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4 stages of General inhalation:
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1. beginning anesthesia (warm, detached, numb, dizzy, buzzing in ear, noises are exaggerated)
2. excitement, talking, laughing, crying 3. surgical anesthesia 4. overdose anesthesia (vasomotor collapse) |
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Post-Op assessment:
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respiratory status (rate, rythem, depth)
Cardio-vascular status CNS status Fluid status Wound condition General condition |
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Initial Assessment on post-op unit
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vital signs
color/temp of skin LOC IV fluids wound other tubes (account, color of drainage) Level of comfort (PQRST) Psycho-social needs |
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If a pulmonary embolus (dislodged blood clot) what do you assess for?
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SOB
Cough Cyanosis Anxious |
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What are Pulmonary Complications and the signs/symptoms?
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Pneumonia
Atelectasis S/S: chills, fever, rusty purulent drainage |
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What are the complications for Atelectasis?
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crackles
dyspnea decreased breath sounds apprehensive |
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What are complications of cardio-vascular system?
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hemmorrhage/hypovolemic shock
Thrombophlebitis Pulmonary embolus |
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What are interventions to prevent wound complications?
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Assessment
Maintain hydration Maintain nutritional status |
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What are clients that undergo general anesthesia more likely to face than clients that undergo local anesthesia or conscious sedation?
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complications
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A clients post-op course involves 2 phases. What is it for ambulatory surgical clients and hospitalized clients?
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1-2 hours and convalescence occurs at home
occurs over a few hours convalescence occurs over 1 or > days |
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The PACU nurse attaches the client to monitoring equipment such as:
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noninvasive blood pressure monitor
ECG monitor pulse oximeter Clients often receive some form of O2 in immediate recovery period |
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Nursing care in the PACU focuses on:
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monitoring/maintaining airway
respiratory, circulatory and neurological status and on managing pain |
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Post-op confusion is frequently secondary to _____, especially in older adults
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hypoxia
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Careful assessment of heart rate, rhythm, along w/ BP reveals cardiovascular status--monitor VS every ___ ____
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15 minutes
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A common circulatory problem is ____
Name signs/symptoms: |
hemorrhage
(fall in BP, elevated heart and respiratory rate, thready pulse, cool, clammy, pale skin and restlessness) |
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What is the first sign of malignant hyperthermia?
What is a late sign? What is it? |
increased expired CO2
elevated temperature life threatening complication of anesthesia (heat loss due to open body cavity) |
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Genitourinary function post-op depending on the surgery, some clients do not regain voluntary control over urinary function for __- ___ hours
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6-8
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What is paraytic ileus?
What is an indication on assessment? |
nonmechanical obstruction due to lack of intestinal peristalsis from handling of the bowel in surgery
distention |
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Name measures to promote lung expansion:
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diaphragmatic breathing exercices every hour while awake
Incentive Spirometer for max inspiration Early ambulation reposition every 2 hours while awake keep client comfortable |
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List preventative measure for circulatory complications?
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leg exercises every hr while awake
elastic antiembolism stockings or sequential compression early ambulation avoid positioning that interrupts BF to extremities Admin anticoagulant drugs adequate fluid intake orally or IV |
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When should you provide analgesics to improve pain control?
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around the clock for the 1st 24-48 hours after surgery
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How do you decrease shivering as prescribed by a health care provider?
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meperidine (demerol)
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What drug is recommended for clients at high risk for the development of nausea and vomiting or clients who must not vomit (eye surgery)?
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combination of antimetics
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Normal peristalsis for a client who has had surgery on GI structures takes __-___ days to return
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2-3
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Clients who have had abdominal surgery are usually NPO for ___
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24-48 hours
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What are risks for delayed wound healing?
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inadequate nutrition
impaired circulation metabolic alterations |
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A critical time for wound healing is ____.
If a wound becomes infected it usually occurs ____ days after surgery. |
24-72 hours
3-6 days after surgery |
