Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/51

Click to flip

51 Cards in this Set

  • Front
  • Back
Perioperative-
Begins from the time the patient enters the hospital, medical facility
or doctor’s office for surgery until the time the patient is discharged home.
Preoperative-
Begins when the client is scheduled for surgery and ends at the time of transfer to the operating room (OR).
Intraoperative-
Begins at the time the client is transferred to the OR and ends when the client is transferred to the post anesthesia care unit (PACU).
Postoperative-
Begins from the time the client is transferred to the PACU and ends when the patient is discharged home.
Diagnostic
Purpose- to determine cause of disorder or type of cancer
Examples- biopsy, exploratory laparoscopy, arthroscopy
Curative
Purpose- to resolve a health problem by repair or removal
Examples- laparoscopic cholecystectomy, mastectomy, hysterectomy
Restorative
Purpose- to restore or improve a client’s function
Examples- total knee replacement, finger reimplantation
Palliative
Purpose- to relieve symptoms of disease or disorder, not a cure
Examples- colostomy, ileostomy, nerve root resection, tumor debulking
Cosmetic
Purpose- to enhance/alter a person’s appearance
Examples- blepharoplasty, liposuction, rhinoplasty, scar revision
Elective
F. Elective
Purpose- for correction of non acute problem
Examples- cataract removal, hemmorhoidectomy, bunionectomy
Urgent
Purpose- requires prompt intervention, may be life threatening if delayed
Examples- Intestinal obstruction, bladder obstruction, kidney stones, fracture
Emergent
Purpose- immediate intervention, life threatening
Examples- appendectomy, abdominal aortic aneurysm, gunshot/stab wound
Minor
Purpose- without significant risk, usually with local anesthesia
Examples- Incision & drainage, insertion of venous access device
Major
J. Major
Purpose- associated with greater risk, more extensive than minor surgery
Examples- Mitral valve replacement, pancreas transplant
History
History- data collection begins prior to the date of surgery and may occur in the
surgeon’s office, preoperative testing center, preadmission office, or via telephone
Age
-document advanced directives
-Client’s over 65 at increased risk for surgical complications
-Aging process decreases immune system and delays wound healing
-The older client may have:
Greater incidence of chronic illness
Greater incidence of malnutrition (dehydration)
More allergies
Impaired self care abilities
Inadequate support systems
Decreased ability to withstand stress of surgery/anesthesia
Increased risk for cardiopulmonary complications
Change in mental status due to unfamiliar surroundings
Increased risk of falling
Decrease ability to respond/cope with stress
Drugs and Substance abuse
-Smokers at increased risk for pulmonary complications
-Excessive alcohol and substance abuse can alter response to anesthesia and pain medications
-Alcohol withdrawal prior to surgery can cause delirium tremens
-Prescription/OTC medications and herbal supplements can affect the client’s response in the perioperative period
Medical/Surgical/Anesthesia history
-
Presence of chronic illnesses (diabetes, lupus, CAD, MI, CHF, HTN, asthma,
emphysema, cancer, etc)
-Previous surgeries and type of anesthesia (number/type of surgery,
type of anesthesia, and any complications
Allergies
Allergies
Blood Donations
autologonous or directed blood donation
- document where donation was made and if blood as arrived
Family History
document any family history of complications from anesthesia
-malignant hyperthermia
Type of surgery
as stated by patient and documented by surgeon
Knowledge/Understanding of perioperative events
assess client’s readiness for surgery
-validate/clarify information received from surgeon’s office
-assess for signs’/symptoms of anxiety/fear (anger, crying,
restlessness, profuse sweating, increase pulse rate, palpitations,
insomnia, diarrhea, increased frequency of urination)
-assess for educational/teaching needs
-allow patient to voice their concerns (worries, fears)
-document any language barriers or disabilities
Client’s support system
-assess client’s living situation
-document person responsible for patient’s care upon discharge (parent,
spouse, significant other, relative, friend, home care agency
or extended care facility)
-assess the readiness/desire of the family to participate in presurgical
planning and postoperative care
Expected outcomes as stated by the client
-explaining the purpose and expected results of surgery
-asking questions when term/procedure not known
-adhering to NPO requirement (able to voice understanding that
food and fluids are restricted to reduce the danger of aspiration)
-stating understanding of preop preparations (skin or bowel prep)
-demonstrating correct use of exercises/techniques to be used after
surgery for prevention of complications (splinting incision, coughing
and deep breathing, incentive spirometry, performing leg exercises,
antiembolism stockings, pneumatic compression devices, ace wraps
-possible placement of tubes, drains, vascular access devices (foley
catheter, NG tube, IV’s)
-explain to client that coughing and deep breathing help in clearing lungs to
prevent atelectasis or pneumonia
Encourage communication (to reduce anxiety)
allow client/family to express feelings, fears, and concerns
-develop trusting relationship
-keep the client/family informed
Teaching client, family and significant others
-encourage preop classes (if available)
-explain perioperative events
Importance of involvement prior to and after surgery
-assess for any knowledge deficits
-encourage preop classes (if available)
-explain perioperative events
Chart review
to ensure all documentation, preoperative procedures, and orders are
completed
-the consent form documents the client’s consent and signature for the
procedure listed (responsibility of surgeon to obtain written consent)
-nurse responsibility is to ensure consent is signed and you serve as
witness to signature
-if you feel client not adequately informed contact surgeon for clarification
-chart height/weight and current set of vital signs
-report any abnormal symptoms/vital signs to physician
-ensure results of all lab, xray, and diagnostic tests are on the chart
-document and report any abnormal results to surgeon/anesthesiologist
-include blood donation information (if applicable)
-report special needs, concerns, instructions to surgical team
-have the client mark surgical area in front of surgical team
Client Preparation
-change into hospital gown
-remove jewelry, give valuables to family member/sig other
-remove dentures, prosthetic devices, hair clips, fingernail polish
-have client empty bladder
-place client identification and allergy bands (bracelets)
-assure privacy
Preoperative medications
-the client’s usual drug schedule will be affected the day of surgery
- drugs for cardiac disease, respiratory disease, seizures and HTN are
usually allowed with sip of water before surgery-check with surgeon/
anesthesiologist
-check with physician/anesthesiologist regarding insulin administration
-ensure that anticoagulants have been discontinued according to physician
-usually given while client is on call to OR
-pre-anesthetic medications reduce the patient’s anxiety so induction and
maintenance of anesthesia will be smooth
-the nurse must document the time and type of preoperative medication given
-prior to administration positively ID the client, make sure consent is signed,
verify order, and explain to the client/family
-after administration raise the side rails, place call bell within reach and
remind the client not to get out of bed
Evaluation
-review and update client’s chart
-reinforce teaching
-ensure client is properly dressed and valuables removed
-give preoperative medications as directed and document on chart
-use flow sheet for smooth transition to surgical team and OR
-the client, the signed consent, the chart, and addressograph plate are
Transported to the OR with the client
Surgeon
assumes responsibility for surgical procedure
Anesthesiologist/CRNA
-selects the anesthesia after consulting with the client and surgeon and after
physical assessment and review of medical/surgery/anesthesia history
Surgical Assistant
includes interns, residents, physician’s assistant
Holding Area Nurse
presurgical holding area
-promotes comfort, privacy & confidentiality
-correctly ID’s the client, reviews the medical record,
preoperative flow sheet, and ensures operative consent(s) are signed
-highlights any known allergies
-reports to surgeon any discrepancy between procedure noted on surgical consent
and the procedure stated by patient
-assesses the clients emotional and physical status, provides emotional support,
answers questions and provides additional education as needed
-applies grounding pads if needed
-complete skin preparation
-apply padding to OR bed, assist in positioning patient safely/comfortably
Circulating Nurse
registered nurse-Registered Nurse
-Coordinates nursing care in OR
-Sets up OR
-Ensures supplies/support available
-Equipment inspected for safety
-Greets /properly ID’s client in holding area
-participates in client marking/identification of surgical site
-Reviews chart/info with holding RN
-verifies NPO status/allergies and assesses skin integrity
-Assists in transfer of client to OR
-applies grounding pads if needed
-apply padding to OR bed, assist in positioning patient safely/comfortably
-may prep surgical site
-ensures that sterile technique and sterile field is maintained
-participates with scrub nurse in accurate count of sponges, sharps, instruments,
amount of irrigating fluids and drugs

-assess for signs/symptoms of malignant hyperthermia (tachycardia, increased end tidal CO2 level, increased body temp), have Dantrolene available
Scrub Nurse/Tech
-may be nurse or surgical tech
-sets up the sterile field
-drapes the client
-hands sterile supplies, equipment and instruments to surgeon
-assists surgeon with instruments
-maintains accurate count (with Circulating Nurse) of:
sponges, sharps, instruments, amount of irrigating fluids and drugs
-counts performed before, during, and after procedure
Preparation of Operating Room
protects client from injury and infection
-electrical equipment meets safety standards
-equipment cleaned/sterilized
-cool room temp/low humidity
-bed locked/safety straps present
-heating pads- to prevent hypothermia
-gel pads present- to prevent skin breakdown
Preparation of Surgical Team
Clean scrub attire worn in OR-surgical team changes from street clothes to
Scrubs in OR locker rooms/changing areas (jewelry also removed)
-Scrub attire includes-scrub shirt/pants, cap/hood, and shoe covers
-Protective attire-masks, eyewear, gloves, gowns
-Surgical scrub by surgeon, surgical ass’t, scrub person
-Sterile gloves, gloves, gowns, materials at operative field
-hand washing performed as indicated throughout day
General Anesthesia
-reversible loss of consciousness
-depresses the central nervous system causing analgesia (pain relief)
amnesia (short term memory loss), unconsciousness with loss of muscle tone and
reflexes
-used for head, neck, upper torso and abdominal surgery
-administered by inhalation and IV injection
Spinal Anesthesia
-anesthetic agent injected in cerebrospinal fluid (“intrathecal block”)
-produces analgesia/relaxation
-used for lower abdominal and pelvic surgery
Epidural Anesthesia
-anesthetic agents injected into epidural space (never enters spinal cord areas)
-decreases cardiac/pulmonary complications
-epidural catheter can be used for pain relief post-op
-used for anorectal, vaginal, perineal, hip, and lower extremity surgery
Local Anesthesia
-topical anesthesia- used for intubation, bronchoscopy, and cystoscopy
-local Infiltration- used for suturing
Regional Nerve Block
-injection of local anesthetic into or around nerves
-prevents pain during procedure
-can be used to treat chronic pain
Conscious Sedation
-IV administration of drugs (sedative, hypnotic, and/or opioids)
-reduces level of consciousness
-allows client to maintain airway and respond to verbal commands
-used for endoscopies, cardiac catheterizations, cardioversions, reduction of closed fractures
Malignant Hyperthermia
-complication of general anesthesia
-acute/life threatening
-If client or family history of hyperthermia, then client can be treated with Dantrolene for prevention
-early indicator- tachycardia
-late stage indicator- extreme elevated temperature
Evaluation: outcomes
-Circulating nurse evaluates client’s care during surgery
-Assures client is safely anesthetized, does not experience injury, is free of skin and tissue contamination during surgery
-Anesthesiologist and circulating nurse transfer client to PACU
Assessment of client upon admission to the Post Anesthesia Recovery Unit (PACU)
-the respiratory system is the most important system to assess immediately
-the admitting nurse receives report from the anesthesiologist/circulating nurse
-nurses assist admitting nurse by placing client on oxygen source, assessing respiratory
status, placing client in monitors, taking initial vital signs, and ensuring client safety
Assessment Data includes:
level of consciousness
vital signs (temp, pulse, respiratory rate & BP)
respirations (breath sounds, oxygen saturation, chest expansion)
examine surgical site/area and surgical dressing
record findings on PACU flowsheet
review client’s chart
Post Anesthesia Care
-Administer oxygen
-Monitor oxygenation
-Monitor respiratory rate and status
-Encourage C & DB
-Monitor/record VS & pain level every 15 minutes (per P & P)
-Monitor fluid status/IV’s/I&O
-Monitor level of consciousness
-Monitor neurological status/ motor function/sensation return
-Monitor surgical site/drains/tubes, record draining (color and amount)
-Administer meds as ordered
-Determine status for discharge
Post Operative Teaching
-Care and assessment of surgical wound and/or site
-Prevention of Infection (hand washing, coughing & deep breathing)
-Dietary (hydration, dietary restrictions, etc)
-Pain management/medications (dosage, side effects)
-Activity (client to follow activity restrictions/directions of surgeon)
-follow up care with surgeon/physician