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51 Cards in this Set

  • Front
  • Back
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.
Begins when the client is scheduled for surgery and ends at the time of transfer to the operating room (OR).
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).
Begins from the time the client is transferred to the PACU and ends when the patient is discharged home.
Purpose- to determine cause of disorder or type of cancer
Examples- biopsy, exploratory laparoscopy, arthroscopy
Purpose- to resolve a health problem by repair or removal
Examples- laparoscopic cholecystectomy, mastectomy, hysterectomy
Purpose- to restore or improve a client’s function
Examples- total knee replacement, finger reimplantation
Purpose- to relieve symptoms of disease or disorder, not a cure
Examples- colostomy, ileostomy, nerve root resection, tumor debulking
Purpose- to enhance/alter a person’s appearance
Examples- blepharoplasty, liposuction, rhinoplasty, scar revision
F. Elective
Purpose- for correction of non acute problem
Examples- cataract removal, hemmorhoidectomy, bunionectomy
Purpose- requires prompt intervention, may be life threatening if delayed
Examples- Intestinal obstruction, bladder obstruction, kidney stones, fracture
Purpose- immediate intervention, life threatening
Examples- appendectomy, abdominal aortic aneurysm, gunshot/stab wound
Purpose- without significant risk, usually with local anesthesia
Examples- Incision & drainage, insertion of venous access device
J. Major
Purpose- associated with greater risk, more extensive than minor surgery
Examples- Mitral valve replacement, pancreas transplant
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
-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
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
-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/
-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
-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
assumes responsibility for surgical procedure
-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
-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