Adult Health Ii - Week 1 - Perioperative Nursing

Front 1

What are the categories of surgery based on urgency?

Back 1

EUREO

Emergent - immediate surgery
Urgent - prompt surg within 24hr
Required - surgery within few weeks/mo
Elective - pt. should have surgery
Optional - pt's decision

Front 2

Pt. has BPH. What is the urgency of the surgery?

Back 2

depends

if there is urinary obstruction, it is emergent

if there is no obstruction, it is required

Front 3

Pt. has kidney stones. What is urgeny of surgery?

Back 3

Urgent - should have surgery within 24 hours

Front 4

give examples of types of emergent surgery

Back 4

severe bleeding, skull fracture, urinary or intestinal obstructions, gunshot wounds, extensive burns

Front 5

give examples of urgent surgery

Back 5

acute gallbladder infection, kidney stones

Front 6

give examples of surgeries that require "required" care

Back 6

prostatic hyperplasia w/o urinary obstr, thyroid disorders?

Front 7

Give examples of surgeries that are elective

Back 7

simple hernia, vaginal repair

Front 8

What is nurse's role with Informed Consent?

Back 8

witness and patient advocate.

witness - acknowledges that the patient has been given the information and is the witness to the patient’s signature on the consent form.

patient advocate - nurse asks questions of the patient to determine whether the patient has received sufficient information to make an informed decision.

Front 9

What are the required topics for informed consent?

Back 9

1. explanation of procedure, risks
2. description of benefits, alternatives
3. offer to answer q's
4. tell pt that they may withdraw consent at any time

Front 10

Can a mentally ill person give informed consent?

Back 10

No. Like cognitively impaired or ppl that are neurologically incapacitated, or children under 18, they cannot give consent due to potential inability to be truly informed.

Front 11

When should a nurse teach a pateint about deep breathing, coughing, and incentive spirometry regarding surgery?

Back 11

preoperative patient teaching!

Front 12

What things should a nurse teach a patient before going into surgery?

Back 12

- deep breathing, coughing, incentive spirometry
- ... what are these things?

Front 13

What is a "time-out"?

Back 13

- prior to anesthesia, patient identity, surgical procedure, and surgical site is verified
- role of circulating nurse

Front 14

roles of the circulating nurse

Back 14

- coordinating team
- cleanliness, proper environment optimal for srugery
- monitor for breaks in aseptic technique
- surgical "time out"
- counting all instruments as the incision is closed

Front 15

roles of the scrub nurse

Back 15

- setting up sterile tables
- preparing special equipment
- assisting surgeon during procedure
- counting all instruments as the incision is closed

Front 16

What is RNFA?

Back 16

= registered nurse first assistant
- responsibilities - suturing, handling tissue, maintaining hemostasis

Front 17

What is considered sterile on a gowned OR health professional?

Back 17

- from chest to sterile level (downwards)
- sleeves, 2 inches from the elbow to the cuff

Front 18

what is the basic principle about touching other objects in the OR?

Back 18

- sterile touches sterile
- unsterile touches unsterile

Front 19

How far must one stand to maintain sterility with a sterile field?

Back 19

- 1 foot from sterile field

Front 20

The best time to set up sterile field is?

Back 20

- as close to its time of use

Front 21

What are early signs for malignant hyperthermia? later signs?

Back 21

- tachycardia
- generalized musle rigidity

- SNS - ventrc dys --> hypotension --> dec CO --> cardiac arrest
- rise in temp is late sign, rises rapdily

Front 22

What is done when symptoms of Malignant hyperthermia is recognized?

Back 22

- D/C anesthesia
- anesthesia and surgery postpomed
- (unless dantrolene sodium is availbale)

Front 23

rare muscle disorder that is chmeically induced by anesthetic agents. characterized by tachycardia and muscle rigidity

Back 23

malignant hyperthermia

Front 24

What is malignant hyperthermia?

Back 24

= genetic disorder in which anesthetics causes
- altered calcium function in skeletal muscle cells,
- hypermetabolic conditions
- hyperthermia

Front 25

How does a nurse check that a patient is breathing in the PACU?

Back 25

- place palm in front of nose to feel breathing
- movement of thorax and diaph does not always indicate breathing

Front 26

WHat is hypopharyngeal obstruction? how is it treated?

Back 26

= when jaw and tongue fall back under relaxed anesthetized state
- obstructs airway

- treated by tilting head back, pushing forward on the angle of the mandible
- pulls tongue forward and opens passages

Front 27

What action should one take if pt is vomiting?

Back 27

- turn patient on side to prevent aspiration
- collect vomitus in emesis basin

Front 28

How often should PACU nurse check pt?

Back 28

every 15 or more frequently as needed

Front 29

Pt. is experiencing nausea. what is primary nursing action?

Back 29

turn patient on side to prevent aspiration, asphyxiation, and death

Front 30

What is the aldrete score?

Back 30

Scoring system used to determine if patient is well enough to be discharged from PACU

8-10 = discharge from PACU
< or = 7 --> stay in PACU or transferred to ICU

Front 31

frequency of assessments 24 hours post surgery

Back 31

- VS every 15 min for first 1 hr
- every 30 min for next 2 hrs
- temp every 4 hours first 24 hours

Front 32

What are surgical drains used for?

Back 32

= tubes from perisurgical area that drains fluid that would otherwise be used as a culture medium for bacteria
- may suction (closed) or into dressings (open)

Front 33

What are kinds of surgical drains?

Back 33

- penrose
- hemovac
- jackson - pratt

Front 34

In an open jackson-pratt, what is done to detect increases in drainage?

Back 34

- outline drainage with pen
- jackson pratt = drainage tube

Front 35

If hemovac drains blood, what should nurse do?

Back 35

- it depends. blood is normal drainage, but excessive amounts should be reported to surgeon
- increasing amts should be reported

Front 36

What should nurse do with wound dehiscence and evisceration?

Back 36

- instruct pt to lie in low fowler's position to minimize protrusion of bowels
- cover bowels with sterile dressings moistened with saline
- notify surgeon immediately

Front 37

What can nurse do to improve postoperative delirium?

Back 37

- reorient pt often
- introduce name often
- engage pt in coversation and activities
- place clock and calendar nearby may improve cognition
- make sure to maintain phys activ
- avoid restraints. it worsens confusion.

Front 38

Prolonged sitting

Back 38

should be avoided as it promotes venous stasis