Perioperative Nursing Quiz 1

Front 1

What is a Perioperative Nurse?

Back 1

- A perioperative nurse is a nurse who provides patient care, manages, teaches, and studies the care of patients undergoing operative or other invasive procedures.

- Perioperative nurse is also a term used to describe the nursing functions in the total surgical experience of the patient: preoperative, intraoperative, and postoperative.

Front 2

What Does a Perioperative Nurse Do?

Back 2

-Provides specialized nursing care to patients before, during, and after their surgical and invasive procedures

-Help plan, implement, and evaluate treatment of the patient

- Acts as a patient advocate for patients undergoing surgical and invasive procedures

- Works closely with all members of the surgical team (Surgeon, anesthesiologist, surgical technologist, etc.)

Front 3

What is the goal of a perioperative nurse?

Back 3

Has one continuous goal: to provide a standard of excellence in the care of the client before, during, and after surgery.

Front 4

What is PNDS ?

Back 4

Perioperative Nursing Data Set. It is a nursing language which describes nursing process in the perioperative setting by utilizing four domains.

-The focus of perioperative nursing is on safe surgical outcomes.

-The role that the perioperative nurse plays follows the conceptual framework of the PNDS and the four identified domains.

Front 5

4 Domains of PNDS ?

Back 5

1) Safety

2) Physiologic Responses

3) Behavioral Responses: Patient and Family

4) Health System

Front 6

3 phases of Perioperative Nursing:

Back 6

1) Preoperative (Pre-Surgical Testing)

2) Intraoperative (Circulator/Scrub)

3) Postoperative (Post Anesthesia Care Unit PACU)

Front 7

what is Preoperative nursing?

Back 7

Takes place from the time the decision is made for surgical intervention to the transfer of the patient to the operating room.

Begins when the client is scheduled for surgery and ends at the time of transfer to the surgical suite

Front 8

What is Intraoperative Nursing

Back 8

Begins from the time the patient is received in the operating room until admitted to the recovery room.

Front 9

What is Postoperative Nursing

Back 9

Begins when the patient enters the Post Anesthsia Care Unit (PACU) and lasts through some degree of convalescence.


- This phase has two parts:

a) Recovery from anesthesia

b) Recovery from surgery

Front 10

What are the 5 types of Surgery ?

Back 10

1) Optional

2) Elective

3) Required

4) Urgent

5) Emergency

Front 11

What is Optional Surgery ?

Back 11

Surgery is scheduled completely at the preference of the patient (eg, cosmetic surgery

Front 12

What is Elective surgery?

Back 12

The approximate time for surgery is at the convenience of the patient; failure to have surgery is not catastrophic (eg, superficial cyst).

Front 13

What is Required surgery?

Back 13

The condition requires surgery within a few weeks (eg, eye cataract).

Front 14

What is Urgent surgery ?

Back 14

The surgical problem requires attention within 24 to 48 hours (eg, cancer ).

Front 15

What is Emergency surgery ?

Back 15

Situation requires immediate surgical attention without delay (eg, intestinal obstruction).

Front 16

Pre-Operative Teaching Consists of?

Back 16

1) Tubes, drains, additional vascular access (ie: IV)

2) Post-op procedures

3) Post-op exercises: breathing exercises, incentive spirometry, coughing & splinting, leg procedures and exercises

4) Early Ambulation

5) Range of Motion exercises (ROM)

6) Reinforce physician’s explanations and instructions

7) Discuss what to expect

8) Instruct in breathing and leg exercises

9) Demonstrate splinting of abdomen (if appropriate)

10) Explain rationale for frequent position changes

11) Discuss pain management

12) Discuss cognitive coping strategies: imagery, distraction

Front 17

Pre-op check list/ Preoperative Chart Review consists of?

Back 17

1) Surgical informed consent

2) Anesthesia informed consent

3) Blood transfusion consent

4) Site verification checklist

5) Lab results-report abnormal lab values

6) H&P (history & physical) present & signed

7) Current vital signs

8) Special Needs ie: bariatric equipment

Front 18

What info does OR Nurse gather in Assessment Phase of nursing process?

Back 18

1) procedure

2) medical and surgical history

3) medication history

4) allergies

5) Imparts information about perioperative course of events

6) planned procedure

7) post op pain management

8) wound healing

9) post op recovery/rehab

10) medication management

Front 19

In pre-Op phase what does the nurse assess?

Back 19

Lab Data

Blood tests

Urine tests (pregnancy?)

Chest x-ray

EKG

Front 20

In Planning phase what does nurse plan

Back 20

Correction of any abnormal labs

Blood donations

Bloodless surgery

Nutrition

Pain Management

Surgery Classes

Discharge planning

Front 21

What is nurse concerned about in Implementation phase ?

Back 21

Explain purpose of planned procedure

Asking questions

Adhering to NPO status

Stating understanding of preop preparations

Demonstrating correct use of exercises/techniques to prevent complications

Front 22

3 Stages of the Nursing Process that occurs in the Pre-Op Phase are?

Back 22

1) Assessment

2) Planning

3) Implementation

Front 23

2 stages of the nursing process that occurs in the IntraOperative Phase are?

Back 23

1) Intervention

2) Evaluation

Front 24

Interventions in the Intraoperative Phase consists of?

Back 24

Safety

Advocacy

Verification

Counting-instruments, sponges, needles

Front 25

Evaluation in the Intraoperative Phase consists of? (things u are doing in the intraoperative phase during surgery)

Back 25

Expected outcomes

Unexpected outcomes

Documentation

Informing Client & Family in surgical waiting room

Ongoing Updates by OR Team

Front 26

Nurses are responsible for managing 6 areas of risk during Intraoperative Nursing. They are?

Back 26

1) Risk of infection related to invasive procedure and exposure to pathogens.

2) Risk for injury related to positioning during surgery.

3) Risk of injury related to foreign objects inadvertently left in the wound.

4) Risk for injury related to chemical, physical, and electrical hazards.

5) Risk for impaired tissue integrity.

6) Risk for alteration in fluid and electrolyte balance related to abnormal blood loss and NPO status.

Front 27

Nurses are responsible for managing 7 areas of risk during Postoperative Nursing

Back 27

1) Risk for ineffective airway clearance.

2) Risk for ineffective breathing pattern.

3) Risk for aspiration.

4) Risk for decreased cardiac output

5) Risk for fluid volume deficit.

6) Risk for sensory/perceptual alterations.

7) Risk for injury and for altered thought processes.(bc of anesthesia)

Front 28

Nursing Diagnosis r/t to Perioperative Nursing

Back 28

Deficient knowledge r/t lack of exposure

Anxiety r/t threat of a change in health status or fear of unknown (biggie)

Disturbed sleep patterns r/t internal sensory alteration (illness & anxiety)

Ineffective coping r/t impending surgery

Disturbed body image r/t anticipated changes

Disabled family coping r/t temporary family disorganization and role changes

Powerlessness r/t health care environment, loss of independence and loss of control of one’s body

Risk for Infection

Ineffective airway clearance

Risk for impaired peripheral tissue perfusion

Acute pain

Front 29

Immediate Post-anesthesia Care Concerns for Intraoperative nurse before pt transfers to PACU are?

Back 29

Airway
Breathing
Circulation

Front 30

Postoperative RESPIRATORY Assessment Diagnosis

Back 30

Impaired gas exchange or impaired airway clearance

Risks: pneumonia, atelectasis

Front 31

PACU Interventions

Back 31

Turn & Position

Deep breathe & cough

Incentive spirometry

In-bed exercises

Ambulation

Front 32

What are the Physiologic responses that the perioperative nurse is concerned about pre & intraoperatively

Back 32

Tissue and wound perfusion

Normothermia

Fluid electrolyte and acid-base balances

Respiratory Status

Cardiac status

Neurological status

Front 33

Perioperative nurse concerned about Behavioral Aspect of Patient

Back 33

Psychosocial

Spiritual

OR nurse is the eyes/ears of the patient

Front 34

Desired Patient Outcomes

Back 34

1) Re-establishment of physiologic, psychosocial equilibrium

2) Alleviation of pain

3) Prevention of complications

Front 35

What are the Perioperative Practice Settings?

Back 35

Acute care hospitals

Main OR

Interventional Radiology

Cardiac Catherization Lab

Endoscopy Suite

Procedure Rooms

Ambulatory Surgery Center

Office-Based Surgery Center

Front 36

What is Ambulatory Surgery ?

Back 36

Surgical care performed under general, regional, or local anesthesia and involving fewer than 24 hours of hospitalization.
ie: plastic surgery, dermatology, GI surgery

Also known as same-day, one-day, outpatient, or short-stay surgery.

Cost containment, governmental changes, and technological advances have all promoted concept of ambulatory surgery.

Front 37

Department Team Members that Support the Perioperative team are?

Back 37

Materials management
Central sterile Processing
Pharmacy
Laboratory
Radiology
Pathology
Health Care Industry Representative

Front 38

WHo are the Surgical Team Members ?

Back 38

Surgeon

Anesthesiologist / Nurse Anesthetist

Registered Nurse

Scrub Person (RN/ST)

Surgical Assistant

MD

PA

RNFA (registered nurse first assistant)

Front 39

WHo are the STERILE Members of the Surgical Team

Back 39

1) Surgeon

2) First assistant (Physician, RN, PA) Directly assists surgeon, controls patient’s bleeding provides wound exposure and suturing, involved in care before, during, and after surgery. Requires additional education

3) Scrub nurse (RN, or surgical technologist who prepares and maintains integrity, safety, and efficiency of the sterile field throughout the operation).

-they don sterile gown, gloves

Front 40

Who are the Non Sterile Members of the Surgical Team ?

Back 40

1) Anesthesia provider: Anesthesiologist or
a Certified Registered Nurse Anesthetist
(CRNA)

2) Circulating nurse (Manages the individual operating room and care of the patient in the OR, Creates and maintains comfortable, safe environment, helps all team members work together works in the OR in the area outside the sterile field).

Front 41

Preoperative Initial Assessment I

Back 41

1) Develop a nursing history; this may be initiated in the health care provider’s office or be part of the inpatient record.

2) Obtain a signed informed consent form.

3) Explain what laboratory studies are needed and why.

4) Determine the following during initial assessment of

5) Assess the patient’s physical and psychological status: Calm or agitated? Overweight? Disabilities or limitations?

6) Clean or dirty? Allergies? Medications being taken?

7) Condition of teeth (dentures, caps, crowns)? Blood
pressure problems? Major illnesses? Other surgeries?

8) Seizures? Severe headaches? Smoker?

Front 42

Preoperative Initial Assessment II

Back 42

1) Begin health education regimen. Instructions to patient:
Notify health care provider and surgical unit immediately if you get a
cold, have a fever, or have any illness before date of surgery.

2) Arrive at specified time.

3) Do not ingest food or fluid from midnight previous to day of surgery.

4) Do not wear make-up or nail polish.

5) Wear comfortable, loose clothing and low-heeled shoes.

6) Leave valuables or jewelry at home.

7) Brush teeth in morning, rinse, but do not swallow liquid.

8) Shower the night before or day of surgery.

9) Have a responsible adult accompany you and drive you home—have
person stay with you for 24 hours after surgery.

Front 43

Important Things to Consider Preoperatively are?

Back 43

1) Stop ASA 7-10 days before surgery

2) Stop herbals 2-3 weeks before surgery

3) Encourage no smoking for 4-8 weeks before surgery; stop smoking at least 24 hours before surgery

4) Monitor immunocompromised patient closely for s/s of infection before surgery

5) Surgery contraindicated if acute renal problems

6) Control hypertension prior to surgery if possible

7) Obesity increases risk and severity of complications

Front 44

Preoperative Common Anxieties include?

Back 44

Fear of the unknown.

Fear of pain and discomfort.

Fear of mutilation and disfigurement.

Fear of anesthesia.

Fear of disruption of life patterns (separation from family and significant others; impact on sexual and financial situation).

Fear of death/not waking up.

Fear of not being in control.

Front 45

Common Preoperative Laboratory Tests
are?

Back 45

1) Hemoglobin and hematocrit (Hgb and Hct)

2) White blood cell count (WBC)

3) Blood typing and cross matching (screening)

4) Serum electrolytes

5) Prothrombin time (PT) and partial thromboplastin time (PTT)

6) Bilirubin

7) Liver enzymes

8) Urine analysis

9) Blood urea nitrogen (BUN) and creatinine

Front 46

Purposes of Preoperative Teaching are?

Back 46

To answer questions and concerns about surgery.

To ascertain client’s present knowledge of the intended surgery.

To ascertain the need or desire for additional information.

To provide information in a manner most conducive to learning.

Front 47

Pre-operative Teaching Include?

Back 47

Tubes, drains, additional vascular access

Post-op procedures

Post-op exercises: breathing exercises, incentive spirometry, coughing & splinting, leg procedures and exercises

Early Ambulation

Range of Motion exercises (ROM)

Reinforce physician’s explanations and instructions

Discuss what to expect

Demonstrate splinting of abdomen (if appropriate)

Explain rationale for frequent position changes

Discuss pain management

Discuss cognitive coping strategies

Front 48

General Pre-Operative Care

Back 48

Protect from injury

Manage nutrition and fluids
NPO

Prepare bowel (if appropriate)

Prepare skin (if appropriate)

Front 49

Immediate Pre-Operative Care

Back 49

Gown

Cap (braid long hair, no hairpins)

Remove dentures/plates

No jewelry

Void immediately before transport

Cover with bath blanket

Administer preanesthetic medication if ordered

Front 50

Preoperative Client Preparation include

Back 50

1) Clothing removed/don patient gown

2) Jewelry removed including body any piercing

3) Prosthesis: dentures, wigs, limbs

4) Aides: hearing, glasses, cane

5) Arm bands: identification, code status, blood bracelet, fall risk status bracelet

6) Misc: contact lenses, hairpins

7) Nail polish, artificial nails

8) Empty bladder

9) Pre-operative medications

10) Safe transfer to surgical suite

Front 51

Preoperative Chart Review/Pre-Op checklist includes

Back 51

1) Surgical informed consent

2) Anesthesia informed consent

3) Blood transfusion consent

4) Site verification checklist

5) Lab results-report abnormal lab values

6) H&P present & signed

7) Current vital signs

8) Send entire medical record (chart) to surgery with patient
Includes current MAR

9) Special Needs ie: bariatric patient, deafness

Front 52

Informed Consent
What is it?
Who does it?

Back 52

1) A legal form signed by the client and witnessed by another person that grants permission to the client’s physician to perform the procedure described by the physician.

2) It is the surgeon’s responsibility to explain the surgical procedure, alternatives, risks, and benefits. Purpose is to ensure the patient is not undergoing a procedure without informed consent. Helps protect from liability. Adults must be oriented and not under sedation in order to sign. May take a telephone consent. Consent is witnessed - that is a witness to the signature.

Front 53

Informed Consent is required When?

Back 53

1) Anesthesia is used.

2) Procedure is considered invasive.

3) Procedure is nonsurgical but has more than a slight risk of complications.

4) When radiation or cobalt therapy is used.

Front 54

Holding Area Responsibilities Include?

Back 54

1) Initiation of verification form

2) Pre-anesthesia medication if ordered

3) Foley catheter if ordered

Note: Entire peri-operative team should be involved in verification process (correct patient, correct site, etc)

Front 55

What are Family Needs for OR nurse to think about?

Back 55

Explain where to wait

Surgeon will talk to them after surgey

Never judge seriousness by length of time patient in surgery (keep family updated)

Prepare them for what they will see post-op

Explain post-op protocol and routines

Front 56

Psychosocial Assessment focus

Back 56

Cultural beliefs can influence a person’s perception of surgery.

Clients should be provided the opportunity to express their spiritual values and beliefs.

Front 57

Physiologic Assessment focus

Back 57

The outcome of surgical treatment is tremendously enhanced by accurate preoperative nursing assessment and careful preoperative preparation.

Information gathered through preoperative assessment and risk screening is later used for preparation of the surgical site, for surgical positioning, and as a comparative basis for postoperative assessments and complication screening.

Front 58

Psychological Condition & effects on OR Patient

Back 58

The psychological condition of a client can have a stronger influence than does the physical condition.

Encourage clients to express their feelings and fears about receiving anesthetic and having surgery.

Observe the client for nonverbal clues indicative of anxiety.

To reduce client anxiety, explain to client what will be happening throughout the surgical experience.

Front 59

Physical Preparation of OR Patient

Back 59

Identifying the client and verifying the operative procedure.

Preparing operative site.

Checking client’s vital signs.

Assisting in putting on hospital gown, cap, and, if ordered, compression hose.

Verifying allergies.

Verifying NPO (nothing by mouth) status.

Identifying any sensory deficits in the client.

Front 60

Variables Affecting Surgical Status are?

Back 60

Age

Nutritional status

Fluid and electrolyte status

Respiratory status

Medications

Cognition

Ethnicity

Language

Cardiovascular status

Renal and hepatic status

Neurological, musculoskeletal, and integumentary status

Endocrine and immunological status

Front 61

Considerations for the Elderly Include

Back 61

Increased risk for complications

Less physiologic reserves

Hazards. . . are proportional to the # and severity of co-existing health problems and the nature and duration of the operative procedure.

Front 62

Surgical Risk Factor-- Aging & Danger

Back 62

Recognize that reactions to injury are not as obvious and are slower in appearing.

Be aware that the cumulative effect of
medications is greater in the older person than it is in younger people.

Note that medications such as morphine and barbiturates in the usual dosages may cause confusion and disorientation; morphine may cause more noticeable respiratory depression than with the younger patient.

Front 63

Surgical Risk Factor (Therapeutic Approach- for the Elderly)

Back 63

Consider using lesser doses for desired effect.

Anticipate problems from chronic disorders such as anemia, obesity, diabetes, hypoproteinemia.

Adjust nutritional intake to conform to higher protein and vitamin needs.

When possible, cater to set patterns in older patients, such as sleeping and eating.

Front 64

Surgical Risk Factor (Obesity - Danger)

Back 64

Increases difficulty involved in technical aspects of
performing surgery (eg, sutures are difficult to tie because of fatty secretions); wound dehiscence is greater.
Increases likelihood of infection because of lessened resistance.
Increases postoperative pneumonia and other pulmonary complications because greatly obese patients chronically hypoventilate.
Increases demands on the heart, leading to cardiovascular compromise.
Increases possibility of renal, biliary, hepatic, and
endocrine disorders.
Decreases ability to conserve heat due to radiant heat loss.
Has altered response to many drugs and anesthetics.

Front 65

Surgical Risk Factor (Obesity Therapeutic Approach)

Back 65

Encourage weight reduction if time permits.
Anticipate postoperative obesity-related complications.
Be extremely vigilant for respiratory complications.
Carefully splint abdominal incisions when moving or coughing;

Be aware that some drugs should be dosed according to ideal body weight versus actual weight, or an overdose may occur (eg, digoxin [Lanoxin].
Avoid intramuscular injections in morbidly obese individuals (intravenous [IV] or subcutaneous routes preferred).
Never attempt to move an impaired patient without assistance or without using proper body mechanics.
Obtain dietary consultation early in patient’s postoperative course.

Front 66

Surgical Risk Factor ( Poor Nutrition - Danger)

Back 66

Preoperative malnutrition (especially protein and calorie deficits) greatly impairs wound healing.

Increases the risk of infection and shock.

Front 67

Surgical Risk Factor (Nutrition- Therapeutic Approach)

Back 67

Any recent (within 4–6 weeks) weight loss of 10% of patient’s normal body weight should alert health care staff to poor nutritional status.

Attempt to improve nutritional status before and after surgery. Unless contraindicated, provide diet high in proteins, calories, and vitamins (especially vitamins C and A); this may require enteral and parenteral feeding.

Recommend repair of dental caries and proper mouth hygiene to prevent respiratory tract infection

Front 68

Common Nursing Diagnoses for Perioperative Nursing

Back 68

Deficient knowledge r/t lack of exposure
Anxiety r/t threat of a change in health status or fear of unknown
Disturbed sleep patterns r/t internal sensory alteration (illness & anxiety)
Ineffective coping r/t impending surgery
Disturbed body image r/t anticipated changes
Disabled family coping r/t temporary family disorganization and role changes
Powerlessness r/t health care environment, loss of independence and loss of control of one’s body

Front 69

Perioperative Legal & Ethical Considerations are

Back 69

Advanced Directives
Informed Consent
Language Service
HIPPA
Patient Privacy
Patients Rights

Front 70

Universal Protocol
Pre-operative Verification: Identifying/Interviewing Patients

Back 70

Purpose: To ensure the effective and safe transition of the operative patient through the pre-operative phase, beginning with the physician’s office and concluding upon the patient’s arrival to the operating room suite.
Process: The continuous sharing of pertinent information to ensure appropriate verification of correct patient, correct procedure and correct site.

Front 71

Universal Protocol

Marking the Operative Site:

Back 71

Purpose: To identify the correct operative/procedure site.
Process: Clearly marking the surgical site to eliminate any ambiguity and ensure correct bilaterality/level, even once the patient is prepped and draped.

Front 72

Universal Protocol

“Time-out” Immediately Prior to Starting the Procedure

Back 72

Purpose: To prevent medical error by conducting a final verification of correct patient, procedure, and site.
Process: Active (two-way) communication among all surgical/procedural team members that is consistently preformed prior to all procedures.

Front 73

Communication of Relevant Patient Data

Back 73

Assessment information with relevance to intra- and postoperative care must be communicated to other members of the healthcare team. Continuity of care and appropriate therapeutic interventions cannot be assured without the communication of information. Joint commission implemented “Hand Off” communication

The nurse providing care to the patient in the perioperative period must provide appropriate handoff information to the nurse caring for the patient during the intraoperative period.