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Med-Surg Nursing > Peri-Operative > Flashcards

Peri-Operative Flashcards

1
Q

What are the 3 phases of peri-operative?

A
  1. Preoperative
  2. Intraoperative
  3. Post operative
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2
Q

Important questions to ask during the pre-operative medical history interview and physical assessment.

A
  1. What is the proposed surgery?
  2. History of previous surgeries
  3. Co-morbidities, especially respiratory or cardiac related.
  4. Smoking history
  5. Height and weight
  6. Vital signs
  7. Mobility issues
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3
Q

Always ask if the patient has allergies to what 3 things?

A
  1. Foods
  2. Medications
  3. Latex
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4
Q

Lab tests to do for the pre-op patient.

A
  1. Blood studies (CBC, Electrolytes, Coagulation, PTINR)
  2. Urinanalysis
  3. EKG
  4. Chest Xray
  5. Blood type and cross match
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5
Q

When does discharge planning begin?

A

During the pre-op phase.

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6
Q

Patient education. What will you teach the patient?

A
  1. General orientation
  2. Complication prevention
  3. Pre-op preparation
  4. Post-op care
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7
Q

For what period of time should a patient be NPO before a procedure?

A

8 hours

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8
Q

Why is it recommended that a patient remain NPO before a surgery?

A

To prevent aspiration pneumonia.

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9
Q

Important aspects of post op care education

A
  1. TCDB (Turning, coughing, deep breathing)
  2. IS (Incentive spirometer)
  3. Early ambulation
  4. Moving in bed
  5. Anti-embolitic hose
  6. SCD (sequential compression devices)
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10
Q

When should post op education be done?

A

During the pre-op phase.

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11
Q

What are recommendations for the patient that smokes?

A
  1. Stop smoking 4-6 weeks before surgery.

2. Breathing exercises and use of incentive spirometer

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12
Q

What does informed consent mean?

A

That the physician presented the necessary information and that the patient understood the information and wasn’t forced to sign.

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13
Q

When should an informed consent be signed by the patient?

A

Before the procedure and when the patient is fully coherent.

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14
Q

In regards to informed consent, what is the RN responsible for?

A
  1. Verifying that consent is signed
  2. Verifying that consent was witnessed
  3. Verifying that information was presented to and understood by the patient
  4. Making consent part of the legal record prior to surgery.
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15
Q

In regards to informed consent what is the physician responsible for?

A
  1. Giving the information

2. Determining patient competence

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16
Q

What 6 elements does informed consent include?

A
  1. Name and qualifications of the surgeon
  2. Description of the surgery
  3. Risks/benefits/Probability of success
  4. Why surgery is indicated
  5. Consequences of nonsurgical intervention
  6. Any limits on confidentiality
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17
Q

What are the patients rights?

A
  1. To ask any questions

2. Withdrawal consent at any time

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18
Q

What are the requirements in an emergency?

A

Signatures of two physicians

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19
Q

6 item patient prep checklist

A
  1. NPO confirmation
  2. IV insertion. No smaller than 20 guage.
  3. NG tube placement if needed
  4. Skin prep
  5. Bowel prep if needed
  6. Pre-op meds if needed
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20
Q

When should you remove glasses from a patient?

A

They can keep them on until just before they go to sleep.

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21
Q

What items should you ask about that need to be removed?

A
  1. Glasses
  2. Jewelry (ask about body piercings)
  3. Dentures
  4. Hearing aids
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22
Q

What is the responsibility of the scrub person?

A

To prepare the sterile fields and provide the surgeon with the tools they need.

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23
Q

Who’s job description is this?
To protect patient safety, ensure the patient’s rights are protected, patient positioning, and to count the instruments with the scrub person post surgery.
Also emotional support for the patient and family.

A

The circulation nurse.

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24
Q

What 5 factors are taken into consideration when positioning a patient for surgery?

A
  1. The surgical site
  2. Access to airway
  3. Ability to take vital signs
  4. Patient comfort
  5. Safety
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25
Q

Who can administer anesthesia?

A

An anesthetist or a certified registered nurse anesthetist

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26
Q

3 types of general anesthesia.

A
  1. analgesia
  2. amnesia
  3. relaxation
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27
Q

4 types of anesthesia

A
  1. General
  2. Conscious sedation
  3. Regional
  4. Local
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28
Q

What 2 ways is general anesthesia administered?

A
  1. IV

2. Inhalation

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29
Q

What are the disadvantages of general anesthesia?

A
  1. Requires mechanical ventilation

2. Risk for death, MI, CVA, malignant hyperthermia

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30
Q

5 frequent side effects of general anesthesia

A
  1. Sore throat
  2. Nausea and vomiting
  3. Headache
  4. Shivering
  5. Confusion
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31
Q

What is conscious sedation?

A

IV analgesia without unconsciousness

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32
Q

What medication is often used for conscious sedation?

A

Midazolam (Versed)

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33
Q

What medication is used to reverse conscious sedation?

A

Flumazenil (Romazicon)

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34
Q

What are the advantages of conscious sedation?

A

Rapid recovery

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35
Q

What is a contraindication for conscious sedation?

A

Highly anxious patients

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36
Q

What is regional anesthesia (or spinal anesthesia) used for?

A

The lower extremities

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37
Q

What are 2 advantages of regional anesthesia?

A

Minimizes pulmonary and GI complications.

Quicker recovery time.

38
Q

Who administers local anesthesia?

A

Usually the surgeon.

39
Q

3 things used for wound closure

A
  1. Sutures
  2. Glue
  3. Skin Staples
40
Q

What are two types of sutures?

A
  1. Absorbable

2. Non-absorbable

41
Q

2 Benefits of skin staples for wound closure

A
  1. Reduced tissue trauma

2. Quicker to apply

42
Q

When are staples removed after a wound closure and with what?

A

7-10 days post-op with a staple remover

43
Q

What do you apply to an incision after staples are removed?

A

Steri-strips.

44
Q

What does PACU stand for?

A

Post Anesthesia Care Unit

45
Q

What is the priority when transporting the patient to the PACU?

A

Maintaining the airway.

46
Q

What should be included in the transfer report to the PACU nurse?

A
  1. Type and extent of surgery
  2. Type of anesthesia
  3. Dosage and times of meds given
  4. Estimated blood loss (EBL)
  5. Respiratory status
  6. Any complications
  7. Discharge plans
47
Q

3 things to assess for in PACU

A
  1. ABCs
  2. Hypoxia
  3. Respirations
48
Q

What might loud irregular respirations indicate?

A

An obstruction (e.g. secretions, emesis, the tongue)

49
Q

How do you know when its safe to give ice chips?

A

With return of the gag reflex.

50
Q

What will you monitor in regards to circulation in the PACU?

A
  1. EKG monitoring
  2. Pulse and blood pressure
  3. Inspect dressings for drainage
  4. Check under patient for bleeding
51
Q

What are signs of impaired tissue perfusion or shock?

A

Cold and clammy skin, cyanosis

52
Q

What are signs of hemorrhage?

A

Decreasing BP and increasing pulse

53
Q

What are the 8 criteria for discharge from an Ambulatory Care Surgical Center?

A
  1. Void
  2. Ambulate
  3. Be alert and oriented
  4. Have minimal nausea and vomiting
  5. Require no pain meds in the last hour
  6. Have no excess drainage or bleeding
  7. Have received discharge teaching
  8. Have a responsible person to accompany them home
54
Q

What are the 7 criteria for discharge from the PACU to a Surgical unit?

A
  1. Stable vital signs, including temperature
  2. Complications are absent or controlled
  3. Patent airway
  4. Control of bleeding/drainage
  5. Full (or almost full) recovery from anesthesia
  6. Oriented, able to request help
  7. Adequate fluid balance with urinary output
55
Q

What should the transfer report from the PACU nurse to the surgical unit nurse include?

A
  1. Type and extent of surgery
  2. Type of anesthesia
  3. Dosage and times of meds given
  4. Estimated blood loss (EBL)
  5. I/O in OR and PACU
  6. Any complications
  7. Discharge plans
56
Q

6 areas to assess for post surgical complications

A
  1. Respiratory
  2. Cardiac
  3. Gastrointestinal
  4. Genitourinary
  5. Hemorrhage/ Hypovolemia
  6. Surgical incision
57
Q

3 respiratory complications to look for

A
  1. Aspiration pneumonia
  2. Atelectasis
  3. Pulmonary embolus
58
Q

6 key respiratory assessments

A
  1. Breath sounds
  2. Cough, sputum
  3. Dyspnea
  4. Fever
  5. Labs: WBCs
  6. Oxygen saturation
59
Q

10 Nursing interventions to prevent respiratory complications

A
  1. NPO until GI motility and swallowing returns
  2. Suction as needed
  3. Encourage TCDB
  4. Encourage use of incentive spirometer
  5. Encourage ambulation
  6. Encourage moving in bed
  7. Leg exercises
  8. SCDs
  9. Ted hose
  10. Patient education
60
Q

4 Leg exercises

A
  1. Flexing and extending the feet
  2. Rotating their ankles
  3. Wiggling their toes
  4. Range of motion with knees and hips
61
Q

2 cardiac complications to be on the lookout for

A
  1. Thrombophlebitis

2. Embolus

62
Q

2 key cardiac assessments

A
  1. S/sx of pulmonary embolism

2. Extremities for color, temperature, pain, edema

63
Q

6 Nursing interventions to prevent cardiac complications

A
  1. Early, frequent patient ambulation
  2. Encourage leg exercises (no crossing legs)
  3. TED hose
  4. SCDs
  5. IV hydration
  6. Patient education
64
Q

Why should patients be discouraged from crossing their legs?

A

Crossing the legs creates a pressure point in which venous return isn’t effective which increases risk of developing a clot.

65
Q

4 GI complications to be on the lookout for.

A
  1. N/V
  2. Distention
  3. Constipation
  4. Ileus
66
Q

3 key GI assessments to prevent complications

A
  1. Bowel sounds
  2. Full abdominal assessment (look, listen, feel)
  3. N/V, retching
  4. Abdominal discomfort, bloating or pain
67
Q

6 Nursing interventions to prevent GI complications

A
  1. Maintain NPO
  2. Advance diet slowly
  3. Manage pain
  4. Encourage mobilization
  5. Encourage increase of fiber and fluids once eating
  6. Patient education
68
Q

When restarting intake, what should the patient be started on?

A

Small sips of water or ice chips

69
Q

3 GU complications to be on the lookout for.

A
  1. Renal failure
  2. Urinary retention
  3. UTI
70
Q

8 key GU assessments to prevent complications

A
  1. Urine output (minimum 30 mL/hr)
  2. BUN and creatinine levels
  3. Bladder distention
  4. Suprapubic pain
  5. Equal I/O. Output will be < Intake at first though
  6. Inability to void or small frequent voidings
  7. Hypertension
  8. Restlessness
71
Q

What is the absolute minimum urine output per hour?

A

30 mL/hr

72
Q

Nursing interventions for prevention of GU complications

A
  1. Monitor I/O
  2. Monitor lab values
  3. Monitor for s/sx of possible complications
  4. Catheterize PRN
  5. Aseptic technique for Cath insertion and peri care.
  6. Adequate hydration
  7. Patient education
73
Q

7 assessments to prevent hemorrhage or hypovolemia

A
  1. Dressings for drainage
  2. Drains for amount of drainage
  3. Increased pain, increased abd girth (which indicates internal bleeding)
  4. Tachycardia and hypotension
  5. Decreased urine output
  6. Thirst, dehydration
  7. Under patient for blood
74
Q

7 Nursing interventions for prevention of hemorrhage or hypovolemia

A
  1. Frequent monitoring of vital signs, dressings and drainage
  2. Foley catheter PRN to monitor I/O
  3. Identify causes of VS changes
  4. IVs as ordered
  5. Encourage oral intake when appropriate
  6. Administer blood/blood products
  7. Patient education
75
Q

8 classic signs of shock

A
  1. Pallor
  2. Cool, moist skin
  3. Tachypnea
  4. Circumoral cyanosis (cyanosis around the mouth)
  5. Rapid, weak, thready pulse
  6. Decreasing pulse pressure
  7. Low BP
  8. Concentrated urine
76
Q

3 complications of the surgical incision to be on the lookout for.

A
  1. Dehiscence (edges of incision separating)
  2. Evisceration (internal organs coming out)
  3. Wound infection
77
Q

5 key assessments for preventing complications of the surgical incision.

A
  1. Sensation of popping or tearing
  2. Intactness of incision
  3. Increasing swelling, redness, heat
  4. Fever
  5. Foul smelling drainage or change in color of drainage
78
Q

7 nursing interventions for prevention of surgical incision complications

A
  1. Appropriate skin prep in pre-op
  2. Monitor for s/sx of infection
  3. Inspect incision, drain sites and dressings for drainage and odor
  4. Hand hygiene (for patient too)
  5. Sterile saline for wound cleansing 48 hours post op
  6. Food and fluid intake
  7. Patient education
79
Q

4 things to do when dehiscence occurs.

A
  1. Maintain patient on bedrest
  2. Head of bed at 20 degrees, knees flexed
  3. Notify physician
  4. Abdominal binder to prevent evisceration
80
Q

4 things to do when evisceration occurs

A
  1. Immediately cover with sterile dressings or towels soaked in sterile saline
  2. Put patient back in bed/Keep patient on bedrest
  3. Notify physician
  4. Prepare patient for surgery
81
Q

5 nursing interventions for a confused patient

A
  1. Orient (or reorient them) to unfamiliar environment and people.
  2. Maintain safe/comfortable environment
  3. Monitor medications
  4. Promote increased visual and auditory input during waking hours
  5. Promote a quiet restful environment during hours set aside for sleep/rest
82
Q

3 things that might cause hypoglycemia in a diabetic patient during peri-op

A
  1. During anesthesia
  2. Inadequate CHO post op
  3. Excessive insulin administration
83
Q

2 things that might cause hyperglycemia in a diabetic patient during peri-op

A
  1. Stress of surgery or illness

2. Increased levels of hormones

84
Q

5 situations where you might see immunosuppression

A
  1. Corticosteroid therapy
  2. Organ transplant (due to anti-rejection drugs)
  3. Radiation therapy
  4. Chemotherapy
  5. Immune system disorders
85
Q

In a patient with immunosuppression, what vital sign must be acted on and the physician called with the slightest increase?

A

Temperature

86
Q

examples of immune system disorders

A
  1. Diabetes
  2. Scleroderma
  3. Lupus
  4. Rheumatoid arthritis
  5. Sarcoidosis
87
Q

What signs define malignant hyperthermia?

A

Temperature ≥ 105°F and muscle rigidity

88
Q

*What medication is the treatment for hyperthermia?

A

Dantrolene sodium (Dantrium)

89
Q

What part of anesthesia causes hyperthermia?

A

succinylcholine

90
Q

Discharge instructions should include these 7 items verbally as well as in written form.

A
  1. Dressing changes
  2. Effects of surgery
  3. Prescribed diet and activity (with rationale)
  4. S/sx of complications requiring followup
  5. Follow up appointments
  6. Lifestyle changes
  7. Community resources

Med-Surg Nursing (11 decks)

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