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Semester Two - Nursing 112 > Perioperative #1 > Flashcards

Flashcards in Perioperative #1 Deck (85)
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1
Q

Types of clients at risk for developing a latex allergy

A

health care workers, children with spina bifida or congenital urological abnormalities, people who have multiple surgeries, workers in jobs that regularly require latex glove use, workers in industries that manufacture latex, frequently people with latex allergy are cross reactive to certain foods such as bananas, kiwi fruit, avocados, chestnuts, potatoes, tomatoes, hazelnuts, peaches, grapes, apricots

2
Q

Assessment of pt who is latex-sensitive

A

latex allergy questionnaire - ever had a reaction, allergy-related disorders such as asthma, contact dermatitis, autoimmune disease, drug or food reactions, had frequent surgeries, extensive dental work, or occupational exposure to latex, use both latex and natural rubber when asking the client about possible allergic reactions

3
Q

Strategies recommended for safeguarding hospitalized clients with latex allegies

A

private room, natural latex rubber items removed, cover and avoid use wall-mount BP devices, wipe down bed and contact surfaces to remove residual glove powders, place latex-sensitive labels above client’s bed, on room door, and on client non latex arm band, keep latex safe cart in client room/hall, maintain latex safe environment, keep all latex products out of area, substitute latex-free injection port caps for those containing latex, use silicone-coated urinary catheters, use latex-free pharmacy protocol for medications, use latex-free syringe plungers

4
Q

Common psychological responses which commonly occur in the preoperative phase

A

anxiety, fear, concerns with the unknown, concerns with body image, knowledge deficits

5
Q

Nursing Diagnoses for the client in the preoperative phase

A

deficient knowledge r/t:

  • lack of education about the perioperative process
  • lack of exposure to the specific perioperative experience

Anxiety r/t

  • effects of surgery on ability to function in usual roles
  • outcomes of exploratory surgery for malignancy
  • risk of death
  • loss of control during anesthesia or waking during
  • perceived inadequate post-op analgesia
  • change in health status/body image

Disturbed Sleep Pattern r/t

  • hospital routines
  • psychological stress

Grieving r/t
-perceived loss of body part associated with planned surgery

Ineffective Coping r/t

  • conflicting values
  • unresolved past negative experience with surgery
  • lack of clear outcomes of surgery
6
Q

Outcomes for a client with actual/risk problems related to the preoperative phase

A
  • Information, including what will happen to the client, when, and what the client will experience, such as expected sensations and discomfort
  • Psychosocial support to reduce anxiety
  • The roles of the client and support people in preoperative preparation, the surgical procedure, and during the postoperative phase
  • Skills training which includes moving, deep breathing, coughing, splinting incisions with the hands or a pillow and using an incentive spirometer
7
Q

Clinical Assessment Immediate Post-anesthetic Phase

A

airway, oxygen sat, adequacy of ventilation, cardiovascular status, level of consciousness, presence of protective reflexes, activity & ability to move extremities, skin color, fluid status, condition of operative site, patency of and character and amount of drainage from catheters, tubes, and drains, discomfort, safety

8
Q

Nursing Diagnoses for client recovering from anesthesia

A
  • ineffective airway clearance
  • ineffective breathing pattern
  • impaired gas exchange
  • risk for aspiration
  • potential complication: hypoxemia
  • potential complication: pneumonia
  • potential complication: atelectasis
  • decreased cardiac output
  • deficient fluid volume
  • excess fluid volume
  • ineffective peripheral tissue perfusion
  • activity intolerance
  • potential complication: hypovolemic shock
  • potential complication: venous thromboembolism
  • disturbed sensory perception
  • risk for injury
  • acute confusion
  • impaired verbal communication
  • anxiety
  • ineffective coping
  • disturbed body image
  • fear
  • acute pain
9
Q

Three psychological factors to consider when preparing the client psychologically for surgery

A

anxiety, fear, hope

10
Q

nursing diagnoses for children experiencing surgery

A

risk for injury r/t surgical procedure, anesthesia, hypothermia, anxiety r/t separation from support system/unfamiliar environment, fear r/t unknown outcome of surgery, risk for fluid volume deficient r/t NPO status before of after surgery, loss of appetite, vomiting, risk for infection r/t surgical procedure

11
Q

When should the RN begin orientation explanations to the client during the client’s recovery from general anesthesia?

A

upon arrival in the PACU

12
Q

What assessment data suggests alteration in tissue perfusion?

A

pallor or cyanosis

13
Q

Preoperative Care

A

begins when the decision to have surgery is made and ends when the client is transferred to the operating room

14
Q

Intraoperative Care

A

begins when the client is transferred to the operating table and ends when the client is admitted to the postanesthesia care unit (PACU)

15
Q

Postoperative Care

A

begins with the admission of the client to postanesthesia care unit (PACU) and ends when healing is complete

16
Q

Preoperative Care ADPIE

A

A- Identification of client, assessment of client - identify baselines and risks
D- Identification of potential or actual health problems
P- Determine outcomes
I- Implementation of the TNIs for day of surgery preparation, begin postoperative
E- evaluate outcome attainment

17
Q

Nursing Activities for Intraoperative Phase

A
  • preparing client for induction of anesthesia
  • maintaining homeostasis and asepsis throughout the procedure
  • assisting surgeon and team members as needed by providing aseptic environment, hazard-free environment, supplies in a timely fashion
18
Q

Postoperative nursing activities

A
  • assessment for physical adaptation following anesthesia and surgical intervention
  • assist in orienting the client back to consciousness
  • provide continuity of information between nursing units about client progress and adaptation following surgical procedure
  • assessment vigilance, assess return to baseline, pain control
  • anticipate/prevent/reduce/treat complications
19
Q

Anesthesia

A

CNS is altered, depression of consciousness, relaxation of skeletal muscles, diminished or absent reflexes

20
Q

Priority Assessments Anesthesia

A

airway, breathing, circulation

21
Q

Regional Anesthesia

A

No loss of consciousness. Renders a specific portion of the body insensitive to pain

22
Q

Priority TNIs regional anesthesia

A

circulation, movement, sensation

23
Q

What are the types of regional anesthesia?

A

epidural, nerve block, spinal anesthesia, local, topical

24
Q

Moderate Sedation (conscious sedation)

A

minimally depressed level of consciousness with maintenance of the client’s protective airway reflexes. The primary goal of moderate sedation is to reduce to client’s airway and ability to respond appropriately to verbal commands with or without light tactile stimulation.

25
Q

Endotracheal tube

A

curved tube that is inserted through with the mouth or the nose and into the trachea with the guide of laryngoscope. It is inserted by a physician, anesthesiologist or a nurse with special preparation to perform endotracheal intubation. It prevents the tongue from falling back and prevents airway obstruction resulting from laryngospasm. it is used to administer oxygen by a mechanical ventilator and to suction secretions easily

26
Q

Oral Airway

A

it is a semicircular tube of plastic or rubber inserted into the back of the pharynx through the mouth. It is shaped to follow the contour of the mouth and upper resp. tract. it keeps the airway passage open and the tongue forward until the pharyngeal reflexes have returned. oral airway is removed as soon as the client begins to awaken and has regained coughing and swallowing reflexes or when the client starts pushing the device out with the tongue. at this point of recovery, the presence of an oral airway can be irritating and can stimulate vomiting and laryngospasm

27
Q

Ambu Bag (ventilating bag)

A

used to assist clients whose respirations have ceased. operator can compress bag at a rate that approximates normal respiratory rate 12-20 breaths per minute

28
Q

Laryngeal Mask Airway

A

alternative airway device used for anesthesia and airway support. it consists of an inflatable silicone mask and rubber connecting tube. it is inserted blindly into the pharynx, forming a low-pressure seal around the laryngeal inlet. it is used during elective surgical procedures where face masks are currently used or when tracheal intubation in not necessary. it does not protect the airway from effects of regurgitation and aspiration. contraindicated in clients which have not fasted or if fasting cannot be confirmed, morbidly obese clients, obstruction or abnormal lesions of the oropharynx

29
Q

laryngospasm

A

sudden spasm of vocal cords that partially or completely occludes laryngeal opening. occurs post-op from irritation caused by endotracheal tube or anesthetic gases. most likely to occur after removal or endotracheal tube.

30
Q

TNIs for laryngospasm

A

oxygen, positive pressure ventilation, IV muscle relaxant, lidocaine/corticosteroids

31
Q

Aspiration

A

inhaling of gastric contents into lungs

32
Q

Assessment data aspiration

A

tachypnea, bronchospasm, R distress, R failure, atelectasis, interstitial edema, crackles, decrease in O2 sat, alveolar hemorrhage

33
Q

Assessment data for laryngospasm

A

inspiratory stridor (crowing resp), sternal retraction, acute resp. distress

34
Q

TNIs aspiration

A

oxygen, cardiac support, antibiotics

35
Q

Goals of preoperative care

A
  • thoroughly asses client and identification of risks
  • minimize stressors and anxiety
  • prepare physically and psychologically
36
Q

Baseline Client Assessment

A
  • identification of needed care

- physical concerns and anxiety

37
Q

Informed Consent

A
  • client understand surgical procedure, risks involved and the alternative treatment option
  • sign informed consent; client must be competent, sound mind, understands the language and not be sedated
  • no preoperative medication is administered until informed consent is signed
38
Q

Time out

A

a safety check taken in the operating room before the surgery starts. verify correct patient, site, procedure, and hardware, positioning, availability of documents, diagnositc images, instruments, implants, and the need for preoperative antibiotics and other essential medications

39
Q

Hyperthermia

A

body temperature elevated above normal range. elevated body temp can be either fever or hyperthermia

40
Q

Malignant hyperthermia

A

can be caused by anesthesia. an inherited disease that causes a rapid rise in body temperature and severe muscle contractions when the affected person receives general anesthesia. NUR diag. is hyperthermia

41
Q

Risk for perioperative positioning injury

A

at risk for inadvertent anatomical and physical changes as a result of posture or equipment used during an invasive/surgical procedure. (injury related to pressure and friction when moving/positionning patients during a surgical procedure.)

42
Q

Postoperative exercises

A
  • diaphragmatic breathing to increase lung expansion
  • coughing and turning to improve oxygen delivery
  • leg exercises to decrease venous stasis and enhance venous return
43
Q

Types of leg exercises

A

food circles, quad setting, calf pumping, hip and knee movements

44
Q

Goals of postoperative phase

A
  • maintain client’s airway and circulation
  • recognize and manage complications
  • ensure client’s safety
  • stabilize vital signs
  • dissipate residual anesthesia
  • provide pain relief
  • provide reassurance
45
Q

Arrival in post anesthesia care unit

A
  • connect tubings
  • check IV fluids
  • VS every fifteen minutes until stable
46
Q

Proper positioning to maintain patent airway

A
  • supine considerations when required

- ideally in side lying position

47
Q

Supplemental oxygen protocols

A
  • pulse oximetry 92-98
  • oxygen until LOC returns
  • cough and deep breathe encouraged
  • vital signs and cardiac monitor
  • skin color, temp, and cap refill
48
Q

Comfort and Safety Post-op

A
  • evaluate LOC - reorientation as necessary

- oral airway and suction equipment as necessary

49
Q

Regional anesthesia post-op

A
  • CMS assessment critical
  • proper positioning of affected area
  • vasomotor tone – can lead to decreased blood pressure may require IV fluid bolus
  • bladder assessment critical
  • temp may feel cold (blankets)
  • Difficulty swallowing - mouth care critical
  • inspect surgical site (change dressing)
  • pain (may need pain medication as ordered, narcotics can cause resp. depression)
50
Q

Convalescent Phase

A
  • preparing for discharge
  • resources
  • teaching
51
Q

Convalescent Phase to do

A

set up room, position IV fluids, drainage tubes, immediate VS

52
Q

Convalescent Phase Assessment

A
  • void within 8 hours of surgery
  • I & O and VS critical - pain meds
  • surgical site
  • return of bowel sounds and flatus NPO until perisalsis returns then diet as tolerated
  • call light and side rails up, call before OOB
  • exercises
  • discharge preparation, teaching
53
Q

OSA (Obstructive sleep apnea) post-op patients

A
  • close monitoring- continuous pulse oximetry and/or cardiac monitoring 24 hours or until IV opioids D/C
  • CPAP
  • notify MD if less than 92%
54
Q

Circulating RN

A

pre-op, documentation, preparation, transfers, PACU reports

55
Q

Scrub nurse

A

in OR, counts instruments, records meds

56
Q

Surgeon

A

physician who performs the surgical procedure

57
Q

Surgeons Assistant

A

physician or RN

58
Q

Anesthesia care providor

A

anesthesiologist or nurse anesthetist

59
Q

What is the purpose of a surgical skin preparation?

A

To reduce to number of microorganisms available to migrate to the surgical wound.

60
Q

What is the RN’s role in informed consent for surgery?

A
  • Verifying that the client understands the consent form and its implications
  • Contacting the surgeon and explaining the need for additional information if the client is unclear about operative plans
  • The nurse may not obtain the patient’s signature on the consent form. The nurse can witness the patient’s signature on the consent form.
61
Q

What are the goals of the preoperative assessment?

A
  • determine the psychologic status of the client to undergo the proposed surgery
  • establish baseline data for comparison in the intraoperative and postoperative period
  • identify prescription medications, over the count medications and herbs that have been taken by the client that may affect the surgical outcome
  • identify if the results of all preoperative labortory and diagnostic tests are documented and communicated to appropriate personnel
  • identify cultural factors that may affect the surgical experience
62
Q

Urinalysis

A

renal studies, hydration, urinary tract infection and disease

63
Q

Chest X Ray

A

heart failure, pulmonary disorders and cardiac enlargement

64
Q

CBC Blood studies

A

Anemia, immune status, infection, RBC, Hgb, Hct important to oxygen carrying capacity of blood

65
Q

Serum Electrolytes

A

fluid and electrolyte status - metabolic status, renal function, diuretic side effects

66
Q

Electrocardiogram

A

identify cardiac disease and electrolyte abnormalities, dysrhythmias

67
Q

hCG

A

pregnancy

68
Q

What is the responsibility of the RN associated with laboratory testing prior to surgery?

A

obtain and evaluate the results of laboratory and diagnostic tests

69
Q

What does the preoperative CBC (blood studies) assess?

A

Immune status (anemia, infection)

70
Q

What does the preoperative chest x-ray assess?

A

pulmonary disorders, cardiac enlargement and heart failure

71
Q

NPO Clear liquids

A

2 HOURS

72
Q

NPO Breast Milk

A

4 hours

73
Q

NPO nonhuman milk, infant formula

A

6 hours

74
Q

NPO light meal

A

6 hours

75
Q

NPO regular or heavy meal

A

8+ hours

76
Q

What are two reasons that the client must void shortly before surgery?

A
  • involuntary elimination under anesthesia

- reduces possibility of urinary retention during early postop period

77
Q

What is the purpose of the nursing physical assessment prior to surgery?

A

identify risk factors and plan care to ensure patient safety

78
Q

Inpatient

A

same day admission, hospital

79
Q

ambulatory surgery

A

same day, outpatient, minimally invasive, operating time less than 2 hours, less than 24 hour post op stay

80
Q

p1 perioperative risk

A

healthy patient with no systemic disease

81
Q

p2 periop risk

A

mild systemic disease without functional limitations

82
Q

p3 periop risk

A

severe systemic disease that is an ongoing threat to life

83
Q

p4 periop risk

A

severe systemic disease associated with definite functional limitations

84
Q

p5 periop risk

A

patient unlikely to survive more than 24 hours with or without surgery

85
Q

p6 periop risk

A

brain dead, organs being removed for donor purposes

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