Ch 37 Perioperative Nursing – Flashcards

Operating room nurse" (old term) Involves care of the client Before surgery During surgery After surgery AORN Standards guide perioperative nursing practice

Surgical procedures can be classified By purpose: e.g., palliation By degree of urgency: e.g., elective By degree of risk

Age/personal habits/allergies Type of wound Preexisting conditions Mental status Medications

Complete Nursing history Health history Client knowledge/understanding of the surgery Physical assessment Focus on symptoms that indicate risk for surgery

Preoperative screening tests CBC Urinalysis ECG Surgical consent Confirm its presence

Complete preoperative teaching Discussion Printed materials Procedure Post-procedure process: home vs. hospitalization Turning, coughing, deep breathing

Preparing the client physically Assess NPO status Prepare skin: surgical scrub Bowel preparation Facilitate an empty bladder Administer preoperative medications Apply antiembolism stockings

Sterile team Clean team Anesthesia Skin preparation Positioning the client

Final verification of correct Client Procedure Site Sterile field Monitor I&O Sponge, sharps, and instrument count Documentation

Recovery from anesthesia Airway management Vital signs/level of consciousness Dressing assessment/drainage Fluid therapy Pain control

Initial physical assessment Frequent vital signs Dressing management Pain control DVT prevention - SCDs Incentive spirometry/ cough and deep breathing Early ambulation Client teaching

Define preoperative phase. Answer: The preoperative phase begins with the client's decision to have surgery and ends with the actual entry of the client into the operating room.

What are four ways surgeries may be classified? Answer: Surgeries may be classified in these four ways: ● By body system (e.g., gastrointestinal, gynecological, neurological) ● By purpose (e.g., ablative, diagnostic, palliative, reconstructive, cosmetic, transplant) ● By degree of urgency (e.g., elective, urgent, emergency) ● By degree of risk (i.e., major or minor

What factors affect surgical risk? Answer: Seven factors affect surgical risk: ● Age ● Type of wound (potential for infection) ● Preexisting conditions ● Mental status ● Medications ● Personal habits ● Allergies

List the information you should gather in the preoperative nursing history. Answer: Ten types of information are gathered in the preoperative assessment: ● Health history. Discuss current and chronic health problems and prior hospitalizations or surgeries. ● Physical status. Identify any mobility concerns, as well as whether hearing aids, glasses, or contact lenses are used to improve sensory perception. ● Allergies. Check allergies to medications, food, tape, soaps, latex, or other substances. ● Medications. Ask about prescribed medications as well as over-the-counter, herbal, and natural remedies. ● Mental status. Note whether the client is able to respond to questions and offer a health history. Is he oriented? Does he appear anxious? ● Knowledge and understanding of the surgery and anesthesia. Ask the client to explain in his own words the planned surgery and postoperative course. Reinforce accurate statements and correct misconceptions. ● Cultural and spiritual factors. Identify any practices or beliefs that bring comfort to the client. Discuss how you can integrate these practices into the client's surgical experience. ● Access to social resources. Identify the client's support network. Who is available to assist the client after surgery? Who does the client rely on? Are the members of the support system aware of the client's upcoming surgery and condition? ● Coping strategies. Have the client identify the strategies he uses to cope with stress. ● Use of alcohol and drugs. Inquire about the amount and frequency of alcohol use. Discuss the use of pain medications and recreational drugs. If the client uses these substances, identify the amount and frequency. Additional assessments may be needed if the client is undergoing outpatient surgery or has a planned short stay after surgery.

What type of physical assessment is performed as part of the preoperative assessment? Answer: Part of the preoperative assessment is a brief head-to-toe assessment. For concerns that have been identified in the nursing history, perform a focused assessment.

What laboratory tests are most commonly prescribed before surgery? Answer: Before surgery, the following lab tests are commonly prescribed: ● A complete blood count, urinalysis, and serum electrolytes (chemistry panel) ● An ECG (electrocardiogram) is often required for clients older than 50 years or with a history of cardiac problems ● Clients with chronic health problems may need additional testing. Some students may also refer to the tests listed in the Diagnostic Testing section in Chapter 37, Volume 2.

Who is responsible for obtaining informed consent for the surgical procedure? Answer: Before a surgical procedure can be performed, the surgeon is required by law to provide the necessary information and obtain the client's consent.

What are the nursing responsibilities with informed consent? Answer: Nurses are responsible for verifying that the surgical consent is signed and witnessed. Often you will obtain the signature and document this information on the preoperative checklist. If at any time you believe that the client does not understand the planned surgery or that he is not competent to consent, notify the surgeon and delay sending the client to the operative suite

identify topics that should be discussed in preoperative teaching. Answer: Preoperative teaching is focused on explaining what will happen before, during, and after surgery and how the client can participate in the care. Part of the teaching plan is also to discuss common feelings and concerns that clients have about surgery

● Describe the typical physical preparation of a client undergoing surgery. Answer: Typical physical preparation of a client undergoing surgery involves the following: ● Maintain NPO for 8 hours before surgery. ● Shower or scrub the surgical site with an antibacterial solution the evening before surgery and the morning of the surgery. ● Have the client void before receiving preoperative medications, including prophylactic antibiotics. ● Administer any prescribed preoperative medications. ● Review daily medications with the anesthesia team. ● Remove all artificial body parts, such as dentures, limbs, or contact lenses; wigs, eyeglasses, makeup, and jewelry must also be removed. ● Apply antiembolism stockings, if prescribed

Identify the intraoperative nursing roles that are part of the sterile intraoperative team and those that are part of the clean intraoperative team. Answer: Intraoperative nursing roles are as follows: ● The scrub nurse and registered nurse first assistant (RNFA) are part of the sterile intraoperative team. ● The circulating nurse is part of the clean intraoperative tea

Which nursing roles are always held by a registered nurse? Answer: The circulating nurse and RNFA must be registered nurses

What is the purpose of anesthesia? Answer: Anesthesia is used to obtain analgesia, muscle relaxation, and/or amnesia

● Under what type(s) of anesthesia does the client remain conscious? Answer: The client remains conscious in all types of anesthesia except general anesthesia

For what activities is the circulating nurse responsible in the OR prior to the skin incision? Answer: The circulating nurse is responsible for the following activities: ● Assessing the client in the holding area ● Developing relevant nursing diagnoses and a plan of care for the intraoperative phase of care ● Prepping the skin ● Positioning the client ● Ensuring client safety

Describe six intraoperative safety measures performed by the circulating nurse. Answer: The circulating nurse performs these six intraoperative safety measures: ● Assisting the scrub nurse to prepare and maintain the sterile field ● Providing supplies and materials during surgery ● Monitoring intake and output of the client ● Handling specimens ● Performing sponge, sharp, and instrument counts ● Documenting care and the client's response to care on the surgical record

What are the two phases of the postoperative phase of care? Answer: Postoperative care has these two parts: ● Recovery from anesthesia ● Recovery from surgery

What are the two phases of the postoperative phase of care? Answer: Postoperative care has these two parts: ● Recovery from anesthesia ● Recovery from surgery

what assessments are made? Answer: The following initial assessments are made in the PACU: ● Vital sign,including respiratory rate, respiratory competence, and breath sounds; cuff or arterial blood pressure; temperature and type of measurement used; pulse (apical and peripheral); and oxygen saturation ● Airway: patency, presence of artificial airway, mechanical ventilator settings ● Respiratory adequacy, including skin color and condition ● Peripheral circulation (postoperative tissue perfusion): for example, peripheral pulses and sensation at extremities ● Neurological status, including pupil response ● Mental status: level of consciousness, alertness, lucidity, orientation ● Patency of IV: location of sites and rates of solution(s) and/or blood products infusing ● Allergies and sensitivities ● Pain ● Motor abilities, including return of sensory and motor control in areas affected by local or regional anesthetics ● Skin integrity ● Temperature regulation ● Positioning ● Surgical incision site, including condition of suture line(s) if visible ● Condition of dressing(s) ● Type, patency, and amount of drainage from dressings, tubes, and catheters ● Nausea and vomiting ● Fluid and electrolyte balance ● Safety needs (e.g., siderails raised) ● Central venous pressure (CVP), arterial BP, pulmonary wedge pressure, and intracranial pressure (as indicated)

entify six potential postoperative complications. Answer: Six types of potential postoperative complications may occur: Respiratory system ● Aspiration pneumonia ● Atelectasis ● Pneumonia ● Pulmonary embolism Cardiovascular system ● Thrombophlebitis ● Embolus ● Hemorrhage ● Hypovolemia Gastrointestinal system ● Nausea and vomiting ● Abdominal distention (tympanites) ● Constipation ● Ileus Genitourinary system ● Renal failure ● Urinary retention ● Urinary tract infection Surgical incision ● Dehiscence ● Evisceration ● Wound infection

Why are sequential compression devices used? Answer: Sequential compression devices are used for clients at high risk for thrombophlebitis. They compress the veins, thereby promoting venous return to the heart and decreasing venous stasis.

Perioperative Phase A. Preoperative phase B. Intraoperative phase C. Postoperative phase Nursing activity 1. Patient teaching 2. Airway management 3. Frequent vital signs 4. Maintain sterile field 5. Obtain informed consent Answer: 1, A & C 2, A, B, & C 3, B & C 4, B 5, A

Answer: C. A 60-year-old man scheduled for a transurethral resection of the prostate (TURP) who smokes a pack of cigarettes a day and has labile hypertension. Rationale: This patient has three risk factors: age, smoker, and labile hypertension

Answer: B. Inform both the surgeon and the surgical team immediately. Rationale: It is the responsibility of the physician to explain the procedure to the patient and obtain informed consen

Answer: D. Assess NPO status. Rationale: If a patient having general anesthesia has not been NPO for the required length of time, the patient will be at high risk for vomiting and potential aspiration during surgery.

Answer: A. a patient having a general anesthetic may need postoperative nausea management. Rationale: Local anesthesia will not likely impair respiratory effort. A patient having spinal anesthesia will not be able to move his legs. A person having conscious sedation does require frequent vital sign measurements while sedated and recovering from the sedation.

Answer: False Rationale: It is a complication of general anesthesia

Answer: False Rationale: Recent literature indicates that preoperative shaving results in small nicks in the skin that may put the patient at risk for infection.

true