question

What is perioperative nursing?

answer

nursing that addresses the surgical experience

question

What is the preoperative checklist?

answer

1) nutritional and fluid status 2) drug and alcohol use 3) respiratory status 4) cardiovascular status 5) hepatic/renal function 6) endocrine function 7) immune function 8) previous and current medications

question

What is the 1st phase of perioperative nursing?

answer

Preoperative phase- the pd of time from the decision for surgery until the pt is transferred into the OR

question

What is the 2nd phase of perioperative nursing?

answer

Intraoperative phase- the pd of time from when the pt is transferred into the OR to the admission to PACU

question

What is the last phase of perioperative nursing?

answer

Postoperative phase- the pd of time that begins with the admission to the PACU and ends with follow-up evaluation in the clinical setting or home

question

What are the special considerations during the perioperative period?

answer

-elderly pts -obese pts -pts with disabilities -pts undergoing ambulatory surgery -pts undergoing emergency surgery

question

During the intraoperative phase, on what does the nurse focus?

answer

*safety vitals equipment

question

During the postop phase, on what does the nurse focus?

answer

complications DVT pain

question

What is it called when the pt has control over their pain?

answer

PCA pump

question

What position helps with diaphragmatic breathing and splinting when coughing?

answer

high or semi-Fowlers

question

What nutrients are important for wound healing?

answer

protein amino acids carbs and fats water Vitamins A,B,C, and K Magnesium Copper and Zinc

question

What medications can affect surgery?

answer

corticosteroids diuretics tranquilizers insulin antibiotics anticoagulants anti-seizure medications thyroid meds opoids

question

General preop nursing interventions

answer

-pt teaching (mobility, coughing, incentive spirometer) -psychosocial- reducing anxiety and fear -safety -managing nutrition and fluids -bowel prep -skin prep

question

What paperwork goes with the pt to the OR?

answer

-surgical consent form -preop checklist -lab reports -any last-minute observations that may have a bearing on anesthesia or surgery

question

What are the expected outcomes in the preop phase of care?

answer

-relief of anxiety and fear -understanding the surgical intervention -no evidence of preop complications

question

Use of herbal products should be discontinued how long before surgery?

answer

2-3 weeks

question

What are the IMMEDIATE preop nursing interventions?

answer

-administering preanesthetic medication -maintaining the preoperative record -transporting the patient to the presurgical area -attending to family needs

question

Anesthesia

answer

Agent that produces states such as loss of consciousness, analgesia, relaxation, and loss of reflexes.

question

Atelectasis

answer

Incomplete expansion or collapse of a part of the lungs.

question

Deep Vein Thrombosis (DVT)

answer

Formation of a blood clot ("thrombus") in a deep vein.

question

Elective Surgery

answer

Surgery that is recommended but can be omitted or delayed without catastrophe.

question

Embolus

answer

Blood clot, foreign body, or air in the circulatory system, plural form is emboli.

question

Emergency Surgery

answer

Surgery that must be performed immediately to save the person's life or a body organ.

question

Hemorrhage

answer

Excessive blood loss due to escape of blood from blood vessels.

question

Hypothermia

answer

Low body temperature.

question

Moderate Sedation/Analgesia

answer

Conscious sedation or procedural sedation. Used for short term and minimally invasive procedures.

question

Optional Surgery

answer

Surgery that is not critical to survival or function.

question

Peri-operative Nursing

answer

Wide variety of nursing activities carried out before, during, and after surgery.

question

Peri-operative Period

answer

Three phases of peri-operative patient care including the preoperative, intraoperative, postoperative phases.

question

Pneumonia

answer

Inflammation or infection of the lungs.

question

Shock

answer

Body's reaction to acute peripheral circulatory failure due to an abnormality of circulatory control or to a loss of circulating fluid.

question

Thrombophlebitis

answer

Inflammation of a vein associated with thrombus formation.

question

Urgent Surgery

answer

Surgery that is not an emergency, but must be done within a reasonable short time frame to preserve health.

question

When does the preoperative phase begin?

answer

When the patient and surgeon mutually decide that surgery is necessary and will take place. It ends when the patient is transferred to the operating room (OR) or procedural bed.

question

When does the intraoperative phase begin?

answer

Beginning when the patient is transferred to the OR bed, also called a table, until transfer to the postoperative recovery area.

question

When does the postoperative phase begin?

answer

Lasting from admission tot he recovery area to complete recovery from surgery and the last follow up physician visit.

question

Diagnostic Surgery

answer

To make or confirm a diagnosis. e.g., breast biopsy.

question

Ablative Surgery

answer

To remove a diseased body part. e.g., Appendectomy.

question

Palliative Surgery

answer

To relieve or reduce intensity of an illness; is not curative. e.g., Colostomy.

question

Reconstructive Surgery

answer

To restore function to traumatized or malfunctioning tissue. To improve self-concept. e.g., Plastic Surgery.

question

Transplantation Surgery

answer

To replace organs or structures that are diseased or malfunctioning. e.g., Kidney.

question

Constructive Surgery

answer

To restore function in congenital abnormalities. e.g., Cleft palate repair.

question

General Anesthesia

answer

Involves the administration of drugs by the inhalation or intravenous (IV) route to produce central nervous system depression.

question

Desired outcomes of General Anesthesia:

answer

Loss of consciousness, analgesia, relaxed skeletal muscles, and depressed reflexes.

question

What are the three phases of General Anesthesia?

answer

Induction, maintenance, and emergence.

question

Induction Phase

answer

Begins with administration of the anesthetic agent and continues until the patient is ready for the incision.

question

Maintenance Phase

answer

Continues from this point until near the completion of the procedure.

question

Emergence Phase

answer

Starts as the patient begins to awake from the altered state induced by the anesthesia and usually ends when the patient is ready to leave the OR.

question

Regional Anesthesia

answer

Occurs when an anesthetic agent is injected nerve or nerve pathway in or around the operative site, inhibiting the transmission of sensory stimuli to central nervous system receptors.

question

Nerve Block

answer

Accomplished by injecting a local anesthetic around a nerve trunk supplying the area of surgery such as the jaw, face, and extremities.

question

Spinal Anesthesia

answer

Achieved by injecting a local anesthetic into the subarachnoid space through a lumbar puncture causing sensory, motor, and autonomtic blockage. e.g., lower abdomen, perineum, and legs. Hypotension, headache and urine retention may occur.

question

Caudal Anesthesia

answer

The injection of the local anesthetic into the epidural space through the caudal canal in the sacrum; it may be used for procedures on the lower extremities or perineum.

question

Epidural Anesthesia

answer

Involves the injection of anesthetic through the intervertebral spaces, usually in the lumbar region (although it may be used in the thoracic or cervical regions). It is used for surgeries in the arms, shoulders, thorax, abdomen, pelvis and legs.

question

Topical Anesthesia

answer

Used on mucous membranes, open skin surfaces, wounds, and burns. lidocaine and bupivicaine. May be sprayed, spread, or applied with a compress of drug saturated gauze or cottontipped applicators.

question

Local Anesthesia

answer

Injection of an anesthetic agent such as lidocaine, bupivicaine, or tetracaine to a specific area of the body. It is administered by the surgeon in minor, short term surgical or diagnostic procedures such as tissue biopsy.

question

What should the patient be aware of by the procedural physician:

answer

-informed consent/advanced directives -description of the procedure, along with potential alternative therapies. -underlying disease process and its natural course -name and qualifications of the person performing the procedure or treatment -explanation of the risks involved, including risk for damage, disfigurement, or death, and how often they occur -explanation that the patient has the right to refuse treatment and that consent can be withdrawn -explanation of expected outcome, recovery, and rehabilitation plan and course.

question

What does assessment involve in preoperative care?

answer

-obtaining a health history and performing a physical assessment to establish a baseline data base -identifying risk factors and allergies that could pose surgical complications -identifying medications and treatments the patient is currently receiving -determining the teaching and psychosocial needs of the patient and family -determining post-surgical support and referral needs for recovery.

question

What are diseases and associated risk for surgery?

answer

Cardiovascular diseases - inc risk for hemorrhage and hypovolemic shock, hypotension, venous stasis, thrombophelmbitis, and overhydration with IV fluids. Respiratory disorders - inc risk for respiratory depression from anesthesia as well as postop pneumonia, atelectasis and alterations in acid-base balance. Kidney and liver diseases influence the patients response to anesthesia, affect fluid and electrolyte as well as acid-base balance, alter the metabolism, and excretion of drugs, and impair wound healing. Endocrine diseases- inc risk for hypoglycemia or acidosis -slow wound healing and present an increased risk for postoperative cardiovascular complications.

question

What are medications that can create a surgical risk?

answer

Anticoagulants - may precipitate hemorrhage diuretics - may cause electrolyte imbalances with resulting respiratory depression from anesthesia, tranquilizers - may increase the hypotensive effect of anesthetic agents, adrenal steroids - abrupt withdrawal may cause cardiovascular collapse in long term use. Antibiotics in the mycin group when combined with certain muscle relaxants used during surgery, may cause respiratory paralysis. Oral antidiabetic meds such as metformin hydrochloride may react with radiologic iodinized contrast dyes, and cause acute renal failure.

question

What information do you assess in a health history?

answer

Developmental considerations, medical history, medications, previous surgeries, nutritional status, use of alcohol, illicit drugs, or nicotine, activities of daily living and occupation, coping patterns and support systems, sociocultural needs.

question

How do you prepare the patient psychologically through teaching about surgery?

answer

Teach about surgical events and sensations, teach about pain management, teaching about physical activities.

question

What physical activities does the patient need to be taught?

answer

Deep breathing, coughing, incentive spirometry, leg exercises, turning in bed.

question

What is the function of deep breathing post-operatively?

answer

During surgery the cough reflex is suppressed, mucus accumulates in the tracheobronchial passageways and the lungs do not ventilate fully. After surgery, respirations often are less effective as a result of the anesthesia, pain medications, and pain from the incision. Alveoli do not inflate and may collapse, and secretions are retained, increases the risk for atelectasis and respiratory infection. Deep-breathing exercises hyperventilate the alveoli and prevent them from collapsing again, improve lung expansion and volume, and help to expel anesthetic gases and mucus, and faciliate oxygenation of tissues.

question

What is the function of coughing post-operatively?

answer

Coughing helps remove retained mucus from the respiratory tract and usually is taught in conjunction with deep-breathing. Especially important for patient at risk for respiratory complications. Splinting should be taught along with coughing.

question

What is the function of Incentive Spirometry?

answer

The device helps to increase lung volume and inflation of alveoli and facilitates venous return. A gauge on the incentive spirometry device allows the patient to measure his or her progress and provides immediate positive reinforcement for the breathing effors.

question

What is the function of leg exercises post-operatively?

answer

During surgery, venous blood return from the legs slows; in addition, some surgical positions, such as having the legs elevated in the lithotomy position decrease venous return. With circulatory stasis in the legs, thrombophlebitis and resultant emboli are potential complications. Leg exercises increase venous return through flexion and contraction of the quadriceps and gastrocnemious. Leg exercises must be individualized to patient needs, physical conditions, physician preferences, and agency protocol.

question

What is the function of turning in bed post-operatively?

answer

Improved venous return, respiratory function, and intestinal peristalsis and prevents the unrelieved skin pressure that would occur if the patient were to remain in only one position.

question

What are deep-breathing teaching techniques?

answer

Place the patient in semi-fowlers position with the neck and shoulders supported. Ask the patient to place the hands over the rib cage, so he or she can feel the chest rise as the lungs expand. Ask the patient to exhale gently and completely, inhale through the nose gently and completely, hold his or her breath for 3 - 5 seconds and mentally count. Exhale as completely as possible through the mouth with pursed lips, repeat 3 times. Should be done q 1 - 2 hours for first 24 hours post-operatively.

question

What are effective coughing teaching techniques?

answer

Place the patient in semi-fowlers position, leaning forward. Provide a pillow or folded bath blanket to use in splinting incision. Ask the patient to inhale and exhale deeply and slowly through the nose three times, take a deep breath and hold if for three seconds, hack out for three short breathes, cough deeply once or twice, taken another deep breathe. Repeat q 2 hr.

question

How long does it take for peristalsis to return after GI surgery?

answer

24 - 48 hours after the bowel is handled.

question

What are the pre-operative patient care checks on the day of surgery?

answer

Check consents are signed, witnessed and correct, advanced directives, and patients chart. Gather needed equipment and supplies, perform hand hygiene. CHECK VITAL SIGNS. Notify of any changes. Provide hygiene and oral care. REMIND PT OF FOOD AND FLUID RESTRICTIONS. Instruct pt to remove all personal clothing. Ask pt to remove all cosmetics, jewelry etc. Give valuables to family member or hospital safe. HAVE PT EMPTY BLADDER. Attend to any pre-operative orders. Complete pre-op checklist. ADMIN PRE-OP MEDS AS PRESCRIBED. Raise side rails, place bed in lowest position. Instruct pt to remain in bed. Help transport pt. Tell family of pt where pt will be taken after surgery and location of waiting room. Prepare room with post-op bed for pt. Anticipate any necessary equipment.

question

What is the average PACU stay?

answer

1 hour.

question

What is immediately assessed post-operatively?

answer

Respiratory status, cardiovascular status, CNS status, fluid status, wound status, pain management and general condition.

question

What are the steps in conscious return?

answer

1. unconciousness, 2. response to touch and sounds, 3. drowsiness, 4. awake but not oriented, 5. awake and oriented.

question

What factors are assessed individually post-operatively?

answer

Vital signs and oxygen saturation, color and temperature of skin, LOC, IV, surgical site, other tubes, comfort, position and safety.

question

How do you promote post-operative rest and comfort with Nausea and Vomiting?

answer

Avoid giving pt large fluids or fluid at one time, esp after being NPO. Admin prescribe meds. Provide oral hygiene, as needed. Maintain clean environment. Avoid use of a straw. Avoid strong-smelling foods. Assess for possible allergy to meds, such as antibiotics or analgesics. Maintain bowel elimination.

question

How do you promote post-operative rest and comfort with Surgical Pain?

answer

Assess pain frequently, admin prescribed analgesics q 2 - 4 hours or reg schedule during the first 24 - 36 hours. Reinforce preoperative teaching for pain management. Offer nonpharmacologic measures to supplement meds: massage, position changes, relaxation, guided imagery, meditation, music.

question

How often do you do VS post-operatively?

answer

q 15 min for -------, q -------------, q 1 hour next 4 hours, then every 4 hours. (need to double check)

question

how long will it take for someone who abuses alcohol or drugs to have DT's (delirium tremors)

answer

72 hours

question

In regards, to respiratory status, when do we want someone to stop smoking prior to surgery

answer

2 months is requested; but definitely 24 hours

question

What is the most important role of a scrub nurse/circulating nurse

answer

to make sure all of the instruments and sponges are accounted for before closing a patient up

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