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Stack #182372
HCC 2008 Perioperative Nursing
| Question | Answer |
|---|---|
| Diagnostic surgery | done fore testing ex. biopsy of spot on lung |
| Palliative surgery | relieve pain/symptoms for comfort ex. lung tumor |
| Ablative surgery | remove something completely ex. hysterectomy or appendectomy |
| Constructive surgery | build something that was never there ex. child born without ear or nose |
| Transplant surgery | take one organ from one person and give to another ex. kidney transplant |
| Reconstructive surgery | fixing or rebuilding something that was already there |
| Emergency surgery | performed immediately to preserve function or life of client |
| Elective surgery | not immediately life threatening but ultimately could threaten life |
| preoperative phase is | before surgery |
| intraoperative phase is | during surgery |
| the postoperative phases 1-3 is | after surgery |
| Phase 1 of postop phase | immediate post op (PACU) |
| Phase 2 postop | Ambulatory center |
| Phase 3 postop | discharge from ambulatory |
| Major degree of risk | involves a high degree of risk to preserve life, restore function, remove or repair a body part e.g. hysterectomy, open heart surgery |
| Minor degree of risk | normally involves little risk to restore function correct deformities e.g. breast biopsy, D&C, cataract extraction |
| types of anesthesia | general, regional, topical and local, moderate sedation/analgesia |
| General anesthesia is given to produce | CNS depression |
| routes of general anesthesia | IV, rectal, inhalation, oral |
| induction phase of general anesthesia | administration of anesthetic agent |
| maintenance phase of general anesthesia | surgical anesthesia |
| emergence phase of general anesthesia | "wake up period" when surgery is over |
| Advantages of general anesthesia | can be used for children or adults of any age, provides complete muscle relaxation |
| Disadvantages of general anesthesia | depression of the respiratory system and circulatory systems. may cause post operative n/v difficulty regulating body temperature |
| regional anesthesia | anesthetic agent injected near nerve root of operative site, inhibits transmission of sensory stimuli |
| Regional injection of regional anesthesia | peripheral nerve block, intravenous regional (Beir block), caudal and epidural anesthesia, spinal anesthesia |
| Local application of regional anesthesia | injection of local anesthetic around a specific group of nerves e.g. brachial plexus or retrobulbar block |
| Topical application of regional anesthesia | applied directly to the skin e.g. EMLA cream (Euteric mixture of local anesthesia) |
| Spinal anesthesia | local injection of anesthetic agent into the subarachnoid space via the lumbar puncture |
| Epidural anesthesia | injection of anesthetic agent into the epidural space outside of the dura mater |
| Complications of Spinal Anesthesia/Epidural | hypotension, headache, urinary retention |
| Treatment of complications of Spinal Anesthesia/Epidural | fluids, flat without pillow for several hours, analgesic, blood patch |
| Moderate Sedation/ Analgesia is usually given ... client maintains the ability to | intravenous route by an anesthesiologist or a trained nurse ... maintain airway, retain protective reflexes and respond appropriately to verbal commands |
| Nursing Implications for Analgesia/Sedation | Knowledge of drugs, monitor for RR, B/P, pulse, LOC, oxygen saturation, skin color, return of GAG reflex |
| Informed Consent | agreement by a client to accept a course of treatment or procedure after being given complete information, must include benefits and risks and alternative to treatment, must be obtained by the person who is performing the surgery, nurse witness signature |
| preoperative Assessment should include | Lifestyle: nutrition, use of alcohol, ADLs- exercise/sleep and rest, occupation, coping patterns |
| Coping Patterns/Support | fear of the unknown, encourage questions, refer to the surgeon, provide accurate information, fear of body image/self concept, mutilation, listen to patients fears with a non-judgmental attitude , fear of pain of death, notify the physician |
| Preoperative physical assessment | general survey, height/weight, status of skin, respiratory system, cardiovascular system, abdominal system, neurological system, musculoskeletal system |
| Lab Data and Diagnostic Screening tests preop | Chest x-ray, electrocardiogram(EKG/ECG), complete blood count (CBC), U/A, urine creatinine, electrolytes, PT,PTT(coagulation studies), type and cross match, liver functions(Diagnosis) |
| Specifics to include in pre-op teaching Implementing | deep-breathing exercises, coughing/incentive spirometer, turing, time in the PACU, leg exercises, PCA pump |
| Nutrition for pre-op patient, days prior to surgery | nutritious foods high in protein, vitamins B12, C, iron, and folic acid-TPN if NPO----eve of surgery NPO, IVFs |
| Elimination preoperative | cleansing enemas, laxative-go-lightly, phospo-soda, Antibiotics-prophylactic |
| Hygiene and skin preop | shower with dermatologic, disinfectant or antimicrobial soap, shaving(operating room) |
| Immediate Pre-op care Day of surgery | hospitol gown and cap, no hairpins, jewlery or nail polish, secure valuables, remove dentures and partials, have patient void and record I&O, PO meds, antihypertensives, give and record pre-op meds, leave hearing aid in last action -transfer note |
| Preoperative medications | goal: relieve anxiety, provide sedation, induce amnesia. Decrease respiratory secretions, decrease amount of anesthesia, decrease N/V, decrease pain |
| adjunct to anesthesia | anti-anxiety agents, sedatives- hypnotics, neuromuscular blocking agents, anticholinergics, opioid analgesics, antiemetics |
| Sedatives/Hypnotics examples, action/use, Side effects, and N/I | ex: Valium, versed, Ativan, action: alleviate anxiety, facilitate anesthesia induction, decrease recall or events related o sugery, provide sedation, S/E: drowsiness-slurred speech, resp depression, hypotension N/I: Safety |
| Anticholinergics examples, action/use, Side effects, and N/I | ex: Atropine, Robinul, action: decreases secretions, prevent bradycardia, prevent aspiration, prevent laryngospasm, S/E: dry mouth, dialatied pupils, blurred vison N/I: V/S, use cautiously in pts with glaucoma |
| Narcotic and OPIOID Analgesics examples, action/use, Side effects, and N/I | ex: Morphine, Meperidine; action: decrease the amount of anesthetic agent, facilitates sedation and relaxation, relieves pain; S/E: sedation, euphoria, hypotension, N/V, dizziness constipation, respiratory depression |
| Neuroleptic/Antiemetic Agents examples, action/use, Side effects, and N/I | ex: Inapsine(antiemetic); action: anxiolytic, increase effects of opiate analgesics, tranquilization, side effects, CNS depression, hypotension, drowsiness, tachycardia; N/I: have narcan available, monitor vital signs |
| Role of scrub nurse or technician | maintain surgical asepsis while draping patient and handling instrument and supplies |
| role of circulating nurse | assists scrub nurse and surgeon, help with positioning, arrange lighting and obtain needed supplies |
| Post-op nursing care includes | transporting the patient to the PACU and patient saftey |
| immediate post op nursing assessment should include | Loc, pulse Ox, V/S Q 5-15 minutes, IVs, wounds, pain, drains, general condition, catheter, ability to move extremities, N&V, cardiac and respiratory status |
| Goal of care in the PACU is | ventilation support |
| Criteria for discharge from the PACU | eveidence of good pulmonary exchange, urinary output>30 CC/HR*, N/V, pain under control, stable V/S, oxygen saturation >95%, patient orientation x 3 |
| responsibility of floor nurse post op | oxygen bed:high, clean linen, PAD(CHUX), incentive spirometer, suction and drains, IV pump, TEDs and/or SCDs, pulse ox, BP cuff and thermometer, vital signs, head to toe physical exam, wound assessment, pain& last medicated, ivf drip&rate,check order, EBL |
| Assessment responsibilities of floor nurse | urinary output, drainage amount and type, extent or surgery, patient debility, location of surgical site, presence of drains, amount of drainage in drains |
| post operative complications | hemorrhage, shock, atelectasis and pneumonia, pulmonary embolism, deep vein thrombosis, urinary retention, urinary retention, wound infection, dehiscence evisceration |
| when discharging an ambulatory client give information on the following | bathing, diet, activity, medications, wound care, follow-up, must have ride home |
| when discharging an ambulatory client make sure they know to call the MD when there is | infection, bleeding, excessive pain, inability to tolerate fluids, temperature >101.1F |
| decision of anesthetic agent selected based on | patients health status, emotional stability, length of procedure, position during operation, surgical site |
| inhalation agents | mainstay of general anesthesia, volatile liquid at room temperature, administered via: mask, endotracheal tube, tracheostomy, laryngeal mask airway(LMA) |
| General intravenous Anesthetics are | fast acting, maybe used alone for brief procedures, produces rapid loss of consciousness, pleasant induction, short acting, induces sleep |
Created by:
jaed008
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