Week 2: Exemplar: Perioperative Care

what is preoperative care?

get patient ready to safely undergo surgery

what is intraperative care?

maintain patient safety during surgery like keep them breathing and pain free

what is postoperative care?

when patient recovers safely after surgery and returns to baseline

what are safety ways for preoperative phase?

• patient identification

• informed consent

• can the patient tolerate the procedure?

• NPO status

• medication list and plan-including herbs and supplements

what are physical assessments for preoperative phase?

• accurate health history (with medications)

• baseline vitals

• focused physical assessment

• prep prn such as skin cleaning

what are emotional assessments for preoperative phase?

• stress and coping

• plan for discharge

• cognitive abilities

what is the anticipatory care for preoperative care?

• concern with a medication

• allergy risk

• general patient health and stable status

• patient education including port-op pain management and expectations

what is PARQ?

• procedure

• alternatives

• risks

• questions

what’s a nurse’s role with informed consent?

ensure all questions have been addressed and verify patient’s signature

what is to look for in intraoperative phase?

• Continuous surveillance (nurse acts as the substitute for the senses temporarily lost by the patient during surgery)

• safety precautious (checklists)

• documentation

• surgical site prep (check for allergies)

what are emergence from anesthesia for postoperative phase?

• airway and breathing → gas exchange

• level of consciousness

• pain management

what is the recovery support for postoperative phase?

• pain management

• wound care

• early mobilization

• nutrition

• stress and coping

what to do for discharge for postoperative phase?

• education (moving and who to call if any issues)

• support system

• follow-up care

• PT/OT and other team members

what are some diversity considerations?

• interpreter may be needed

• religion ( blood transfusions and certain gender caregiver)

• cultural needs

• skin tones (can change: redness and pale)

what are postop safety problems?

falls

what are postop neurological problems?

pain

what are postop psychological problems?

• stress and coping

• self-image

what are postop cardiovascular problems?

• hemorrhage

• hypotension and shock (lack of blood flow/perfusion)

• deep vein thrombosis

what are postop respiratory problems?

• atelectasis and pneumonia

• hypoxia

• pulmonary embolism

what are postop gastrointestinal problems?

• nausea and vomiting

• constipation

• paralytic ileus (intestines are not moving)

what are postop genitourinary problems?

urinary retention

what are postop integumentary problems?

• wound infection

• wound dehiscence

• evisceration

what are local anesthetics?

numb you locally and are short term which means that doesn’t last long

what is the mechanism of local anesthetics?

block pain transmission in peripheral nerves

what are some nursing considerations for local anesthetics?

• what should you assess before/during/after giving?

• how do you know the medication worked?

• what patient education would you provide?

what is general anesthetics?

it numbs your whole body and puts you to sleep temporarily which is normally done for a procedure or surgery

what is the mechanism for general anesthetics?

enhance transmission at inhibitory synapses and inhibit transmission at excitatory synapses

what are the prototype drugs for general anesthetics?

propofol, fentanyl, and benzodiazepines

what does general anesthetics do?

• decreases:

  • pain

  • agitation and anxiety (relaxation)

  • alertness (hypnosis)

  • memory of event (amnesia)

  • reflexes (paralysis)

what to monitor for respiratory depression?

decreased RR, decreased SpO2, and cynosis

what is the response for respiratory depression?

oxygen (up the ladder of delivery methods), sternal rub, ambu bag, code blue, notify provider

what to monitor for spinal headaches?

onset of headaches, particularly when the patient is upright

what is the response for spinal headache?

notify provider, encourage hydration, anticipate orders to administer analgesics, anticipate orders for blood batch if conservative measures fail

what to monitor for postoperative nausea and vomiting (PONV)?

report of nausea and emesis

what is the response for PONV

administer antiemetics (ex. ondansteron), ensure hydration, provide comfort measures

what to monitor for malignant hyperthermia?

muscle rigidity and hyperthermia

what is the response of malignant hyperthermia?

hold triggering agents (anesthesia meds), notify provider, anticipate orders to administer dantrolene, and cool the patient