preoperative nursing!!

what is the nurses role?

client advocate, care provider, and care planner

what are some nursing diagnoses?

-risk for aspiration, ineffective airway

-pain

-altered tissue perfusion

-deficient fluid volume

-impaired tissue/skin integrity

subjective assessments?

client history, age, medications, and substance abuse. surgical history, psychosocial, religious and cultural

what are some common allergies to be aware of?

latex, povidone-iodine, and propofol

what are risk factors of a latex allergy?

history of asthma, spina bifida, daily exposure. allergy to avocados, strawberries, potatoes, bananas, kiwis, and chestnuts

mild symptoms of latex allergy?

itching and redness

moderate symptoms of latex allergy?

sneezy, watery eyes, scratchy throat

anaphylactic symptoms of latex allergy?

difficulty breathing, tachycardia, N/V, hypotension

what to look at for a systems review during subjective assessment?

cardiovascular, respiratory, renal disease, diabetes

what is the objective, baseline data?

head to toe so baselines and identify potential issues

cardiovascular objective assessment?

HR, B/P, palpate pulses, undiagnosed HTN

respiratory objective assessment?

rate, depth, lung sounds

renal objective assessment?

what is the color, clarity, and amount of urine. is there chronic fluid overload or dehydration

why is it important to check musculoskeletal for head to toe preop?

because it may affect post op ambulation

neurological objective assessment?

LoC, weakness, sight, hearing

integumentary objective assessment?

breakdown, bruises, wounds

GI/nutrition objective assessment?

obese and malnourishment.

what is the effect of surgery on nutrition?

increases metabolism. depletes K, vitamin B and C

psychosocial objective assessment?

anxiety

pregnancy objective assessment?

monitor fetal status

children objective assessment?

parents stay; be honest

degree of risk for minor surgery?

low risk and local anesthesia

degree of risk for major surgery?

higher risk and longer and extensive

extent of surgery for simple?

affected area only

extent of surgery for radial?

extensive, find root cause

extent of surgery for minimally invasive?

endoscopic

diagnostic?

confirm

prophylactic?

preventative

palliative?

relieve

ablative?

removal of contributing

curative?

remove cause

constructive?

congenital

restorative/reconstructive?

existing

cosmetic?

enhance

transplant?

replace

elective?

planned

urgent?

prompt

emergent?

immediate

LOOK AT STRESS RESPONSE POWERPOINTS!!!

!!!!

what are some fears?

of death, loss of control, pain, mutilation, anesthesia

what are some causes of anxiety?

teaching ability

nursing interventions for patients stress?

listen, educate, and involve patient

causes of stress based on sociological?

family roles may change, financial concerns, cultural and religious beliefs, family support, and healthcare providers attitude

what is needed for informed consent?

physician must state options, risks, and pt has right to refuse or revoke at any time

what is informed consent?

implies understanding

what are some important legal issues?

DNR, advanced directives, organ donation, and emancipated minor

CBC?

Hbg, Hct, platelets, WBC

BMP?

electrolytes and glucose. BUN and creatinine

PT/PTT?

clotting factors

other important diagnostics?

urinalysis, chest x-ray, and ECG

what is the purpose of pre op meds?

promote relaxation, minimize secretions, relieve pain, and prevent infection

what are some sedatives and hypnotics?

benzodiazepines so diazepam (valium), lorazepam (Ativan), midazolam (versed)

what are precautions when using benzodiazepines?

sedation, short term use only, tolerance, dependence, suicidal, and the beers list

what to check when giving benzodiazepines?

assess LOC and hold for low respiratory

who should there be caution in for benzodiazepines?

elderly and those with renal disease

what safety is important when using benzodiazepines?

rails up, call light

client education for sedatives and hypnotics?

take only as directed, do not take non prescribed forms, do not drive, no alcohol, rise slowly, do not stop abruptly.

when should call doctor for sedatives and hypnotics?

allergic reaction and suicidal thoughts

what is important to have for pre op nursing?

consent, ID band, surgery verified by client, lab results, and reversal agents available

what are the reversal agents?

naloxone (narcan) and romaziacon (flumazenil)

what is client education when using sedatives and hypnotics?

take only as directed, do not take non prescribed forms, do not drive, no alcohol, rise slowly, do not stop abruptly. call doctor if: allergic reaction and suicidal thoughts

for pre op care what is important?

pre op check list, post op education, skin prep, bowel prep, and preparing for surgery

what is the diet before surgery?

NPO so decreases risk of aspiration. solid food up to 6 hrs and clear liquids up to 2 hrs. make sure to ask client what they have eaten

when should you inform the client of their post op diet?

in pre op

what does bowel preparation prevent?

intestinal injury and reduce bacteria.

what to use for bowel preparation?

magnesium citrate and bisacodyl

when doing an enema who should you take caution in?

the elderly

requirements prior to surgery?

patient ID bands, double identifiers, permits signed, H+P on chart, recent diagnostics. allergy, blood, and fall risk bands

when and what should be done for skin prep?

may to at home with last shower given chlorhexidine. use clippers or depilatories for shaving

prior to surgery what to make sure patient has done?

remove make up. put on gown and gap for hair. vital signs are taken and IV is in

what are some clot preventatives to take?

DVT prevention, antiembolism stockings, sequential compression device, and post op medication

what to teach about prior to surgery?

deep breathing, incentive spirometer, pain control, splinting, control, leg exercise, ambulate,

what to do during transfer to OR?

report, verify patient, and document