NURS-332: Management of Care 2 (Module 5)

What is perioperative nursing?

The timeframe that constitutes the surgical experience and includes preoperative, intraoperative, and postoperative care

What are the two primary surgical settings?

Ambulatory surgery centers (ASCs) and inpatient facilities

What are the six surgical classifications?

Diagnostic, constructive, reconstructive/cosmetic, palliative, ablative, and transplant

What are the two categories of surgery based on complexity?

Major and minor

What are the four categories of surgery based on urgency?

Emergent, urgent, expedited, and elective

What are the primary areas of focus in the AORN Perioperative Patient-Focused Model?

Safety, physiologic responses, behavioral responses, and health system outcomes

What information must be included in informed consent?

Procedure, potential risks, type of anesthesia and risks, possible additional procedures, postoperative plan of care, and potential complications

Who is responsible for obtaining informed consent?

The surgeon

What is the nurse's role regarding informed consent?

Verify the consent and sign as a witness

True or False: Abbreviations are allowed on informed consent forms.

False

What is the purpose of the surgical checklist?

To document completion of required preoperative activities and promote safety

What information is included on a surgical checklist?

Arrival time, scheduled surgery time, transport time to OR, and completion of preoperative requirements

What assessments should be completed before surgery?

Health history, allergy assessment, head-to-toe assessment, baseline vital signs, height, and weight

What skin preparation may be required before surgery?

Cleaning and preparing the surgical site according to provider orders

Why is NPO often required before surgery?

To prevent pulmonary aspiration

What personal items should be removed before surgery?

Jewelry, dentures, makeup, nail polish, glasses or contacts, hearing aids, and artificial limbs

Why is psychological support important before surgery?

It helps reduce anxiety and improve coping

Why are older adults at greater risk for surgical complications?

Age-related physiologic changes affect multiple body systems

How does aging affect the integumentary system in surgical patients?

Decreased subcutaneous fat and fragile skin lead to slower healing

How does aging affect the musculoskeletal system in surgical patients?

Inflamed and arthritic joints increase swelling and discomfort

How does aging affect the renal system in surgical patients?

Decreased kidney function and reduced waste excretion

How does aging affect the neurologic system in surgical patients?

Impaired cognition, delayed reactions, and sensory deficits

How does aging affect the cardiovascular system in surgical patients?

Increased risk for hypertension, hypotension, and decreased circulation

How does aging affect the respiratory system in surgical patients?

Decreased oxygenation, decreased lung elasticity, and shortness of breath

Why are preoperative diagnostic tests performed?

To provide baseline data and identify potential postoperative complications

What types of diagnostic tests are commonly completed before surgery?

Laboratory tests, radiology exams, and cardiac tests

Who should receive communication about abnormal assessment findings and diagnostic results?

The surgeon or anesthesiologist

When are preoperative diagnostic tests usually completed?

Days to weeks before surgery

Why should preoperative teaching occur before surgery?

Patients learn better before receiving anesthesia or sedatives

What topics should be included in preoperative education?

Fasting, bowel preparation, skin preparation, and postoperative expectations

Why is documentation of preoperative teaching important?

It verifies education was provided and understood

Why should family members receive preoperative education?

To support recovery and assist with postoperative care

What should patients be taught about routine postoperative care?

Expected procedures, recovery processes, and activity expectations

What special equipment should be explained before surgery?

Equipment such as incentive spirometers or drains

Why should breathing exercises be taught preoperatively?

To reduce the risk of postoperative respiratory complications

What breathing exercises should patients learn before surgery?

Coughing, deep breathing, and incentive spirometry

Why should patients be taught to change positions after surgery?

To prevent complications such as pneumonia and blood clots

What should patients know about postoperative pain management?

Available medications and nonpharmacologic pain relief methods

When does the intraoperative phase begin and end?

Begins when the patient is transferred to the operating table and ends when transferred to the PACU

What are the roles of the intraoperative nurse?

Circulating nurse or scrub nurse

What must the nurse know before surgery begins?

The type of surgery and anesthesia being used

Why is proper surgical positioning important?

To prevent injury and provide surgical access

What is a major nursing responsibility during surgery?

Maintaining an aseptic environment

What complications must be monitored for during surgery?

Any physiologic or anesthesia-related complications

What documentation is required during surgery?

Intraoperative care and time-out documentation

What is the purpose of a surgical time-out?

To verify the correct patient, procedure, and surgical site

What position is commonly used for abdominal surgery such as a laparotomy?

Supine position

What position places the patient's head lower than the feet?

Trendelenburg position

What position is commonly used for gynecologic and urologic procedures?

Lithotomy position

What position is commonly used for kidney surgery?

Lateral position

What characterizes minimal sedation?

Patient responds to verbal commands though cognition and coordination may be impaired

What characterizes moderate sedation?

Deeper sedation while maintaining the airway

What characterizes deep sedation?

Patient is difficult to arouse and may require airway support; general anesthesia

Why is airway management critical during surgery?

To ensure adequate oxygenation during anesthesia

What advanced airway devices may be used during surgery?

Laryngeal mask airway, intranasal intubation, or oral intubation

What is the first intraoperative nursing goal?

Reduce patient anxiety

How can positioning injuries be prevented during surgery?

Proper positioning and padding

Why is patient safety a major intraoperative goal?

To prevent preventable surgical complications and errors

Why must nurses maintain patient dignity during surgery?

To protect patient rights and emotional well-being

What complications should intraoperative nurses work to prevent?

Vomiting, hypothermia, anaphylaxis, hypoxia, and malignant hyperthermia

What is the primary postoperative priority?

Maintaining a patent airway

What physiologic assessments should be performed immediately after surgery?

Vital signs, airway status, and pain assessment

What does ERAS stand for?

Enhanced Recovery After Surgery

What are the goals of ERAS?

Faster recovery, fewer complications, and shorter hospital stays

What activities are encouraged early in ERAS protocols?

Ambulation, eating, drinking, and discontinuation of IV fluids when appropriate

Why are mild analgesics often emphasized in ERAS protocols?

To minimize opioid use and promote recovery

Why is nausea and vomiting management important after surgery?

To improve comfort and reduce complications

What is the purpose of postoperative education?

Reinforce preoperative teaching and prepare patients for discharge

What nutrition teaching should be included after surgery?

Maintaining adequate nutritional intake

What medication topics should be discussed before discharge?

Continuing medications, new medications, and medication schedules

What lifestyle modifications may be required after surgery?

Activity restrictions and healthy lifestyle practices

What wound care education should be provided?

Dressing changes, infection prevention, and monitoring for complications

What should patients know about patient-controlled analgesia (PCA)?

How to safely use it for pain management

Why is follow-up care important after surgery?

To monitor recovery and identify complications

How should postoperative pain be managed?

Assess frequently and treat appropriately

What should nurses monitor for when administering pain medications?

Oversedation

What wound assessments should be performed after surgery?

Inspect dressings and monitor wound VAC output

What is wound dehiscence?

Separation of a surgical wound

What is malignant hyperthermia?

A life-threatening genetic reaction to certain anesthetics

What are signs of malignant hyperthermia?

Rapid temperature increase, tachypnea, tachycardia, arrhythmias, and muscle rigidity

When does malignant hyperthermia most commonly occur?

During surgery or in the PACU

How is malignant hyperthermia treated?

Stop anesthetics, administer dantrolene, and initiate cooling measures

What is the highest priority throughout the perioperative period?

Patient safety

What is the purpose of National Patient Safety Goals for Surgery?

To reduce preventable surgical errors

How is wrong-site surgery prevented?

The patient marks the correct site, the site is verified, and a time-out is completed

What must be verified before surgery begins?

Patient identity, surgical site, informed consent, allergies, and history and physical

When should prophylactic antibiotics be administered before surgery?

Within 1 hour before incision

When should prophylactic antibiotics generally be discontinued?

Within 24 hours after surgery

How should hair be removed from the surgical site?

With clippers, not razors

Why may patients shower before surgery?

To reduce bacteria on the skin

Which patients are at increased risk for surgical infection?

Older adults, smokers, immunocompromised patients, obese patients, patients with infections, chronic diseases, diabetes, alcohol use, or poor nutrition

What communication tool is used for postoperative hand-off reports?

SBAR

What does SBAR stand for?

Situation, Background, Assessment, and Recommendation

What information belongs in the Situation section of SBAR?

Patient identification, surgeon, procedure, and surgical site

What information belongs in the Background section of SBAR?

Medical history, allergies, labs, imaging, and comorbidities

What information belongs in the Assessment section of SBAR?

Abnormal findings and important clinical information

What information belongs in the Recommendation section of SBAR?

Necessary interventions and follow-up actions

What is the nurse's role in transplant therapy?

Protect, promote, and optimize the well-being of both donor and recipient

What postoperative care is required after organ transplantation?

Supportive care, fluids, blood products, and monitoring for rejection

What are the three types of organ rejection?

Hyperacute, acute, and chronic