NSG 320: Perioperative Care

so are all the test q's from the textbook or what cause if so these powerpoints don't matter-

AORN???

textbook lists everything abt taking a preoperative history??

general status of health, review of systems, medical and previous surgical history (including anesthesia hx cause of malignant hyperthemia concerns), drug and substance abuse (latex allergy?), blood donation considerations, and discharge planning

the most sensetive indication is an increase in? (pg 62 in textbook)

carbon dioxide level

ex of a nursing diagnosis

Need for health teaching due

to unfamiliarity with surgical

procedures and preparation

Anxiety due to fear of new or

unknown experience, pain,

and/or surgical outcomes

need for health teaching (reference textbook fml)

 Provide information

 Ensure informed consent is obtained

 Ensure site marking

 Implement dietary restrictions

 Discuss scheduled drugs (reinforce

surgeon’s or health care provider’s

instructions)

 Explain intestinal and skin preparation

 Explain tubes, drains, vascular access

 Teach methods to prevent respiratory

and cardiovascular complications

respiratory assessment

 Assess for patent airway, adequate gas exchange

 Note artificial airway, if applicable

 Check oxygen delivery device, if applicable

 Check lungs every 4 hours for first 24 hours

following surgery (more frequently if needed); then

follow agency policy

cardiovascular system assessment

 Assess vitals and compare with baseline

 Report BP changes that are 25% higher

or lower than baseline

 Cardiac monitoring may be ordered

 Perform peripheral vascular assessment

daily

 Apply antiembolism stockings and pneumatic compression devices if ordered; administer prophylactic drugs if ordered

neuro assessment

 Cerebral function and level of

consciousness

 Orientation to person, place, time, and

situation

 Prevent postoperative delirium

 Motor and sensory function (after general

anesthesia)

Fluid, electrolyte, and acid-base balance assessment

 Intake and output (I&O)

 Hydration status

 IV fluids

 Acid–base balance (nasogastric (NG) tube drainage)

kidney/urinary assessment

 Return of urination

 Effects of drugs on urination

 Signs of urine retention

* Report urine output of <30 mL/hr

gastrointestinal assessment

 Postoperative nausea/vomiting (PONV)

 Intestinal peristalsis return

 NG drainage, if applicable

 Constipation related to anesthesia, opioid analgesia, decreased activity, and decreased oral intake)

drainage types

• Sanguineous

• Serosanguineous

• Serous

impaired wound healing

dehiscence (edges of the skin come apart)

evisceration (intestinal parts coming out of the abdomen)

psychosocial assessment

 Psychological, social, cultural, spiritual issues

 Assess for signs of anxiety

 Reassure patient of safety

 Assess family or caregiver

 Refer as needed

laboratory assessment

 Analysis of electrolytes

 CBC

 Urinalysis

 Kidney function tests

 ABG

PCA

patient-controlled analgesia

Preventing complications related to postoperative bleeding or hemorrhage:

ALWAYSSSS look under the patient

drains, recognize early warning signs

Surgical Care Improvement Project (SCIP)

The Surgical Care Improvement Project core measures were established in 2006 as combined efforts from the Centers for Medicaid and Medicare (CMS) and the Joint Commission. The purpose is to reduce surgical complications and mortality, with specific emphasis on the prevention of surgical site infections.