perioperative

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36 Terms

1
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reasons for surgery

  • diagnosis ex. biopsy

  • cure ex. removal of cancerous tumor

  • palliation ex. amputation - improves quality of life

  • prevention ex. mastectomy

  • cosmetic ex. BBL

  • exploration ex. in the abdomen, can be done to find site of bleeding

2
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information obtained in pre-op stage

  • health history (INCLUDING FAMILY HISTORY)

  • psycosocial (anxiety?)

  • medications including OTC and herbals

  • allergies

3
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goal of a pre-op assessment

identify risk factors and plan to ensure patient sagety

4
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what to include in pre-op education

  • sensory - what they’ll see, hear, feel, etc.

  • process - general flow ex. when they wake up in PACU

  • procedural - more detailed information ex. where IV line will be placed

5
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if the patient is confused and not deemed AAO4, can they sign the consent form?

NO; have a healthcare proxy sign it for patient

must have adequate disclosure, show clear understanding, and give consent voluntarily

6
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pre-op checklist

  • ID and allergy band

  • obtain baseline vitals before transfer

  • remove all glasses, contacts, makeup, etc.

  • have pre-op lab work on chart (notify surgeon of abnormalities)

  • complete patient education

  • INFORMED CONSENT IS SIGNED

  • NPO

  • skin prep

  • have patient void

  • pre-op meds

7
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how long should a patient be NPO before surgery

at midnight or 8-12 hours before

8
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what medication should NOT be taken before surgery?

aspirin

9
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what medication can be taken before surgery?

cardiac meds (if not contraindicated) like beta blockers

10
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scrub nurse vs. circulating nurse

remains sterile

vs.

is non-sterile; can assist with putting sterile materials on field before and is mostly there for charting

11
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why is patient positioning in surgery important?

prevents skin breakdown and gives the surgeon the best view of an area

12
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what technique is used for surgery?

aseptic

13
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what should be used when communicating with other medical professionals when transferring a surgical patient?

SBAR (situation, background, assessment, recommendation)

14
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time out

preparation in the OR; done before administering anesthesia to patient

check:

  • introduction

  • name

  • allergy

  • procedure

  • correct side and site

15
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what are grounding pads used for in the OR?

to protect the patient from electrocution and smoke by the machines

16
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local vs. regional anesthesia

patient is still conscious and numbness is focused on a specific area

vs.

patient is still conscious and numbs a larger region by blocking nerves that serve that area ex. epidural

17
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first action when patient on OR table receives anesthesia and their temperature, heart rate, and respirations begin to increase while becoming acidotic?

  1. STOP ANESTHESIA

  2. administer dantrolene - relaxes muscle

  3. ADMINISTER 100% OXYGEN

  4. cool the patient around the core and where arteries are

18
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malignant hyperthermia

genetic reaction to anesthesia (important to obtain family history before, avoid triggers, and do genetic testing)

causes a calcium overload → muscle contraction and breakdown making patient hypermetabolic

19
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PACU

post anesthesia care unit

20
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phase I PACU

most intensive care

monitors ECG and uses invasive blood pressure monitoring and mechanical ventilation

21
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phase II PACU

once the tubing is out, patient’s move to this phase (some come straight here)

patient should be AAO

introduce ice chips and monitor I&Os

prepare client for transfer

continue pain assessment

22
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phase III PACU

if patient is needed for extended observation before getting discharged

23
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which body systems is the PACU nurse’s priority?

neuro and pulmonary

24
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greatest indicator of hypoxemia

confusion

25
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what might be needed if a patient has an airway obstruction?

oral access

26
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expected vs. unexpected findings after anesthesia

  • low grade fever

  • hypoactive bowel sounds

  • unlabored breathing

  • scant blood at incision

  • increased WBCs

  • decreased hemoglobin and hematocrit

vs.

  • absent bowel sounds

  • 102-103ºF

  • very low hemoglobin and hematocrit

  • very high WBCs = infection

27
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nursing intervention for emergence delirium?

reorient

28
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how to prevent pneumonia and atelectasis in post-op patients?

teach them how to cough, deep breathe, and use incentive spirometer

do a chest X-ray and auscultate if there are any signs

29
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how to prevent aspiration in post-op patients?

treat N/V

keep suction at bedside

30
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how to prevent venous thromboembolism in post-op patients?

help with early ambulation

use sequential compression devices (SCDs)

small doses of heparin???????

31
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what post-op GI condition can ambulation help prevent?

postoperative ileus

32
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what post-op GI condition should the provider be notified about?

ulcers

33
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prevention and interventions for surgical site infections and bleeding

  • use aseptic technique when assessing

  • give antibiotics

  • pre-op bathing can reduce risk

  • follow activity restrictions

  • assess amount and COCA

34
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what can be done pre-op that will help prevent surgical site infection?

shower or bath with anti-microbial soap

35
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what can cause pre-op anxiety?

lack of knowledge

36
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if a patient has a strong feeling of impending death before surgery, what do you do?

notify the surgeon immediately; surgery may need to be delayed