perioperative

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

information obtained in pre-op stage

• health history (INCLUDING FAMILY HISTORY)

• psycosocial (anxiety?)

• medications including OTC and herbals

• allergies

goal of a pre-op assessment

identify risk factors and plan to ensure patient sagety

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

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

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

how long should a patient be NPO before surgery

at midnight or 8-12 hours before

what medication should NOT be taken before surgery?

aspirin

what medication can be taken before surgery?

cardiac meds (if not contraindicated) like beta blockers

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

why is patient positioning in surgery important?

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

what technique is used for surgery?

aseptic

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

SBAR (situation, background, assessment, recommendation)

time out

preparation in the OR; done before administering anesthesia to patient

check:

• introduction

• name

• allergy

• procedure

• correct side and site

what are grounding pads used for in the OR?

to protect the patient from electrocution and smoke by the machines

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

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

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

PACU

post anesthesia care unit

phase I PACU

most intensive care

monitors ECG and uses invasive blood pressure monitoring and mechanical ventilation

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

phase III PACU

if patient is needed for extended observation before getting discharged

which body systems is the PACU nurse’s priority?

neuro and pulmonary

greatest indicator of hypoxemia

confusion

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

oral access

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

nursing intervention for emergence delirium?

reorient

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

how to prevent aspiration in post-op patients?

treat N/V

keep suction at bedside

how to prevent venous thromboembolism in post-op patients?

help with early ambulation

use sequential compression devices (SCDs)

small doses of heparin???????

what post-op GI condition can ambulation help prevent?

postoperative ileus

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

ulcers

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

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

shower or bath with anti-microbial soap

what can cause pre-op anxiety?

lack of knowledge

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