CJ 2 Exam 1

Number one priority in the perioperative setting

patient safety

Ways to ensure patient safety in the perioperative setting

preop checklist, surgical safety checklist, surgical care improvement project (SCIP)

Why is the surgical care improvement project

prevention of infection, cardiac events, VTE

How is laproscopic different than open

minimally invasive

Document that autonomously and cognitively grants permission

safety-informed consent

Is safety-informed consent the role of the nurse

no

Components of a safety-informed consent

procedure, anesthesia, blood products, photos

If a patient is unable to consent what can you do

medical power of attorney, 2 providers in an emergency

Who obtains the consent before a procedure

surgeon and preop nurse

What happens multiple times before a procedure to ensure patient identifiers, correct site identified, everyone must stop what they are doing

safety timeout

Timeouts before the procedure ensure we have the right

patient, location, procedure

What should you take when gathering a history assessment in preop

increase in risk of complications, drug use, current medications, oral intake, allergies, anxiety, previous complications, blood donation, advanced directives

Why should you take a complete baseline assessment before surgery

to compare with after (to ensure return to baseline)

Vitals are acceptable for surgery if they are ~___% within baseline

20

You should take vitals on ___ before surgery

both arms

Abnormal SBP vitals before surgery

<90, >180

Abnormal RR vitals before surgery

<12, >24

What respiratory disease should you assess for in preop

OSA (obstructed sleep apnea)

Needed to check kidney function in preop

BUN and creatine

High vitamins ____ affect wound healing

K and B

Why does high adipose tissue slow wound healing

increased vascularity

Does surgery increase or decrease metabolic rate

increase

UA

urinalysis

Labs to take before procedure (for baseline)

UA, blood type, CBC, clotting, electrolytes, BUN, creatinine, pregnancy

Before administering regularly schedule medications in preop, you should ask the

anesthesiologist

What medications are given with a small sip of water in preop

cardiac diseases, respiratory disease, seizures, HTN

What meds are held before surgery

Antidepressants and some HTN

What should you do about a diabetic patient in preop

1/2 dose correction insulin

Postop procedures and excercises

check dressings, breathing, SCD, mobility

Preop medications are often used to

reduce anxiety, prevent laryngospasm, reduce vagal bradycardia, inhibit oral/gastric secretions, prophylactic antibiotic

What gauge is required for blood products and surgery

18-20 (18 recomended)

If a patient has never had surgery before what issue should you be prepared to deal with

anxiety

Operating rooms are typically going to be in the ___ hospital

mainstream (to be close to PACU, ICU, etc.)

MIS

minimally invasive surgery

MIS typically reduces ___

blood loss, recovery time, pain

Health and hygiene requirements of the surgical team

no open wounds, no infection, hygiene, covering skin, hair, airway

Is scrub surgical attire clean or sterile

clean

Are surgical gowns clean or sterile

sterile

When should you scrub in

after putting on a mask and before sterile gown and gloves

Does a scrub sterilize the skin

no

Surgical scrub reaches from fingertips to

elbow

How long should a surgical scrub last for

3-5 min

reduces or temporarily eliminates sensory perception with or without loss of consciousness

anesthesia

Anesthesia purpose

block nerve transmission, suppress reflexes, relax muscles, achieve controlled unconsciousness

How does general anesthesia achieve a reversible loss of consciousness

inhibit neuronal impulses in CNS

Ways to administer general anesthesia

inhalation, IV, muscle relaxants

General anesthesia can cause a suppression of

memory and pain

Signs of malignant hyperthermia

extremely high fever, clenched jaw, tachycardia, dysrhythmias, cyanotic, brown protein urine, acidotic

Intubation complications

broken teeth, vocal chord trauma

How do local/regional anesthetics work

briefly disrupt sensory nerve impulse transmission from a specific body area/region

Is motor function affected by local/regional anthesia

possibly

Are you conscious for a local or regional anesthetic

yes

How are regional and local anesthetics different

local goes into skin or tissue, regional blocks multiple peripheral nerves

Nerve blocks (such as an epidural) are an example of what type of anesthetic

regional

Most common complications for local anesthesia

edema and inflammation

Complications of regional anesthesia

anaphylaxis, headache, hypotension, cardiac arrest, incoherent speech, blurred vision, metallic taste, excitement, tachycardia, tachypnic

IV delivery of sedative, hypnotic, and opioid drugs to reduce sensory perception

conscious/moderate sedation

Can a patient maintain a patent airway on conscious/moderate sedation

yes

Common conscious/moderate sedation medications

diazepam, midazolam, propofol, morphine sulfate

Is drowsiness an expected or adverse effect when giving conscious/moderate sedation

expected (as long as easily aroused)

How to tell if there is a complication of the airway during surgery

low spo2

How can surgical positioning put a client at risk for injury

cannot guard against pain, pressure ulcers, repositioning

Ways to ensure proper positioning

anatomic alignment, circulation, breathing, exposure of op site and IV, access to patient by anesthesia

supine with feet down

trendelenburg

prone with legs down

jacknife

Legs spread on stirrups

lithotomy

When closing the skin and tissue to promote wound healing, you will also ___ to prevent poor clotting and hemorrhage

occlude blood vessels

Pressure dressings are used to prevent

poor clotting and bleeding

Drains are used to remove wound/closure

secretions

Examples of common skin closures

sutures, staples, tape, retention bridge

___ determines patient readiness for discharge from PACU

PACU team

___ will discharge to the hospital unit or home from PACU

anesthesia provider (or sometimes surgeon or nurse if discharge criteria is met)

Most critical assessment to perform after surgery

respiratory

Your immediate respiratory assessment in PACU should involve checking for

patent airway and adequate gas exchange

If you notice your patient is a mouth breather, what oxygen delivery device is recomended

face mask

Does a face mask require a higher or lower O2 delivery rate compared with a nasal cannula

higher

A postop patient is at risk for ____ related to the effects of anesthesia, pain, opioid analgesics, and immobility

hypoxemia

What is the reversal agent for a benzo (anesthesia sedation) overdose

flumazenil (romazicon)

Does hypothermia (which can be a complication of anesthesia) increase or decrease O2 demands

increase

Position for a post op hypoxemic patient

semi fowlers

You should perform a cardiovascular assessment upon admission to PACU and every ___ until more stable

15 min (then 30+ for an hour when stable)

How to tell if your postop patient might have a dysrhythmia without using telemetry

pulse deficit

When should you use clot prevention measures during periop

prior to and 24 hours after surgery

If your postop patient who has a history of clots begins to complain of back pain and tingling/numbness in the limbs, especially the lower limbs, what should you be expecting as the diagnosis

spinal hematoma

I&O should be tracked for at least ___ postop

24 hrs

What can affect the acid-base balance of the intraop patient

respiratory status, metabolic changes, loss of acids/bases in drainage

Sign of an active GI system postop

passing gas

Before feeding a postop patient, you should ensure their ___ has returned

gag reflex

Most common GI side effects post op

NV, constipation, paralytic ileus

Normal wound healing drainage

sanguineous or sero-sanguineous

Partial or total separation of wound edges

dehiscence

internal organs protrude through wound edge separation, due to high intraabdominal pressure

evisceration

How to treat evisceration

sterile gauze covered in sterile saline to cover, immediately call provider

soft flexible tube that is inserted into a wound to allow passive drainage

pinrose drain

closed suction drain with a bulb to decrease pressure and remove fluid into the bulb

JP drain

The very first dressing change is done by the

surgeon

Sometimes staples will be

open to air

Sutures and staples are removed ___ days after surgery

5-10

When does post op pain reach its peak

Day 2

Usually opioids are given for the first ____ hrs post op

24-72 (IV but switch to oral when pt can tolerate)