NURS3802 Module 18: Care of a Peri-Operative Patient

What are the peri-operative phases?

- pre-operative

- intra-operative

- post-operative

What is the pre-operative phase?

before the surgery begins

What is the intra-operative phase?

from start of surgery to end of surgery

What is the post-operative phase?

- PACU/recovery room

- after the surgery

What does major and minor surgery refer to?

the level of risk

What is an elective surgery?

- patient choses to do the surgery, and schedules it in advance

- goal is to improve quality of life (QOL)

- often associated with decreased morbidity and mortality

- ex. gastric bypass

What is semi-elective surgery?

- more time-sensitive than elective

- more of a priority

- does not need to be done immediately

- ex. cholecystectomy

What is urgent surgery?

- required within 24 hours of diagnosis

- ex. appendectomy

What is emergency surgery?

- cannot be delayed

- must be done immediately

- ex. trauma, intestinal perforation,

What is salvage surgery?

- occurs when CPR is in progress

- can be done to determine if patient can be an organ donor

- harvesting organs

What is included in the pre-op interview?

- patient's understanding

- past health history

- previous surgeries

- family's health history

- current medications

- allergies/intolerances

- drug use

- tobacco and etOH use

- pregnancy

- last menstrual period (LMP)

What should be asked about a patient's previous surgeries?

- what procedure was done

- when the procedure was done

- anxiety around surgery

- post op nausea and vomiting

- past experiences with surgery

What is included in a patient's medication history?

- prescriptions

- over the counter

- herbals

- illegal drugs

- tobacco use

- alcohol use

- vitamins and supplements

Who performs a physical exam on a pre-op patient?

the surgeon or the anesthesia provider

Identify the ASA classification:

- healthy

- no systemic disease

I

Identify the ASA classification:

- mild systemic disease

- no functional limits

II

Identify the ASA classification:

- severe systemic disease

- definite functional limits

III

Identify the ASA classification:

- severe systemic disease that is an ongoing threat to life

IV

Identify the ASA classification:

- unlikely to survive >24 hours without surgery

V

Identify the ASA classification:

- brain death

- awaiting procurement

VI

What are considerations for anesthesia?

- age

- physical status

- type of surgery

- surgeon's preference

- status: inpatient or outpatient

- skills of the provider

- patient preference

What is informed consent?

a patient's agreement to have a surgery after being told what to expect

What are components of informed consent?

- presumed diagnosis

- differential diagnosis

- risks

- alternative treatments and risks

- risk of not treating

- short-term costs

- long-term costs

What are the 2 types of advance directives?

- living will

- durable power of attorney

What is a durable power of attorney?

appointing someone ahead of time to make healthcare decisions on behalf of a patient who cannot make these decisions

What is a durable power of attorney also known as?

healthcare proxy

What is a living will?

a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent

Who is in the pre-operative holding room with the patient?

- holding nurse

- anesthesia provider

- surgical provider

- circulating nurse

- friends & family

Why is marking in surgery important?

to ensure that the right site and side is operated on

What are the 2 types of anesthesia?

- general

- local

What is the role of the circulating nurse?

- in charge of the room

- ensures that sterility is maintained

- documentation

- assists anesthesia

- pt positioning

- assessment

- chart review

- room prep

- call the time out

What is a RNFA?

registered nurse first assist:

- nurse who is the first assistant in the operating room

What is the time out?

- occurs after the prep and induction

- before the surgical incision

- includes patient ID, name of procedure, site, allergies

When would general anesthesia be used?

- to provide skeletal relaxation

- prolonged surgical time

- the patient has increased anxiety

- contraindications for local or regional anesthesia

- patient is uncooperative

What are the routes of general anesthesia?

- IV

- inhalation

What is local anesthesia?

- anesthesia of a specific area or site

- no loss of consciousness

What are the routes for local anesthesia?

- regional

- spinal

- epidural

- topical

What is a nerve block?

anesthetic agent is injected into and around a nerve that supplies sensation to a small area of the body to block pain signals

What are examples of intra-operative emergencies?

- malignant hyperthermia

- anaphylaxis

What is malignant hyperthermia?

increased temperature with skeletal rigidity caused by a hyperactive metabolic state

When does malignant hyperthermia occur?

- during general anesthesia

- phase I

Who is at risk for malignant hyperthermia?

those with family history of the genetic disorder

What vital changes are seen with malignant hyperthermia?

- increased HR

- increased RR

- increased CO2

- increased temperature

- ventricular dysrhythmias

How is malignant hyperthermia treated?

dantrolene slows the body's metabolism and relaxes the skeletal muscles

What is anaphylaxis?

severe allergic reaction

What can cause intra-operative anaphylaxis?

- medications

- blood

- latex

- other allergens

What are the priorities of post-op care?

ABCs:

- airway

- breathing

- circulation

What is the Aldrete Score?

PACU assessment

What is included in the Aldrete Score?

- activity

- respiration

- consciousness

- color

- O2 saturation

When is the Aldrete score assessed?

- 1 minute after surgery

- 5 minutes later

- before leaving the PACU

What are respiratory challenges regarding post-operative patients?

- obstruction: most common is the tongue

- hypoxemia can lead to atelectasis, bronchoconstriction, and bronchospasm

- hypoventilation

What are cardiovascular challenges regarding post-operative patients?

- hypotension

- hypertension

- hemorrhage

- dysrhythmias

Who is most at risk for post-operative delirium?

young, healthy men

What is hypothermia?

low body temperature < 36C (96.8F)

What vital signs are required for the PACU?

- VS within 20% of baseline

- O2 > 94%

- pain < 4

- no bleeding or discharge

- no nausea or vomiting

- 20 minutes since last opioid

The nurse is caring for a patient scheduled for a breast reduction to decrease pain in her back. How is this operation classified according to the degree of urgency?

a. Urgent

b. Emergency

c. Emergent

d. Elective

d. Elective

What is the role of the nurse in securing an informed consent for a surgical procedure?

a. Ensuring that the patient signs the informed consent document

b. Signing the consent form as a witness

c. Ensuring that the patient does not refuse treatment

d. Refusing to participate based on legal guidelines

b. Signing the consent form as a witness

A 55-year-old male is scheduled to have a bowel resection for a diagnosis of colon cancer. He is very nervous about the surgery. How can the nurse help decrease his anxiety?

a. Ask him if he is concerned the cancer has spread to other areas of his body.

b. Talk to him to find out what is causing his anxiety.

c. Question him to find out what the surgeon has told him about the surgery.

d. Give him a preoperative medication to help him relax.

b. Talk to him to find out what is causing his anxiety.

The nurse is precepting a student nurse and explains that perioperative nursing care occurs _________.

a. Before, during, and after surgery.

b. In pre-admission testing.

c. During the surgical procedure.

d. In the post-anesthesia care unit.

a. Before, during, and after surgery.

The nurse is caring for a patient who is scheduled to undergo a surgical procedure. The nurse is completing an assessment and reviews the patient's laboratory tests and allergies. In which perioperative nursing phase would this work be completed?

a. Perioperative

b. Preoperative

c. Intraoperative

d. Postoperative

b. Preoperative

The nurse is caring for a patient in the post anesthesia care unit. The patient has developed profuse bleeding from the surgical site, and the surgeon has determined the need to return to the operative area. This procedure would be classified as _________.

a. Elective.

b. Urgent.

c. Emergency.

D. Major

c. Emergency.