Term
| When does the pre-operative phase begin and end? |
|
Definition
| Starts when decision is made to have surgery, ends when patient goes to OR |
|
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Term
| List Pre-Op baseline assessments |
|
Definition
-PMH (Cardiac, respiratory, previous surgical history)
-Vital signs including pulse ox
-Weight
-Physical assesssment
-General labs: CBC, Chem 7, Coags (aPPT, PT, INR)
-Specific labs for surgery |
|
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Term
| What are possible nursing diagnosis for Pre-Op? |
|
Definition
-Knowledge Deficit
-Anxiety |
|
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Term
| Other than baseline assessment and nursing diagnosis, what are some additional Pre-Op nursing responsibilities? |
|
Definition
-Check that informed consent has been signed by appropriate person
-Clarify which regularly scheduled meds should be held
-Skin prep
-NPO or diet restriction |
|
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Term
| What should the nurse do one hour before the procedure? |
|
Definition
-Double-check pre-op checklist and have all paperwork ready to go
-Patient in gown only, no dentures, no jewelry
-Have patient void
-Check fasting glucose if patient is diabetic
-Ask about hearing aids and glasses |
|
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Term
| When does the intraoperative phase begin and end? |
|
Definition
| Starts when patient is received in OR, ends when patient is transferred to PACU |
|
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Term
|
Definition
-General
-Regional
-Local
-Moderate/Conscious Sedation (in non-OR settings) |
|
|
Term
| What is general anesthia and what are its possible complications? |
|
Definition
Patient is unconscious and paralyzed.
-CNS Depression
-Malignant hyperthermia: acute and life-threatening
-Hypoventilation
-Intubation complications
-Tissue injuries due to positioning |
|
|
Term
|
Definition
-Inherited condition
-R/T inhalation anesthetics and succinylcholine
-Symptoms can occur anytime after administration of triggering agent
-Treatment: Dantrolene sodium |
|
|
Term
|
Definition
-Epidural (spinal is rare)
-Nerve block
-Infusion usually a combination of opioid and local anesthetic
-Chosen when patient is poor risk for general anesthia, when post-op analgesia is desired. |
|
|
Term
| What are some complications of regional anesthia? |
|
Definition
-Systemic delivery or absorption
-Overdose
-Catheter movement
-Nerve damage |
|
|
Term
| What are the post-op nursing implications of regional anesthia? |
|
Definition
-Monitor for appropriate level of analgesia
-Monitor for epidural catheter
-Monitor for complications
-Maintain patient safety |
|
|
Term
| What is moderate sedation? |
|
Definition
-Procedural sedation: endoscopy, ED, bedside
-Reduced level of consciousness - pt. is arousable and can maintain airway (reflexes intact)
-Fast-acting, short-duration meds |
|
|
Term
| What equipment is needed at bedside for moderate sedation? |
|
Definition
-Code cart for airway supplies (Ambu-bag, non-invasive and invasive airway devices)
-Suction
-Cardiac monitor/defibrilator
-BP cuff |
|
|
Term
| Nursing management for conscious sedation |
|
Definition
-Requires extra training for MD & nurse
-Do not leave the bedside if you ar the primary nurse
-Patent IV site
-Monitor VS, airway, and CV status before, durign, and until patient is stable after procedure
-Hold PO until LOC improve and gag reflex is checked (if upper endoscopy) |
|
|
Term
| What is the surgical safety checklist |
|
Definition
Right patient
Right procedure
Right site and/or side |
|
|
Term
| What are some intraoperative nursing diagnosis? |
|
Definition
-Risk of bleeding
-Risk for infection
-Risk for injury and impaired tissue perfusion
-Risk for respiratory complications |
|
|
Term
| When does the post-operative phase begin and end? |
|
Definition
| Starts with admission to PACU and ends with follow-up evaluation in clinical setting or home |
|
|
Term
| Post-Anesthesia Care Unit (PACU) |
|
Definition
-Pt. may be discharged home or to inpatient unit when stable (not necessarily baseline)
-PACU nurses have critical care experience |
|
|
Term
| What is the typical length of stay in PACU? |
|
Definition
|
|
Term
| What are nursing concerns in inpatient unit when patient is received from PACU? |
|
Definition
-Immediate: Patient stable and recovering from surgery
-Intermediate: Patient healing appropriately
-Discharge planning |
|
|
Term
| What info should the nurse from PACU report to the floor nurse about transfering patient? |
|
Definition
-PMH, pre-op diagnosis, post-op diagnosis
-Surgical procedure, lenght of surgery, any complications during surgery
-VS
-Assessment
-I/O: IVF or blood; Estimated blood loss (EBL); UO; Drainage |
|
|
Term
| What are some general (respiratoty, CV, GI) possible post-op complications? |
|
Definition
-Respiratory: hypoventilation, atelectasis, pneumonia
-CV: shock, VTE (DVT/PE), bleeding (surgical, GI)
-GI: N/V, ileus
-Infection |
|
|
Term
| What should you assess during post-op respiratory assessment? |
|
Definition
-Rate, pattern, depth of breathing
-Breath sounds
-Accessory muscle use
-Snoring
-Oxygen rate and delivery device |
|
|
Term
| What factors impact individual respiratory response? |
|
Definition
-Type of surgery and anesthia
-Hx of pulmonary disease
-Opioid pain meds
-Hypoventilation due to pain |
|
|
Term
| What are some post-op respiratory interventions? |
|
Definition
-Assess every 4 hours for first 24 hours, then every 8 hours or every shift
-DB&C, Incetive spirometer every hour while awake
-Semi-Fowlers position and turn every 2 hours while in bed
-Increase activity as tolerated (dangle, chair, BRP, ambulate)
-Wean oxygen as tolerated
-Medicate for pain
-Call MD if oxygen sat is low despite DB&C, or for any persistent low sat or sudden onset resp distress |
|
|
Term
| What should you assess during a post-op CV assessment? |
|
Definition
-HR & rhythm
-Heart sounds
-Cardiac monitoring (if monitoring)
-Peripheral vascular assessment: Monitor for VTE, distal to site
-Bleeding |
|
|
Term
| What factors impact individual CV response? |
|
Definition
-Past cardiac history
-Type of surgery
-Blood loss and fluid replacement
-Third spacing |
|
|
Term
| What are some general post-op CV in interventions? |
|
Definition
-Assess HR and rhythm, BP every 4 hours for 24 hours, then every 8 hours or every shift
-I/O
-Labs
-Monitor for shock and orthostatic hypotension
-Monitor for VTE
-Monitor for bleeding - visible and occult
-Call for SBP <90 >180, HR <50 >120 (or trending below baseline) |
|
|
Term
| What would you assess during a post-op neurological assessment? |
|
Definition
-LOC
-Orientation
-Motor and sensory assessment after epidural anesthesia |
|
|
Term
| What factors impact individual neuro response? |
|
Definition
-PMH (dementia, stroke)
-Age
-Meds
-Hypoxia
-Type of anesthesia |
|
|
Term
| What are some post-op neurological interventions? |
|
Definition
-Assess LOC with each visit
-Assess every 4 hours if epidural present (follow hospital protocol)
-Call MD for change in LOC or altered mental status |
|
|
Term
| What factors influence renal fluid and electrolyte response post-op? |
|
Definition
-PMH (DM, renal insufficiency)
-How long was the patient NPO?
-How long was the surgery? (Long surgeries increase insensible fluid loss)
-Meds (nephrotoxic)
-CV and renal function |
|
|
Term
| Fluid and electrolyte, renal, post-op interventions |
|
Definition
-Monitor I/O & VS every 4 hours for 24 hours, then every 8 hours
-Monitor labs and trends (H/H, BUN/Creatinine, Lytes)
-IVF until able to take PO adequately
-Manage N/V aggresively
-Report urine output of <30mL/hr
-DC foley cath asap |
|
|
Term
| Post-Op Gi assessment and interventions |
|
Definition
-Postoperative N/V common (30% of patients experience N or V after general anesthesia)
-Peristalsis may be delayed up to 24 hours
-Monitor for bowel sounds
-Delay giving solid foods if peristalsis slow to return
-Increase activity as tol
-Treate N/V (watch for aspiration)
-Monitor for ileus |
|
|
Term
| Management of NG tube for GI surgeries |
|
Definition
-Assess drainage every 4 hours: quantity and quality
-Assess NGT is secured properly
-Verify placement each time before inserting anything |
|
|
Term
| What needs to be done to ensure the patient is ready for discharge? |
|
Definition
-All tubes need to be out
-Ambulating independently
-On room air with sat at baseline
-Eating and drinking
-Voiding
-Had a BM (depends on LOS and surgery) |
|
|
Term
| Discharge teaching methods |
|
Definition
-Starts on admission
-Include family whenever possible
-Assess their understanding and learning needs first
-Use multiple modalities to teach
-Evaluate teaching ("teach back" method) |
|
|
Term
| What should you teach the patient during discharge teaching? |
|
Definition
-Acitivity level
-Care of incision
-Managing constipation
-Pain management
-Medications (review home meds and meds in hospital)
-When to call MD
-Follow-up appts |
|
|
Term
| What is the neurologic impact of delirium? |
|
Definition
-Not a disease but a symptom: global cerebral function
-Acute
-Transient
-Reversible
-Symptoms: Decreased attention span and fluctuating confusion
-Requires urgent attention |
|
|
Term
|
Definition
Incision closed: heals from outside in
-Dehiscence, evisceration: loss of incisional integrity seen most often between 5th and 10th days after surgery |
|
|
Term
|
Definition
Wound left open after surgery: heals from inside out
-Indications:
-Infected wounds
-Too much internal edema to close wound
-Too much trauma to close wound |
|
|
Term
| What are the signs of pain? |
|
Definition
-Increased BP & HR
-Increased RR
-Profuse sweating
-Restlessness
-Confusion (older adults)
-Wincing, moaning, crying
-Pain scale |
|
|
Term
| What are the main things to remember when implementing pharmacologic and alternative pain interventions? |
|
Definition
Pharmacologic
-Assess 30-60 min after medicating
-Monitor for effectiveness, side effects
Alternative therapy
-Positioning
-Massage
-Relaxation/diversion techniques |
|
|
Term
| Fever in post-op patients |
|
Definition
-Monitor for temp >101.5
-Fever in first 48 hrs
--Usually due to inflammatory response
--Unlikely to ve r/t surgical site infection but watch for malignant hyperthermia
--May be r/t pneumonia or UTI or other nosocomial infection
--Careful assessment and interventions to decrease risk of infection
-Check WBCs
-Remeber that older patients may blunted response to inflammation or infection |
|
|
Term
| How are surgical procedures categorized? |
|
Definition
-Purpose
-Body locations
-Extent
-Degree of urgency |
|
|
Term
| What do the terms "outpatient" and "ambulatory" refer to? |
|
Definition
| A patient who goes to the surgical area the day of the surgery and returns home on the same day. |
|
|
Term
| What population is most at risk for anesthesia complications? |
|
Definition
| Patients with cardiac problems |
|
|
Term
| What 3 populations are most at risk for pulmonary complications during surgery? |
|
Definition
-Older patients
-Those with chronic respiratory problems
-Smokers |
|
|
Term
| When can autologous blood donations be made? |
|
Definition
| Up to 5 weeks before surgery |
|
|
Term
| What are some alternative options for patients with religious or medical restriction to blood transfusions? |
|
Definition
-Bloodless surgery
-Minimally invasive surgery |
|
|
Term
| What are some of the reasons a patient would be prescrived preoperative drugs? |
|
Definition
-Reduce anxiety
-Promote relaxation
-Reduce nasal and oral secretions
-Prevent laryngospasm
-Reduce vagal-induced bradycardia
-Inhibit gastric secretions
-Decrease the amount of anesthetic needed for th induction and maintanence of anesthesia |
|
|
Term
| Why would a patient need bowel or intestinal preparations? |
|
Definition
-To prevent injury to the colon
-To reduce the number of intestinal bacteria when a patient is having major abdominal, pelvic, perineal, or perianal surgery |
|
|
Term
| What are the benefits of promoting mobility soon after surgery? |
|
Definition
-Stimulates intestinal motility
-Enhances lung expansion
-Mobilizes secretions
-Promotes venous return
-Prevent joint rigidity
-Relieves pressure |
|
|
Term
| What members make up the surgical team? |
|
Definition
-Surgeon
-One or more surgical assistants
-Anesthesia provider
-OR nursing staff |
|
|
Term
| What does the Joint Commisions currently recommend for marking the surgical site? |
|
Definition
| That the patient and the professional who knows the most about the patient (usually the surgeon) mark the surgical site |
|
|
Term
| What are some indicators of malignant hyperthermia? |
|
Definition
-Tachycardia
-Increased end-tidal carbon dioxide level
-Increased body temp |
|
|
Term
| What are some possible intubation complications? |
|
Definition
-Broken or injured teeth
-Swollen lip
-Vocal cord trauma |
|
|
Term
| What are some of the benefits of minimally invasive surgery? |
|
Definition
-It reduces surgery time
-Allows smaller incisions
-Reduces blood loss
-Promotes faster recovery time and less pain |
|
|
Term
| What is robotic technology surgery and what type of nurse can assist in this procedure? |
|
Definition
-The surgeon inserts the required instruments and positions the articulating arms, then breaks scrub and performs the surgery while sitting at the console.
-This technology requires a perioperative robotics specialist who provdies education for patient and family adn training for members of the surgical team. |
|
|
Term
|
Definition
| Laser surgery uses a laser to cut tissue instead of a scalpel. A laser may be sued in different cases, such as in routine surgical procedures, eye surgery, and in soft tissue surgery in which soft tissue with high water content is vaporized. |
|
|
Term
| What are two categories of injury that a patient can incur during MIS and robotic surgery? |
|
Definition
-Mechanical trauma
-Thermal injury |
|
|
Term
| What is the purpose of the PACU? |
|
Definition
| Ongoing evaluation and stabilization of patients, to anticipate, adn treat complications after surgery |
|
|
Term
| What is the most important assessment in PACU? |
|
Definition
|
|
Term
| When is the highest incidence of hypoxemia after surgery? |
|
Definition
| Occurs on the second postoperative day |
|
|
Term
| About how long does it take clean surgical wounds to heal at skin level? |
|
Definition
|
|
Term
| About how long does complete healing of all tissue layers with in the wound take? |
|
Definition
| May take 6 months to 2 years |
|
|
Term
| What technique should you use during dressing changes? |
|
Definition
|
|
Term
| What steps should you take if dehiscence or evisceration occurs? |
|
Definition
-Remain with the patient
-Have the patient lie flat with knees bent to reduce intra-abdominal pressure
-Apply sterile, nonadherent dressing materials to the wound |
|
|
Term
| What percentage of surgical procedures in America are outpatient? |
|
Definition
|
|
Term
|
Definition
| Number of serious problems |
|
|
Term
|
Definition
| Decrease serum potassium level - increase risk for toxicity |
|
|
Term
|
Definition
| Increased serum potassium level - increased risk for dysrythmias |
|
|
Term
| Why do obese have an increased risk of poor wound healing? |
|
Definition
-Excessive adipose tissue
-Has fewer blood vessles
-little collagen
-Decreased nutrients
-All of these were needed for wound healing |
|
|
Term
|
Definition
Used to assess the level of sedation in a hospitalized patient
-Ranges from 1-6
1. Anxious/Restless
2. Co-operative, oriented, and calm
3. Responsive to commands only
4. Exhibiting brisk response to light glabellar tap or loud noise
5. Exhibiting sluggish response to light glabellar tap or loud noise
6. Unresponsive |
|
|
Term
| What is the difference between prophylactic and therapeutic treament? |
|
Definition
Prophylactic: before
Therapeutic: now |
|
|
Term
| Why do PACU nurses need to have critical care experience? |
|
Definition
| PACU requires in depth knowledge of anatomy, physiology, anesthetic agents, pharmacology, pain management, extubation, and surgical procedures. |
|
|
Term
| How does a nurse know that a patient is ready to transfer from PACU? |
|
Definition
-Has a 9 or 10 on the recovery scale
-Is aware, oriented, alert
-Stable vital signs for 15-30 minutes
-Possess a core body temp not less than 96.8
-Have no acute bleeding |
|
|
Term
| How do you calculate nasogastric tube drainage? |
|
Definition
| Drainage in collection device minus amount of irrigant equals true amount of drainage |
|
|
Term
| What is sanguinous drainage? |
|
Definition
|
|
Term
|
Definition
| A partial or complete separation of the outer wound layers |
|
|
Term
|
Definition
| Total separation of all wound layers and portrusion of internal organs through the open wound |
|
|
Term
| What are the 5 different categories of surgical procedures? |
|
Definition
1. Diagnostic: performed to determine origin or cause
2. Curative: Performed to resolve a health problem
3. Restorative: Perfromed to improve pt.'s functional ability
4. Palliative: Performed to relieve symptoms of a disease process, but does not cure
5. Cosmetic |
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