Term
| Major Classifications of Surgery |
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Definition
1.Cosmetic
2.Curative
3.Diagnostic
4.Elective
5.Emergency
6.Palliative
7.Required
8.Restorative |
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Term
| Stages of Care for the Surgical Patient |
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Definition
Pre-operative
Intra-Operative
Post-operative |
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Term
| Main goal/emphasis of the peri-operative nurse's assessment |
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Definition
| The overall goal of the pre-operative assessment is to gather data in order to identify risk factors and plan care to ensure patent safety throughout the surgical experience. |
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Term
| Peri-Operative Nursing Functions |
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Definition
-Determine psychological status of the patient.
-Determine psychological factors related to the surgical procedure that may contribute to operative risk factors.
-Establish baseline data for comparison in the intra and post op periods.
-Identify and document the surgical site.
-Confirm that the results of all preoperative labs and diagnostics tests are documented in the patient’s records.
-Identify cultural and ethnic factors.
-Determine if the patients has received adequate information from the surgeon to make an informed decision. |
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Term
| Risk factors for surgery patients |
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Definition
**Not nursing function to assess risk, surgeon and anesthesiologist are responsible for that**
Obesity
Cardiac Disorders
Respiratory Disease
Neuro Disorders
Renal Disorders
Endocrine Disorders
Gastrointestinal Disorders
Hematological Conditions |
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Term
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Definition
| Written permission that protects the patient from unsanctioned surgery and protects the surgeon and hospital against claims of unauthorized surgery. |
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Term
| Criteria for Valid Informed Consent |
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Definition
Consent voluntarily given
Incompetent subject
Informed subject
---Explanation of procedure and risks
---Description of benefits and alternatives
---Instructions that the patient may withdraw
---Statement if protocol differs from customary procedure.
Subject able to comprehend |
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Term
| Pre-Op Teaching includes: |
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Definition
Equipment that the patient might return from the OR with
Pain medications and PCA
Explain pre-op prep, enemas, no nail polish, no hair pins
Inform will go to PACU before return to room
Include family in teaching
Teach T/C/DB |
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Term
| Components of Pre-op nursing |
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Definition
Pre-op check list
Provider's Orders
Baseline information
Ht and weight
Allergies?
Previous health history
Recent or current medications
Family history |
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Term
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Definition
Skin Prep
G.I. Prep (if ordered)
Prep for Anesthesia (done by anesthesia day before)
Bedtime Hypnotic (if ordered)
Lab Studies:Hgb, Hct,K+, Na++,UA
Chest X-ray & EKG
Voided, cath’ed or indwelling catheter
TED hose (if ordered or standing order)
Identification bracelet
Pre-op Meds (if ordered)
Safety precautions
Adm. of IV fluids or blood (#l8 or #l6)
Remove dentures,Glasses, contact lens,nail polish, Jewelry, & hair pins.
Vital Signs |
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Term
| Circulating RN's role in OR |
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Definition
Patient care as she prepares him/her for procedure
Communication of events between team members in the surgical unit and outside persons
Gathering supplies
Confirming sponge count
Wiping perspiration from sterile team members
Completing accurate record of operation
Observe for any breech of sterile technique |
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Term
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Definition
Unrestricted Zone:
Semi-restricted Zone:
Restricted Zone: |
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Term
| Factors to consider when positioning a Pt for surgery |
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Definition
Patient should be as comfortable as possible
The operative area must be adequately exposed
The vascular supply should not be obstructed by an awkward position
Should be no interference with the pt’s resp.
Nerves must be protected from undue pressure
Pt need gentle restraint before anes. induction in case of excitement. |
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Term
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Definition
General
Conscious Sedation
Local/Regional |
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Term
| Complications from general anesthesia |
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Definition
Primarily effects the circulatory and respiratory systems
Complications:
Respiratory depression
Vomiting/aspiration
Nerve trauma/paralysis
Malignant hyperpyrexia (abnormal, acute rise in temperature) |
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Term
| Malignant hyperexia signs and treatment |
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Definition
Symptoms:
-Tachycardia
-Ventricular dysrhythmias
-Hypotension
-Decreased cardiac output
-Oliguria
-Rise in temperature
Treatment:
-Iced IV fluids
-Cessation of anesthesia
-Oxygen at 100%
-Dantrium- a skeletal muscle relaxant
-Sodium bicarbonate- correct acidosis |
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Term
| Pros/Cons & stages of general anesthesia |
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Definition
Advantages:
Pt totally unconscious
Prevention of pain
Disadvantages:
Some of these agents highly flammable
Cause circulatory and respiratory depression
Stage I. Beginning of anesthia, relaxtion, loss of consciousness.
II. loss of consciousness to stimulation/excitement
III. Surgical anesthesia, complete relaxation, surgery perform
IV. Danger zone-vitals start to become depressed. |
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Term
| Reqs for conscious sedation: |
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Definition
-Can only be administered by RN or MD
-Must have a consent form and ROS
-Must be applied to monitoring device and be monitored q 5 minutes during procedure and 10-15 minutes after procedure
-Must have easy access to reversal agent (Narcan and Romazicon)
-Ambu Bag
-Oxygen supplementation |
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Term
| Pros and Cons of conscious sedation: |
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Definition
Advantages:
Rapid
Pleasant
Smooth induction
Shorter Recovery
Disadvantages:
Powerful depressant of breathing
Poor relaxant
Wide variance of tolerance |
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Term
| Types of Local/Regional Anesthesia & Pros and Cons |
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Definition
Field block,Nerve block,Epidural Anesthesia and Spinal Anesthesia
Advantages:
Patient is alert
Can be used with “full” stomach
Excellent muscle relaxation
Does not cause fetal depression
Can be used with COPD patient and elderly
Complications:
1. Hypotension
2. N & V
3. Headache
4. Respiratory Paralysis
5. Neuro complications |
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Term
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Definition
Respiratory status (Crowing, OAW)
Orientation
Circulation
Comfort
I.V. fluids
Catheters or drains
Operative Area??
Spinal -
Motor?
Sensory?
Abd? Bowel sounds? (as appropriate)
Postanesthesia Recovery Score
Check M.D.’s Orders |
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Term
| Body temp control post op |
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Definition
Patient may become hyper or hypothermic during and after surgery.
Risk for imbalanced body temperature R/T:
-Passive re-warming (heating w/ blankets)
-Active re-warming (running warm IV fluids) |
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Term
| PACU/Ambulatory Surg discharge process-phase 1 |
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Definition
Patient awake
Vital signs stable
No excess bleeding or drainage
No respiratory depression
O2 sat > 90%
Report given |
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Term
| PACU/Ambulatory Surg discharge process-phase 2 & 3 |
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Definition
All PACU D/C criteria met
No IV opioid drugs for 30 minutes
Minimal N/V
Voided
Able to ambulate if appropriate
Responsible adult present
D/C instructions given and understood |
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Term
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Definition
Risk for ineffective breathing pattern RT..
Risk for altered body temperature RT ….
Risk for dec. fluid volume RT …………
Pain RT …………………………………
Impaired Tissue integrity RT …………..
Risk for infection RT …………………..
Risk for thrombophlebitis RT …………. |
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Term
| Post op respiratory interventions |
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Definition
Turn, Cough, DP
Assess rate and depth of respirations
Auscultate BS
Incentive Spirometer
O2
Po fluids and IV fluids |
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Term
| Post op cardiac interventions |
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Definition
Assess BP, HR, Resp, and UOP
Assess dressing for drainage/bleeding
Characteristics of pulse
Report B/P difference of > or < 15-20 point difference
FOB
S/S shock |
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Term
| Post op comfort interventions |
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Definition
Positioning
Explain and reinforce PCA
Back Massage
Rectal Tube
Pressure Points
Administer PRN meds as ordered |
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Term
| Post op renal considerations |
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Definition
Measure I & O for first 48 hours or as long as patient has IV
Assess for bladder distention or S/S of urinary retention
Assist patient in voiding
Obtain order to cath if necessary |
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Term
| Post op wound care and infection control guidelines |
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Definition
Assess wound daily for s/s infection
Monitor oral temp q shift and PRN
Wash hands before and after care
Note patency of wound drainage
Keep surgical patients away from patients with bacterial diseases
Administer antibiotics as ordered
Change surgical dressings |
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Term
| PARALYTIC ILEUS Symptoms and TX |
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Definition
Symptoms
Absent Bowel Sounds > 48 Hours
No BM or flatus
Abdominal Distention and Firm to Palpation
Treatment
Gastric suction
IV fluids
NPO until return of bowel sounds |
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