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Peri-operative
| Question | Answer |
|---|---|
| Surgery | The art and science of treating diseases, injuries, and deformities by operation and instrumentation |
| Purposes of Surgical Procedures | Diagnostic Palliative Ablative Constructive Transplant |
| Types of Surgery | Emergency vs. elective Major vs. minor Inpatient vs. outpatient |
| Health Problems that Increase the Surgical Risk | Malnutrition Obesity Cardiac conditions Blood coagulation disorders Upper respiratory infections or chronic obstructive lung diseases Renal diseases Diabetes Liver disease |
| Perioperative Period | Perioperative nursing; management and treatment of the patient before, during, and after surgery Preoperative Intraoperative Postoperative |
| Nursing Responsibilities | Prepare and teach the patient Assess the patient Schedule diagnostic tests Complete the preoperative checklist Verify that all the necessary documents are on the patient’s medical record Report abnormal diagnostic report to the surgeon |
| Nursing Responsibilities | Prepare the surgical suite Prepare and teach the patient |
| Planning for Home Care | Discharge planning begins on or before admission for the planned procedure. Assess functional ability and resources/support systems |
| Preparing the day before surgery | Preoperative medications Preoperative procedures Nothing by mouth (NPO) 2-8 hours before the scheduled time of surgery |
| Preoperative Phase | Assessment Planning |
| Psychosocial integrity | Anxiety Fear Body image changes Lifestyle changes |
| Physiological Integrity | Early ambulation Leg Exercises Coughing and deep breathing exercises (C&DB) Antiemboli Stockings Pain management |
| Informed Consent | Guidelines for Consent Must be in language the person understands Patient must be conscious, mentally competent, and not sedated May not be signed by a minor Nurses must know their responsibilities |
| Informed Consent | Guidelines for Consent Must be in language the person understands Patient must be conscious, mentally competent, and not sedated May not be signed by a minor Nurses must know their responsibilities |
| Informed Consent | Nature and intent of surgery Name and qualifications of the person performing the surgery Risks, including tissue damage, disfigurement, complications, death Chances of success Possible alternative measures |
| Informed Consent | The right of the patient to refuse consent or later withdraw consent |
| Physical Preparation | Prostheses Special orders Skin prep Vital signs Anti emboli stockings (TED hose) Sequential Compression Devices (pneumatic hose) If the patient insists on wearing their hearing aid, and or dentures, make sure the OR staff know this... |
| Evaluating | What actions would you take if the patient did not meet the criteria: stable vital signs, skin intact, NPO after midnight, oriented to person, time and place…………. |
| Intraoperative Phase | Assessment Confirm identity Two identifiers Assess physical condition and emotional status Verifies preoperative check list Evaluates knowledge about the surgery and events to follow |
| Intraoperative Phase | Assess response to preop meds Monitor VS, ECG, oxygen saturation, I&O, blood loss, ongoing lab values Assess patency of lines before, during and after procedure |
| Planning: Goals | Position the patient appropriately for surgery Assist in preparing and maintaining sterile field Monitor and maintain sterility and aseptic environment Open and dispense sterile supplies during surgery Manage sharps, sponge and instrument counts |
| Planning: Goals | Document nursing care given to patient Document patient responses Assist in transport to PACU |
| Surgical Asepsis | Sterile items may only touch sterile items When opening sterile items with a cap, place the cap upright Open wrappers by peeling back edges Never reach across a sterile field unless you are wearing sterile attire |
| Surgical Asepsis | Items open to air are considered contaaminated after one hour Solutions are considered sterile for 24 hours after opening Time and date when items are opened Edges of a sterile field are considered contaminated within a one inch margin |
| Types of Anesthesia | General Local/regional Conscious Sedation |
| General anesthetic agents | Barbiturates Brevital (methohexital) Pentothal (thiopental) Hypnotics Diprovan (propofol) Amidate (etomidate) Inhalants |
| General anesthesia—adverse Effects | Respiratory depression Cardiac depression Malignant hyperthermia Hepatotoxicity Acute renal failure |
| Local/regional anesthetic agents | Topical Peripheral Nerve block Parenteral Intravenous administration Spinal administration |
| Conscious sedation agents | Benzodiazepines midazolam (versed) diazepam (valium) Opioids Morphine fentanyl (Sublimaze) sufentanil (Sufenta) |
| Postoperative Phase | The primary goal of nursing care during the immediate postoperative phase is to maintain “A-B-Cs”. Following assessment of respiratory status, head-to-toe is performed. Ongoing care is directed toward restoring the patient to an optimum level of functio |
| Immediate Post-anesthetic Phase | Skin color Fluid status Condition of operative site Patency of and character of drainage from catheters, tubes and drains. Discomfort, nausea, vomiting Safety |
| Hypothermia | Assume that all patients will arrive cold Get baseline temperature Actively re-warm Administer oxygen if shivering |
| Discharge from PACU… | When VS have been stable or within baseline ranges for 30 minutes. Intake and urinary output are adequate to maintain the circulating blood volume. The patient is afebrile or a febrile condition has been treated. Must be conscious, oriented. |
| Discharge from PACU… | Must be able to maintain own airway if not on ventilator. Dressings are dry or have only minimal drainage. Must be moving all unaffected limbs. |
| Returning to the Nursing Unit | Assessment Check for stat orders Check post operative orders Review PACU record Pain medication Surgical site Intraoperative events |
| Post Operative Complications Respiratory complications | Hypoxemia(SaO2 90 or less),Pulmonary edema(at risk for CHF,pink frothy sputum,fluid overload),Aspiration(vomit,thick secretions in lungs),Bronchospasm(smooth muscle in lung spasms-stidor),Hyoventialtion(lungs not being inflated adequately when under) |
| Alterations in cardiovascular function | Hypo/hypertension-(hypo-give fluids,check H&H,HTN-pain,hypothermia,distended bladder evaluate VS)Thromboemblosim-(asses for sings in lower extremities,risk for DVT)F&E imbalances(hypo/hypernatremia)Dysrhythmias. |
| Shock | Low BP,tachycardia,cool,clamy skin,increased pulse&resp.(If pt is thirsty Hypovelemic shock) |
| Shock | May be the result of hemorrhage,volume depletion,cardiac insufficiency.Check dressing for signs of bloody drainage or bedclothes posterior to the wound(Look under the patient!) |
| Neurologic Complications | Emergenic delierium-come out of anastesia-reversal agent. Delayed emergence-houurs after-Renal/Liver BUN/Creatinine increased. Confusion,anxiety,ajitation. STROKE-clinical manifestations are neurologic even though it is a cardiovascular complication. |
| Nursing Implementations to Prevent | check for hypoxemia,pain,fluid & electrolyte,monitor I&O, maintain safety. |
| GI Complications | N/V,Constipation-assess normal bowel elimination,fluid intake 2500ml,increase activity,NG tube, Ileus-gut has stopped working,no bowel sounds.If ok, give feeding tube,monitor for abd distention,& paralysis. |
| GU Complications | Urinary Retetion-assess for bladder pain& distention,Monitor I/O-if output is not equal to intake. Notify Dr. if there is no output for 6hrs postop. |
| Acute Renal failure | Not urinating, Geriatric considerations,procedure specific,olguria,monitor renal function. |
| Surgical site complications & pain management | Dehiscence-incision comes open. Evisceration-guts come out. Infection Pain(PQRSTU) |
Created by:
LauraHall
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